- WILL CRNAs REPLACE MD ANESTHESIOLOGISTS? - 25 Apr 2021
- WAS TIGER WOODS DRIVING UNDER THE INFLUENCE? - 12 Apr 2021
- A MORBIDLY OBESE PATIENT WITH MEAT STUCK IN HIS ESOPHAGUS - 4 Apr 2021
2) A PHARMACIST’S SON IN SOUTH DAKOTA
Eight months earlier
My cell phone pinged with a text message from my son Johnny. The text read:
911 call me
I was administering an anesthetic to a 41-year-old woman in an operating room at Stanford University, while a neurosurgeon worked to remove a meningioma tumor from her brain. I stood near my patient’s feet in an anesthesia cockpit surrounded by two ventilator hoses, three intravenous lines, and four computer monitor screens. Ten syringes loaded with ten different drugs lay on the table before me. My job was to control my patient’s breathing, blood pressure, and level of unconsciousness, but at that moment I could only stare at my cell phone as my heart rate climbed.
911 call me
911? My son was in trouble, and I was stuck in surgery, unable to leave. I wanted to contact Johnny as soon as possible, but my patient was asleep, paralyzed, and helpless. Her life was my responsibility. I scanned the operating room monitors and confirmed that her vital signs were perfect. I had to make a decision: should I call him now, or attend to my anesthetic and call after the surgery was over? My patient was stable, and my son was in danger. I pulled out my cell phone and dialed his number. He picked up after the first ring. “What is it, son?” I said.
“I’m screwed,” Johnny wailed. “I just got my report card for the first semester and my grades totally suck. Mom is mega-pissed. She’s going ballistic, and I’m screwed.”
My shoulders slumped. This was 911 for a 17-year-old? “How bad were the grades?”
“I got six B’s. I didn’t get one A. I just met with my counselor and he says I’m ranked #101 in my high school class. I’m so doomed. Mom is so pissed. She called me a lazy shit.”
I resisted my initial urge to scream at Johnny for scaring the hell out of me. The kid had no insight into what I did minute-to-minute in the hospital. Did he think his report card trumped my medical practice? Did he really think his report card full of B’s was an emergency?
“I’m not sure what’s worse, the grades or Mom’s screaming about the grades,” he said.
I imagined my wife having a temper tantrum about Johnny falling short of her straight-A’s standard of excellence, and I knew the answer to that question. My wife could be a total bitch. “I’m sorry Mom got mad, Johnny, but…”
“No buts, Dad. You know Mom’s idea of success is Ivy League or bust, and I’m a bust.”
“Son, four of your six classes are Advanced Placement classes, and those grades aren’t that bad.”
“Dad, almost everyone in the school takes four AP classes. Every one of my friends got better grades than me. Ray, Brent, Robby, Olivia, Jessica, Sammy, and Adrian all got straight A’s. Devon, Jackson, Pete, and Rod had all A’s and one B. Even Diego had only two B’s.”
Johnny cut me off. “There’s no ‘buts,’ Dad. I’m ranked in the middle of the pack in my class. I’m cooked. I’m ordinary. Forget Harvard and Princeton. I’m going to San Jose State.”
My stomach dropped. Johnny was halfway through his junior year at Palo Alto Hills High School. The competition for elite college acceptance was on my son’s mind every day, and on his mom’s mind every minute. Johnny was a bright kid, but the school stood across the street from Stanford University and was packed wall-to-wall with the sons and daughters of Stanford MBA’s, Ph.D.’s, lawyers, and doctors. Johnny’s situation wasn’t uncommon. You could be a pretty smart kid and still land somewhere in the middle of the class at P.A. Hills High.
“Everything will work out,” I said. “There are plenty of great colleges. You’ll see.”
“Lame, Dad. Don’t talk down to me. You stand there with your doctor job at Stanford and tell me that I’ll be all right. I’ll be the checkout guy at Safeway when you buy your groceries. That’s where I’m heading.”
Catastrophic thinking. Johnny Antone was holding a piece of paper in his hand—a piece of paper with some letters typed after his name—and he was translating it into an abject life of being average.
“Johnny, I can’t talk about this any more right now. My patient …”
“Whatever,” Johnny answered.
I heard a click as he hung up. I hated it when he did that. In the operating room I had authority, and respect was a given. With my family, I was a punching bag for of all sorts of verbal blows from both my kid and my wife.
I reached down and turned off my cell phone. For now, the haven of the operating room would insulate me against assaults from the outside world.
Judith Chang was the neurosurgeon that day. Dr. Chang was the finest brain surgeon in the western United States, and was arguably the most outstanding female brain surgeon on the planet. She peered into a binocular microscope hour after hour, teasing the remnants of the tumor away from the patient’s left frontal lobe. Dr. Chang always operated in silence, and her fingers moved in precise, calculated maneuvers. A 50-inch flat screen monitor on the wall of the operating room broadcast the image she saw from inside her microscope.
I paid little attention to the surgical images, which to me revealed nothing but incomprehensible blends of pink tissues. My full attention was focused on my own 42-inch monitor screen which depicted the patient’s electrocardiogram, blood pressure, and oxygen saturation, as well as the concentration of all gases moving in and out of her lungs. Everything was stable, and I was pleased.
It had been five hours since the initial skin incision. Dr. Chang pushed the microscope away and said, “We’re done. The tumor’s out.”
“A cure?” I said.
“There was no invasion of the tumor into brain tissue or bone. She’s cured.” Dr. Chang had removed a 5 X 10-centimeter piece of the patient’s skull to access the brain, and began the process of fitting the piece back into the defect in the skull—the placement not unlike finishing the last piece in a jigsaw puzzle. As Dr. Chang wired the bony plate into place, she said, “How’s your family, Nico?”
She hadn’t said a word to me in five hours, but once she was finished with the critical parts of surgery, Judith Chang had a reputation as a world-class chatterer. Some surgeons liked to listen to loud rock n’ roll “closing music” as they sewed up a patient. Some surgeons preferred to tell raunchy jokes. Judith Chang enjoyed the sound of her own voice. We hadn’t worked together for months, so we had a lot to catch up on.
“They’re good,” I said. “Johnny’s in 11th grade. He’s going to concerts, playing video games with friends, and sleeping until noon on weekends. Alexandra is working a lot, as usual. She just sold a house on your street.”
“I heard about that property,” Judith said. “You’re a lucky guy. That house sold for close to $5 million. Her commission is more than some doctors earn in a year. In my next lifetime I’ll be a big-time realtor like Alexandra. Does she give you half her income to spend?”
“In theory half that money is mine, but she invests the dough as soon as it hits her checking account.”
“Smart. Is Johnny looking at colleges yet?”
Her question had eerie relevance, because I’d been ruminating over Johnny’s phone call all morning. “That’s a sensitive point. Johnny just got his mid-year report card, and he’s freaking out.”
“How bad was it?”
“Six B’s. No A’s. He’s ranked #101 in a class of 480 students.” I spilled out the whole story while Dr. Chang twisted the wires together to affix the bony plate into the patient’s skull. I left out the “lazy shit” label from Johnny’s mom.
Dr. Chang had no immediate answer, and I interpreted her silence as tacit damning of Johnny’s fate. She opened her mouth and a flood of words began pouring out. “You know my twin daughters Meredith and Melody, who are sophomores at Stanford? They worked their butts off in high school. They were both straight-A students. Meredith captained the varsity water polo team, played saxophone in the jazz band, and started a non-profit charity foundation for an orphanage in Costa Rica. Melody was on the debate team and the varsity tennis team, and for three years she worked with Alzheimer patients at a nursing home in Palo Alto. Meredith and Melody were sweating bullets waiting to hear if Stanford would accept them, even though they were both legacies since I went to undergrad and med school here.
“The college admission game is a bitch, Nico. It’s not like when we were kids. It’s almost impossible to get into a great school without some kind of massive gimmick. It’s a fact that Harvard rejects 75% of the high school valedictorians that apply. Can you believe that?”
I could believe it. And I didn’t really care, since my only kid was at this moment freaking out because his grades qualified him for San Jose State, not the Ivy League. I didn’t care to hear any more about the Chang daughters right now, either. To listen to Judith Chang, her daughters were the second and third coming of Judith Chang, destined for world domination. I was envious of the Chang sisters’ academic successes—what parent wouldn’t be? But I didn’t want to compare them to my own son.
“What are Johnny’s test scores like?” Dr. Chang said.
Ah, a bright spot, I thought. “He’s always excelled at taking standardized tests. His SAT reading, math, and writing scores are all at the 98th percentile or better. His grade point average and class rank don’t match his test scores.”
“Does he have many extracurricular activities?”
“Johnny’s extracurricular activities consist mostly of watching TV and playing games on his laptop. At the same time,” I said, as if the combination of the two pastimes signaled a superior intellect.
Dr. Chang grew quiet again. More silent condemnation of my son’s prospects. “Listen to me,” she said. “My brother is a pharmacist in Sioux Falls, South Dakota. His son got accepted to Princeton, and let me tell you, my nephew isn’t that bright. His test scores aren’t anywhere near as high as Johnny’s. But he just happens to live in South Dakota. He just happens to be a straight-A student in a rural state. He just happens to be one of the best students in South Dakota.”
“How much do you think that matters?”
“It matters big time. The top schools want geographic variety in their student body. Stanford wants diversity. The Ivy League wants diversity. Princeton can find fifty kids from Palo Alto who meet their admission requirements. They want kids from all walks of life. They want … the son of a pharmacist from Podunk, South Dakota. If Johnny lived in South Dakota, with those test scores he’d be a shoo-in with the Ivy League admissions committees.”
Judith Chang turned her back on the operating room table, and peeled off her surgical gloves. The bony plate was back in place, and her patient’s skull was intact again. The surgical resident would conclude the task of sewing the skin closed. Dr. Chang paused for a moment, turned her palms upward, and said, “Just move to the Dakotas, Nico.”
I stroked my chin. She made it sound so easy.
Published in September 2017: The second edition of THE DOCTOR AND MR. DYLAN, Dr. Novak’s debut novel, a medical-legal mystery which blends the science and practice of anesthesiology with unforgettable characters, a page-turning plot, and the legacy of Nobel Prize winner Bob Dylan.
In this debut thriller, tragedies strike an anesthesiologist as he tries to start a new life with his son.
Dr. Nico Antone, an anesthesiologist at Stanford University, is married to Alexandra, a high-powered real estate agent obsessed with money. Their son, Johnny, an 11th-grader with immense potential, struggles to get the grades he’ll need to attend an Ivy League college. After a screaming match with Alexandra, Nico moves himself and Johnny from Palo Alto, California, to his frozen childhood home of Hibbing, Minnesota. The move should help Johnny improve his grades and thus seem more attractive to universities, but Nico loves the freedom from his wife, too. Hibbing also happens to be the hometown of music icon Bob Dylan. Joining the hospital staff, Nico runs afoul of a grouchy nurse anesthetist calling himself Bobby Dylan, who plays Dylan songs twice a week in a bar called Heaven’s Door. As Nico and Johnny settle in, their lives turn around; they even start dating the gorgeous mother/daughter pair of Lena and Echo Johnson. However, when Johnny accidentally impregnates Echo, the lives of the Hibbing transplants start to implode. In true page-turner fashion, first-time novelist Novak gets started by killing soulless Alexandra, which accelerates the downfall of his underdog protagonist now accused of murder. Dialogue is pitch-perfect, and the insults hurled between Nico and his wife are as hilarious as they are hurtful: “Are you my husband, Nico? Or my dependent?” The author’s medical expertise proves central to the plot, and there are a few grisly moments, as when “dark blood percolated” from a patient’s nostrils “like coffee grounds.” Bob Dylan details add quirkiness to what might otherwise be a chilly revenge tale; we’re told, for instance, that Dylan taught “every singer with a less-than-perfect voice…how to sneer and twist off syllables.” Courtroom scenes toward the end crackle with energy, though one scene involving a snowmobile ties up a certain plot thread too neatly. By the end, Nico has rolled with a great many punches.
Nuanced characterization and crafty details help this debut soar.
Click on the image below to reach the Amazon link to The Doctor and Mr. Dylan:
Learn more about Rick Novak’s fiction writing at ricknovak.com by clicking on the picture below: