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  As Grant finished stapling the scalp flap together, he noticed the incision looked swollen, like something was pushing up from underneath. Damn it. With today’s packed schedule, he couldn’t afford to waste any time. He quickly removed the staples, hoping the nurses wouldn’t notice the speed bump. Draining the small collection of blood with a suction catheter, he hummed along with the Charlie Parker saxophone riff coming through the speakers to assure the staff everything was on track. When the bleeder stopped, Grant replaced the staple line and returned the stapler to the instrument tray.

  “One down. How many more to go?” He looked over at Wendy, his favorite surgical nurse and right-hand woman. With her bleached blond hair and prominent crow’s feet from her two-pack-a-day smoking habit, her look was less than classy, but no one kept an OR running like she did. Though she was nearing retirement, Grant hoped Wendy would stick around for at least a few more years. He had no patience for anything less than exemplary competence and efficiency. In fact, he had filed with the OR director a list of staff members he found acceptable, and only those on the list were allowed to step foot inside his sacred temple.

  Wendy checked her schedule. “Craniectomy for a massive MCA stroke. We’ll be ready to go within a half hour, Dr. Kaplan.”

  He pulled off his surgical gown and gloves. “Let’s keep moving. I can’t afford any delays today.”

  Grant stepped out for a breather and Vikram Chawla, his preferred anesthesiologist, followed behind. They had trained together during their residencies and had both stayed on here when they graduated. Over time, they’d come to learn each other’s habits and eccentricities. Grant didn’t need to explain to Vik how he wanted his patients anesthetized, and Vik knew Grant wouldn’t tolerate small talk or unnecessary chatter. No blathering about headlines or baseball scores during his operations.

  In the hallway, Vik grabbed a paper cup from the top of the water cooler. “How about a drink?”

  “With the way my schedule looks today, I could use something stronger,” Grant said. “I swear Wendy’s trying to kill me.”

  Vik filled his cup. “It’s her job. Keep the OR humming. The quicker the turnover, the better for the bottom line.”

  “I wouldn’t have it any other way. You know that.”

  “Sometimes it might be nice to have a few minutes to decompress.” Vik walked over to the floor-to-ceiling window overlooking the Charles River. “Maybe take a walk outside.”

  Grant stepped up to the window and looked down at the trees along the river, the bare branches coated with ice. “No sunlight for us.”

  “Going anywhere for February break?” Vik asked.

  “Not this year,” Grant said. “Too many surgeries.”

  “Meera booked a trip to some resort in Mexico. I told her as long as there’s no boats.”

  “Not even the kind where you can see fish through the bottom?” Grant said. “The twins would love it.”

  “No way. Just thinking about that makes me nauseous. Puking over the railing isn’t my idea of a vacation.”

  “Remember the time you lost your lunch on the booze cruise before you’d even had a drink?” Grant asked.

  “The memory is burned in my brain forever.”

  Grant pulled his Claritin bottle out of his pocket and slid one into his mouth. He didn’t normally need it midday, but with today’s line-up, he’d make an exception. Some days he needed a little extra push to reach the finish line.

  “Allergies still bothering you?” Vik eyed the bottle. “In February?”

  Grant nodded and put it back into his pocket.

  “Maybe you should take the family somewhere, too,” Vik said. “It’s good to take a breather from this place once in a while.”

  “I don’t know if I can spend that much time with Sadie. Her teen drama is over the top these days.”

  “That bad?” Vik asked.

  “She’s a bit Jekyll and Hyde,” Grant said. “One minute she’s my sweet little girl, and the next she’s the devil incarnate.”

  “I’m not looking forward to the teenage years.” Vik tossed his cup into the garbage can next to the water cooler. “The twins want to be with me all the time. It’s exhausting, but not bad for the old ego.”

  “Enjoy it while it lasts,” Grant said. “Sadie spends every minute with her friends.”

  “How’s high school going?”

  “Not sure,” Grant said. “She doesn’t really share much. When we ask her what she did in school, she always says ‘nothing’.”

  “This is when kids start to experiment with things.”

  “Like what?”

  “Smoking, sex, smack,” Vik chuckled. “So many selections available to teenagers these days.”

  “Sadie would never do anything like that,” Grant said.

  “Just make sure you keep an eye on her.” Vik flipped through a magazine someone had left on the window ledge. “Seriously? You made the list again?”

  “What?”

  Vik held up the copy of Boston Magazine and pointed to the page. “It’s getting a little ridiculous.”

  Grant shrugged. “I can’t help being the best.”

  “They don’t even have a section for anesthesiologists. It’s like we’re not even doctors.”

  “But you still pull in the big bucks.”

  “Good point,” Vik said. “I may not get the accolades, but I’ll be able to pay for college.”

  Wendy poked her head into the hall. “Doctors, the next case is teed up.”

  Before going back into the OR, Grant’s cell phone buzzed in his pocket. He pulled it out, saw Michael’s name and pressed ignore. His brother-in-law was probably calling to drone on about the Red Sox spring training. Grant was a lifelong fan, but Michael’s passion for the team bordered on obsession. Grant would call him back on his way home when he had nothing better to do than listen to monologues about batting averages and stolen base percentages.

  “Wendy, what would I do without you to keep me in line?” he called from the sink, as he scrubbed up for the next case.

  “You’d be nowhere without me, Dr. Kaplan,” she said.

  Grant slipped his arms into the surgical gown she held open for him and waited for her to tie it around his waist. “Okay, team,” he said, stepping up to the operating table. “Let’s crack this one open before it’s too late.”

  After he finished the last surgery, Grant went to the locker room. He loved the feel of a hot shower after a long day in the OR, the way the water washed the burnt smell of bone dust from his hair and the dried sweat from his body, leaving him invigorated and ready to face the rest of his day. Despite the scalp bleed as he’d closed, the subdural drainage had been the highlight of the day. The other patients he’d operated on were pretty much gorked. He never said that derogatory term out loud, but that didn’t stop him from thinking it. If those patients regained any neurologic function it would be nothing short of a miracle. As he rinsed the shampoo from his hair, his recent malpractice case flashed through mind. Lawsuits weren’t uncommon in neurosurgery, but it was still an annoyance he didn’t have time for in his busy life. He hoped his lawyer would settle it soon and make it go away. He shut off the water and wrapped a towel around his waist.

  It always felt so refreshing to put on street clothes after a day in the OR. Sitting down on the bench, he looked at his phone to see he’d missed three more calls from Michael with two voicemails, and two missed calls from Cynthia. He decided to call Michael back first to find out what could be so important. It had to be something more than baseball.

  “Where have you been?” Michael asked.

  “I was scrubbed in.”

  “Alison’s in the hospital. Wellesley Community. She passed out at school and came in by ambulance.”

  “Jesus. What happened?”

  “I’m not sure yet. They’re still running tests.”

  “Did she vasovagal?”

  “What the fuck does that mean?” Michael said.

  “Sorr
y.” Grant often used medical terms without realizing.

  “She passed out,” Michael continued, “And it’s all so confusing, and we needed you. We need you, I mean.”

  “What did the tests show? Did they do a CT or MRI?”

  “I don’t know. It looked like a donut.”

  “Okay and did they give you results?” Grant hoped they had done a CTA and an MRI, but he knew it wasn’t likely at that podunk hospital.

  “They said she’s bleeding into her head and they’re not sure why. I don’t know how this happened. She’s so healthy.”

  “Shit,” Grant said. He gathered his keys and wallet, and slammed his locker. “I’m heading to the garage right now. Is Cynthia with you?”

  “Yeah, she’s sitting right here.”

  “Okay. Tell her I’ll be there in twenty-five minutes.”

  As he ran down the stairs and into the hospital garage, Grant thought about what could have caused the bleed. The most common cause of spontaneous intracranial hemorrhage was hypertension, but Alison definitely didn’t have high blood pressure. She was a vegetarian and a fitness fanatic, an early adopter of all the newest exercise crazes. Lately, she’d been obsessed with some new surfboard class at her health club. That left more ominous reasons—tumor or aneurysm or some other congenital vascular malformation— none of which spelled good news.

  He drove out of the garage, took a few quick turns through the narrow cobblestone streets, before speeding onto Storrow Drive to the Mass Pike. He accelerated and merged into an opening in the left lane, ignoring the honking and raised middle finger of the driver behind him as he considered his next steps. First of all, Alison should be transferred to his hospital as soon as possible. A community hospital was no place for anything more serious than constipation or Strep throat.

  He used the voice recognition in his car to call Calvin Shin, one of his partners at Downtown Neurosurgical Associates, and the one he respected most. Cal was the only other neurosurgeon who consistently made it onto the Boston Magazine list every year.

  “Hello?”

  “Hey, Cal,” Grant said. “I have a bit of a situation.”

  “What’s up, bud?”

  “Cynthia’s sister had a spontaneous brain hemorrhage a few hours ago. She’s in the ER at Wellesley Community. From what I can tell, the staff is sitting with their thumbs up their asses.”

  “Alison? Shit—that sounds like their MO. What can I do?”

  “She needs a real work-up,” Grant said. “They haven’t even done a CTA yet.”

  “We need to get her over to the mecca,” Cal said.

  “My thought exactly,” Grant said. “Do you think I can transfer her to your service?”

  “Whatever you need, bud,” Cal said. “I can come in tonight and get things going once she arrives.”

  Grant turned the car into the hospital garage and parked in the first open spot. “Thanks, Cal. I’ll keep you posted.” As he hung up, gratitude surged through him. He was so lucky to have friends like Cal and Vik by his side no matter what.

  Grant entered the ER and followed a nurse through the automatic doors. If he checked in at the desk in the waiting room, the high school dropout at the window would make him fill out every line of the stick-on name badge, and he needed to get in there as soon as possible.

  Walking down the ER corridor, he passed an elderly man repeatedly moaning, “Can I get some help over here?”, an obese woman whose oxygen mask was sliding off the side of her face, and a teenage boy lying on a gurney in a pair of red underwear. Finally, he saw Alison in one of the last patient rooms and she waved at him to come in. Doing a quick inventory, he noticed her pink skin and symmetrical smile. He felt relieved to see her looking healthy, alert, and neurologically intact. It must be a small bleed, he thought with relief.

  Cynthia sat on the chair next to the bed, holding Alison’s hand.

  His wife stood up when Grant walked in. “What took you so long?”

  Grant could tell by the tone of her voice she was stressed. She had always been protective of her little sister and was probably feeling out of her element here. He gave Cynthia a peck on the cheek before leaning down to hug Alison.

  “I came as fast as I could,” he said. “Where’s Michael?”

  “He went to grab something for us to eat,” Cynthia said. “I think he couldn’t stand all the waiting.”

  “How are you feeling?” he asked Alison.

  “I’ve been better. It’s like my head is being squeezed in a vice.”

  “You passed out at school?”

  “Yeah. I don’t really know what happened. One minute I was fine and the next thing I knew, I woke up in an ambulance.”

  “It sounds like you were out pretty good. Were you doing anything strenuous when you passed out? Exercising or something?”

  “No,” Alison said quickly. “Nothing out of the ordinary.”

  “Has the doctor been in to talk to you yet?”

  “We saw a PA,” Cynthia said, “but we’re waiting for the neurosurgeon to see her.”

  “They probably don’t have someone in-house. Did the PA say what the scan showed?”

  “She said I have a bleed in my brain,” Alison said. “That I may need to stay overnight.”

  “That’s it? How big is the bleed? Did she say anything about mass effect or midline shift?”

  “Grant, quit it with the doctor speak,” Cynthia said. “Alison is anxious enough as it is.”

  “I’m just trying to gather the necessary—”

  Before he could finish his thought, a doctor in a white coat strode into the room. Grant knew right away by his straight posture and confident gait that this had to be the neurosurgeon. No weak egos in my specialty, he thought.

  The man walked past him and stopped at the side of the stretcher with his back to Grant. “I’m the neurosurgeon on call,” he said to Alison. “I understand you passed out at work.”

  “Yes,” Alison said. “I don’t remember much.”

  He asked Alison to squeeze his fingers with both hands, and then instructed her to lift her legs off the table while he pushed down on them. Grant watched him perform a perfunctory neurologic exam.

  “Are you going to grace us with an introduction?” Grant asked. At this point he didn’t care if he sounded rude. This guy wasn’t even close to good enough to take care of Alison. He had to figure out a way to get her out of here, and quick.

  “I’m Dr. Howie,” the doctor said, turning around to shake Grant’s hand.

  Grant recognized the crooked smirk. “Seth?” Seth Howie had graduated near the bottom of Grant’s medical school class at Tufts. He had matched in family medicine and only managed to switch to neurosurgery when a resident at a program somewhere in the corn belt had a sudden psychotic break. Grant and his friends used to call him “Howie will he graduate” behind his back.

  “You escaped Kansas,” Grant said.

  Seth smiled. “Iowa. I was counting the days. What are you doing here, Grant?”

  “Alison is my sister-in-law. So, what can you tell me, Seth?” Grant wanted to gather all the information so he could ship her out. He didn’t want her here to begin with, and the fact that Howie was on the case only increased his sense of urgency.

  “Alison suffered a spontaneous parenchymal hemorrhage in her left frontal lobe, of uncertain etiology,” Seth said. “We’re trying to sort out the differential diagnosis.”

  “What does that mean?” Alison asked.

  “Sorry,” Seth said. “We need to do a few more tests to figure out why you’re bleeding into your brain.”

  “Are there any deficits?” Grant asked.

  “A little weakness in her right hand,” Seth said. “Other than that, she’s neurologically intact.” Mastering the neurologic exam took years of practice, and Grant knew he couldn’t trust Seth’s results. He itched to do the exam himself, but that would have to wait until Alison was on his turf.

  “I don’t feel so intact,” Alison said. �
��I can’t even remember what happened. And the whole school must have seen me being carted away. It’s all so strange.”

  “I’m going to take care of everything,” Grant said. “Seth, I’m requesting a transfer. Calvin Shin will be accepting her to his service.”

  “This is something we can deal with here,” Seth said. “There’s no need—”

  “Need or no need, that’s what I want, and you’re going to make it happen.”

  CHAPTER THREE

  Sadie

  February 5, 2019

  “WE HAVE TO TAKE OUR SHOES OFF in the entryway,” Sadie said, opening the front door of her house and leading Piper inside.

  “Nice digs,” Piper said without acknowledging Sadie’s comment. The soles of her black boots made a clomping noise on the wood floor. She ran her finger along the top of the table along the wall and then picked up Sadie’s mom’s favorite abstract sculpture.

  “No,” Sadie said, taking it from Piper and placing it back on the display stand. “My mom doesn’t like it when I touch things.”

  “I’m just admiring. That looks expensive.”

  “I guess.” Her mother loved to spend money, but since they had just met, Sadie didn’t feel comfortable discussing that with Piper. Walking over to the wall to take off her boots, she hoped Piper would follow suit. She couldn’t bring herself to ask her again.

  She took off her new fitted leather jacket and hung it on the bannister. At the beginning of the school year, Sadie had gotten a new wardrobe. The transition to high school was the perfect time to reinvent herself, to stop being the boring girl and stand out a little. Tired of plain t-shirts and jeans and tennis sneakers, she’d picked out a pair of lace-up boots, black jeans with rips in the knees and a few black and gray tops. She’d even dyed her hair black and started wearing thick mascara and black eye-liner. Learning how to put on the eye-liner proved much harder than she’d expected. The women in the YouTube videos made it look effortless, but Sadie ended up with rings around her eyes and had to keep wiping it off and starting over.