Chapter 32

32

A few hours later, we meet for rounds with Dr. Westin like nothing happened.

I'm all cried out. My eyes are still puffy but everyone probably thinks it's from lack of sleep. Nobody would believe I was actually crying over a patient . Even Thomas Jefferson has no idea. I was too embarrassed to face him again. In my head, I keep replaying that moment when I told him that his wife would be fine, that she'd definitely go home with him.

I promised him.

Alyssa sits next to me in Dr. Westin's office. She's got a list of all our patients in front of her and she's drawn a line through the name Marquette Jefferson.

As usual, Connie goes through her patients before I do. She's only got two of them left so it goes quickly. Then it's my turn.

"My, my, my, unfortunate business last night," Dr. Westin says to me. "You're quite the black cloud, aren't you, Jackie?"

A "black cloud" refers to a person who generally has bad luck on calls. I think the term could accurately be applied to my entire internship so far.

"Yep," is what I say.

"Very unfortunate," Dr. Westin muses.

I wish he'd just move on. Alyssa has already drawn a line through her name—why can't we talk about something else before I start crying again?

"What did Surgery say about the pneumothorax?" Dr. Westin asks.

I blink at him. "What? What pneumothorax?"

A pneumothorax occurs when air gets into the space between the lung and the chest wall. It can potentially collapse the lung, so if it's bad enough, Surgery can stick in a needle or a tube to release the air.

But why is Dr. Westin talking about a pneumothorax?

"It was on Mrs. Jefferson's chest X-ray," he says. "Wasn't it? Here, let me bring it up on my computer."

I practically leap off my chair to get a closer look at the computer screen. Within seconds, a picture of Mrs. Jefferson's chest cavity fills the monitor.

And there it is, on the upper right side: a very clear pneumothorax. A vein starts to throb in my temple.

"I see it!" Connie chirps. "It's on the right. "

"She had a PICC line put in recently, didn't she?" Dr. Westin muses. "That probably did it."

I jerk my head up to look at Alyssa, who is silent. Not acknowledging the fact that she was the one who misread the X-ray as negative.

And now that patient is dead.

My eyes fall again on her list of patients, at Mrs. Jefferson's name crossed off the list. Like she's nothing . Like her death didn't even matter . All the awful things Alyssa's said to me this month flash through my brain until I start seeing red. And at that point, I just can't stop myself.

"This is your fault," I hiss at Alyssa. My cheeks feel like they're blazing. " You are the one who read the X-ray. You read it wrong! If you were competent at your job, that woman would still be alive right now."

Alyssa stares at me, shocked by my outburst. "Jane, I didn't—"

"Didn't what?" I burst in. "Drop the ball? Obviously you did. You talk about high standards and being knowledgeable when it comes to total bullshit, but when it's actually important and a person's life is at stake, you don't have a clue what you're doing. You can't even read a goddamn chest X-ray!"

Alyssa's mouth is open. She looks like she has something to say to me, but she can't get the words out. Good. Because I've got one more thing left to say to her.

"You killed Mrs. Jefferson," I practically spit at her. "You deserve to lose your license. "

Everyone sits there in stunned silence for at least 60 seconds. Even I'm sort of stunned, to be perfectly honest. I can't believe I said all that. I was thinking it, but I can't believe I actually said it. But now that I did, I'm glad. She deserved every word of it.

Alyssa rises from her seat. She's taller than I am, and for a second, I'm slightly afraid she might hit me. I sort of deserve it. But she doesn't. Instead she whirls around and storms out of Dr. Westin's office.

We all watch her leave. It's only after she's gone that I get an inkling that I did something kind of inappropriate. What was I thinking ?

"That," Dr. Westin says, "was incredibly unprofessional."

I hang my head. "I'm sorry."

Dr. Westin considers me for a moment, contemplating my fate. I'm suddenly really embarrassed. Why did I say all that? I'm not five years old. I'm in control of my words. It's not my fault! I'm just really, really tired.

"You need to go apologize to her, Jane," he says.

I nod. I can't believe he finally got my name right. And now he'll remember it forever.

_____

I try paging Alyssa but she doesn't answer. That freaks me out a little, because unlike Sexy Surgeon, Alyssa always answers pages promptly. If she's ignoring her pager, I must have really upset her.

I end up searching the whole damn hospital for Alyssa. She's not in any of the usual locations: the wards, the resident lounge, the call rooms, the cafeteria.

I'm about to give up when I remember that night when I declared that patient dead for the first time and Ryan took me up to the roof. On a whim, I head up to the roof. At the very least, I'll get some fresh air. I could use it.

As the door to the roof swings open, I immediately see her. Alyssa. She's leaning over the edge, facing away from me, holding her phone in her hand. She's not talking to anyone though. She's just looking at the phone. As I get closer, I realize she's looking at a photo of her son.

My chest tightens. She's not going to jump, is she? If I drove her to do that, it's a million times worse than whatever she did or didn't do to Mrs. Jefferson. "Alyssa," I gasp.

She whips her head around. When I see her face, I notice that her eyes are red-rimmed.

"Are you okay?" I say, trying to sound gentle, like the way I'd talk to patients on my psychiatry rotation.

Alyssa snorts and shoves her phone back into her pocket.

"I'm sorry about what I said," I say, taking a careful step towards her. "Just… you know, don't do anything crazy. "

Alyssa wipes her eyes. "Don't worry, I'm not going to throw myself off the building, if that's what you're thinking."

"Oh," I say, my shoulders sagging in relief. "Alyssa, I shouldn't have said that you… that you killed Mrs. Jefferson. You didn't."

I'm being honest. Yes, Alyssa missed the pneumothorax. But now that I'm being realistic, that pneumothorax was admittedly pretty small. Mrs. Jefferson was a really sick woman, and as of now, it's not clear that any intervention done for that pneumothorax would have made a difference. In all likelihood, she still would have died. If not today, then tomorrow. It was inevitable—even Mrs. Jefferson realized it.

"No, you had it right the first time," Alyssa says. "I did. I killed her. Or at least, I let her die." She takes a deep breath. "That's something I'm going to have to live with the rest of my life."

I don't know what to say to that.

"I hope it never happens to you," she says.

We stand there in silence for a minute, then Alyssa shivers with a passing breeze. She hugs herself for a moment then pushes past me to go back into the hospital and get back to work.