Cutting for Stone - Abraham Verghese [259]
One look at Vinu and you knew the stories about him buying groceries for patients he discharged were probably true. Id seen him extend a patient's stay to insulate her from some madness at home. He was the best friend to everyone on the staff and regularly baked cakes and cookies for me. I always sent him a card on Mother's Day, which pleased him no end.
“I was called the minute that Marion was brought here, Dr. Madam,” Vinu went on. “Hepatology, the liver, that is my field. Hepatitis B swims around here. Lots of carriers, intravenous drug addicts and people who acquire it from their mothers at birth—very common in immigrants from the Far East. Madam, we see no end of silent cirrhosis and even liver cancer from this virus. But acute fulminant hepatitis B? In my career I have seen only two other patients quite this severe.”
“Vinu, tell me the truth,” Hema said, taking on a no-nonsense, Mother India tone with this young doctor who was all too ready to play the role of nephew. “Is my son a drinker?”
I suppose it was a fair question. I hadn't seen her in more than seven years. She knew it was in my genes. What did she really know of who or what I had become?
“Madam, categorically no!” Vinu responded. “No, no. A gem of a son you have.”
Hema's stern expression softened.
“Although, madam,” Vinu continued, “in the past few weeks, madam—don't take this wrongly—by the report of his neighbor, Marion had been troubled and drinking.”
Deepak had found a new prescription in my house for isoniazid, a drug used to prevent tuberculosis. Isoniazid was also famous for causing severe liver inflammation. It was routine to check liver enzymes two weeks after starting treatment so the drug could be discontinued if there was any sign of liver damage.
“My hypothesis, madam, is that Marion-bhaiya started isoniazid on his own. The prescription is a month old. He probably didn't get his blood drawn to check liver functions the way he was supposed to. He is a surgeon after all, poor fellow. What does he know about these fine matters? If he'd only consulted me! I would have been honored to take care of him. After all, Marion-bhaiya took care of my hernia so lovingly.
“In any case, madam, I personally went to Manhattan, to Mount Sinai, and I chauffeured over the world's best liver man, the man who trained me in this specialty. I said, ‘Professor, this is a not a case of hepatitis, but a case of my own brother.’ He is in agreement that the alcohol and the isoniazid might be contributory, but there is no doubt that what we are dealing with here first and foremost is hepatitis B.”
“What is the prognosis?” Hema said. “Will someone tell me that?” It was the most basic thing a mother wanted to know. “Will he get better?”
Vinu looked to Deepak and Thomas Stone, but neither man was willing to speak. The disease was, after all, Vinu's area of expertise.
“Just tell me. Will he live?” Hema spat out.
“It is undoubtedly very grave,” Vinu said, and the fact that he was fighting back tears told her everything.
“Come on!” Hema said, annoyed by this and turning to Thomas Stone, and then to Deepak. “It's hepatitis. I understand hepatitis. We see the damage it does in Africa. But … here, America! In this wealthy place, this rich hospital”—she swept her hands at all the machinery— “surely here in America you can do more for hepatitis than to wring your hands and say it is very grave.“
They must have winced when she said “rich.” Compared with the state-of-the-art ICUs in the money hospitals, such as Thomas Stone's institution in Boston, ours was bare-bones.
“We tried everything, madam,” Deepak said now in a more subdued