(list of medical terminology specific to this chapter is included below)
The morning had started off like cold molasses, a slow-motion rodeo of the demented and down-trodden, each case sadder than the last. Sarah didn't get too involved with these patients, but Minerva's situation had impressed her because they were exactly the same age. So were their sons. She'd caught a glimpse of Tyler on Peter's iPhone as she was scribbling down Minerva's pre-op assessment. "What a cutie!" she'd responded automatically, trying to sound enthusiastic. Her throat tightened with regret as bittersweet thoughts of her own son flooded her consciousness. Fighting back the same tears she'd already cried too many times, Sarah returned to her paperwork. I've gotta keep myself together in that courtroom today.
In less than an hour, she'd be attending the final custody hearing in her long, drawn out divorce. Two years ago, her husband, Carter, blind-sided her with the news that he'd filed for divorce as well as sole physical custody of their son, Dylan. It literally came out of nowhere, hitting her like a ton of bricks. Carter had lost his job in pharmaceutical sales when the economy collapsed, so he played house-husband while she went back to working full-time with her old anesthesia group, taking extra call to cover their expenses. Dylan was only three then. Transitioning from being a stay-at-home mom to working 60 hours a week was tough on all of them, especially Dylan--he'd always been such a mama's boy. She recalled a recent conversation she'd had with her girlfriend, Viv, an ENT surgeon/divorcée. "Medicine is insidious--it'll suck the life right out of ya," Viv philosophized. "Under the guise of altruism, that deeply ingrained sense of responsibility we learned as medical students holds us hostage somewhere between our unachievable ideals and incomparable standard of living." This immediately called to mind the two million dollar life insurance policy that had been mandated in the terms of Sarah's divorce. "Ain't that the truth?" Sarah quipped. "I just mailed off a $2500 insurance premium check. Hell, I'm worth more dead than alive!" Rolling her eyes while slicing her throat with her index finger, she'd added, "If only it weren't for that two year exclusion on suicide." Hearing herself say this made Sarah flinch; it sounded so cynical. Although she and Viv shared a commiserating "been there, done that" laugh, the truth was that Sarah had seriously contemplated ending her life. But, that was normal under circumstances like hers, right? Surely she was just disillusioned, having forgotten what it was like to hold Play-Doh, instead of life, in her hands.
Long story short, Carter was going to get Dylan, their mountain cottage, and half of her 401K, as well as a small fortune in child support and alimony. This was the thanks she got for supporting him all those years. Once Dylan started school, Carter had nothing but time on his hands, time to devise an airtight defense which portrayed her as cold and chronically unavailable, "an absentee mother and unfaithful wife, who is married to her work," according to the original complaint. She never would have asked Carter for a divorce. Sure, neither of them was happy, but wasn't that just marriage-with-kids in general? Doesn't everyone's sex drive suffer when life becomes a monotonous routine? Mediation had failed, and because of the custody dispute, the case went before a judge. During the divorce proceedings, she was dumb-founded at the judge's obvious sympathy for Carter, but her attorney insisted there was no recourse. "It's the luck of the draw, Sarah," he'd told her defeatedly upon learning Judge Dixon was appointed to their case. "I wish judges could be hand-picked because you've gotten stuck with a real lemon." To make matters worse, Carter was starting a job on the West coast next month, and Dylan could hardly wait. "Daddy's gonna teach me how to surf and ski, Mommy!" He wasn't quite grasping the distance that would soon be separating them. Sarah chastised herself for feeling irritated by the unfiltered ignorance contained within Dylan's childish innocence, and for wishing that he loved her the most.
After depositing Minerva in the recovery room, Sarah gave report and washed her hands. "It's normal for this lady to wake up crying," she'd informed the nurse. "Try not to give her any Ativan if you can help it." Sarah didn't need any complications today. One of her partners was coming to relieve her in just a few minutes so she could appear in court, and she was trying to lighten his load as much as possible, insuring future favors she eventually hoped to return. Upon exiting the ECT lab, she noticed it was raining again. Having forgotten a raincoat or umbrella, Sarah dashed out to her car, shielding her hair from the rain with her purse. Even though she felt herself becoming increasingly more unglued, she was determined to at least look composed. Fuck 'em. In six years, Dylan can make up his own mind about which one of us he'd rather live with.
It was 10:15 when Sarah pulled out of the parking lot, giving her ample time to deal with any weather-induced traffic she might encounter. Court didn't start until 11:00, so she'd be able to grab a coffee to go. There was a coffee shop along the way, in the strip mall just past the public elementary school. This route had become a regular detour for her on court days, and despite the fact that Dylan attended private school across town, she still imagined him among the kids she saw, playing kickball or waiting for their buses to arrive. Lost in pleasant thoughts of the days when she heard "Mommy" a thousand times, when all of Dylan's hurts could be healed by her kisses, she barely noticed her phone ringing. Fumbling for her phone, she was simultaneously distracted by the sight of a young boy, scaling the outstretched limb of a massive tree 50 yards in front of her. For a split second, she watched in horror as the child lost his balance, attempting to recover what appeared to be a lunch box dangling from a branch just beyond his reach. Veering spontaneously off the rain-slicked street to avoid possible collision with the faltering child, she barreled into a huge oak tree. Startled to find herself now hovering above the tree tops, she observed as the boy righted himself, grasping his lunchbox and the gnarled limb resolutely with both hands, hanging on for dear life twelve feet off the ground. Vaguely bothered by the fact that he didn't seem to hear her, she kept screaming at him. "Hold on tight, baby! Don't let go!" Below her, amidst the gathering crowd and the flurry of emergency vehicles screeching onto the scene, a lifeless woman slumped over the steering wheel of a crumpled sedan that was wrapped inextricably around an oak tree, the pre-existing condition under which she'd desperately stashed syringes and several vials of propofol and rocuronium inside her glove box no longer an obstacle to her insurance.
Part I: The Appointment
Part II: Amplitude
Part III: Redemption
ECT: electroconvulsive therapy (shock therapy), used to treat severe refractory depression
Flaccid: lacking in tone; limp
Succhinylcholine: a short-acting, depolarizing paralytic agent which paralyzes skeletal muscle.
Defasciculation: the prevention of muscle twitches
Hyperventilation: rapid breathing that lowers the blood's CO2 level as well as seizure threshold
End-tidal CO2: expired CO2, a measurement of ventilation
milliCoulombs: a unit of electric charge in amps/second
EEG: electroencephalogram. A wavelike recording of the brain's electrical activity
Brevital: methohexital, a short acting barbiturate used to induce general anesthesia
Ativan: a benzodiazepine, like Valium or Xanax, used to produce sedation and treat anxiety
Propofol: an IV anesthetic, used to induce deep sedation and general anesthesia (aka "the Michael Jackson drug")
Rocuronium: a rapid onset, non-depolarizing paralytic agent, used to paralyze skeletal muscles during general anesthesia.