Page 70 of The Ampersand Effect
Grier turned but continued to walk backward, blowing a kiss and winking. “If we’re lucky, I’ll star in your dreams tonight.”
Grier sat in the conference room for grand rounds. As a department chair, she was required to be present for these weekly meetings, though she’d been invited as an esteemed colleague for months preceding her appointment. Many of the cases discussed weren’t hers, but she always attended with an open mind—and almost always walked away having learned something new.
Despite her lack of surgical training, she relished the pride that came when her opinion on a case was requested—and subsequently received without ego among her peers. Thanks almost entirely to her persistence, it had become standard practice for surgeons to ask how her department couldsupport their shared patients, both before and after surgery. She particularly enjoyed when some of the more progressive surgeons sought her input on the probability of avoiding surgical interventions altogether.
Today’s cases were mostly irrelevant to her department: an infant’s heart hole repair, a toddler’s kidney transplant to replace the one that had failed to grow in utero, and a surgery to correct severely misaligned eyes.
Grier sat forward when Dr. Miles directed a question at her. “We’ve had good luck with expedited post-operative improvements in balance when patients see the physical therapist after these strabismus corrections. Dr. Savage, do you think your team could handle this?”
“Absolutely! Our PT department recently completed training in balance and coordination for early-walking populations. I think they’d love to apply their new skills alongside tried-and-true approaches they’ve used in the past.”
“I’d love to see that syllabus,” Dr. Miles responded.
“Of course. I’ll forward it to you this afternoon. I looked it over when I was approving the course—the research they’re reporting is pretty impressive. I’m excited to see what we can do with it.” Grier could hear the eagerness in her own voice and recognized the confidence she had in her team was likely evident to the entire group. “Indeed,” Dr. Miles said—curt but interested—before continuing. “The final case today is a severe scoliosis case transferred from a regional hospital. She’ll be arriving this afternoon, via Airbus.” At this, Grier’s mind struggled to decipher which piece of information to chase first. She knew the priority was to inquire about the girl’s case—how many spinal curvatures, whether there was organ compromise, previous interventions, and pain levels. But the mention of the Airbus flooded her with visions of Tobin—piloting, transportingthe patient—in her pilot’s uniform. The thought sent a chill along the length of her spine.
They’d been texting steadily since Saturday, although there were frequent blackout periods thanks to their demanding jobs and family obligations. Grier often woke to a string of texts: Tobin’s latest flight tales, answers to questions Grier had asked before the blackout, followed by a fresh question in response. Somehow, they’d slipped into a 20-Questions-style exchange, probing for each other’s truths while sharing their own—navigating that thrilling, awkward early stage of a new relationship, full of discovery, curiosity, and just the right amount of suspense.
They’d long since surpassed twenty questions, and Grier was enjoying every parcel of information she gleaned from Tobin through their texts. She looked forward to the random messages—especially the ones she’d find in the morning or after long, hectic stretches at work. Tobin’s texts had become something she genuinely anticipated: a welcome break from the trials of her day, an outlet, and—if the feelings she was wont to acknowledge were real—a promise.
The memory of Tobin’s indignation still played in her mind when Dr. Miles’s voice cut through her reverie, pulling her squarely back into the conference room.
“Ally is eight years old with chronic recurring bacterial pneumonia, secondary to lung compromise associated with idiopathic double major spinal curvatures—primary levothoracic scoliosis. Her family is low-income and underinsured, which has played an unfortunate role in their ability to seek early intervention. The hospital has acquired this case on a pro bono basis, but that will not affect her care or outcomes.” Dr. Miles looked at each of the twelve physicians in the room as he spoke.
Pro bono cases weren’t uncommon at the hospital—each physician and department was required to contribute a certain percentage of no-cost interventions annually. However, the hospital barred these cases from being included in research or publication materials, a restriction that, unfortunately, deterred some of the more ego-driven physicians from volunteering their time to care for these kids.
She heard a familiar throat clear to her left and tried not to visibly bristle as she recognized the coarse voice of Dr. Vanders. “It’s clear she needs corrective rod placement. I can clear my schedule this afternoon and evaluate her. She should have surgery as soon as possible—try to give her back some of the life her… unfortunate home life has failed to provide her so far.”
Her hackles rose. He hadn’t even seen the girl’s most recent films and he was already talking surgery? And he wasvolunteeringfor a pro bono case? She knew for a fact Surgery had to practically strong-arm him into meeting his no-cost quotas each year, tracking him down and assigning him cases just to fulfill the requirement. He never willingly worked for free—and certainly not on cases he couldn’t publish. What was he playing at?
“I disagree,” Haleigh said matter-of-factly. She sat to Dr. Vanders’s immediate left, shoulders squared. “We haven’t evaluated her ourselves—we have no idea what her system is like. Even if the report recommends immediate surgery, I feel it would be rash to assume it’s true without evaluating her. We need to evaluate her entire system, not just her skeleton.”
Grier buried a smile, grateful her friend was defending the child. She knew she’d likely need surgery, but not before they knew what they were walking into. If they could implement some alternative treatments to help relax the girl’s muscles and skeletal structures—even by a few degrees—her surgical outcome would likely improve significantly.
Still, there was something nagging at her about this case. Something in the periphery of her mind was scratching at her, clawing for attention. Something she couldn’t quite name.
“Her latest report from the regional hospital shows compromised lung function, reduced oxygen levels, and an increased heart rate,” Vanders countered. “She needs surgery.Now.”
Grier’s gaze flicked to Dr. Miles as he turned toward Haleigh, clearly waiting for her rebuttal. But that scratch in her mind grew insistent, like static turning to a hum.
What did Dr. Miles say about her double major curvature? There was something there.
Haleigh persisted. “And if you’d read the entire report instead of skimming it, you’d have realized those numbers were acquired during active pneumonia, where oxygen levels would be obviously reduced and fever would naturally elevate heart rate. Values preceding the infection were borderline normal—weak, maybe—but still stronger than during the illness. I reiterate: there’s a need to evaluate before we cut. That left thoracic curvature is going to be more difficult to address than the more common right curvature as it is; she needs to be as healthy as possible before we cut.”
That was it! Haleigh’s mention of the curvature triggered a memory from Grier’s advanced scoliosis class in grad school— specifically, how laterality of spinal curvature was influenced by other underlying factors.
“I agree with Dr. Rhodes. I think there’s more going on here.” Grier drew herself upright, steadying her nerves as she prepared to present her case. “Do her existing records have a brain MRI?”
“It’s scoliosis, Grier. You of all people should understand that scoliosis affects the spine and leaves the brain unaffected,” Vanders scoffed, deliberately dropping her title to insinuate his superiority.
“I understand that, Dr. Vanders—thank you for your board review.” She smiled at him, the kind of smile that stopped short of her eyes. “Theoppositecan be true, however. A brain tumor can affect the spine. I’ve read studies correlating a dominant left thoracic curvature with pituitary tumors. I think it would be prudent to at least consider the possibility of a tumor and its associated pathology prior to a surgical intervention that may be doomed in the absence of due diligence.”
“A pituitary tumor? Are you serious?” Vanders glowered at her.
Grier remained poised, refusing to let him intimidate her— especially when it came to appropriate patient care. She’d be damned if he was going to bully her into acquiescing when a patient’s quality of life was on the line.
“I have to agree with Dr. Savage,” Haleigh offered, directing her comment to Dr. Miles and bypassing Vanders altogether. “This girl has been mishandled by every previous physician she’s come across. She’s likely terrified of us by now. If we can properly diagnose her, we may be able to spare her from numerous unnecessary interventions as her body grows.”
The room grew quiet—and tense—as all eyes rested on Dr. Miles, awaiting his verdict. Grier watched as the senior surgeon deliberated internally, rolling his lips between his teeth as he weighed the opposing arguments.