Mutation

Since Victor acted at ease in the environment, no one questioned his presence, despite the fact that he was not wearing an ID. Victor went to the desk and asked if Dr.

Nakano was available.

“He was just here,” a pert young woman replied. She half stood and leaned over the counter to see if she could spot him. Then she sat down and picked up the phone. A moment later the page system added Dr. Nakano’s name to the incessant list that issued from speakers in the ceiling.

Walking about the room, Victor tried to locate Mark, but too many of the kids were on respirators that distorted their faces. He returned to the desk just as the ward clerk was hanging up the phone. Seeing Victor, she told him that Dr.

Nakano was on his way back to the unit.

Five minutes later, Victor was introduced to the handsome, deeply tanned Japanese-American. Victor explained that he was a physician and friend of the Murray family, and that he hoped to get some idea of what was happening to Mark.

“It’s not good,” Dr. Nakano said candidly. “The child is dying. It’s not often we can say that, but in this case the problem is unresponsive to any treatment.”

“Do you have any idea of what’s going on?” Victor asked.

“We know what’s happening,” Dr. Nakano said, “what we don’t know is what’s causing it. Come on, I’ll show you.”

With the hurried step of a busy doctor, Dr. Nakano took off toward the rear of the ICU. He stopped outside a cubicle separated from the main portion of the ICU.

“The child’s on precautions,” Dr. Nakano explained.

“There’s been no evidence of infection, but we thought just in case . . .” He handed Victor a gown, hat, and mask. Both men donned the protective gear and entered the small room.

Mark Murray was in the center of a large crib with high side rails. His head was swathed in a gauze bandage. Dr.

Nakano explained that they’d tried a decompression and a shunt, hoping that might help, but it hadn’t.

“Take a look,” Dr. Nakano said, handing Victor an ophthalmoscope. Leaning over the stricken two-year-old, Victor lifted Mark’s eyelid and peered through the dilated, fixed pupil. Despite his inexperience with the instrument, he saw the pathology immediately. The optic nerve was bulging forward as if being pushed from behind.

Victor straightened up.

“Pretty impressive, no?” Dr. Nakano said. He took the scope from Victor and peered himself. He was quiet for a moment, then straightened up. “The disappointing thing is that it is getting progressively worse. The kid’s brain is still swelling. I’m surprised it’s not coming out his ears.

Nothing has helped; not the decompression, not the shunt, not massive steroids, not mannitol. I’m afraid we’ve just about given up.”

Victor had noticed there was no nurse in attendance. “Any hemorrhage or signs of trauma?” he asked.

“Nope,” Dr. Nakano said simply. “Other than the swelling, the kid’s clean. No meningitis as I said earlier. We just don’t understand. The man upstairs is in control.” He pointed skyward.

As if responding to Dr. Nakano’s morbid prediction, the cardiac monitor let out a brief alarm, indicating that Mark’s heart had paused. Mark’s heart rate was becoming irregular.

The alarm sounded briefly again. Dr. Nakano didn’t move.

“This happened earlier,” he said. “But at this point it’s a

‘no-code’ status.” Then, as an explanation, he added: “The parents see no sense in keeping him alive if his brain is gone.”

Victor nodded, and as he did so, the cardiac monitor alarm came on and stayed on. Mark’s heart went into fibrillation.

Victor looked over his shoulder toward the unit desk. No one responded.

Within a short time the erratic tracing on the CRT screen flattened out to a straight line. “That’s the ball game,” Dr.

Nakano said. It seemed like such a heartless comment, but Victor knew that it was born more of frustration than callousness. Victor remembered being a resident too well.

Dr. Nakano and Victor returned to the desk where Dr.

Nakano informed the secretary that the Murray baby had died.

Matter-of-factly the secretary lifted the phone and initiated the required paperwork. Victor understood you couldn’t work here if you let yourself become upset by the frequent deaths.

“There was a similar case last night,” Victor said. “The name was Hobbs. The child was about the same age, maybe a little older. Are you familiar with it?”

“I heard about it,” Dr. Nakano said vaguely. “But it wasn’t my case. I understand many of the symptoms were the same.”

“Seems so,” Victor said. Then he asked: “You’ll get an autopsy?”

“Absolutely,” Dr. Nakano said. “It will be a medical examiner’s case, but they turn most over to us. They’re too busy downtown, especially for this kind of esoteric stuff.

Will you tell the parents or do you want me to do it?”

Dr. Nakano’s rapid change of direction in his conversation jarred Victor. “I’ll tell them,” he said after a pause.

“And thanks for your time.”

“No problem,” Dr. Nakano said, but he didn’t look at Victor. He was already involved with another crisis.