“Disinformation is one of the leading causes of death.
If that isn’t true now, I say it will be.”
For hospital physician Dr. Mark Lin, nothing is more gut-wrenching than saving a life only to see it taken by murder.
When one of his patients is killed by a suicide bomber blowing up a clinic, everyone points the finger at a group of anti-abortion extremists. Mark, however, knows the killer’s final words and has a different theory about the culprit: a secretive healing cult called the Path to Purity. It seems the only way to get answers and avenge his patient is to join the Path himself.
Juggling the dual roles of doctor and undercover cult follower, Mark treats patients for ill effects of the Path’s dangerous practices while also proving his worth and advancing along the Path’s ranks. He has only one goal: get close to the mysterious leader known as the Sun Priest and destroy the cult. But the deeper he goes, the deadlier things get. Mark will stop at nothing to uncover the truth, before getting trapped in a heinous plot that could spell devastation on a massive scale.
“Disinformation is one of the leading causes of death.
If that isn’t true now, I say it will be.”
For hospital physician Dr. Mark Lin, nothing is more gut-wrenching than saving a life only to see it taken by murder.
When one of his patients is killed by a suicide bomber blowing up a clinic, everyone points the finger at a group of anti-abortion extremists. Mark, however, knows the killer’s final words and has a different theory about the culprit: a secretive healing cult called the Path to Purity. It seems the only way to get answers and avenge his patient is to join the Path himself.
Juggling the dual roles of doctor and undercover cult follower, Mark treats patients for ill effects of the Path’s dangerous practices while also proving his worth and advancing along the Path’s ranks. He has only one goal: get close to the mysterious leader known as the Sun Priest and destroy the cult. But the deeper he goes, the deadlier things get. Mark will stop at nothing to uncover the truth, before getting trapped in a heinous plot that could spell devastation on a massive scale.
In a hospital, quiet days are rare blessings. They really are.
What do you expect in a place where people are too sick to carry on with their lives as usual? Constant medical attention, that’s what. There’s usually someone in pain, or fear, sometimes both. I always anticipate tests that need to be done here and there, plus whatever treatments are needed to end the patient’s suffering. If a patient crashes, my day gets ruined. I’m on the move pretty much all the time. I’m so used to it that I don’t think about it anymore.
And yet, here I am: Ivory Memorial Hospital, seventh floor, East side, computer workroom behind the nurse’s station, so relaxed and carefree. It’s Tuesday morning and I have only four patients on my service. None are unstable or in serious condition. Three of them could possibly be discharged tomorrow. The last one will leave the hospital today, after I wrap up her paperwork.
Four days ago, 32-year-old Shannon Dixon came to the emergency department downstairs because of difficulty breathing. Right away, a CT scan of her chest nailed the diagnosis: pulmonary embolism, a blood clot stuck in a major lung artery. It formed initially in one of her leg veins before breaking off and traveling all the way to the right side of her heart and then into her lung circulation. As for how that happened, I’m thinking it’s her recent ten-hour flight from Tokyo to Los Angeles, where she barely moved her legs and never stood up once because she slept the entire flight. That means blood moving slower than usual. That means a higher chance for clotting factors in the blood to coalesce into clots. Thankfully, her treatments went just fine: injections of the blood thinner heparin, then transitioning to the blood-thinner pill warfarin. She’s now on the right dose of warfarin, which she will continue after leaving this place.
As great as that sounds, there’s still something else. One unexpected detail about Shannon’s case got thrown into the mix and has knotted my stomach since. Today will be my last chance to talk to her about it.
I submit the discharge orders through Icarus, the Integrated Clinical Record System, and leave the workroom. Shannon is in room 724, still in bed wearing a light-blue hospital gown. She adjusts her wavy blonde hair before getting a kiss from a muscular man, her husband Craig. The two spot me at the door, then smile.
“Well, it’s finally done,” I say, returning an equally friendly grin. “You’ll be going home in no time.”
“Woohoo,” Shannon responds, almost beaming like a little girl. “What time am I leaving?”
“Likely before noon. You can even stop by the cafeteria on your way out.”
“Is the food any good?” Craig asks.
“Oh, it’s five-star dining,” I answer with a small laugh. “But yeah, there are decent options. I would say they’ve got better in the past year.”
“Anything you recommend?”
“Not really. Just follow your gut.”
“I’m in the mood for ham sandwiches. What do you think, honey?”
“Sounds great,” Shannon says. “What about dinner?”
“I found a nice restaurant we could try out,” Craig says. “But it won’t be cheap.”
“I’m not worried. You’re the one paying.”
“Right. I lost to you in Trivial Pursuit.”
Shannon giggles slightly.
“So which restaurant did you pick?” she asks.
“I’ll surprise you.”
“Aw, come on, babe.”
“You’ll like it. Trust me.”
“Fine. I’m sure you won’t disappoint me, just like when you found that every bar on Super Bowl Sunday had no room for us.”
“For that, your football team beat mine.”
“Go Chiefs!”
The couple share a hearty laugh, face to face and eye to eye. Yeah, they are true lovebirds. Gotta love these two. Craig kisses his wife on the lips. Shannon smiles.
But all of a sudden, she freezes. Her expression does a 180. The happy face is gone. She also raises a finger, as if remembering something.
“Dr. Lin, about that thing we talked about yesterday,” she says.
I nod. This is the moment I’d been waiting for. I had expected that I would be the one to bring up the issue, but Shannon just beat me to it.
She and Craig had been trying to have a baby for some time. Two days ago, while she was hospitalized, Craig came here with a home pregnancy test kit. Shannon went into the restroom to do the test, and sure enough, the stick showed the wonderful plus sign they were hoping for. The next day, she asked me if her treatments for pulmonary embolism might harm her unborn child. I stopped in my tracks. I had no idea she was pregnant. All I could do was say that I would look into it.
I consulted Micromedex and other drug reference sources. They all confirmed it: warfarin is teratogenic. It causes bleeding in a developing fetus. Birth defects are sure to result, or worse, the baby might come out already dead sometime in the nine-month period. No wonder it’s contraindicated in pregnancy. Should I have considered the possibility of pregnancy beforehand? Yeah, sure. But when a blood clot gets stuck in a pulmonary artery and that problem is priority number one, it’s hard to think of anything else. Presumably, the emergency doc had that same problem, especially with the ED staff often overworked. Man, talk about falling through the cracks.
“I remember,” I say, trying to still sound friendly. “You caught me by surprise. Well, I hate to say it, but warfarin can harm a developing baby.”
“I’m so sorry,” Shannon says with a hint of guilt. “I should’ve asked you earlier.”
“No, don’t worry about it. What’s done is done.”
“But now our baby might be deformed.”
“When was your last menstrual period?”
Shannon stops to think.
“Like one-and-a-half months.”
“Early stage,” I respond. “That’s when the most critical development occurs in the womb, I believe.”
“Now I’m really concerned.”
“Dr. Lin, what are the chances that, if we wait eight more months, the baby will still come out normal?” Craig asks.
I pause, trying to recall any statistics about fetal warfarin syndrome. But I’m no obstetrician.
“Taking warfarin during pregnancy may not be one hundred percent guaranteed to result in birth defects, but I don’t want to say that the chance is small, either,” I comment slowly.
“Maybe we should assume the worst,” Shannon says, before pulling out a tissue from a box on the nightstand. Then she closes her eyes, sighs, and frowns. Craig leans over to hold her hand.
“It’s OK,” Craig says soothingly.
“But it’s gonna have problems,” Shannon says with a quiet sob.
Craig gives her a hug, letting his wife cry into his chest instead of her tissue. I hold still, not wanting to disturb what is already a difficult moment. So much for a happy patient discharge. I wait another minute before Shannon is calm once again.
“Do you want to wait and see if the baby turns out OK?” she asks her husband. “Or should I get an abortion?”
Craig slowly turns to me.
“Any advice, Dr. Lin?” he asks.
“It’s really up to the two of you,” I answer calmly. “I’m also not the best doctor to handle issues related to pregnancy, including the simultaneous use of warfarin. In fact, on the discharge paperwork, I included a referral to OB/GYN. Just wait for them to contact you. Then you can schedule an appointment.”
“How long until they call?” Shannon asks.
“I don’t know. I hope it’ll be soon.”
Shannon nods and looks at Craig. The couple talk to each other at a whisper level. I cannot hear them, which is fine by me. But I do see their faces. For a while, both husband and wife wear serious expressions. But soon, Shannon’s frown fades as Craig smiles a little. Then she smiles, too, while nodding her head slightly. Maybe Craig has suggested something to Shannon, who has arrived at some kind of acceptance or agreement.
They turn back to me.
“Is everything OK?” I ask politely.
“We’re fine,” Shannon answers. “This is the first time we ever had to deal with this.”
“You’re not alone.”
“Of course.”
“We can talk more about it over dinner,” Craig suggests. “You know what? Forget the surprise. I’ll tell you right now. We’ll eat at that Mediterranean restaurant you always wanted to try.”
“Ooooh, you read my mind.”
“Not really. You said you were in the mood for falafel.”
“Did I?”
“Yeah, just yesterday.”
“Oh, right. My mind has gotten fuzzy. Blame it on this hospital.”
The two laugh together. Now is the time to signal my exit.
“Do either of you have any questions?” I ask.
Shannon and Craig only shake their heads. I nod, wish them a wonderful rest of the day, and leave the room.
* * *
Today really is my lucky day. It’s a little after 4:15 PM and I have almost nothing to do. I still have only three patients in my list. All are doing well after I followed up on them this afternoon. I’m amazed that I haven’t been called down to the emergency department to pick up new admissions. After all, patients requiring hospitalization here in Ivory Memorial are assigned to hospitalists who currently have the fewest patients. So I can think of only two possibilities. One, no patients in the ED today need to be admitted. Two, the few who do are now assigned to hospitalists who happened to have zero to two patients. I could care less which is happening. This downtime is unbelievable.
In my corner cubicle, I sift through work emails and respond where needed. Nothing is terribly urgent, so I don’t bother rushing. Even then, I get it all done in no time. My next task is to compile summary notes on my three patients, in preparation for signing them out to the nocturnist covering from five o’clock PM to seven o’clock AM. That really doesn’t take long either. Now there’s still half an hour to kill before I can finally go home, if things remain quiet.
I stand up and stretch my arms above my head. Then I step away from my desk, out to the big empty space in the middle of the room. My stomach soon growls. I grab a granola bar from the nearby lounge and devour it in two bites. That’s when I hear a door open. A fellow doc has entered this office area from the hallway. I recognize the black man with the big smile and upbeat demeanor: one of my friends, Thomas Chandler.
“Hey, Mark. Aren’t you getting any work done?”
“I’m all finished,” I clap back, almost laughing.
“Seriously? Man, I wish I had your workload.”
“How big is your list right now?”
“Eight patients.”
“Are they terribly sick?”
“None of them are, thank god.”
“So why are you complaining?”
“What are you talking about?”
“You said you wish you had my workload.”
“I did?”
I glare at Thomas.
“Come on, stop being in denial,” I say, stifling a laugh. “I have good short-term memory.”
“Not a short memory?”
“Oh, be quiet.”
Thomas chuckles out loud as he walks by and pats me on the back. He sits at his cubicle while I remain standing.
“So yeah, I did have a busy day,” Thomas says, logging into his computer. “When one focuses on work, everything else goes out the window. You know how it is.”
“Unlike today, I think I’ll be super busy tomorrow,” I say calmly.
“Because of new admissions?”
“Yeah. I only have three patients, all likely discharges.”
Thomas whistles.
“I think you’ve set a new record in this hospital: the shortest time to zero patients.”
“What’s the previous?” I ask.
“I don’t think there is one.”
“You mean nobody ever had an empty patient list?”
“Probably not.”
“OK, so I might become the first. Maybe the last as well.”
“Watch it, Mark. I’ll soon catch up with you.”
“When? The day you retire?”
Thomas and I share another good laugh before I let him get back to work. Still in the room’s open space, I slowly pace around. I don’t want this downtime to end. But I’m also a realist. I know it’s not going to last.
Soon, one of my mobile phones starts vibrating. Not the personal one in my right pants pocket. The work phone in my left. I pick it up and answer, noticing a phone number displayed instead of someone’s name. The caller is not in my contacts list.
“Hello. Dr. Mark Lin speaking.”
“Hi, it’s Shannon Dixon. Sorry if I’m interrupting anything.”
“Oh, not at all. But even if you were, I’d still be answering.”
She giggles a little.
“Well, don’t pick up if a patient is dying. So, I’m at Ivory Memorial Clinic right now. I got an OB/GYN appointment at four forty-five.”
“Really? In just a few minutes?”
“Yeah. Someone else had it before cancelling. When the clinic called to schedule an appointment and I asked about the earliest date and time, they told me about that slot and I requested it.”
“Wow. Lucky you.”
“I know, right? Anyway, I’m calling because I have two questions.”
“Sure. What’s up?”
“First off, should I worry about my Coumadin dose getting changed?” she asks, referring to a common brand name for warfarin.
“Any reason you’re concerned?”
“I remember you saying the medication must be taken at the dose and frequency you prescribed.”
“I don’t believe the obstetrician will adjust the Coumadin. Chances are that the doc will understand how important it is for you at this time.”
“OK.”
“In my experience, when there are multiple doctors of different specialties for the same patient, they try to keep current medications the way they are, unless it’s very clear that particular meds are causing a big problem or two. Does that make sense?”
“Yeah, sure.”
“Good. Hopefully, I won’t have to go over there and pester them about your Coumadin. Not that it’s even a possibility.”
Shannon laughs before continuing.
“That’s fine. Now, my second question. Since I survived a blood clot in my lung, should I worry about getting a clot somewhere else?”
I nod. I like it when patients take their health seriously.
“I don’t want to have another major crisis, you know,” Shannon says.
“It’s good to ask. In your case, I would say no.”
“Is it impossible for me to get another clot?”
“No, but I would say the probability is low, at least for now.”
“Why do you say that?”
“The most likely reason you developed a blood clot is that you kept your legs still for a very long time, during your flight from Tokyo. Combine that with your pregnancy, which made your blood more prone to clot formation because of all that estrogen. Now, if you were to avoid both down the line, or at least one of them, the risk won’t be as high.”
“So I should avoid flying while expecting.”
I pause as Shannon laughs.
“That’s one way,” I say, also chuckling a little.
“But seriously, do I need to worry about a clot in another part of my body?”
“Like where?”
“I don’t know. The brain, maybe?”
“Probably not. You don’t have atrial fibrillation, do you?”
“I don’t think so. But I don’t know what that is.”
“Your heart has four chambers: the two atria at the top and the two ventricles at the bottom. Atrial fibrillation is when the two atria beat chaotically, not strongly. That makes blood flow slower than normal there, making it easy for clots to form. The same way that a clot formed in your leg, dislodged, and traveled all the way to your lungs, a clot from the heart could make its way to the brain, causing a stroke.”
“Oh god. And you’re sure that won’t happen to me?”
“Very sure. Your EKG shows a normal heart rhythm, not a-fib.”
“OK.”
“Again, don’t worry. Remember, the factors underlying your clot were only temporary. You don’t have any chronic conditions that make you a constant clotting machine. You understand what I’m saying?”
“I do now, thank you. God, why am I such a coward?”
“Don’t feel bad. Caution can save your life.”
“Sure. But now I have the wait time to deal with. I’m supposedly the last appointment for the day, but there are still others in the waiting room.”
“Are you sure they’re waiting for appointments?”
“I don’t know. I just see—”
Her voice is cut off by a sound, probably a door knob turned forcefully. Followed by a pounding. I picture a door slamming open and hitting a wall. A different female voice speaks, in the distance.
“Ma’am, what are you doing?”
There is silence. I’m also holding my breath. All of a sudden, I hear footsteps, then a few high-pitched grunts before what sounds like a hand slapping someone’s face. The commotion gets louder.
“Oh my god,” Shannon whispers quickly.
“What?” I say.
“Some woman just barged into the waiting room with a gun. Others are restraining her.”
“Oh no. Can you hide somewhere?”
“I can’t.”
“OK, try to stay far away.”
Now I hear a big thud.
“She’s pinned to the ground,” Shannon says, voice quivering. “Now she’s clawing her hands at people. And… she’s pulling something from her jacket.”
I stand still now, not daring to move one muscle. Not even my diaphragm for breathing.
“It’s some kind of button,” Shannon says softly. “With a wire going into her.”
I picture what she’s describing. Suddenly, the grunts reach an intense pitch, a mad struggle of women fighting for dear life. One voice shouts at the top of her lungs.
“Purity is mine!”
Followed by Shannon’s scream.
“Nnnnnoooooooo!”
A deafening boom instantly cuts her off. My whole body stiffens, especially my chest. I’m not breathing. I want to, I really do, but I can’t. The room is blurring now. I feel the phone slipping away from my hand. Its thumping along the floor barely registers. Everything is out of reach, out of sight. My body slumps. I’m sinking quickly with no strength left.
Darkness finally captures me. I welcome it with open arms.
Toxic Minds, by Anthony Lee
Meet Dr. Mark Lin, a hospitalist who treats the many patients who come into the hospital via the emergency room. After a female patient of his is advised of a serious medical problem and that she's also pregnant, Dr. Lin refers her to the OBGYN clinic next to the hospital. But he hears an explosion while on the phone with his patient. Dr. Lin has also been assigned new patients with unusual symptoms and complaints. One, a woman with many health issues now has a swollen leg due to injecting herself with an unknown substance referred by her "health doctor" who calls modern science "junk science". The patient describes her activities as a journey on the "path" toward perfect health. Other doctors at the hospital report additional patients using unconventional means to purity. Dr. Lin begins his investigative journey into the unknown by going to meetings of an unknown origin toward an unknown goal. He is now on a roller coaster ride of activity in the meetings and the hospital.
Additional patients in the ER continue to be admitted after taking unknown medical treatments from an unknown source and refusing medical treatment from the doctors. Dr. Lin is getting closer to the source of the medical misinformation and discovers things are getting more serious and dangerous each day; people are already dying, and many more could be as well. The roller coaster ride is spinning out of control, with more patients, more threats, and physical violence closing in on Lin. Yet, he continues his quest to get to the source of the "Path" and "Purity" to stop the madness.
The story is full-bodied in that the medical issues are explained, and whatever issues may not be adding up after a patient's death. The characters have strong personalities, including mental health aspects that they are dealing with due to the violence. The suspense comes quickly and deeply, the pace never lets up, and just when you think the story will be done, it isn't.