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couldn’t have happened, because she hadn’t changed anything.
    Sandra shook her head as if to loosen imagined cobwebs. Maybe she did need a break. Yet her fear that the possible artifact had been real kept her glued to her seat and watching the patient monitor closely. It was mesmerizing as the tracings raced across the screen, particularly the ECG, with its rapid, repetitive, staccato up-and-down movements.
    After about ten minutes Dr. Weaver got Sandra’s attention by telling her that he was within twenty minutes from closing the skin. That meant that her second most busy time had arrived. She shut off the isoflurane but maintained the nitrous oxide and oxygen. The second she did so, disaster struck! The blood oxygen alarm went off, making Sandra jump.
    Sandra’s eyes shot to the monitor. The oxygen had suddenly gone from nearly 100 percent down to 92 percent. That wasn’t terrible, but it was a change, as it had been pegged at maximum during the whole case. It was also encouraging that it was now at 93 percent and already heading upward. But why did it drop? Sandra didn’t have the foggiest notion. That was when she noticed the ECG had changed, too. At the same moment the oxygen level had fallen, there was sudden tenting of the T wave, suggesting endocardial ischemia, meaning lack of adequate oxygen to the heart. That was not good. But how could it be? How the hell could the heart be lacking oxygen when the blood level hadn’t changed but an instant earlier and not by much? This was nuts!
    Sandra forced herself to be calm by sheer force of will. She had to think. Something was wrong, that was clear. But what? Quickly she upped the oxygen percentage, cutting back on the nitrous oxide. That was when she noticed the tidal volume was seemingly falling, meaning Carl wasn’t taking as deep breaths as he had been. Immediately Sandra dialed in ventilation assist. She wanted to push in more oxygen to get the low-oxygen alarm to turn off.
    “Hey!” Dr. Weaver yelled out with alarm. “Both his legs are hyperextending. Is he seizing? What the hell is going on?”
    “Oh, God, no!” Sandra cried out silently. She leaped up, snatching a penlight in the process. Pulling off the tape holding Carl’s eyelids closed, she shined a beam of light into his pupils. What she saw terrified her. Both pupils were widely dilated and only sluggishly reactive! She felt a sudden weakness in her legs, requiring her to momentarily support herself by grabbing the edge of the operating table. Her fear was that the hyperextension of the legs was something called decorticate rigidity, suggesting that the cortex of the brain, the most sensitive part, was not getting the oxygen it needed. When the cerebral cortex of the brain is deprived of oxygen, the millions of brain cells don’t merely malfunction like the heart—they die!

2.
    Monday, April 6, 9:20 A.M.
    L ynn Peirce and the friends she was sitting with burst out laughing. Unfortunately for her, she had just taken a sip of coffee and ended up spraying a small arc of it onto the table in front of her. She was mortified and couldn’t quite believe what she had done. “I’m so sorry,” she managed while wiping her lips with a napkin. Michael Pender, positioned directly opposite her, leaped back, overreacting for dramatic effect, knocking over his chair in the process. Everyone laughed even harder, to the point where they garnered disapproving looks from people nearby.
    Lynn and Michael were sitting with four other fourth-year medical students in the popular ground-floor coffee shop of the Mason-Dixon University Medical Center. It was an 800-bed hospital, run by Middleton Healthcare, which owned and operated a total of thirty-two hospitals sprinkled throughout the southeastern corner of the United States. The students were crowded around a four-top table, having pulled over a couple of extra chairs for a celebratory coffee break. The floor-to-ceiling sliding glass windows directly next to