Final Mercy

by Frank J Edwards

  Samuels froze.

  “He won’t bite. Come forth, Mr. Samuels.”

  The other medical students parted, the majority of them looking relieved that today it would be Samuels burned at the stake. It was shaping up to be quite a conflagration, too.

  Witner folded his arms.

  “Before you start,” he said, “tell us what you see when you look at this patient.”

  “Well,” said Samuels, “this is a young man who is unresponsive.”

  Witner turned to Delancy and indicated with a nod that the latter could take over the line of questioning. Delancy beamed like an apprentice butcher given a prime carcass.

  “How do you know he’s unresponsive?” he demanded.

  “How?” Samuels said, slightly defiant. “Well, because he’s not responding to anything.”

  Delancy shook his head.

  “Maybe he’s just asleep.” His tone was derisive. “How do you know?”

  “Dr. Delancy raises a very important point, doesn’t he?” interjected Witner. “Is there anyone who can tell Mr. Samuels a more definitive way of determining a patient’s state of responsiveness?”

  Several hands shot up.

  “Prick him with a pin,” said one.

  “Put an ammonium capsule under his nose,” said another.

  “Do a sternal rub,” offered a third. “Or press something hard into his eyebrow.”

  Witner nodded. “Yes, all of those things could be done, but isn’t there something simpler?”

  “A rectal exam?” suggested an intern.

  “Dr. Delancy,” Witner said, “enlighten us.”

  “Yes, sir. The first step in determining a patient’s level of consciousness is to try verbal stimulation. You talk to the patient.”

  “Thank you. Simple things first. Now, Mr. Samuels, assess his level of responsiveness.”

  Samuels shuffled his feet. “You mean try and talk to him?”

  Witner looked toward the window and tapped his toe on the floor. Samuels sighed and bent toward the patient.

  “Hello, there,” he said. “Hi, how are you feeling today?” He then straightened and stepped away from the bed. “Okay, well, I guess he’s not responding to that.”

  “Now, auscultate, Mr. Samuels,” Witner ordered.

  Samuels again leaned over the comatose patient and began listening to his chest. There was a problem, however—he had forgotten to put the earpieces of his stethoscope in his ears. They were still clamped around his neck.

  Witner held up his hand to silence the chuckles that began erupting. The pyre had been lit, and the flames were now licking up Samuels’s legs. He continued for another ten seconds, and then his ears suddenly turned the color of ripe tomatoes. He straightened and slipped the earpieces into their proper place, and would have continued if Witner hadn’t broken in.

  “That’s quite enough, Mr. Samuels. Quite enough. Tell me something. You’ve gone through four years of college and are now in your fourth year of medical school, is that not correct?”

  “Yes, sir.”

  “That makes eight years of post-high school education focused on a career in medicine.”

  “Yes, sir.”

  “Such effort usually means an individual truly wants to become a physician.”

  Samuels nodded, his temples and forehead glistening.

  “However, I have to wonder, as I suspect your colleagues are also wondering, if that’s the case with you. Do you really possess that desire?”

  “I was a little nervous.”

  “People standing on thin ice usually are. And you are on very thin ice.” Not to mention that you’re ugly, unambitious and probably one of the Infected already.

  Samuels’s lips parted, but no words came out.

  “Let me put it this way,” Witner continued. “Until the moment you graduate in May—that is, if you graduate—please consider yourself under the lens of a very high-power microscope. I will be watching you, Dr. Delancy will be watching you, all the house staff will be watching you, the nurses will be watching you, the entire faculty of this medical center will be watching you.

  “But most of all, your classmates will be watching you, because as a reward for all their hard work and dedication, it would be unfair to make them share the honor of achieving a medical degree in the company of someone unworthy of it, don’t you agree?”

  Samuels stood like a statue.

  “Tomorrow morning, you will give us an exhaustively referenced twenty-minute lecture on the nature of the occulo-cephalic reflex. Goodbye to you all for now.”

  Back out in the hallway, the team scattered, leaving Witner and Delancy to continue to the elevators. Witner felt as fresh as if he’d just stepped from the shower. There was something so invigorating about teaching.

  Delancy looked up at him.

  “Dr. Witner, I just wanted to tell you I agree with the way you handled Samuels.”

  “You don’t think I was too harsh, Randy?”

  “Definitely not. You were more generous than he deserved. Samuels started slacking off when he came back from emergency leave last week.”

  “Oh? What was he on leave for? To have his teeth fixed? No, it couldn’t have been that.”

  “His father died suddenly.”

  “What did his father do?”

  “A shoe salesman or something like that.”

  “Keep the thumbscrews on him—I don’t like his demeanor. There’s something sullen and crafty about his face. If he quits, excellent.”

  “All of us appreciate the way you’re trying to raise the bar here. And personally, for what it’s worth, sir, I truly hope you’ll accept the permanent deanship.”

  “Thank you, Randy, but I’m like George Washington. I’m happy to serve when the country’s need is great, but when the crisis is over, I’ll return to the farm—in my case, the laboratory and clinic.”

  “George Washington became president.”

  “But he didn’t campaign, Randy. He didn’t campaign. I’ll leave that decision to the board of trustees.”

  “They’d be crazy not to keep you on. Look at all you’ve done. The media program is so exciting. And the Blue Team.”

  Witner put his hand on Delancy’s shoulder.

  “By way of returning a compliment, my young friend, if ever I were to assume that office, I would want people like you on the faculty—bright and trustworthy young clinicians who share my vision of renewed greatness.”

  Delancy blushed furiously.

  “There’s nothing I’d like more than to join the faculty here.”

  “Then consider it a promise, doctor. If I become permanent dean, you will be offered an assistant professorship.”

  “Sir…did you say assistant professorship?”

  “Given your abilities and your contributions this year to the Blue Team, I’m sure we can arrange for you to skip the clinical instructor phase. Especially if you were to write a couple of good papers before, say, June?” Witner gave his shoulder a pat. “Onwards,” he said. “New challenges wait. As an aside, Randy, if the deanship is offered to me, I’d like to rename the Blue Team the Dean’s Team. What do you think?”

  The young man was most appropriately enthusiastic.

  IX

  Lonely At The Bottom

  Jack called upstairs and learned that surgery to remove the arrow from the attempted suicide’s skull had gone smoothly, and the man was now stable in the surgical intensive care unit awaiting a psychiatric evaluation. As he sat in his office, exhaustion hit him. He shuffled listlessly through a stack of letters and reports. He should go home and sleep, but there was paperwork to catch up on.

  In any case, he had too much to think about. It was hard to concentrate on anything except the meeting this morning, and Dr. Gavin’s return, and, most of all perhaps, the letter Gavin had mentioned.

  He laced his fingers behind his head and leaned back, his gaze coming to rest on a poster of Mount Everest above the filing cabinet. A woman he’d dated a
couple of years ago had given it to him. In red letters across an azure sky was the phrase, Because It’s There.

  He looked away, eyes burning. Maybe it had been an impossible idea all along, to bring a modern emergency department to New Canterbury. He’d been warned by plenty of people in California that coming back here was a mistake. The East Coast wasn’t ready yet for real emergency medicine.

  That might have been true back in the 1990s, but this was a new millennium. Nor was it a problem with the entire East Coast. It was New Canterbury, Bryson Witner and Norman Scales.

  The woman who’d given him the poster had been an attorney Sonia Bonadonna introduced him to. She’d wandered into his life and wandered out again. It had been the same with the other women he’d gotten close to since returning to New Canterbury half a decade ago. They’d been frustrated by his work schedule, his frequent breaking of dates, and they’d all been less than thrilled when they found out he had a younger brother living with him, an atavistic hermit with an untrimmed beard who seldom spoke and who prowled the woods hunting.

  That was a facet of his life he had neither the power nor the desire to change.

  He stared down at the carpet, listening to the sounds of voices and activity swirling in the department just beyond the thin wall. What had he accomplished in the past five years? Not much, really—a teaching award and a few articles published. The ED was still a work in progress, with four- and five-hour waiting times on busy days, never enough staff, an inefficient layout; and now any chance of moving things forward was on hold for who knew how long?

  The phone rang. It was Kathy, ward secretary for the ED’s acute side.

  “There’s someone here to see you, Jack,” she said. “Were you expecting a Mr. Fleusterman?”

  “Who’s Mr. Fleusterman?”

  “I think he’s a patient with a complaint.”

  “Great.” Jack looked at his watch. “As long as I’m here, I’ll see him.”

  Out by Kathy’s post in the eastern alcove of the central station stood a stoop-shouldered old man with rather long but well-combed gray hair. He had on a black cashmere overcoat and held an ivory-handled cane in one hand and a black beret in the other. A green scarf hung around his neck. He did not look happy.

  After escorting the man to his office, Jack arranged two chairs while Mr. Fleusterman scrutinized the walls.

  “So,” the old man said in a gruff voice. “What have we here? Bachelor of Arts and Sciences, University of New Mexico. Phi Beta Kappa. Doctor of Medicine, New Canterbury University. Alpha Omega Alpha, whatever that might be. And ‘Be it known that the below named physician has fulfilled the requirements set forth by the California Board of Regents for completion of the Residency Program in Emergency Medicine at the University of California, Los Angeles.’ And here’s an award. ‘The City of New Canterbury presents this with gratitude in honor of Dr. Jack Forester’s contributions to the training of volunteer ambulance services, 2010.’”

  “Please have a seat.”

  The old man turned to face him. “All of you love to flaunt your education, you medical men, don’t you? You put hardwood frames around your degrees then hang them up where people must look at them.”

  “I thought patients wanted to see a doctor’s credentials.”

  “That’s because half of what you do is show business. At any rate, I came here to lodge a complaint, and I will not be brushed aside. I want to be heard and I want satisfaction, or I will go to every newspaper and attorney who will listen to me. I’ve lived in this community for seventy-five years. Am I making myself clear? No, I don’t need to sit to talk.”

  “Why don’t you tell me what happened?”

  Fleusterman drew himself up. “Three weeks ago, my daughter brought my ten-year-old grandson here because the boy had been acting clumsy, dropping things, fumbling with words. That particular day, he stumbled in gym class, and his ankle swelled up.”

  “I see.”

  “They put Rory in a cubicle, and after about two hours of waiting he went to sleep despite the fact they’d put a loud and obnoxious drunkard in the next cubicle.”

  “That was a bad choice of rooms,” Jack agreed.

  “Hah, that’s nothing! One of your doctors—a genuine moron—comes in and grabs Rory’s ankle and makes him cry. He tells Susan it’s probably a sprain, but he’s going to get an x-ray. Fine, but then Susan starts describing Rory’s recent behavior, the clumsiness and all. She’s worried, you see.”

  “Do you remember who the doctor was?”

  “His name was Heartwood, or something like that. Susan said he had red hair and a mustache.”

  “That would be Dr. Atwood.”

  “Yes, that’s the one. So, Susan starts telling him about Rory’s recent problems, and he just cuts her off and then—” The old man stopped and gathered himself. “Do you have any idea what he asked her?”

  “No, I don’t.”

  “He asked my daughter if she has an alcohol problem.”

  ”What?”

  “Yes. He asked her if she or anyone else in the family drinks to excess.”

  “He must have smelled the patient in the next room.”

  “There!” said Fleusterman. “You, sitting here three weeks later, can figure it out. Susan says no, she doesn’t have an alcohol problem, thank you, and what does that have to with the price of beans? But he keeps going. Well, has she considered the possibility Rory’s been getting into the liquor cabinet, and that might explain his behavior?”

  Jack closed his eyes.

  “Susan reacts as any concerned mother would act and tells the dingle-brain off. So, what does he do but huff out and call the Department of Social Services to investigate my daughter! When Rory gets back from having the x-ray taken there’s a social worker waiting to interview him.”

  “Mr. Fleusterman,” Jack said. “I am deeply sorry.”

  Fleusterman’s eyes were all but glowing with rage.

  “Story not finished, Dr. Forester. The ankle was sprained, and they wrapped it and sent him home. Next day, the Department of Social Services comes to their house. Once a doctor makes a referral, you see, they’ve got to carry through. They not only visited Susan, they called the school and they spoke with the neighbors—oh, yes, the neighbors, too.

  “Meanwhile, Rory’s clumsiness was getting worse. So, Susan took him to see their pediatrician, who actually…” Fleusterman jabbed his finger toward Jack. “…listened to her. He listened to her, and he examined Rory, and then he sent him right away for one of those scans of his head.”

  “A CT scan,” Jack supplied.

  “What have you,” said Fleusterman, whose voice broke slightly.

  He paused, and Jack stepped closer. He knew what the answer would be before he asked.

  “What did they find, Mr. Fleusterman?”

  “My grandson has a brain tumor, Dr. Forester. If that quack, Atwood, had listened and not jumped to ridiculous conclusions, the diagnosis might have been made a week sooner, and my family spared public humiliation.”

  The old man’s voice was drained of anger and outrage, and he looked like a drifting ship. He sank as though exhausted into the chair.

  Forester went to his desk. He reached for the phone and dialed the Department of Internal Medicine’s secretary.

  “Hi, this is Dr. Forester. Could you get a message to Humphrey Atwood for me? I need to talk with him ASAP.”

  “Don’t do that for my benefit, Dr. Forester,” Fleusterman protested. “I do not want to see the man—not unless it’s to watch him get tied to a rail and covered with tar and feathers.”

  “I need to talk to him,” Jack told him. “How’s your grandson doing now?”

  “He’s scheduled for surgery tomorrow in Boston. We could have had it done here, but no, thank you. Not after this.”

  * * *

  After getting a security guard to help Mr. Fleusterman out to his car, Jack returned to his office. He got on his computer and reviewed the chart for Mr. Fl
eusterman’s grandson—it was exactly as the man had described—then called to have Atwood paged again. Ten minutes later, his phone finally rang.

  “You wanted me?” said an impatient voice.

  “Yes, Humphrey. Can you come speak with me?”

  “If you want to tell me about the failure of your proposal, I’ve already been apprised. So sorry to hear it.”

  I’m sure you are. “No, it’s something else.”

  “About my new study, then?”

  “There’s been a patient complaint filed against you,” Jack said.

  “Anything to be concerned about?”

  Jack thought of several responses to that, all of which he knew he would regret. He bit his tongue.

  “Yes, Humphrey, it is something to be concerned about. Can you stop in my office?”

  “This is a busy day for me, Forester. I have to work an ER shift this afternoon, and in the meantime, I’ve got administrative chores.”

  “Humphrey, I consider it a mandatory part of your job as the assistant ED director to respond to my request for an urgent meeting, unless you’re dealing with a life-or-death situation. I’ll be waiting here for you.”

  He didn’t give Atwood a chance to respond, re-cradling the phone vigorously. Almost every shift Atwood worked in the ED there were problems of one sort or another. He had a cold and supercilious bedside manner—if it could be called a bedside manner at all. He had no tact in dealing with the nurses, treating them like servants. He’d been trained as an internist and had precious little interest in pediatrics and a near-total paucity of skills for dealing with trauma. When he was on duty, he let the residents and medical students do nearly all the real work.

  About the only thing the man could do decently was give a lecture.

  Until Witner had shoved Atwood down his throat, Jack had never really thought much about why some physicians chose academic medicine instead of private practice. Now the truth of the old saying was clear—if you can’t do it, teach it.

  Someone rapped on the door.

  “Come in.”

  Humphrey Atwood was in his mid-thirties, a red-haired man of medium height with blue eyes and a neatly trimmed mustache. Today he wore a dark maroon shirt and a paisley tie. His right hand held a cup of coffee, his left a glazed doughnut.