by Robin Cook
“I won’t go far,” said Charles, gently loosing Michelle’s grip. He was preoccupied by Dr. Brubaker’s statement that Michelle had received a double dose of Daunorubicin. That sounded irregular.
Cathryn saw Charles before he saw her and leaped to her feet, throwing her arms around his neck.
“Charles, I’m so glad you’re here.” She buried her face in his neck. “This is so difficult for me to handle.”
Holding Cathryn, Charles glanced around the small chart room. Dr. Wiley was leaning against the table, his eyes on the floor. Dr. Keitzman was sitting opposite from him, his legs crossed, and his hands clasped together over his knee. He appeared to be examining the fabric of his slacks. No one spoke, but Charles felt nervous, his eyes darting from one doctor to the other. The scene seemed too artificial, too staged. Something was coming and Charles hated the theatrics.
“All right,” said Charles challengingly. “What’s happening?”
Dr. Wiley and Dr. Keitzman started to speak simultaneously, then stopped.
“It’s about Michelle,” said Dr. Keitzman finally.
“I assumed as much,” said Charles. The vise on his stomach turned another notch tighter.
“She’s not doing as we would have hoped,” said Dr. Keitzman with a sigh, looking up into Charles’s face for the first time. “Doctors’ families are always the most difficult. I think I’ll call it Keitzman’s law.”
Charles was in no mood for humor. He stared at the oncologist, watching the man’s face twist into one of its characteristic spasms. “What’s this about a double dose of Daunorubicin?”
Dr. Keitzman swallowed. “We gave her the first dose yesterday but she did not respond. We gave her another today. We’ve got to knock down her circulatory leukemic cells.”
“That’s not the usual protocol, is it?” snapped Charles.
“No,” Dr. Keitzman replied hesitantly, “but Michelle is not a usual case. I wanted to try . . .”
“Try!” shouted Charles. “Listen, Dr. Keitzman,” Charles snapped, pointing a finger in Dr. Keitzman’s face. “My daughter isn’t here for you to try things on. What you’re really saying is that her chances of remission are so poor that you’re ready to experiment.”
“Charles!” said Cathryn. “That’s not fair.”
Charles ignored Cathryn. “The fact of the matter, Dr. Keitzman, is that you are so certain she’s terminal you abandoned orthodox chemotherapy. Well, I’m not sure your experimentation isn’t lessening her chances. What about this cardiac problem. She’s never had any trouble with her heart. Doesn’t Daunorubicin cause cardiac problems?”
“Yes,” agreed Dr. Keitzman, “but not usually this fast. I don’t know what to think about this complication and that’s why I asked for a cardiac consult.”
“Well, I think it’s the medicine,” said Charles. “I agreed to chemotherapy, but I assumed you would be using the standard doses. I’m not sure I agree with doubling the usual treatment.”
“If that’s the case, then perhaps you should retain another oncologist,” said Dr. Keitzman wearily, standing up and gathering his things. “Or just handle the case yourself.”
“No! Please!” said Cathryn, letting go of Charles and clutching Dr. Keitzman’s arm. “Please. Charles is just upset. Please don’t leave us.” Cathryn turned frantically to Charles. “Charles, the medicine is Michelle’s only chance.” She turned back to Dr. Keitzman, “Isn’t that right?”
“That is true,” said Dr. Keitzman. “Increasing the chemotherapy, even if it is an unusual approach, is the only hope for a remission, and a remission has to be obtained quickly if Michelle is going to survive this acute episode.”
“What are you proposing, Charles?” said Dr. Wiley. “To do nothing?”
“She’s not going to go into remission,” said Charles angrily.
“You can’t say that,” said Dr. Wiley.
Charles backed up, watching the others in the room as if they were going to force him into submission.
“How do you think she should be treated?” asked Dr. Wiley.
“We can’t do nothing, Charles,” pleaded Cathryn.
Charles’s mind screamed for him to get away. Within the hospital, close to Michelle, he could not think rationally. The idea of causing Michelle additional suffering was a torture, yet the concept of just allowing her to die without a fight was equally abhorrent. There were no alternatives open to him. Dr. Keitzman was making sense if there was a chance they could get a remission. But if a remission was impossible, then they were merely torturing the dying child. God!
Abruptly Charles turned and strode from the room. Cathryn ran after him. “Charles. Where are you going? Charles, don’t go! Please. Don’t leave me.”
At the stair he finally turned, gripping Cathryn’s shoulders. “I can’t think here. I don’t know what’s right. Each alternative is as bad as another. I’ve been through this before. Familiarity doesn’t make it easier. I’ve got to pull myself together. I’m sorry.”
With a feeling of helplessness Cathryn watched him go through the door and disappear. She was alone in the busy corridor. She knew that if she had to, she could handle the situation even if Charles couldn’t. She had to, for Michelle’s sake. She walked back to the chart room.
“The strange thing,” said Cathryn with a tremulous voice, “is that you two anticipated all this.”
“Unfortunately we’ve had some experience with families of physicians,” said Dr. Keitzman. “It’s always difficult.”
“But it’s usually not this difficult,” added Dr. Wiley.
“We were talking while you were gone,” said Dr. Keitzman. “We feel that something must be done to ensure continuity of Michelle’s care.”
“Some kind of guarantee,” said Dr. Wiley.
“It’s mostly because time is so important,” said Dr. Keitzman. “Even if the treatment were stopped for a day or two, it could mean the difference between success and failure.”
“We’re not suggesting that Charles’s concerns are unfounded,” assured Dr. Wiley.
“Absolutely not,” agreed Dr. Keitzman. “In Michelle’s case, with circulating leukemic cells unresponsive to the Daunorubicin, the outlook is not the best. But I think she deserves a chance no matter what the odds. Don’t you agree, Mrs. Martel?”
Cathryn looked at the two doctors. They were trying to suggest something but she had no idea what it was. “Of course,” said Cathryn. How could she disagree? Of course Michelle deserved every chance.
“There are ways of making sure that Charles cannot arbitrarily stop Michelle’s treatment,” said Dr. Wiley.
“The powers need only be evoked if they are needed,” said Dr. Keitzman. “But it’s good to have them just in case.”
There was a pause.
Cathryn had the distinct impression that the doctors expected her to respond, but she had no idea what they were talking about.
“Let me give you an example,” said Dr. Wiley, leaning forward in his chair. “Suppose a child desperately needs a transfusion. If the transfusion is not given, then the child will die. And further, suppose that one of the parents is a Jehovah’s Witness. Then there is a conflict between the parents as to the proper treatment of the child. The doctors, of course, recognize the need for the transfusion to save the child. What do they do? They have the court award guardianship to the consenting parent. The court is willing to do this to guarantee the rights of the child. It’s not that they disrespect the beliefs of the nonconsenting parent. It’s just that they feel it’s unfair for one individual to deprive another of lifesaving treatment.”
Cathryn stared at Dr. Wiley in consternation. “You want me to assume guardianship of Michelle behind Charles’s back?”
“Only for the specific purpose of maintaining treatment,” said Dr. Keitzman. “It might save the child’s life. Please understand, Mrs. Martel, we could do it without your help. We would ask the court to appoint a guardian, which is what we do when both parents resist es
tablished medical treatment. But it would be much simpler if you participate.”
“But you’re not giving Michelle standard treatment anymore,” said Cathryn, remembering Charles’s words.
“Well, it’s not that unusual,” said Keitzman. “In fact I’ve been working on a paper about increased chemotherapeutic doses in cases as recalcitrant as your daughter’s.”
“And you must admit that Charles has been acting bizarrely,” added Dr. Wiley. “The strain of this may be too great. He may be incapable of making sensible decisions. In fact, I’d feel much better if we could also get Charles to seek some professional help.”
“You mean see a psychiatrist?” asked Cathryn.
“I think it would be a good idea,” said Dr. Wiley.
“Please understand us, Mrs. Martel,” said Dr. Keitzman, “we’re trying to do our best, and as Michelle’s doctors our primary concern is her well-being. We feel we must do everything in our power.”
“I appreciate your efforts,” said Cathryn, “but . . .”
“We know it sounds drastic,” said Dr. Keitzman, “but once the legal papers are obtained, guardianship doesn’t have to be evoked unless the situation calls for it. But then if Charles tried to take Michelle off treatment or even out of the hospital, we’d be in a position to do something about it.”
“An ounce of prevention is worth a pound of cure,” said Dr. Wiley.
“The idea doesn’t make me feel comfortable,” said Cathryn. “But Charles has been very strange. I can’t believe he left like he did just now.”
“I can understand it,” said Dr. Keitzman. “I can sense that Charles is a man of action, and the fact that he cannot do anything for Michelle must drive him mad. He’s under a terrible emotional burden, and that’s why I think he could benefit from professional help.”
“You don’t think he could have a nervous breakdown, do you?” asked Cathryn with increasing anxiety.
Dr. Keitzman looked at Dr. Wiley to see if he wanted to answer, then he spoke: “I don’t feel qualified to say. Certainly the strain is there. It’s a matter of how strong his defenses are.”
“I think it’s a possibility,” said Dr. Wiley. “In fact, I think he’s showing certain symptoms. He doesn’t seem to be in command of his emotions and I think his anger has been inappropriate.”
Cathryn was swept by a turmoil of emotion. The idea that she was capable of going between Charles, the man she loved, and his daughter, whom she’d learned to love, was unthinkable. And yet if the strain was too much for Charles, and he interrupted Michelle’s treatment, she would have to share the blame for not having the courage to help the child’s doctors.
“If I were to do as you ask,” said Cathryn, “what would be the procedure?”
“Hold on,” said Dr. Keitzman, reaching for the phone. “I think the hospital attorney could answer that better than I.”
Almost before Cathryn knew what was happening, the meeting with the hospital attorney was over, and Cathryn was hurrying after the man in the Boston courthouse. His name was Patrick Murphy. He had freckled skin and indeterminate light brown hair that could have been red at one time. But by far his most distinguishing characteristic was his personality. He was one of those rare people whom everyone instantly liked, and Cathryn was no exception. Even in her distraught state, she had been charmed by his gentle and forthright manner and engaging smile.
Cathryn was not sure when the conversation with the attorney had changed from discussing a hypothetical situation to discussing an actual one. Making the decision to petition for legal guardianship for Michelle behind Charles’s back was so difficult that Cathryn had welcomed its accomplishment by default. Patrick had assured Cathryn, as had Dr. Keitzman, that the legal powers would not be used except in the unlikely instance that Charles tried to stop Michelle’s treatment.
Still Cathryn felt very uneasy about the whole affair, especially since she had not had time to see Michelle in the rush to get to the court before the 4 P.M. deadline.
“This way if you will,” said Patrick, pointing to a narrow stairwell. Cathryn had never been in a courthouse before, and it was nothing like she’d imagined. She’d thought it would be grand in some symbolic way, standing as it did for the concept of justice. Yet the Boston courthouse, which was actually over one hundred years old, was dirty and depressing, especially since, for security reasons, the public was forced to enter through the basement.
After ascending the narrow steel stairs, which Cathryn could not believe served as the sole public entrance to the court, they reached the old main hall. Here there was at least a shadow of former grandness with an arched two-story ceiling; marble pilasters and marble floors. But the plaster was chipped and cracked, and the elaborate moldings gave the appearance they were about to break free and fall to the floor below.
Cathryn had to run a few steps to catch up with Patrick as he turned into the Probate Court. It was a long, narrow room with a heavy, dusty appearance, especially with the hundreds of aged ledgers sitting sideways on their low shelves to the right. On the left was a long scuffed and pitted counter where a coterie of court employees seemed suddenly roused from their diurnal slumber at the prospect of quitting time.
As Cathryn surveyed the room she did not feel the confidence and reassurance she’d hoped. Instead its shabbiness evoked images of being snared in a quagmire of red tape. Yet Patrick did not allow Cathryn to stop. He pulled her over to a smaller counter at the end of the room.
“I’d like to speak to one of the Assistant Registers of Probate,” said Patrick to one of the bored clerks. She had a cigarette in the corner of her mouth, making her cock her head to the side to keep the smoke from stinging her eyes. She pointed to a man facing away from them.
Hearing the request, the man turned; he was on the phone but put up a finger for them to wait. After finishing his conversation, he came over to Cathryn and Patrick. He was tremendously overweight, a middle-aged man with a thick, flaccid layer of fat that shook when he walked. His face was all jowls, wattles, and deep creases.
“We have an emergency,” explained Patrick. “We’d like to see one of the judges.”
“Hospital guardianship case, Mr. Murphy?” questioned the Assistant Register knowingly.
“That’s correct,” said Patrick. “All the forms are filled out.”
“Must say, you fellows are getting efficient,” said the man. He looked up at the face of the institutional clock. “My God, you’re cutting it close. It’s almost four. I’d better check to be sure Judge Pelligrino is still here.”
He waddled through a nearby doorway, his arms swinging almost perpendicularly to his body.
“Glandular problem,” whispered Patrick. He put his briefcase on the counter and snapped it open.
Cathryn looked at the attractive young lawyer. He was dressed in the typical attorney fashion with a boxy, Ivy League, pin-striped suit. The slacks were slightly rumpled, particularly behind the knees, and they were about two inches too short, exposing black-socked ankles. With great attentiveness, he arranged the forms which Cathryn had signed.
“Do you really think I should do this?” asked Cathryn abruptly.
“Absolutely,” said Patrick, giving her one of his warm, spontaneous smiles. “It’s for the child.”
Five minutes later they were in the judge’s chamber, and it was too late to turn back.
As different as the Boston courthouse was from Cathryn’s imagination, so was Judge Louis Pelligrino. Instead of an older, gowned, Socratic figure, Cathryn found herself sitting across from a disturbingly handsome man wearing a well-tailored designer’s suit. After donning stylish reading glasses, he accepted the papers from Patrick saying, “Jesus Christ, Mr. Murphy. Why is it you always show up at four o’clock?”
“Medical emergencies, your honor, adhere to a biological rather than a probate clock.”
Judge Pelligrino peered at Patrick sharply over his half-glasses, apparently trying to decide if Patrick’s retort was cleve
r or presumptuously brazen. A slow smile appeared as he decided on the former. “Very good, Mr. Murphy. I’ll accept that. Now, why don’t you fill me in on these petitions.”
As Patrick skillfully outlined the circumstances surrounding Michelle’s illness and treatment as well as Charles’s behavior, Judge Pelligrino examined the forms, seemingly not paying attention to the young lawyer. But when Patrick made an insignificant grammatical error, the judge’s head shot up, and he corrected him.
“Where are the affidavits by Doctors Wiley and Keitzman?” asked Judge Pelligrino as Patrick finished.
The lawyer leaned forward and anxiously thumbed through the papers in the judge’s hands. He snapped open his briefcase, and with great relief found the two documents and handed them over with an apology.
The judge read them in detail.
“And this is the adopted mother, I presume,” said Judge Pelligrino, capturing Cathryn’s attention.
“Indeed it is,” said Patrick, “and she is understandably concerned about maintaining the proper treatment for the young girl.”
Judge Pelligrino scrutinized Cathryn’s face, and she felt herself blush defensively.
“I think it’s important to emphasize,” added Patrick, “that there is no marital discord between Charles and Cathryn Martel. The only issue is the wish to maintain the established method of treatment advocated by the appropriate medical authorities.”
“I understand that,” said Judge Pelligrino. “What I don’t understand or like is the fact that the biological father is not here to be cross-examined.”
“But that’s precisely why Mrs. Martel is asking for emergency temporary guardianship,” said Patrick. “Just a few hours ago, Charles Martel rushed away from a meeting with Mrs. Martel and Michelle’s doctors. Mr. Martel expressed the belief that Michelle’s treatment, which is her only chance at survival, be stopped, then left the conference. And, off the record, the attending physicians are concerned about his mental stability.”
“That sounds like something that should be part of the record,” said the judge.
“I agree,” said Patrick, “but unfortunately that would require Mr. Martel seeing a psychiatrist. Perhaps it could be arranged for the full hearing.”
