Deathbed

by William Kienzle

  The doctor glanced briefly and quizzically at Whitaker. But the white hospital coat and ID seemed to assuage his curiosity. Whitaker busied himself at the desk.

  “Maggie,” the doctor addressed a nurse, “get a specimen from the gal in two. I want a urinalysis done.”

  “Okay.”

  The nurse squeezed by Whitaker on her way to and from getting a bottle. Yet she didn’t seem to notice him. He couldn’t get over it: it was almost as if he were invisible.

  The nurse obtained the specimen from the patient in cubicle two and departed. Some twenty minutes passed before she returned. Meanwhile, Whitaker concentrated diligently on remaining as still and inconspicuous as possible. He didn’t notice that one edge of his sleeve had fallen into an open stock bottle cap containing a concentration of Gentian Violet. The dark blue-purple solution was slowly seeping up his sleeve.

  The nurse handed the doctor the test results. With the chart under his arm, the doctor reentered the cubicle. Once again, Whitaker could see the patient only momentarily. She seemed quite young. Again he could hear their voices clearly. It helped a little now that he knew what they looked like.

  The thought crossed his mind that it would be better for the patient if there were more privacy. But he dismissed that thought quickly in favor of the advantage it gave him to be able to overhear their conversation. It did not occur to him that few, if any, in the clinic would ever bother to eavesdrop.

  “Well, Ms. Tyler, according to our records, you’ve been at St. Vincent’s quite a few times. Though usually in emergency or maternity.”

  Whitaker assumed the doctor had referred to the chart. Ms. Tyler did not reply.

  “You’ve been pregnant five times and you have four living children; is that correct?”

  “Not ‘zactly. I been pregnant more like six, seven times.”

  “The others were abortions?”

  “I didn’t have nothin’ done.” Somewhat truculently.

  “Spontaneous abortions, then. Well, you’re not pregnant this time.”

  “Thank the Lord.”

  “Thank the Lord, indeed. You’ve just got a stomach upset. And I’ll give you something for that. But you could have been pregnant, couldn’t you?”

  “How’s that?”

  “You’re sexually active now? You have a boyfriend?”

  “Oh, yeah.”

  “But, Ms. Tyler, you’re a diabetic. The last two times you were here for delivery of a child, you almost died. Didn’t the doctor or a counselor give you any information on family planning? On how not to get pregnant again?”

  “Oh, yeah, they done that.”

  “What did you decide on? What form of contraceptive did you agree on?”

  “Oh, they fitted me with a wire.”

  “An IUD? Then what happened? It’s certainly not in place now.”

  “It come out.”

  “And you didn’t come in to have it replaced? Don’t you know that without it you could get pregnant again?”

  “I guess.”

  “Look, Ms. Tyler”—his tone grew conciliatory—“this is very serious. Your diabetes—your illness—very much complicates matters when you become pregnant. You could die. As a matter of fact, if you get pregnant again, you probably will die. And you might have been pregnant this time. It’s just luck—and no more than luck—that you aren’t.

  “Ms. Tyler, you’ve got four children. You don’t need any more, do you?”

  “No, sir.”

  “You don’t even want any more, do you?” He sounded hopeful.

  There was a pause. “But I can’t lose my man. If I don’t give out, Tyrone be gone.” She sounded worried.

  “There’s a way we can fix this all up.”

  “There is?”

  “Yes. It’s called a tubal ligation.”

  “A what?” Nervous.

  “We could tie your Fallopian tubes.”

  “My what?”

  “It’s a simple operation. We can do it right here in the clinic. We can even do it right now.”

  “It’s an operation?” A touch of panic.

  “Yes. But it’s such a simple operation, we can do it right here in the clinic.”

  “What do it do?”

  “It’ll make it impossible for you to get pregnant ever again.”

  “And I don’t have to wear anything or do anything more?”

  “No. The operation will take care of everything.”

  “And I can give out to Tyrone?”

  “Tyrone will never have been happier.”

  “Then I guess it’s okay.”

  Whitaker had been listening to their conversation so intently that he hadn’t noticed the nurse’s aide who had been standing next to him, studying him. “Bruce”—she’d read his ID—“if I were you, I’d take my sleeve out of that Gentian Violet.”

  Startled, Whitaker glanced first at her, then at his sleeve. The solution had crept upwards until now it had darkened a significant portion of his cuff. And the aide—she was the same girl he had literally run into earlier when they had spilled the lunch tray.

  “It’s all right . . . it’s all right,” he repeated inanely as he squeezed the cuff. He succeeded only in staining his fingers.

  Bruce left the scene in rather total confusion. But he’d heard enough. He must get to the others as soon as possible and tell them what he’d learned. And he would have to do something about that nurse’s aide. She had noticed him. She had read his ID. She knew his name.

  Whitaker had assailed his duties that day confident he was unnoticed. But someone else, due initially to nothing but a series of coincidences, had noted, then taken some interest in this ill-omened man. There had been the food tray collision; the dropped specimen tube; the patient bent almost into pretzel shape when Bruce had tried to adjust her electronically powered bed; the cracked stained-glass window in the chapel where he had tripped over a prie-dieu.

  At that, the silent observer hadn’t noted the nurse who was still searching for the chart Bruce had accidentally set afire; the patient who would never find her dentures that Bruce had accidentally flushed down the toilet; or the medical library where books were now out of order because Bruce had tried to look up some information. Not to mention a variety of other mishaps.

  But merely from what had been noted, the observer was impressed. Never had the observer seen such a star-crossed creature. However, on the one hand, volunteers were not in great supply, and, on the other, one never knew when information about such a person might come in handy.

  3

  It seemed many hours since the coffee break. Actually, it was only a little more than four. But, by his lights, Father Koesler had spent a busy afternoon.

  He had visited with nine newly admitted patients; heard three confessions; anointed five, three of whom would go to surgery tomorrow; and offered Mass at 5:30 p.m.

  It was now 6:15 p.m. “Bay in hand, he was making his way through the cafeteria line. He was hungry, but too tired to eat much. From a fairly generous offering of ingredients, he put together a salad. That and coffee should do it.

  The cafeteria was sparsely occupied. It was between visiting hours and much of the day staff had gone home.

  Koesler took a seat at a long, empty table, said a silent grace, and started on the salad. He noticed Dr. Scott going through the food line. Scott appeared to be unaccompanied. As he settled with the cashier, he scanned the scattered diners, spotted Father Koesler, and headed in his direction.

  That pleased the priest. He had liked Scott from the beginning and was sure he could learn much from him.

  Scott sat down heavily, letting out his exhaustion. Koesler glanced at the doctor’s tray. Apparently, tiredness did not affect all men equally. In addition to a salad, there was an ample piece of pizza, sliced roast beef, potatoes and gravy, and a mixture of carrots and peas. No wonder the doctor’s frame, despite the stress and physical demands of his work, carried excess fat.

  “I’m glad you happened
on this time to eat,” Koesler opened. “Nice coincidence.”

  “It was no coincidence,” Scott replied. “I figured you’d eat right after you said Mass, so I timed my break for now.”

  “Oh?” There was something more. There had to be. Koesler waited.

  “So, then, how did your first day go?”

  “Busily. This is a very demanding place. I can see where you could burn out in a hurry here.”

  Scott smiled and ran a hand through his beard. “Wait awhile. It gets easier. The newness does take its toll. But about the time you’re ready to leave us, you will have fallen into a routine. It’s the routine that insulates you. Just wait and see; I’ll bet in a very short time things will change for you.”

  Koesler picked at his salad while Scott plowed into his meal. Several minutes passed. Still no hint as to why the doctor had selected a dining time that included Koesler’s company.

  “Okay, Doctor,” the priest said at length, “I give up. Why did you decide to dine with me?”

  “Scotty. Everybody calls me Scotty.”

  Koesler would not return the dispensation. Only his relatives, fellow priests, and a few close friends used his given name with his implicit permission. Otherwise, he preferred his title. He was not discountenanced in any way by those who presumed to call him Bob. What others called him was their problem, not his. It was just that he felt he functioned on a professional level better if he was perceived by those he served as a priest rather than a buddy.

  “Very well, then, Scotty, why did you schedule your dinner break to be with me?”

  Scott was mixing a few vegetables with a small piece of the pizza and a forkful of potatoes and gravy. Evidently, he blended his food as he ate. Koesler did not want to look.

  “I didn’t want you to eat alone.”

  “Come on.” Koesler smiled.

  “Okay.” Scott blended his food into an indescribable blob. “It’s this way: Even though your stay here will be brief, we’re going to be working together a lot, often quite closely. All the patients here are sick, almost by very definition. But you’ll find the sickest by far in the OR—operating room—and the ER—emergency. And those two are my bailiwick.

  “Now, there are code blues all over this place. Shoot, people have been known to arrest out in the lobby while they’re waiting to register. But you’ll find you’re going to be summoned for codes down to the OR and ER more often than anywhere else. So I thought it would be good if we got to know each other better. And if you got to know this place and some of its personnel better.”

  “But I’ve already had orientation—”

  “To be a chaplain—a temporary one at that. There are things going on here besides the care of souls that are going to concern you—ready or not. Are you game to learn in the school of hard knocks?”

  Koesler nodded. He felt the question was rhetorical.

  “Right,” Scott affirmed. “First, how about some dessert?”

  “No, thanks.” Koesler found it difficult to believe that Scott had finished all the food on his tray. But he had.

  “Coffee?”

  “Sure.”

  When Scott returned, his tray contained two cups of coffee and one huge banana split. Koesler felt awe at Scott’s appetite.

  “Okay,” Scott said, “let’s start with the boss lady.”

  “Sister Eileen Monahan.”

  “The same. She is unique—and I do not use the term lightly. She, and she alone, is the reason St. Vincent’s continues to sputter along. It long ago passed the point at which it should have been shut down. It is a financial disaster that is getting worse rather than better.

  “Even in the brief time you’ve been here you must have noticed there are very few well-to-do, well-educated patients—white or black—occupying our beds. They’re mostly indigent blacks. And precious few Catholics.”

  Koesler nodded. Making his rounds this day, he had not met a single patient, white or black, who would have fit socially or financially into Koesler’s Dearborn Heights parish.

  Scott continued. “Lots of patients who come here not only can’t pay anything, they’re not covered by anyone—neither their own resources nor medical insurance. But by decree of Sister Eileen, not one of them is turned away. Somehow the hospital is expected to swallow their costs. As you can imagine, the hospital regularly gags on their expenses.

  “Then, there are a goodly number who can’t pay their own costs—well, who can?—but, while they have no private insurance, they are covered by Medicare, Medicaid. Then things get complicated. What with DRGs—that’s diagnostically related groups—we can have the patient hospitalized for only a limited time and we can collect from the government only a set minimum fee. Not only is that extremely restrictive to the patient, the hospital is not going to get rich. Indeed, since the hospital cannot tuck administrative costs or any future planning in the bill, it begins a slow fiscal retreat.

  “These are the kinds of odds facing Sister Eileen.”

  “I see.” Koesler shook his head. “But then even more so now than when I asked Sister this afternoon, I find it difficult to understand why she bothers trying to keep St. Vincent’s afloat. Especially here in the core city.” Koesler’s hands were wrapped around the cup with its untasted coffee. He preferred warm hands to a warm stomach.

  “She’s trying to bring the ideals of service of St. Vincent de Paul to Detroit’s inner city,” Scott explained. “And I’ll be damned if she doesn’t almost carry it off. And it’s all her, too. No doubt about it, St. Vincent’s Hospital and Sister Eileen Monahan are almost identical. They’ve been together so long they have become inseparable. She’s always here. She’s always available to everyone. She inspires a special spirit in everyone, from the orderlies to the volunteers to the head nurses.”

  “Do I detect an omission of the doctors?”

  “Oh, yes, you do. But as far as the doctors go, Sister Eileen has written the book on the care and feeding of doctors. It’s not that she can’t be firm with them when necessary. It’s more that she has a magical touch when it comes to the little things, the infinitesimal perks that are so dear to doctors. Things like—you know—‘Dr. So-and-So wants this special instrument in the OR’ or, ‘Dr. So-and-So wants the charts kept in this special way.’ Then, along comes Sister Eileen to say that Dr. So-and-So really ought to have that instrument. Or, without offending the nurse in charge, Eileen will see to it that an exception is made for Dr. So-and-So and that the floor nurses will keep his charts in his own peculiar way.

  “But those doctors, generally, are the ones who have made a conscious and rather generous decision to stick with the core city. And in doing so they have made the not inconsiderable sacrifice of giving up great wealth and prestige patients. Outside of these, many of the other doctors on staff here simply could not ever be accredited to the swankier hospitals. But . . . they are all we’ve got. “

  “I see.”

  “Take for example Dr. Lee Kim.”

  “The one who was working with you in the emergency unit.”

  “Right.”

  “He’s not a good doctor?”

  “On the contrary, he’s quite good. He just can’t quite figure out what he’s doing here at St. Vincent’s. This is not in his timetable at all.”

  “I don’t understand.” Koesler tasted the coffee. It was tepid. He shuddered and set it aside.

  “He came here from Korea. Not unlike many other doctors. And, like many other foreign doctors, his progress has been arrested at an inner-city hospital. He makes no bones about it: He wants to be affiliated with the affluent suburbs.”

  “And in this, I take it, he is not alone.”

  “No, that’s true. But his ambition causes him to take a rather casual attitude toward some of his work here.”

  “Casual?”

  “Uh . . . for instance, suppose we have a terminal case. Somebody whose life system can be supported by mechanical means alone. Well, rather than waste half an hour of his va
luable time, he will go to the family and say, ‘Do you want us to do everything?’”

  “‘Everything’?”

  “It becomes a rhetorical question. The point is, he could spend some time with the relatives, the next of kin, and talk about the quality of life this patient is not going to have in a coma and plugged into machines that will breathe for him, keep his heart going, filter his waste. Dr. Kim doesn’t want to spend a lot of time explaining the choices the family has. And the easiest way of getting out of that chore in a hurry is to ask the family simply, ‘Do you want us to do everything?’ Few families will have the gumption or the knowledge to ask about alternatives. They will say, ‘Of course, do everything.’ At that point, Dr. Kim will put in an order to plug in the life-support systems, and leave the patient to vegetate.”

  “I see.” Koesler thought he did. “But what does conduct like that have to do with the hospital—or Sister Eileen?”

  “For one thing, it drives costs up, most of the time needlessly. Instead of spending a lot of money on systems that keep essential body functions going, the patient should be allowed to die with some dignity. But doctors like Kim never quite give dignity a chance. So it’s that much more difficult to balance a budget.”

  “I see.”

  “Now, Dr. Kim is by no means alone in his approach to terminal patients. Where he could have a problem, that could cause the rest of us to have a concomitant problem, is in the clinic. Has anyone told you much about the clinic?”

  “I know where it is. You treat outpatients there. You even have outpatient surgery.”

  “Right. It’s also where we have some of our more pressing ethics problems.”

  “Oh?”

  “Normally, they’re not problems for most doctors. Certainly they’re not problems for other hospitals. But they’re very definitely problems for Catholic hospitals.”

  “Let me guess: family planning.”

  “Right.”

  Koesler looked slightly puzzled. “Well, as far as the ‘official’ Catholic teaching goes, there are only two approved means of family planning. One is complete abstinence from sexual activity, and the other, under set circumstances, is the rhythm method.” Absolutely nothing had changed in the Church’s attitude toward family planning in the thirty-odd years Koesler had been a priest. Church approval of the rhythm system had occurred shortly before he had been ordained in 1954. “But very few pay much attention to that view any longer. Just the bishops, some priests, and a few very conservative lay Catholics.”