by Peter Elkind
Later, Holland ran into Robotham outside his laboratory in the medical school. He asked for a word with her, and she recalled that he said, “Hey, I hear you’re taking Genene to Kerrville. You better think twice. There’s a lot at stake up there.” Robotham mentioned the case of Rolando Santos, the child whose repeated bleeding had been documented as a heparin overdose. Holland said she’d heard that the tests on the child’s blood had been performed shortly after he had been given heparin to clear clots from an arterial line. Robotham told her he had other suspicions. She thought he seemed vague.
By June 30, 1982, the end of her residency, Holland had received several evaluations of the nurse she had hired, and most of them were favorable. The hospital had given Genene a good recommendation and offered her another job—hardly possible, Holland thought, if the administrators believed she was harming children. Robotham and some nurses had their suspicions, but their ill will toward Genene was clear. And besides, Holland knew Genene Jones. She would not withdraw her job offer. “How were you supposed to think this was anything but personal when all these things were coming from people that hated her anyway?” the doctor asked rhetorically many months later. “I trusted her implicitly.”
Ultimately, Holland’s decision had as much to do with her own personality as it did with what she was told—or not told—about Genene. Most doctors starting a practice would shun any association with a nurse who was tainted even by gossip. But Kathy Holland had let others tell her what to do for too long. She possessed a stubbornness rooted in insecurity. Once she’d made a decision, she was loath to admit it was wrong; when challenged, she got her back up. Holland sympathized with Genene, because she knew what it was like to be an outcast. Both women felt maligned—by husbands, by institutions, by colleagues who didn’t like their style. And both seemed convinced they knew more about what was wrong and right with kids than anyone.
Grateful for Holland’s decision to stand by her, Genene Jones privately resolved to help make the new pediatric clinic a huge success. She and Kathy would be a team. Together, they would show Kerrville what pediatric medicine was all about.
To begin her practice, Dr. Holland had selected offices in the Fine Medical Center, a busy one-story doctors’ complex. The renovated building, once a grocery store, was less than a mile from downtown Kerrville and Sid Peterson Hospital. Holland signed a five-year lease on a 1,200-square-foot suite, then spent hours selecting wood stains for the cabinets and soothing colors for the walls. Her clinic included a waiting area, three examination rooms, a private office for the doctor, a business office for her receptionist, and a little lounge area with a table and refrigerator, where the staff could relax and eat lunch. A table scale for weighing babies was in the hallway.
On August 18, Holland, with Genene’s help, ordered a stock of drugs from Pampell’s Pharmacy in downtown Kerrville. Included with several standard items, at a cost of $1.25, was a small bottle of a drug not commonly found in a pediatrician’s office: succinylcholine, a powerful muscle relaxant sold in the form of clear liquid under the trade name Anectine. Anesthesiologists routinely used the drug in the operating room to keep their patients from gagging before insertion of a breathing tube. But succinylcholine was rarely employed elsewhere because it temporarily paralyzed the entire skeletal muscle system, making patients incapable of breathing on their own. Inducing such dependence was dangerous outside the controlled environment of an operating room, where respirators and other breathing aids were available. The drug also had a dangerous side effect: It could induce bradycardia, or slow heartbeat, which had to be countered with the drug atropine. Holland wanted succinylcholine on hand for emergencies, in case she needed to place a breathing tube down the throat of a large child whose teeth were clenched.
Dr. Holland had originally planned to open her clinic at the end of August, but the business consultant she had retained suggested that opening a week early might bring in a bit of business from preschool physicals. To signal her arrival in town, Holland placed a small, dignified advertisement in the local newspaper and had stiff buff-colored cards printed, in simple black italic type:
KATHLEEN M. HOLLAND, M.D.
announces the opening of her office
for the practice of
PEDIATRICS
Effective August 23, 1982
320 N. Waters Street
Suite F
Kerrville, Texas 78028
By Appointment from August 15, 1982
The kind of practice Kathy Holland planned promised great burdens but also offered the prospect of great rewards. Pediatrics was medicine’s least lucrative specialty, and opening a new office required large loans for equipment and supplies; it was not unusual for a new doctor to go $100,000 into debt. Solo practice meant long hours and an unending stream of late-night calls from fretful parents. But a lone practitioner also enjoyed the freedom to practice medicine as she wished. And after building a busy practice, the doctor working alone need not share the fruits of her labor. In Kerrville, Kathy Holland felt sure, the harvest would be bountiful.
On April 16, shortly before completing her residency in San Antonio, Holland had married Charleigh Appling. Kathy and Charleigh had big plans for their life together. They would live outside the hamlet of Centerpoint, on a rugged sixteen-acre tract fifteen miles south of the clinic. Charleigh had bought the land in May 1980 with the help of a loan from the state veterans’ land board, and they’d been dreaming of living there ever since. They would have peace and quiet, idyllic countryside, and room for Kathy’s two horses, which she was boarding at a stable. Their property would have two houses: an underground home built into the side of a hill for Kathy and Charleigh, and a second, smaller house for a couple they would hire as caretakers for the property. They would build the underground house as soon as Kathy’s practice was flourishing; in the beginning, they planned to live in the smaller place. Charleigh had quit his job as a campus police officer and was building the house himself.
But as August 1982 arrived, the first house was little more than a foundation and wooden frame. Charleigh often spent nights at the site in a sleeping bag to keep an eye on things. But there was no hot water or bathroom there. Reluctant to commute daily from San Antonio, where Charleigh still owned a house, Holland arranged to stay on Nixon Lane with Genene and her children most nights during the week.
Genene’s devoted friend, Debbie Sultenfuss, also had left Medical Center Hospital when the LVNs had been removed. Like Genene, Debbie had worked at the MedoX nursing agency for a time. In May 1982, with Genene’s encouragement, she moved to Kerrville and began working in the Sid Peterson nine-bed intensive care unit, usually on the 3–11 shift. Debbie moved her trailer to Kerrville, but the utility company was taking its time hooking up the electricity. In her free hours during the day, Debbie helped Kathy and Genene move into the clinic. She joined them at night after work at the house on Nixon Lane.
Completing the crowd of six there was Catherine Marie Ferguson, a peculiar nineteen-year-old Genene had met in her San Antonio apartment complex. Cathy had a history of psychiatric problems and had spent part of her childhood in a Texas state mental hospital. Genene had taken her in. She persuaded the young woman to accompany her to Kerrville and serve as a live-in baby-sitter for Crystal and Edward. Once there, Genene told people Cathy was retarded and suffering from cerebral palsy. Neither claim was true. She began introducing the young woman as her daughter.
In August, Dr. Holland hired a secretary-receptionist, Gwen Grantner, who had bounced from job to job in Kerrville. The thirty-three-year-old woman was less than five feet tall and weighed about 85 pounds—and she talked nonstop. Though Grantner was born in Chicago and had never been to England, she spoke with a strong cockney accent. Introduced by her boyfriend—a mechanic who worked on the office air-conditioning—Gwen told Holland she’d been married to a Briton, found his manner of speech appealing, and decided to affect it herself. The new doctor was intrigued. “She had this neat accent,” said
Holland. “She was very honest about things, and I liked honesty. She said she’d had a lot of different jobs, but that was because of disagreements.” Holland asked Gwen Grantner to join her fledgling medical clinic.
The staff was complete and the office ready to open.
Thirteen
On the Monday the clinic was to open, Genene awoke early and prepared excitedly for work. There were already several appointments on the schedule; she was eager to get to the office. After donning her work clothes, Genene pinned to her chest the new brass name tag she had ordered. It read: “Genene Jones, Pediatric Clinician”—a title that customarily designated an RN with advanced training.
Genene climbed into her car and headed for the clinic. Dr. Holland met her there. Kathy had spent the weekend in San Antonio with her husband. She would bring her suitcase to begin staying in the house on Nixon Lane that night. For the opening of her office, the pediatrician sported a neat, professional look; she wore her hair in Dorothy Hamill bangs.
Gwen appeared and took up her station at the receptionist’s window that looked into the waiting room. Everyone had scrambled to get things ready, but the clinic was not quite finished. The examining tables had arrived only a day or two earlier, several wall cabinets were not yet installed, and they were awaiting some supplies. To start, Holland had decided to equip fully only one of the three exam rooms—the one closest to the front of the office. Because she and Genene stored all their emergency equipment and drugs there, they called it the crash room.
During her clinic’s first day, Dr. Holland would see only one patient. But no one was worried. It was just the beginning. Things were sure to pick up.
Tuesday, August 24, 1982
Like many parents in and around Kerrville, Petti and Reid McClellan were pleased when they heard that a new pediatrician was coming to town. Here was a chance to take their kids to a real expert, a young woman fresh from training in the most modern medical techniques. “Everybody was real excited about it,” said Petti. “I just had this thing about specialists.”
The McClellans, both twenty-seven, lived fifteen miles west of Kerrville, in a three-bedroom mobile home in rural Gillespie County. Their eleven-acre tract of scrubland lay down a dusty, rutted road appropriately named Thrill Hill Drive. Reid repaired electric lines for Central Texas Electric, a local utility company; Petti worked as a secretary. Although they exuded small-town geniality, the McClellans had adopted their country ways; both had grown up around Houston.
Petti had been raised by her mother and stepfather, who held a minor political post in Harris County. In high school, she was a cheerleader and member of the student council, an earnest middle-class girl with middle-American dreams: marriage, her own home, and a houseful of children. After graduation, Petti’s stepfather helped her find a job at the Harris County courthouse, where she spent two years issuing license plates and a third year working as a secretary. In 1978, after her mother divorced her stepfather and moved to Lake Buchanan, a vacation community in Central Texas, Petti joined her there.
William Reid McClellan had grown up in Pasadena, a grimy Houston suburb that bordered the city’s ship channel. At age eighteen, after learning that his girlfriend was pregnant, Reid married, then quit high school to support his new family. He worked as a meter reader, in an oil refinery, and in a Houston plastics plant. In 1977, he bought the Hi-Line Fishing Lodge—eighteen cabins, a restaurant, and a fishing dock—and moved his family to Lake Buchanan. Less than two years later, Reid and his wife split up. The divorce would force him to sell the lodge and go to work as a lineman.
Petti and Reid met in the spring of 1979 in Lake Buchanan. They were introduced by her mother, who belonged to the fire company’s ladies’ auxiliary; Reid was a volunteer fireman. They were married on May 10, 1980, in an outdoor ceremony, and they made an attractive couple: Reid solidly built, with thick black hair and a shaggy mustache; Petti a bit slight, with a sweet face and a girlish smile. Each already had one child from a previous relationship—Reid a son named Shay and Petti a son named Cameron. Now both wanted another child, and both wanted a girl. “From the minute I found out I was pregnant, I started calling it ‘she,’” said Petti. “If someone bought me a baby gift for a boy, I’d take it back.”
Chelsea Ann McClellan was born at 12:01 P.M. on June 16, 1981. She was about four weeks premature, and labor was difficult; the placenta tore early, and Petti bled heavily before she arrived at Sid Peterson Hospital for an emergency cesarean section. Shortly after birth, Chelsea showed evidence of hyaline membrane disease, a respiratory problem caused by underdeveloped lungs, usually found in premature children. A helicopter ambulance rushed her to Santa Rosa Hospital in San Antonio, and she was put on a respirator in the neonatal ICU.
At Santa Rosa, Chelsea improved steadily. On July 5, after twenty-one days in the hospital, she was eating well and breathing on her own, and her weight had climbed to four pounds, six ounces. Her parents took her home to their trailer outside Kerrville, where they had moved by that time. With Chelsea safely out of the hospital, Petti went to her gynecologist and had herself sterilized by tubal ligation.
On May 6, 1982, Petti brought Chelsea back to the Santa Rosa emergency room. She was feverish and on the previous night had experienced what Petti described to hospital personnel as two “breath-holding” spells. Petti later said that Chelsea had briefly stopped breathing and turned blue after one of her brothers knocked her down. After dinner, she began vomiting and lost her breath a second time, until Petti blew air into her daughter’s mouth. Then ten months old, Chelsea remained at Santa Rosa until May 11. She was treated for pneumonia, but an assortment of tests turned up no evidence of seizures or a breathing disorder. “I would just caution the parents to observe her closely,” wrote Dr. Joel Rutman, a pediatric neurologist who examined Chelsea. “Her growth and development have been amazingly fine for her age, and I don’t think there is any reason to suspect she is going to be slow in the future.”
The McClellans brought Chelsea home and lavished attention on her. She developed a spoiled child’s temper, but she was attentive and curious. She followed the large world around her closely with her blue eyes, and when someone caught her staring, she would laugh and break into a wide, coy smile. Even those who barely knew Chelsea were charmed. “She was a beautiful kid,” said Genene Jones. “God, she was beautiful.”
Chelsea Ann McClellan, fourteen months old, was Kathy Holland’s first patient on her second day in private practice. According to Petti, she called in the morning to make an appointment and spoke to receptionist Gwen Grantner. Holland said that Gwen told her Petti was worried about Chelsea’s “erratic breathing” and that when Chelsea arrived in the waiting room, she had a bluish tint around her mouth. But the McClellans said they never described any breathing problems to Holland, Genene Jones, or Gwen Grantner—then or later. “There wasn’t a damn thing blue about Chelsea,” said Petti, “except her eyes.” She took her daughter to the doctor, she said, because Chelsea had the sniffles. On the patient information form she filled out in Dr. Holland’s waiting room that day, Petti listed the reason for the visit as “bad cold.”
Petti and Chelsea arrived at the clinic about 1 P.M., and Dr. Holland led mother and child to her private office in the back of the suite. As Holland began to ask Petti about Chelsea’s medical history, the little girl started pulling things off Holland’s desk. “Why don’t you let me take Chelsea and play with her, so you can talk?” Genene suggested. She picked up the child and took her out of the office.
Five minutes later, Dr. Holland heard her nurse talking to the toddler down the hall: “Don’t go to sleep, baby. Chelsea, wake up!” The summons came a moment later. “Dr. Holland, would you come here?” Holland excused herself, closing the door behind her, and walked back to the treatment room to find Chelsea limp on the examining table and Genene fitting an oxygen mask over her face. Genene later said that she had been playing ball with Chelsea in the receptionist’s area and that the chil
d had suddenly slumped over. But now there was no time to ask questions: Chelsea wasn’t breathing. Genene began pumping oxygen into her lungs with a respiratory bag, and she and Holland started an IV in her scalp. Chelsea began seizing; Holland ordered 80 milligrams of Dilantin, an anticonvulsant drug. Gwen had left for lunch; Holland ran out of the room and told some carpenters working in the building to summon the Kerr County Emergency Medical Service.
Chelsea’s mother had no idea what had happened until Holland returned to her private office to tell her. “Your daughter’s just had a seizure,” she said. Holland told Petti to stay put, but she followed the doctor into the hall and looked inside the treatment room as Holland went back in. Chelsea was sprawled on the examining table, Genene hovering over her. “I could see her little legs,” said Petti. “She was laying there, real limp.”
The EMS ambulance arrived at 1:25 P.M. Genene’s assertive manner left the paramedics uncertain which of the two women treating the child was the doctor; Jones had to point out her boss. Then Genene carried Chelsea into the back of the ambulance as a paramedic followed along with an IV bottle. Holland joined them, and Petti got in with the driver. They arrived at the Sid Peterson emergency room two minutes later.
By then, Chelsea had resumed breathing on her own. She was sent to the ICU and remained at Sid Peterson for ten days, but tests showed nothing to explain the seizure and respiratory arrest. The McClellans, nonetheless, were deeply grateful. Dr. Holland and her nurse, they believed, had saved Chelsea’s life. Petti went all over town, telling her friends about the terrific new pediatrician. “Take your kid to Dr. Holland,” she counseled. “She’s the best thing since canned beer!”
