by Peter Elkind
Kerrville’s newest doctor also had made a favorable first impression on the nurses at Sid Peterson Hospital. Even before opening her practice, Holland had dropped by to introduce herself. When the nurses confessed their anxieties about treating children, Holland reassured them. She carefully went over what special equipment they would need. The pediatrician seemed to regard medicine not just as a job but as a mission. To accommodate working parents, she was taking appointments Saturday mornings and on Wednesdays until 9 P.M. She had even proclaimed her intention to care for sick children whose families couldn’t pay, something many doctors refused to do. “If ever a baby needs help, call me—even if they have no money,” Holland advised the hospital nurses.
Debbie Sultenfuss’s first months at Sid Peterson had threatened to spoil Holland’s reception. Just days after beginning work in the ICU, Sultenfuss announced to the other nurses that Dr. Holland had sent her to evaluate their ability to treat children and report back what she found. She declared that Holland was going to place her in charge of pediatric nursing services at the hospital—a position that didn’t exist. Debbie particularly had antagonized the registered nurses by declaring that “RNs get all the glory while LVNs do all the work.” And her nursing notes angered the doctors: Debbie’s spelling, grammar, and handwriting remained nearly incomprehensible.
Aware that Sultenfuss had made waves, Holland apologized profusely when she met with the nurses before opening her practice. She told them that Debbie had no business making such remarks. Debbie modeled herself after Genene Jones, the nurse who would be working in her office, explained Holland. Debbie had good instincts, the doctor added, but she lacked Genene’s extraordinary pediatric skills.
When EMS radioed in that a baby who had stopped breathing was on her way from Holland’s office, the Sid Peterson nurses stood by anxiously to assist the new doctor on her first emergency. Chelsea McClellan’s arrival had calmed them. The little girl was obviously stable. In fact, while she seemed a bit sleepy, she didn’t look sick at all. And after a few hours’ rest in the ICU, she was tireless. At 9 P.M. the night of Chelsea’s arrival, an RN noted on her medical chart that she was “awake, alert, playing.” During the rest of her stay, she bounced about in her crib and toddled around the halls. She seemed so bright and happy; she didn’t even cry. The nurses wondered: How could there have been anything wrong with Chelsea?
Friday, August 27
Nelda and Gabriel Benites were worried. Brandy Lee, their one-month-old daughter, had blood in her stools and diarrhea that had persisted for two days. Brandy was their first baby, born two months premature. Nelda had given birth to her at age seventeen. She was a housewife. Gabriel, nineteen, stocked shelves at the Super S grocery store. The young couple had no telephone at their home, no medical insurance, and little money to pay a doctor.
Brandy’s parents took her to the emergency room at Sid Peterson Hospital, where the staff gave them Dr. Holland’s card and told them to call Kerrville’s new pediatrician. They arrived at Holland’s clinic late in the morning. Her nurse carried the baby back to the treatment room, while the doctor took Brandy’s medical history. Dr. Holland later summarized what she was told on Brandy’s medical chart: “Presents with two-day history irritability when fed formula, stopped taking formula yesterday morning, received only tea and rice water since, about 20 ounces per day. Mom noticed small amount of blood in one stool yesterday—rest of stool blackish green. Baby appears in pain with bowel movements and Mom reports stomach is distended.”
Dr. Holland told Nelda and Gabriel Benites that she wanted to hospitalize Brandy for tests to determine the cause of her bleeding. Then she asked Brandy’s parents to remain in the waiting room while she examined the baby. Nelda Benites soon saw the doctor’s nurse rushing back and forth. Then Dr. Holland came out and told them their daughter had stopped breathing.
Holland said later that Brandy was gray and lethargic when she arrived in the office and that she left the baby alone briefly with Genene before the child stopped breathing and had a seizure. Holland’s office called EMS at 11:37 A.M. After half an hour at Sid Peterson, Holland told Brandy’s parents that she wanted to transfer their daughter to Santa Rosa in San Antonio. Genene Jones felt certain that Brandy had necrotizing enterocolitis, the dangerous intestinal inflammation that had killed her first pediatric patient at Bexar County Hospital. Kathy Holland listed the disease as her primary suspicion.
The ambulance set out about 3 P.M., with Genene, paramedic Phillip Kneese, and respiratory therapist Sara Mauldin in the back and Kathy Holland following in a car. Holland explained to Mr. and Mrs. Benites that she got carsick after riding in an ambulance for more than a few minutes. As the ambulance raced toward Santa Rosa, Genene began barking orders and pleading with the tiny patient. “Please, baby, don’t die! C’mon! C’mon!” Kneese thought the nurse strange; she was getting out of control. Ten minutes into the trip, Brandy’s pulse suddenly grew faint. “Stop the ambulance!” Genene hollered. The car pulled over to the side of the road. Holland rushed in; Genene was performing CPR, Mauldin bagging Brandy—forcing air into her lungs with a respiratory bag. The doctor told them to stop and placed her stethoscope on the baby’s chest; Brandy’s slow heartbeat was coming back. Holland climbed back into her own car, and the procession went on its way again, this time with siren whining and ambulance lights flashing. Brandy’s condition was unsteady; Mauldin was still bagging her. Then Genene started an IV in Brandy’s foot. Kneese and Mauldin didn’t understand why; the baby already had an IV going. A few minutes later, Brandy’s color, already gray from poor circulation, darkened further. Genene lifted the child’s foot and let it go. It fell like a bag of sand; the baby was limp. “Bag like crazy!” shouted Genene. They took turns breathing for the baby until she arrived at the hospital.
Brandy Benites remained for six days at Santa Rosa, where she ate well and recovered rapidly. Physicians at Santa Rosa dismissed the possibility of necrotizing enterocolitis—it is not unusual for a child to have bleeding with diarrhea, they explained—but they could not determine what had caused Brandy’s emergency. The pediatrician who treated the baby wrote: “It is unclear as to the etiology of her respiratory arrest.”
Fourteen
It did not take long for the little brick house on Nixon Lane to become a cloister. The four women and two children who lived together in the hills outside Kerrville shared daybreak and darkness and many hours in between. Newcomers in a town that warmed to strangers slowly, they formed a tight circle of their own. Genene came to regard all those who shared the house as her family; she had a special fondness for Kathy Holland. She described the doctor as “the big sister I never really had.”
Kathy Holland lived and worked in isolation from her peers. As the only woman doctor in town, she was regarded by the other physicians as a bit of a curiosity. Among a group of backslapping, good-ol’-boy Texans, Holland did not fit—and she made little effort to reach out. While she attempted to disguise her feelings, the pediatrician regarded the Kerrville medical community with contempt. Like many doctors fresh out of residency, she considered the local physicians backward, hopelessly out of touch with the fast-changing world of modern medicine. Holland’s husband, her clinic, and her friends in the house on Nixon Lane became her world.
Her friendship with Genene far transcended the usual bonds of a relationship between a doctor and her nurse. Kathy and Genene shared morning coffee after getting the kids off to school. Sometimes they rode in to work together. At night, after dinner and baths, Kathy listened to Genene entertaining on the piano. When the kids were in bed, they played cards and watched television. Practicing medicine by herself, with no close friends among the other doctors, Kathy often sought Genene’s advice. Doctors and nurses were struck by how much Holland depended on her nurse. At home and in the office, the two women spent hours together smoking cigarettes and talking shop, sharing confidences and dreams.
Genene spoke wistfully of the children she had treated in S
an Antonio. In an autobiography she later began but did not complete, she wrote of her sadness on learning she would have to leave the ICU and the kids she so dearly loved. Genene warmly invoked the names of several children who had died under her care, some of them the very patients she was suspected of harming. Among them all, Genene wrote, Chris Hogeda was “the one who taught me the most.”
He not only taught me the value of life, but the value of love. That to share your love with others, even to the point of hurting, was good and right. That when a part of you dies along with a child, an even bigger part lives because of that love. He taught everyone unselfish love. He brought that love to so many. In touching a part of Christopher’s life, you felt you actually had the privilege of touching an angel. A gift from God Himself.
Those gifts, no one would ever take away from me. They would always be reminders of those days when I was privileged enough to know God’s true children.
In going to Kerrville, Genene wrote, “maybe I would be lucky enough to meet other angels.”
Genene had met other angels in Kerrville; she and Kathy talked about them too. If one simply counted patients, the clinic’s first week had been slow; they had seen no more than two children a day. But in terms of serious illness, it had been frenetic. Two respiratory arrests in a single week! Holland and Genene griped about the Sid Peterson staff’s inexperience at handling pediatric cases. They were glad Debbie Sultenfuss worked in the ICU; she could help treat the most critical patients. The doctor agreed with her nurse that Chelsea and Brandy had been lucky to walk into their clinic at the very moment of crisis. If Kathy and Genene hadn’t been around to rescue them, the two children might not have made it.
Monday, August 30
Mary Ann Parker, a registered nurse at a Kerrville convalescent home, brought her little boy to Dr. Holland’s office at about 10 A.M. Christopher, four months old, had a condition called stridor—raspy breathing caused by constricted air passages. Genene came into the waiting room, looked Chris over, and pointed out that his feet seemed a bit blue. She took the baby back into the treatment area, while Mrs. Parker waited outside.
Then Kathy Holland came out to talk to her. “I told the mother that I felt that we should have him in the hospital so that I could evaluate his stridor and decide what the next step was,” Holland said later. “And I told her that I wanted to transport him by ambulance in case something unexpected happened.” Holland said the baby never stopped breathing or had a seizure in the office; summoned at 10:21 A.M., the paramedics were told he was experiencing “respiratory distress.” The ambulance took Chris, accompanied by his mother and Genene Jones, to the emergency room. Genene rushed the child in and hovered over him as though expecting a disaster. The hospital nurses were puzzled; the baby had breathing problems but seemed to be stable, hardly even an emergency case. Mrs. Parker watched anxiously from close by. “I hope the baby doesn’t go into arrest while we’re waiting,” announced Genene.
Shortly after Chris Parker arrived in the emergency room, Jimmy Pearson was brought in. Jimmy had a seizure disorder, an often fatal heart defect called tetralogy of Fallot, and a hereditary bone condition that stunted the growth of his legs and arms. At the age of seven, he was unable to walk, crawl, or speak, and weighed only twenty-one pounds. Doctors had long predicted his demise.
On this day Jimmy had gone into seizures and turned blue from lack of oxygen. His mother, Mary Ellen Pearson, had taken him to the emergency room. The nurses there called Dr. Holland over and asked her to look at him. In addition to being blue, Jimmy was semiconscious and frothing with phlegm. Holland consulted by phone with the two doctors who had been treating the child in San Antonio, then told Mrs. Pearson that they needed to transport him to Santa Rosa Hospital. The pediatrician called Fort Sam Houston in San Antonio and arranged for a transfer by army helicopter ambulance, a Military Assistance to Safety and Traffic (MAST) unit from the 507th Medical Company.
When paramedics David Maywhort and Gabriel Garcia arrived at the helipad near the city limits and were driven to Sid Peterson, Dr. Holland asked the two army sergeants if they could also take Chris Parker to Santa Rosa. Chris had in the meantime been transferred to the ICU. Maywhort went up to check on him. He looked fine. Maywhort wondered why the baby needed to be transferred at all, but the medics agreed to take him. Before leaving, Holland explained that if the two children should arrest simultaneously, they should try to save Chris first. The paramedics expected no such problem; even Jimmy appeared relatively stable. Genene Jones, who was to accompany them on the flight, was less sanguine. She told Garcia she thought Jimmy might go sour.
The ambulance shuttled the patients, the paramedics, and Genene out to the helipad, about three miles from Sid Peterson. They strapped Jimmy down on the top litter in the helicopter, then tied the portable incubator containing Chris Parker to the litter below. Genene hopped in, carrying a brown paper bag of supplies. With everyone aboard, the chopper took off into a clear blue sky. It would be a wild ride.
Everything was fine for fifteen minutes. Then Genene got out of her seat and began looking at Jimmy Pearson. She shouted and gestured to the paramedics; she seemed to think Jimmy was seizing. The paramedics looked at the boy. His condition didn’t appear to have changed. Genene took out a stethoscope and placed it on Jimmy’s chest. The paramedics looked at each other. They knew it was impossible to hear a heartbeat over the din of the helicopter. They yelled to her, but Genene waved back. She was saying she could hear. What was going on?
The nurse began gesturing again, shouting that the patient was going bad, that his heartbeat was irregular. Garcia checked the monitor; he saw no change. Maywhort was inches from Jimmy Pearson. He looked closely at the child; his condition seemed the same as when they’d taken off. But Genene was getting out a syringe from her paper bag. She was about to inject Jimmy with something through the IV line. Maywhort waved at her to stop, but she went ahead anyway. “Sir, mark time!” Maywhort radioed to the pilot. “She’s pushing medication.” Two or three minutes passed. Then the monitor started showing heartbeat irregularities. Jimmy was turning blue. The paramedics looked at his chest; he had stopped breathing. They checked for a pulse in his neck; there was none.
Genene got out a respiratory bag and began trying to pump air into the child. It wasn’t doing any good; Jimmy’s deformities made it impossible to seal the respiratory mask over his face. Maywhort stood over the boy’s litter and began performing mouth-to-mouth resuscitation. They needed to get a tube down his throat to establish a clear airway, but there wasn’t enough room to maneuver in the cramped helicopter. Maywhort ordered an emergency landing. The pilot dropped down fast into a plowed field. They opened the cabin door, moved Jimmy’s litter, and tried to insert a breathing tube. The paramedics’ third attempt was successful, but when they reentered the helicopter, the tube fell out.
They took off again for San Antonio, Maywhort cradling Jimmy in his arms while performing mouth-to-mouth through the boy’s secretions, Garcia massaging the deformed child’s heart. Genene, looking queasy and breathing heavily, sat back in a crew seat. Somehow, Jimmy clung to life. The helicopter flew at top speed, and the paramedics diverted to Methodist Hospital in northwest San Antonio. A medical team there rushed Jimmy to the emergency room and stabilized him, while the helicopter flew Chris Parker to Santa Rosa. By the time it returned, Jimmy Pearson was able to make the short trip downtown to Santa Rosa.
Genene Jones later offered a sharply different account of what happened. A short time into the flight, she said in an interview, “Jimmy turned black.” Genene said that’s when she gave him an injection—of Neo-Synephrine, a drug used to open breathing passages and dry up secretions. Jimmy’s heart did not falter until ten minutes later, she said. The army paramedics, she asserted, “are full of shit. They didn’t even want to look at Jimmy. They couldn’t stand to look at Jimmy.” When they were trying to put the breathing tube down Jimmy’s throat, Genene claimed, one of the paramedics suggested that th
ey not bother. “He kept telling me, ‘What’s the use of putting it in? Let the kid die.’” Genene even contradicted the paramedics on the weather. In her aborted autobiography, she claimed that the helicopter had taken off in a “sudden downpour.” The routine report the paramedics filed after the mission describes the weather as “sunny day—clear skies.”
After the MAST helicopter took off from Kerrville, Mary Ellen Pearson had returned home to pack before driving to San Antonio. She reached Santa Rosa long before her son. When Jimmy finally arrived, Genene Jones rushed up to explain what had happened, Mrs. Pearson later recalled. “She was very pale, she was trembling, she had an unusual—I can’t explain the look she had in her eyes. It was something I have never seen before. She told me that Jimmy had stopped breathing…that they landed in a cow pasture. She made a joke about the cows not producing milk for twenty years because of the helicopter.”
Jimmy Pearson remained hospitalized for the next seven weeks. He recovered enough to return to Sid Peterson, but his condition deteriorated again. He was taken back to Santa Rosa, where he died on October 21. Chris Parker, who had slept through much of the flight from Kerrville, was discharged after three days at Santa Rosa. Doctors there found no reason to keep the baby in the hospital.
The number of children Kathy Holland had transferred from Kerrville to Santa Rosa—there had been three in three days—was beginning to raise eyebrows among those familiar with the suspicions that had surrounded her nurse in San Antonio. Third-year pediatric resident Marisol Montes—the doctor who discovered the copy of The Sisterhood bearing Jones’s name—was on a rotation in Santa Rosa’s pediatric ICU when Brandy Benites arrived by ambulance. She had been surprised that a child who had arrested would be in such good condition. Montes was also on duty when Kathy Holland called to say she was transferring two more children by MAST helicopter—and alarmed to learn that Genene Jones was on her way with them.
