Downstairs, I set out bowls, grabbed the milk, and examined the pantry for options with a decided lack of enthusiasm. I normally enjoyed being in the kitchen; it was a pleasant, light-filled room with a rectangular nook enclosing a huge old farm table where we ate and a massive marble-topped island. The children, who were sitting dispiritedly at the table, voiced their utter disdain for all proposed breakfast items. I pulled rank and served scrambled eggs, along with Cheerios and milk.
“I hope you can do better than this for lunch,” groused Finn, staring at his egg like it was a pile of vomit.
“Yeah,” seconded Eli, although he was eating his eggs.
Calm parenting. You were supposed to acknowledge their feelings, thus communicating that you accept their personhood. At the same time, you should allow zero tolerance for rudeness, while exhibiting an authoritative but calm demeanor so as not to escalate the battle. No raised voices, no passive-aggressive muttering. Calm.
“I hear you that this is not your favorite breakfast,” I said quietly but firmly. “However, this is what I am serving, and there will be no other food given.”
Finn was investigating his lunch box. His mouth dropped open in abject horror. “Mom! What is this? You know I don’t dig on pretzels!”
Eli backed him up again. “Me neither.”
Now Rowan was butting in. “Mom, we told you that we were sick of turkey sandwiches! You never care what we want.”
In a low, pleasant voice: “May I remind everyone that you asked for turkey and pretzels yesterday?”
“No, we didn’t! We hate turkey and pretzels!”
Delaney, whose head was ping-ponging back and forth between her sister and brothers, suddenly threw her plate on the floor and burst into shrieking tears. “I don’t like it! I telled you already I don’t like it!”
Ed, the golden retriever, trotted in smartly, alerted by the siren call of a plastic toddler bowl hitting the ground, and gobbled the egg and Cheerios before I could stop him. I grabbed a paper towel to wipe up the milk dripping off the table and all over the floor. Calm. A raised voice would only escalate. Calm.
“Delaney, we do not throw food,” I said. “Ever. You need to help wipe this up, and then you will get a new bowl from the drawer.”
“No! I won’t!” Delaney screamed.
Zero tolerance.
Still pleasantly, “Then I’m afraid you will have to stand in the corner.”
“I will not! I will not stand in the corner!”
With a desperately pleasant smile plastered on my face, I wrestled the shrieking, spitting Delaney into the corner and tried to hold her in place. Zero tolerance; you had to train them the first time it happened that intolerable behavior would be addressed promptly and without negative emotion. For a person three feet tall, Delaney was shockingly strong. I felt a stream of sweat snake its way down my temple.
Delaney got an arm free and smacked me in the face, still screaming. It actually hurt quite a bit. I was still processing this, fighting the overwhelming temptation to smack back, when Rowan said snippily, “You bring this on yourself, Mom. I bet she’d be better if you fed her something more good.”
I let go of Delaney. “WHAT IS WRONG WITH YOU UNGRATEFUL, HORRIBLE CHILDREN?” I screamed, loud enough to hurt my throat. “I HAVE SPENT THE LAST HOUR TENDING TO YOUR EVERY NEED, AND ALL YOU DO IS ENDLESSLY COMPLAIN.”
The children stared at me, shocked. It felt good to yell, but I really was hurting my throat, so I continued at slightly lower volume: “You have no idea what it is like to be hungry; you think everything you have appears magically and your slave of a mother will get you more and more and more. Well, I’m done! I’m done! I can’t take it anymore. I’m done!”
The children’s eyes were so wide they looked like they were in the grip of a hyperthyroid storm. There was silence.
Finally: “I’m so sorry, Mommy. I love turkey and pretzels in my lunch. I won’t complain anymore.”
I looked at Rowan with gratitude. Eli and Finn were still silent, but they were nodding metronomically, their eyes locked on me. Delaney, her big eyes still dripping tears, padded over and began stroking my leg, repeating, “It’s okay. It’s okay, sweetie babe,” over and over.
Hmmm. So much for calm parenting. Maybe I could write a book called Volcanic Parenting: The Explosive Method of Intermittent Control. It would probably be a best seller.
“Hello.” Betsy Packard walked into the kitchen, followed by her son, Will. “Everybody ready to go?”
Horrified, I glanced at the clock. “Betsy!” I said, rushing out from behind the counter. “Yes! Give us five minutes.” I motioned to the children with a furtive, frantic hand wave behind Betsy’s back. “Rowan, please help the boys tie their shoes.”
“But we haven’t had—”
“Thank you, honey!” I trilled. “Don’t forget your backpacks!” I pulled Betsy aside and gave her a hug, trying to strike a balance between the kind of welcome that dwells too much on someone’s bereavement and one that ignores it altogether. This was Betsy’s first day back driving the carpool. Naturally, I’d told her not to worry about it, even though I’d been twisting my schedule into hellish knots and calling in every favor from every person I knew in order to make it work over the last few months. But she insisted she was ready to return, saying she couldn’t stand another morning alone in bed after everyone left the house.
“How are you?” I asked after a moment’s awkward pause. I’d expected her to look wraithlike and frail—she’d had the ropy thinness common to wealthy women even before Eleanor’s death—but the only change in her appearance was her expression, which seemed vague.
“I’m functioning,” she said, her gaze landing on the boys after sweeping past Delaney. “I guess it’s good to be out of the house.”
“Okay, but don’t push it,” I said. “I’m happy to keep driving.”
“Zadie,” she said, gripping my wrist. Now I noticed her nails were ragged and yellowish. “I came in because I need to tell you something.”
Chapter Twenty-three
EMERGENCY CHOCOLATE
Zadie, Present Day
I tensed, certain I would not want to hear whatever Betsy was about to say. “Of course,” I said.
“I’m not in favor of it, but he’s . . . latched onto the idea that it will bring him some kind of relief. I know you’re close to her, but he thinks he’s protecting other people from the same kind of tragedy, or he’s forcing a closer look at hospital policies, or something like that. He thinks it’s the only thing to do.”
“Are you . . . talking about Boyd?”
Her neck jerked in a small, tight nod. “He’s going to sue your friend, and he’s leaning on Nestor”—she meant Nestor Connolly, the CEO of Charlotte’s immense hospital complex—“to take some action against her.”
Most physicians dread lawsuits, and it’s not because they think they’ll lose. Every doctor has a colleague who’s been sued. Or maybe they’ve been sued themselves. It lurks over everyone like a ten-foot-tall grizzly, waiting for you to stumble, poised to sink its fangs into your helplessly exposed neck.
Or maybe that’s not an accurate metaphor. One of my partners, a bright-eyed, white-bearded older guy named Charles Frank, known for his consistently terrible jokes and his unflagging enthusiasm for getting to know his little patients, had been sued after one of his teenage patients died. The kid, who had structural problems in his heart, had bled profusely during his last surgery, nearly dying on the OR table. He needed a defibrillator but couldn’t have another immediate surgery. In the meantime, he had taken off the external defibrillator he was supposed to be wearing and gone to a friend’s house to lift weights, defying both his parents and his doctors. Watching Charles negotiate the lawsuit was more like watching the slow agony of someone with an intestinal parasite than like watching someone get his head chomped by a bear. Every
month he bled a little more. I began to dread the hangdog look he wore to the office, especially each time he had to ask the rest of us to cover his patients because of a court date or disposition, which were held according to the schedules of the lawyers. People who knew nothing of the details of his defense rushed to censure him on social media. Patients left the practice. To save money, his insurer forced him to settle, even though, like the overwhelming majority of doctors who are sued, he’d have likely won his case.
Charles Frank took an early retirement.
“Is Boyd suing the hospital too?”
“No.” In the background, I could see the boys, who had apparently tied all their shoelaces together, thudding en masse across the living room. They lurched drunkenly and fell over, shrieking with laughter. Betsy stood like a stone. “He says he’ll indemnify the hospital if they fire her. Our lawyer is screaming about it, but Boyd will get his way. He’s going to bring Nestor down on her like a ton of bricks. He wants her fired.”
I let out an involuntary squeak.
She broke from her lethargy enough to swivel toward me, still expressionless. Her lack of animation struck me—depending on how you looked at her, she could be mistaken for serene, or possibly lobotomized. I reached toward her, but she pivoted again and stared past me. “How is she?” she asked.
“Emma?” I said, surprised at the question. “She’s . . . she’s awful, actually. I’ve barely seen her.”
Betsy nodded. “Well,” she said. “I’m late getting the kids to school.”
We looked toward the front door, where a knotted pile of shoes sat heaped. Out of nowhere, Delaney appeared and clamped onto my pants leg. “Mom,” she puffed, “I am done with being human. I need you to buy me a tail.”
Betsy closed her eyes.
I dislodged Delaney and said quietly, “Delaney, go wait in my room. Okay?”
“Can I have a tail?”
“It’s possible,” I hissed. “Go.”
Betsy zombie-walked toward a torrent of sunshine pouring through the front doorframe. I followed her, scooping up the shoes as I went, hoping the boys hadn’t migrated to a mud puddle in the two minutes we’d stood talking. Just before we reached her new car—a Volvo station wagon, quite unlike the massive black Suburban she’d had before—Betsy turned to me. She whispered into the cuff of my shirt, so faint I could hardly hear her, “Will you talk to Boyd?”
“Of course. Of course I will. But what do you want me to say?”
She blinked, haggard-faced, the skin beneath her eyes so pale it was almost pearlescent, shot through with the faintest of violet undertones. “I don’t know,” she said. “I was hoping you could help me figure out the right thing to do. Should I ask him not to sue her?”
—
First patient of the day: referred for fainting. Second patient: referred for murmur. The third patient broke up the monotony only slightly—valve surgery follow-up—but the fourth one was interesting: a fourteen-year-old who had collapsed while playing soccer.
Shortly after he was born, Christian Kajowski’s delivery room nurses noticed a loud murmur when they auscultated his chest. They called the pediatrician, who ordered an echocardiogram—an ultrasound of the heart—which confirmed a problem: aortic stenosis. The vessel carrying blood from Chris’s heart was too small. A few weeks after birth, he had a temporary procedure to widen the stricture, followed by an aortic graft last year as we waited for him to reach his adult size so he could finally have a valve replacement. Meanwhile, he’d been an active, healthy kid.
But unbeknownst to anyone, a minor infection after Chris’s last surgery had created a small area of scarring in his heart. One afternoon in September, after a warm-up lap around his school’s track, he jogged to the soccer field, waved to his coach, and slow-motion crumpled to the ground.
I knocked on the exam room door, lugging my cumbersome COW (Computer on Wheels) behind me. “Hello there, Chris!” I said, smiling. “I’m happy to see you!”
Chris looked reasonably happy to see me too. He was an amiable kid with broad shoulders, wide gray eyes, and the kind of lush, curving eyelashes often unfairly bestowed on boys. “Hey, Dr. Anson,” he said, lounging in a slumped, knees-wide-apart posture reminiscent of a professional athlete. His mother elbowed him and he politely sat up. If he was feeling any angst related to the possibility that he could die at any moment, he hid it well.
Chris’s mother, Deborah, was not as successful in hiding her angst. Her eyes darted around the room in rabbity assessment, finally locking on me with unsettling intensity. But her voice, when she spoke, held a note of forced calm. “No shocks,” she said, motioning to her son’s chest.
“I know,” I said gently. “That’s good.” Chris had an implantable defibrillator in his chest, which meant he lived with the unsettling knowledge that if his heart rhythm deteriorated again, the device inside his chest would suddenly shock him. This paled in comparison, however, to what he faced next: tomorrow, the surgeons would slice out part of his heart and replace it with a hunk of manufactured pyrolytic carbon.
One of the reasons I love the heart so much is its immense complexity. On the surface, it’s a simple mechanical pump, taking in depleted blood and whooshing out rich, oxygenated red cells to all the nooks and crannies of the human form. But the physics underlying the pump are truly majestic. Every beat is precipitated by an electrical cascade, a subcellular chain of dominoes, alighting like fire along the fibers and muscles that bear the brunt of our bodies’ unceasing demand for fuel. When it works as it should, it’s spectacular.
After Chris collapsed on the soccer field, his heart spasming arrhythmically and uselessly, his cells screaming for oxygen that wasn’t coming, his teammates and his coaches reacted fast. They reached him in seconds, and his coach began CPR as his friend Billy took off in a desperate, all-out sprint to the football field, where the school kept a portable defibrillator. They shocked him three times before the paramedics arrived, and the paramedics shocked him twice more en route to the hospital. Had he been alone, or had he been somewhere without a defibrillator and people who knew CPR, he’d have stayed dead. But his schoolmates brought him back.
I looked over his latest EKG and echo, then placed my stethoscope on his chest. My ears, long attuned to the subtle gradations of the heart’s gray noise, registered no changes from last week. “You’re doing great, Chris,” I said. “Tell me what questions you have.”
He nodded seriously, his eyes a little cloudy. “I just want it to be over with.”
Deborah stirred. “Go change clothes, honey,” she said, waving toward the door of the exam room. I realized she was trembling.
After Chris left, she raised her head and looked at me. I abandoned my professional remove and gathered her into my arms, where she began to weep. “I can’t. I can’t . . .” She sobbed quietly, clutching my back.
“Oh, Deborah,” I said. “I know.”
There was a knock on the door. One of the front desk girls sidled in and whispered to me that I had a phone call, to which I naturally responded that phone calls were not my most pressing priority at the moment. The desk girl nodded but persisted: “I think it’s a doctor from Finland.”
This was perplexing. “See if he can call me back,” I said.
“She says it’s urgent.”
I sighed. “Okay. I’ll be there in one minute.”
—
On the way to my desk to answer the call, I suddenly realized who it must be. Emma was attending a conference in Helsinki; it had to be her, or possibly someone calling on her behalf. I sped up.
I pressed the blinking button on my office phone. “Hello?” I said.
Emma’s voice, imbued with the same flat melancholy I’d heard in Betsy’s this morning: “Hi. Sorry to bother you at work.”
“Oh, that’s fine!” I chirped. I could count on one hand the number of times I’d see
n Emma since Eleanor’s death a few months ago. She avoided our morning coffees with one lame excuse after another, responding to most texts with the digital equivalent of monosyllabic grunting. I wanted desperately to comfort her.
“Do you have a second to talk?”
“Yes, yes, yes,” I said. I would give Deborah a few minutes alone and would return soon. “What’s going on?”
Emma exhaled a long, stiff sigh. “I got off the plane in Finland and checked my phone. And I have all these e-mails from my lawyer.”
“I guess that’s not good.”
“No. No, it’s bad. Boyd Packard’s attorneys are revving up. Tons of subpoenas, discovery materials—they’re interviewing people I work with.” Her voice dropped another notch. “They filed an affidavit called ‘intent to sue.’”
I waited. If she didn’t know that Boyd was also gunning to have her fired, I certainly wasn’t going to tell her. Suing an individual physician is one thing, but most lawsuits also name the hospital system, which has considerably deeper pockets. But the potential of a bigger payout comes at a cost; hospitals are prepared to defend themselves. They have in-house legal counsel and the resources to dig in and ride it out. Aligning oneself with a hospital in a suit isn’t always in a doctor’s best interest—sometimes they force you to settle, even if you’re in the right—but it adds protection. If Nestor Connolly decided to throw Emma under the bus, it could make things exponentially worse for her: it’s hard to win a case if your own employer won’t stand behind you.
This was premature, but I couldn’t stand the despair in her tone. “Emma, I . . . I talked to Betsy this morning about it.”
“You did?” An unmistakable note of hope.
“Yes. She’s about how you’d expect her to be: depressed. Grieving. But there was one positive thing. Em, I probably shouldn’t tell you this, but you deserve to hear something hopeful.”
Cautiously: “What is it?”
The Queen of Hearts Page 18
