I glanced over at the business office and saw Lois. She served as my part-time office-billing manager.
When I finished for the morning, Lois came into my office. “Do we have enough money to put out a contract on Missy Cabot?”
She smiled. “Sure, but you don’t look good in stripes. Not to worry, I’ll come and visit you in San Quentin…I’ll even bake cookies.”
“It’s justifiable homicide, killing her before she kills me.”
“You’re done for the morning, honey. How about taking your wife to lunch?”
“I’d love to, but I have a Quality Assurance meeting in five minutes.”
“Don’t say I didn’t ask. I’m off this afternoon. See you tonight.”
Lois gave me a hug and a kiss. “Love ya, babe.”
Lois was the force that kept me on an even keel. In spite of the declining image of physicians, I found most people were still a little in awe of us. The deference a physician received was seductive. Like politicians, too many of us came to believe our own propaganda.
Early in our relationship, Lois took every opportunity to deflate my ever so slightly overblown ego. She thought it was funny to couch terms of endearment with a little comic sarcasm. “Kiss me, Dr. Roth,” then later, “make love to me, Dr. Roth.” The good-natured kidding, however, never discouraged my enthusiasm for her offers.
I met her when I started my residency at UC San Francisco. She worked in the medical education office as an administrator, bookkeeper, and a Lois-of-all-trades, doing four jobs for the price of one.
She was the oldest of three sisters born to Nora and Milton Kravitz. Milton, a world famous dermatologist, taught at the university and had a lucrative practice in affluent Palo Alto. Coming from modest means, Milton, and to a lesser extent, Nora had evolved or devolved, Lois said, into pretentious snobs. “I can’t believe I’m related to them.”
Well after Lois and I became involved, she told me the story of her parents’ initial reaction to our relationship…
“Are you sure that Arnie’s the right one?” Milton asked exhibiting his characteristic bad judgment. “After all, he couldn’t get into an American medical school.”
Lois reddened. “How can a smart man say something so stupid?”
Nora bristled. “Don’t talk to your father that way.”
Lois never hesitated to speak her mind, so her outburst should not have surprised Milton, but it did. In his own defense, he replied, “I only want what’s best for you, Lois. I think you can do better.”
“Listen, both of you. I love Arnie. I’m going to marry him if he’ll have me. Arnie is the best thing that ever happened to me. You judge without knowing a thing about the man. If you can’t appreciate how fantastic he is, and how happy we’ll be together, you’d best think carefully before you speak, that is if you expect to see me or your grandchildren…”
I’d looked into her tear-filled soft brown eyes. “Screw `em.”
I walked two blocks in the bright sun to Brier Hospital. Automobiles filled every available curb space for blocks around, as paid parking was limited and expensive. Homeowners had parking permits attached to their cars, while interlopers, hospital workers, played hide-and-seek with parking control officers who marked their tires and ticketed those who hadn’t moved in two hours. Many hospital employees had stacks of parking tickets.
I entered the hospital through an ER. They were having a bad day. gurneys lined the hallways and staff scurried from room to room with the intensity of the highly motivated, but over-stressed.
The medical staff office assigned a street level room with large, east-facing windows for our QA meeting. I served as chairman. We watched the lunchtime escapees rushing by, seeking an hour’s relief from their stress.
The committee was responsible for insuring that patient care did not fall below a minimal practice standard. This approach to QA stood in sharp contrast to my experience at the university where our goals were not the minimum, but the highest level of care. In a good community hospital like Brier, there was only so much the QA process could do with private practitioners. We monitored every aspect of hospital care that affected our patients. Docs were our primary focus, but we monitored other elements like nursing and hospital systems.
Cindy Hines, an RN, worked for the department of medicine and family practice. She coordinated QA activities, performed assessment studies to see how well we were doing, and served as liaison with the hospital.
“What’s on tap today?” I asked Cindy as I took my seat.
She sat at the head of a U-shaped table behind a stacked hospital chart fortress. A woman in her 40s, she looked much older due to premature graying. She’d worked the wards, intensive care, and served in nursing administration. She was the regimental Sergeant Major of nursing, a pro.
Cindy smiled. “If I said, ‘the usual’ would you understand?”
“You bet. Maybe we’ve been doing this too long.”
Brier’s QA committee had matured over the years. Warren Davidson, the chief of medicine, had persuaded me to chair the committee. I resisted his offer because I wasn’t the traditional hard-ass usually assigned to this job. In retrospect, I think Warren was right. Often the mixture of an open mind and a little diplomacy was more effective than a full frontal assault.
The committee members arrived and ate their lunches while reviewing the charts they’d present today. Most charts they’d reviewed in detail before hand, others they’d see today for the first time.
We ran through thirty hospital records. Several minor items of concern came up that only required a brief letter to the involved physician. Two cases were more serious and involved an intractable issue—being available to the nurses for hospitalized patients.
Sharon Brickman, the head of cardiology was a tough, take-no-prisoners reviewer. While at times she went overboard with harsh criticism and sadistic remedies, she was usually correct in her assessments.
“Physician 884994 (we used numbers to prevent bias) has been here multiple times for the same damn thing. I’m getting sick of it and more than a little annoyed that he’s ignored our warnings. This time his patient in the coronary care unit went into a dangerous heart rhythm and the nurses couldn’t find him for two hours. This is 2011, and with beepers and cell phones. It’s inexcusable. I recommend that we restrict his privileges for any acute care unit, and require that he use an appropriate consultant.”
Ernie Charles, a family practitioner in his late sixties, was a man who could find no wrong in anything a fellow physician did. I had tried, with Warren’s assistance, to remove Ernie from the committee, but he had the full support of the family practitioner lobby.
Why the knee-jerk reaction to criticism of a physician? Why protect physicians under any imaginable situation, and not their patients? I didn’t get it.
Ernie stared at Sharon. “You’re always ready to jump the gun. You bring out the cannons when a peashooter would do the job. I know this guy, and I assure you that if Arnie or Warren speaks to him in strong terms, the problem will resolve.”
Sharon tightened her jaw. “We’ve done that already, twice in fact, and he’s still at it. You and I have been on this committee together for years, and I’ve yet to see you take a stand against any physician malpractice. You made excuses for that psychopath, Joe Polk, who finally killed a patient before we acted. I’m not going through that again.”
“You’re in the wrong profession, Sharon. You have a real flare for the dramatic.”
After ten minutes, the committee voted to approve Sharon’s recommendation with one vote in opposition.
I grabbed the next chart. “The second case involves the same issue, but this is a first for this doc, so if you agree, I’ll send her a strongly worded letter.”
Sharon shook her head then leaned over to me. “Make it a Poison Pen Letter, Arnie.”
Chapter Five
Connie Rinaldi was eight when, in an instant, her life changed forever.
For their trad
itional Christmas Eve dinner in Grass Valley, the Rinaldi family traveled the Sierra’s mountain roads onto the single lane path that led to her grandparents’ secluded forest cabin.
The light snow fluttered through the trees to cover the forest floor. It started while they were eating and it looked like they’d have a white Christmas.
“We’d better get ready to leave,” said Tina, Connie’s mother. “We don’t have chains and it’s a two and a half hour trip back to Berkeley.”
Connie had eaten too much and was a little sleepy, but she felt fine until she stepped from the warm house into the bitter cold. Instantly, she couldn’t breathe. She grasped the rail and stared, wide-eyed, back at Joseph, her father.
“What’s wrong, Connie?”
She tried to answer, but couldn’t utter a sound. In full panic, she struggled and gasped for breath, but heard only short squeaks, wheezes that fought to pass through her constricted airways.
Her aunt Agnes, a registered nurse, took one look at the girl. “It’s asthma, and it’s bad. We’ve got to get her to the hospital right away.”
“Call an ambulance,” Connie’s mother cried.
“No,” said Joseph. “We can get to the hospital well before they can ever find this place.”
They put Connie into her grandfather’s four-wheel drive Subaru and eight minutes later helped her into the emergency room at Sierra Nevada Memorial Hospital in Grass Valley. When the triage nurse saw Connie’s oxygen-starved blue lips, she rushed her into a treatment room. In seconds, Connie received an Adrenalin shot and inhaled medication to open her airways. In an instant, she could breathe. She coughed and wheezed loudly as she started to move air into and out of her lungs.
That memorable Christmas brought the first of many asthma episodes that would haunt Connie through her teenage years and into adulthood. She went to specialists. They tried the full range of medications; only cortisone insured an uneasy truce with the disease, but left her with complications: weight gain, a swollen face, and acne. Finally, after a pulmonary specialist completed his detailed evaluation, he diagnosed Connie with far-advanced lung disease carrying the label: chronic bronchitis with asthma.
Through her teenage years, Connie fought to control her weight, but circumstances made it difficult to impossible. It wasn’t enough that she came from a family of chunky Mediterranean women, cortisone made the weight problem worse. Whether by vanity or self-discipline, she managed to keep her weight in the 120 to 140 range, not bad for a 5 foot 6 inch woman. Her shapely figure, dark skinned and black-haired Italian looks made her popular with the boys… “voluptuous,” they said. In her junior year, she fell hard for Gino Martini, a Nicholas Cage clone.
They partied and dined with friends and Connie subscribed to Brides Magazine. Everything was well Connie thought until she went to Sacramento State College to study psychology while Gino remained in the bay area to work.
“I can’t make it this weekend,” Gino said one Thursday night.
“This is the fourth time you cancelled out, is anything wrong?”
Gino coughed. “It’s a long trip up and back. I’m just beat.”
Right, she thought, it’s a whole sixty or seventy minutes.
His phone calls became less frequent, and the excuses less convincing, and finally, he stopped calling. Friends at home eventually told her that Gino had been seeing a vivacious blonde for the last few months.
Connie couldn’t say his action surprised her, she’d wondered what this gorgeous guy saw in her, but the loss was devastating. She withdrew into food’s loving embrace. Her weight ballooned to 200, and then to 220 lbs.
Connie’s mother never gave up. “You’re so beautiful. You’ll find someone who’ll appreciate you.”
Right, Mamma, Connie thought. I feel the warmth of my mother’s love, but I couldn’t deny the bloated image in the mirror.
Chapter Six
Antonio Ruiz, Tino they called him, was Beverly Ramirez’s cousin. After five troubling years, he was through with the gangs.
Tino’s life had changed that day nine months ago when his sister Maria slammed open the door to their apartment screaming and sobbing. “They killed her. They killed Angela Rodriguez.”
Tino stood. “Angela! What happened?”
“She was sitting on the stoop playing with her dolls and they shot her. Another senseless drive-by shooting. Three…she was only three-years-old.”
As he watched his sister collapse in tears, his mind flashed, enough, I’ve had enough.
In reality, Tino never fit into gang life. He was too thoughtful and introspective. He took constant abuse for having his nose in books. Several gang members were illiterate, and nobody read anything but sports and pornographic magazines. They called him el profesor, sometimes with affection, more often with disdain.
Facing a cocaine possession sentence, Tino lucked out when the judge gave him counseling, probation, and community service. He took the opportunity to extend the forced separation from the gang into a major life change. After completing his GED, Tino started at Diablo Valley Community College (DVC), and applied for a part-time position with Horizon Drugs.
Beverly came into my office one morning. “Can you help Tino?”
“I don’t know. He’s a gangbanger, Bev. The stigma of that life is tough to overcome.”
“He was never really one of them. In that neighborhood, gang membership was essential if you planned to survive.”
She looked at me with dark, pleading eyes, and I knew I was dead. Beverly, once an employee, was family.
“I’ll call Henry Fischer. We’re one of his oldest and most reliable customers. Maybe he’ll help Tino with a job.”
When Tino went for his interview, he’d dressed carefully in pressed chinos and a blue denim shirt buttoned to the top to hide his tattoos. He’d cut off his ponytail and had neatly parted his thick black hair.
Henry Fischer stood behind his large teak and chrome desk staring down at the younger, smaller man, an act of intimidation. “Have a seat, Mr. Ruiz.”
“Thank you, sir.”
“Let me be frank with you, Antonio, if it hadn’t been for Dr. Roth’s call, I’d have never agreed to see you. Let’s say I’m doing him a big favor. You haven’t made much of your life, have you?”
Tino recognized Henry’s strategy for what it was. Confrontation was the currency of gang life—and Tino was an expert. “Please call me Tino, sir, and yes I agree with you. I’ve changed that now. I’m out of the gangs and three quarter time at DVC. I’m smart and hardworking, and if you give me a try, I won’t disappoint you.”
“I’m a careful man, Tino. I don’t like taking risks, but I’ll give you a chance. Screw up once, you’re out of here.”
“Thank you, sir. You won’t be sorry.”
They put Tino to work unpacking shipments and stocking shelves. For the first two months, they checked and rechecked each order and counted each shelf item. He’d catch them staring at him, peering around corners, and listening to his phone conversations.
Tontos...fools, he thought, smiling to himself. If I were going to steal, I’d have walked away with half your inventory already.
“Okay, Tino,” said Henry, one day after work, “I think we can get more out of you if I train you as a pharmacist’s assistant.”
Chapter Seven
Debbie Ann Wallace lived in a shadowed past that said, “If you think you’re happy, think again—it won’t last.”
She grew up as the youngest of three girls with a cold, rejecting mother and a brutal father.
Her rape at age twelve by her father’s friend was her life’s sentinel event. It permanently altered her sense of herself, of the world, and especially of men.
Trying to talk with her mother was a waste of time. “Oh, grow up, Debbie Ann. Women aren’t worth a damn in this life…get used to it.”
Debbie never did.
She spent years trying to trust, trying to feel safe, trying with psychiatrists and women’s rap
e survivors’ groups. Nothing changed until Matthew Wallace entered her life.
Debbie was a junior at UC Berkeley and Matt a graduate student at the School of Public Health in the dual degree program, M.S.W. and M.P.H. He supported himself as a teaching assistant, and although neither believed in love at first sight, it happened. The wonder was, that Debbie, instead of facing the urgency of a blossoming relationship, found Matt moving at a snail’s pace. Neither would deny the animal attraction, but somehow Matt understood, she thought. He moved gradually with friendship and affection first, and then with infinite patience toward their union.
By the time, she graduated, and they married, Matt accepted the assistant directorship of The Contra Costa County Child Protection Services.
Debbie took a fifth grade teaching position with the Concord School district. She loved the kids and they responded in kind making her one of the school’s most sought after teachers.
One evening after clearing the table and sharing the dishwashing, they moved into the den for coffee.
Both enjoyed their work, and shared their experiences. When Debbie listened to Matt’s tragic cases and the heartbreak, her mouth dried and she felt flushed. Her eyes welled. “How do you deal with it every day? It makes me crazy to hear about these kids, their misery, and the brutality of their lives.”
“You never get used to it.” He reached into his briefcase, extracted a thin blue binder, and dropped it on the table. “On top of it all, this is my operating budget. It’s a joke. What kind of world do we live in where child protective services must fight for funding, fight bureaucratic obstructions, and public apathy? My work makes a difference. That’s what keeps me going. I tell myself I’m helping to save children, and despite all the frustrations, that’s enough for me. At least I hope it’s enough to see me through in the future.”
The Sixth Sense (Brier Hospital Series Book 3) Page 3
