Her touch aroused Jack at once. It wasn’t an eighteen-year-old’s immediately, but what served him well in his thirty-six-year-old body. Physically, there was no equivocation, and emotionally, Jack’s troubling preoccupation vanished with Beth’s first touch. Maybe that was one of the best things about married sex, its casual yet urgent immediacy; a safe harbor in a troubled world.
Afterward they held each other, and Jack’s mind was blissfully silent for a few precious moments.
Beth looked into Jack’s eyes. “I haven’t seen you so obsessed by a case in a while.”
“It’s true. Rachel’s a great lady. She deserves a break, but each time I push, it’s one step forward and two steps back. I hate being this frustrated and pissed off.”
Carla Watts was an experienced ICU nurse. She had three patients that night. They were sick enough to be in ICU, but none was unstable. Unobtrusive sounds; the beeping of the cardiac monitors, and the whirring of respirators provided a background to the quiet of the unit. The room was dark except for the lights over the nursing station and the periodic lighting of the patient’s bed as the nurses did their evaluations. Carla’s shift had gone well except that Rachel Palmer seemed less responsive than normal as Carla did her hourly checks. She was about to do her final check when Carla noted that Rachel was even less responsive. She shook her. “Wake up...wake up.”
I’d better call Jack, she thought as she turned toward the nursing station. Suddenly, the left side of Rachel’s face twitched...a minor ripple at first, and then strong rhythmic contractions of the eyes, cheeks, and mouth.
Carla returned at once to the bedside in time to see the start of Rachel’s seizure. It began with weak spasmodic contractions of both arms and legs and seconds later, they blossomed into a generalized convulsion with major forceful total body contractions that shook the entire bed. Metal rattled against metal and springs stretched. The violent seizure threw Rachel’s head back in extreme neck extension. Her eyes rotated upright in their sockets, with only the whites visible. Carla grabbed a padded tongue depressor and forced it between Rachel’s teeth so she wouldn’t bite her tongue. She watched as foamy, bloodstained, mucous-like material exuded from Rachel’s nose and mouth.
“Get Jack Byrnes stat,” she yelled.
Thirty seconds later, the seizure stopped abruptly.
Jack startled when the phone rang.
“Dr. Byrnes, it’s your service. We have Carla Watts from Brier ICU on the line.”
“What’s up, Carla?”
“Rachel’s been less responsive through the shift, then she suddenly began twitching on the left side of her face, then she went into a full-blown generalized seizure. She’s still out. What should we do?”
“It’s probably just the aftermath from the seizure. I’m on my way in.”
Jack left orders for intravenous Valium in case of another convulsion.
When Jack stepped out of the shower, his nose caught two favorite aromas, coffee and grilled bacon.
“You didn’t have to go through the trouble sweetie. I have to go in.”
She handed Jack his portable coffee mug and an English muffin with egg and bacon. “Have your breakfast on the way to the hospital.”
Jack paused for a moment, moved as he was each time Beth blessed him with the small things, the tokens of her affection–I adore this woman.
“I’ll see you later, babe. Love ya.”
When Jack arrived at the ICU, Rachel was still out.
“What do you think, Jack?” Carla asked.
“I think she’s postictal, you know, the unconscious period following a seizure. I’m not concerned about that, but we sure need to know what caused the seizure.”
Jack became uneasy when his examination, for the first time, revealed abnormal neurological signs suggesting that something was happening on the right side of Rachel’s brain.
When the radiologist brought up Rachel’s brain CT scan on the computer screen, Jack froze. As they flipped through the computer-generated brain slices, two small dark areas grew larger as the slices moved forward toward the frontal lobes. The two rounded areas measured about an inch in diameter, and even an untrained radiologist would recognize them as brain abscesses.
Jack dreaded the call to Tom Palmer. How many more could he make? How many could Tom tolerate?
“It’s Jack, Tom. I need you to get down to Brier ASAP. We have more problems.”
“What more can she have, Jack? She’s running out of unaffected body parts.”
“Come down to my office. I’ll wait for you.”
Twenty minutes later, Tom walked into Jack’s office. As deeply asleep as only a child can be, Carrie, their six-year-old daughter, had her head buried into her father’s neck. Tom gently placed her on Jack’s couch then moved toward his desk.
“What is it now, Jack?” Tom’s face was drawn, eyes dull, affect flat.
Jack described the seizures and the CT findings, two abscesses within Rachel’s brain. “There’s no choice now. We must drain these infected areas ASAP.”
“I can’t take much more of this, Jack. What’s the use...it’s all so hopeless.”
It’s that time, Jack thought, kill or cure.
Jack had never presented treatment options in such words, what he really felt, to a patient or her family. This new problem was more than likely to recur. It changed the equation. We faced two urgent demands; first, rid Rachel of the brain abscesses, and second, eliminate their source, the infection in her abdomen.
Jack explained all this to Tom. “I’m sure we can drain the brain abscesses, and if we’re lucky, the surgeon might find the source of infection in her abdomen.”
Tom stared ahead, eyes unfocused. “Lucky...I don’t think so, Jack.” He paused then shook his head. “Do what you want to do...whatever.”
While Tom’s comment was not unexpected, Jack recoiled at his resignation, his capitulation.
“Don’t do this, Tom. This is your decision, not mine.”
Tom placed both hands on his face. His head slowly sagged into his lap.
“Tom?”
Moments later, Tom raised his head to face Jack. Suddenly calm and in control, he spoke in a soft, but sure voice. “I understand the reasons why you’re approaching me in this manner, and Jack, it’s you who doesn’t understand. None of this is necessary. We trust you. We know as much as we know our love for our children that you are our advocate, our advisor, and yes, our friend.”
“Tom...”
“No, please listen to me, Jack. I’m sorry my ‘do what you want’ comment came out the wrong way, well not totally the wrong way. In truth, I’m physically and emotionally exhausted. Let me say what I really mean. We want you to do what you think is best for Rachel. We support you 100 percent. If the time should come when...” he paused, struggling for control, “when we...”
Jack felt his eyes filling. “We’ll deal with it, but we’re nowhere near making that kind of decision.”
Chapter Six
Only one word could accurately describe Ian Wincott—brave.
This disease had plunged Ian into a world of which he knew nothing, a good-intentioned world, but one that was painful and frightening, Ian revealed to Amanda and Greg his dominant evolving personality characteristics, optimism, and joy.
At first, Ian was terrified.
Stanford’s satellite clinics in Fremont were much closer to their home. They were a group of modern, two-storied white office buildings close to the 880 Freeway.
From the start, his parents and the nurses at the hematology clinic never lied to him about the needles, the ‘pinch’, required for blood samples and for transfusions, very tough with a child so young.
The clinic had painted the treatment room walls soft blue and they furnished each with stainless steel equipment and a leather examining table covered with removable sanitary paper. They sat Ian in a metal and wood chair, like a desk in school, except they reduced the desk surface to hold an extended arm for drawing blood.
At first, they had to restrain Ian’s arm, but after a few months, he’d simply extend his tiny arm, knowing the pain would be brief, tolerable, a minor discomfort in his loving and secure world.
Ian adjusted.
The fact that he was always happy and trusting put an additional burden on the nurses who wanted everything to go well. Sometimes it did not.
Today, early December of his third year of treatment, Ian grimaced as the nurse tried to insert the needle for the third time.
“It’s okay,” he said with a quiet peacefulness in a soft voice too mature for his age, “you’ll get it the next time.”
The nurse rushed out of the room in tears.
“She’ll be back in a minute, honey.” They’d seen this before. “She just can’t stand hurting you with the needles.”
Drawing blood and performing IV’s and transfusions was becoming more difficult as Ian was running out of veins.
Although he was chronically ill, Ian looked like a normal, though overweight, five-year-old. His face was swollen with the typical “moon shape” of the long-term cortisone user. It was December, yet Ian’s skin had a tan, bronze coloration from iron deposits in his skin, the consequence of multiple blood transfusions.
Harry Richmond, the chief of Pediatric Hematology, called two days after his latest visit. After a few pleasantries, he began in earnest. “We can’t go on this way. Ian is requiring more frequent transfusions and his iron stores from all the transfusions combined with the cortisone, is making him diabetic. There’s no future in continuing this way. I’m putting him on the list for a bone marrow transplant. It would be great if you had his cord blood in storage.”
Amanda shook her head. “We’d heard about it, but nobody offered us the option when Ian was born. How difficult will it be to get a good match for Ian?”
“I won’t lie. Ian’s multiple transfusions will make it difficult, but we’ll get one, eventually.”
“This would be a perfect situation for embryonic stem cells so that Ian could grow his own blood producing cells, but you know how limited research is in this area. How can highly moral religious people act with such cruelty by depriving children of life saving treatments?”
Nine months later, using the newest DNA matching technique, they found a compatible donor.
On the ninth day post transplant, Amanda and Greg, gowned and masked, sat at Ian’s bedside. His skin was raw, and the lining of his mouth was beet red with peculiar white-yellow plaques. Slimy blood-tinged saliva drained continuously from his mouth and he had continuous bloody diarrhea.
Richmond stared up from the chart. “It’s a severe graft vs. host reaction. The immune cells in the transplanted bone marrow have recognized Ian’s body as foreign. Those cells are attacking his body. We’re doing everything possible, but it doesn’t look good.”
Amanda wore a glove to hold Ian’s hand. She was withering inside.
Greg sat head down in silence.
Ian never awakened. It was a blessing they thought. Nothing dramatic, just deep sleep, then the cardiac monitor’s alarm when his heart stopped.
Ian’s loss devastated the Wincotts. It wasn’t that Ian’s death had ever been far from their minds, it was simply the reality that they’d never see their boy again...the unbearable reality that they’d never touch or hold him or see his smile or feel the warmth of his love. How could they survive and take meaning from this loss? Did any of this make sense?
Richmond met with them the next day. “I can’t tell you how sorry I am for your loss. Ian was a saint. Everyone loved Ian. We’ll never forget him.”
“Thank you, and please thank the staff for everything,” Greg said. “You all did your best.”
Six months later, Amanda and Greg formed the Ian Wincott Foundation. Twelve months later, with Greg no longer operating his business on a day-to-day basis, they opened People for Alternative Treatment (PAT), a small pharmaceutical company dedicated to developing orphan drugs for treatment of illnesses like the one that killed their son.
Chapter Seven
Ben Davidson had something in mind this morning as he sat with Jack over coffee. “I’d like you to chair the Credentials Committee, Jack.”
“Find someone else boss. I’m over-committed. If I take on any more obligations, Beth’s going to be pissed, and I can’t blame her. Our lives are busy enough, especially with the difficulty we have in synchronizing our call schedules.”
“This won’t take much time. The medical staff office will have completed all the preliminary evaluations, so 99.9 percent of the work can be done at the committee meetings.” Ben paused for a moment. “It shouldn’t surprise you to hear that I have great plans for you, Jack. This is just another rung on the ladder.”
“Beth may hang both of us from it.”
Jack stared at Ben and thought, Okay, I’m ambitious, but how ambitious, and at what price?
Ben, this time at least, was right about the time commitment.
Jack walked past the doctor’s dining room on his way to the credential meeting. Classrooms used by physicians, nurses, administration, and lay groups for all varieties of meetings and educational programs, lined the corridors. The walls had printed signs and arrows pointing and announcing, BASIC CPR, ROOM 103. As Jackrounded the corner, dishes, trays, and spilled food spread across the tile floor. A middle-aged woman dressed in a pale blue and white food service uniform lay sprawled on the ground. A young man, late teens or early twenties, was on his knees next to her trying to perform mouth-to-mouth resuscitation.
“No me molesta–get away,” the woman shouted as she pushed against the young man.
“He attacked me. I must have fainted, and he attacked me.”
Stunned, the man looked at Jack sheepishly. “We just finished our CPR course. I thought she’d had a heart attack.”
Jack smiled. “The next time you find a person fighting off your efforts at CPR, maybe you’d better think again.”
Jack arrived just before noon at the small meeting room off the hospital’s main dining area. He was still smiling from the ‘resuscitation’ he’d just observed. One side of the first floor room was entirely glass and faced the street. Bright midday sunlight made the fluorescent fixtures redundant.
Annie Cox, the Credentials Coordinator, sat at the head of one of the large folding tables placed around the room in a U-shape. A cart filled with thick folders stood by her side. Jack knew each folder represented twenty to thirty hours of staff time.
Jack patted the pile. “How many applicants today, Annie?”
“Just eight, Dr. Byrnes.”
For some reason, while most of the nursing staff called him Jack, Annie and the rest of the medical office staff, knowing him equally well, refused the familiarity. His call-me-Jack attempts had failed with them.
The steps needed to bring a new physician on staff were vitally important, but to the physicians charged with the task, it was boring. Our support staff did all the time-consuming legwork. Physician imposters, who’d somehow made it through the system, were less a problem today due to rampant medical staff paranoia, and access to online physician databases. Trial lawyers had made the price of a credentialing mistake too high. The challenge, the area where physician input was essential, wasn’t the credential items per se. We charged our staff physicians with uncovering the incompetent, the substance abuser, the alcoholic, the morally corrupt, the irresponsible, and the crazies who had spun portraits of normality into their applications. While the process of obtaining approval for joining the medical staff was arduous, once they made it to the staff, getting a physician off was difficult to impossible.
When Jack first came to Brier Hospital, the medical staff had years of practice and behavior problems with the infamous Dr. Joseph Polk, and yet they could not get rid of him. It took Polk killing a patient to force the issue.
The experienced physicians on the committee confirmed the support staff’s work and then they had the task of reading through the documents in search of the
subtle clues, the little hints, a crystal ball’s view that might foretell an applicant’s future. Gaps in training, unusual educational program changes, reprimands, and weak recommendations (faint praise), drew their attention. Like a military fitness report, any recommendation south of “outstanding” was suspect. In addition, due to fear of litigation, formal letters of recommendations were often so perfunctory that they mandated inquiries by other, non-documentable means. Phone calls or queries to friends often brought to their attention the less savory aspects of an applicant’s character and practice.
Jack had nearly finished his lunch when the rest of the committee arrived. This group represented a broad spectrum of the staff.
During last month’s meeting, Ken Harris, a neurologist, reviewed the application of Dr. Harmony Lane to the Department of Medicine and Family Practice. Ken’s perusal of this application had been a bit unsettling, so he had asked Jack to do a more in-depth review and analysis.
So much for Ben’s promise that I could do all my work for this committee once a month at noon.
Dr. Lane graduated from the University of Illinois Medical School and did her Family Practice Residency in Santa Rosa, California. Recommendations from colleagues, patients, and the academic staffs included phrases such as, “a bright, compassionate physician”, “determined to provide the best care for her patients”, and “one of our most outstanding graduates from the Family Practice Program”. Along with records of her attendance at traditional medical conferences, were certificates of her attendance to several unusual seminars. The ones that drew Ken’s and Jack’s attention were light-years from the fundamentals that guided most physicians in practice. These included The American Society of Environmental Medicine meetings, The Australian Society of Orthomolecular Medicine, and a variety of seminars on the effects of electromagnetic radiation on health.
Among several brief comments in her residency notes, was a reprimand for failing to follow the recommendation of an attending physician, and the suggestion that Harmony might benefit from counseling.
The Plague Within (Brier Hospital Series) Page 4
