Diagnosis Death pft-3

by Richard L Mabry

  Bell offered his hand. "Pleasure to meet you, Dr. Gardner. I'm glad Cathy is getting some help. I was afraid she planned to work right up to the time of her delivery."

  Before Elena could reply, Godwin cleared his throat and said, "Now that Dr. Bell is here, let's get down to business." He produced a thin folder from his desk drawer, centered it carefully on his desk, and tapped it with a manicured forefinger. "This is your application for privileges. It seems to be in order, but there's one problem."

  Elena felt a vein in her temple begin to throb and wondered idly if either of the two men could see it. Had what she'd hoped to leave behind in Dallas reached out to grab her already?

  Bell hitched himself forward in his chair and picked up the folder. "What Nathan is trying to say is that you saved Milton Nix's life yesterday before you jumped through all the hoops to be formally granted hospital privileges to do so. I've told him that the awarding of those privileges-already scheduled for the next Credentials Committee meeting-is a slam-dunk."

  Godwin drew himself up to his full height, a difficult feat when sitting, and doubly difficult when you're only five six. "Dr. Bell, surely you recognize that privileges are granted to each physician based upon their training and qualifications. We've only had Dr. Gardner's application for a short time. I have not yet seen all her references."

  Dr. Bell didn't move, yet gave the impression of a lion crouched to spring on a helpless small animal. "Nathan, I liked it a lot better when our old administrator administered and left oversight of the medical staff to me. But, since you want to make this a contest of wills, I've talked with Dr. Amy Gross, the chair of the Family Practice Department where Dr. Gardner trained. She assures me that when her letter reaches me, along with those of others at that medical center, there will be no question of granting the requested privileges."

  "But-"

  Bell held up his hand like a traffic cop. "No 'buts,' Nathan. Just before coming here, I spoke by phone with each member of the Credentials Committee." He turned to Elena. "Dr. Gardner, it's my pleasure to advise you that, in a special called vote, all your requested privileges have been granted, retroactive to the moment you walked into the Emergency Room yesterday and took over Milton Nix's care." He beamed, perhaps as much at his triumph over Godwin as in welcome to Elena, and extended his hand. "Welcome aboard."

  Elena felt the atmosphere in Godwin's office chill as though an unseen hand had run the thermostat to its lowest level. She tuned out as Godwin and Bell exchanged words that were far from pleasant.

  Bell rose. "Well, Nathan, take this to the Board if you want to, but I'm sure you know that your margin there is razor-thin. I'd pick my battles if I were you." He touched Elena lightly on the arm. "Doctor Gardner, let's get out of here."

  Godwin was still talking, although with less assurance, as the door closed behind them. Bell steered Elena past the elevators and said, "Let's get some coffee. I'd like to give you a better welcome to the staff than our esteemed administrator has."

  They settled in at a table in the back of the cafeteria, each with a cup of coffee. Elena sipped hers and decided that it would never win any competitions for taste.

  Bell apparently saw her grimace. "I know. Hospital coffee. And this was probably made for lunch, which was…" He consulted his watch. "Which was at least three or four hours ago."

  "That's okay. I've had worse," Elena said. "Thanks for defending me to Mr. Godwin."

  "My pleasure. As Chief of Staff, I count the day lost when I can't do battle with our Little Napoleon. But don't let him hear you call him Mr. Godwin. Our esteemed administrator is a physician, or so the diploma on his wall from St. George's University certifies."

  "I don't believe I've heard of that one. Where is it?"

  There was a twinkle in Marcus's eyes that his glasses couldn't fully hide. "Grenada."

  "So he doesn't-"

  "I think he may have a license to practice in some state, probably the one with the most lenient board exam, but apparently Dr. Godwin decided early in his career he was more cut out to be an administrator than a practicing doctor." Marcus pushed away his cup, still almost full. "Speaking of medical education, one of the responsibilities I'm saddled with is staff education. How about teaching the next CPR class? The groups are usually pretty small-mainly nurses who need to get certified or renew their certification in basic cardiopulmonary resuscitation."

  "I guess I could do that."

  "Deal. I'll have my secretary call your office with the details. And since we discussed hospital business, now I can turn in a voucher to get reimbursed for the two dollars I spent for your coffee." Marcus laughed. "I wish I could see Nathan's face when that comes across his desk."

  Elena pushed back her chair and reached for her purse. "I guess I'd better be running along. It was nice meeting you. And thanks for the coffee."

  Marcus gestured for her to stay seated. "I've enjoyed it too, although I don't think either of us had much of an opportunity to get acquainted with the other. Why don't we rectify that by having dinner together sometime?"

  Elena wondered how to handle this. She plastered a smile on her face. "Marcus, I'm flattered. But could I have a little time before I take you up on that?"

  "Sure. I guess this is sort of a hectic time, getting settled in and all."

  Might as well come right out with it. "I don't guess Cathy told anyone. I'm newly widowed. My husband died six months ago."

  Marcus's expression didn't change-score one for him. He reached out and covered her hand with his own. "I'm so sorry. You have no way to know this, either, but I'm a widower, although my wound isn't as fresh as yours. If you'd like to get together sometime for a meal and to talk, please call me. But we won't call it a date. We'll call it therapy."

  "You hardly touched your dinner," Mrs. Kennedy said.

  Elena forced a smile. "I'm sorry. Your cooking is wonderful, but I'm just not hungry. It's been a long day."

  Matthew Kennedy blotted his lips and folded his napkin. "Would you like to talk about it?"

  "No, I think I'd like to get some rest. Would you excuse me?"

  In her room, Elena made a stab at rearranging her things, but she had no heart for activity of any kind. She kicked off her shoes and sprawled on the bed. Her eyes were closed, but she still saw the drama that was her life as it unfolded like the scenes of a particularly bad soap opera.

  The ring of her cell phone brought her back to reality. She dug it out of her bag and answered the call.

  "Elena, this is David. Are you free to talk?"

  She almost cried. She'd come close to breaking down and dumping her problems on Pastor Kennedy, but something- some innate caution about letting anyone into her world-kept her from doing it. But David knew her innermost secrets. Well, almost all. And he'd be sympathetic.

  "I'm free to talk as long as you want, or at least as long as my battery holds out." She added a second pillow under her head. "I never thought I'd say this, but I already miss the medical center."

  "I figured you'd be glad to have your residency behind you. No more early morning rounds. No more poring over textbooks and journals to be able to answer the questions of your staff doctor. No more-"

  "I still get up early, but it's to make rounds on my own patients. And if I have a question, there's no calling the staff doctor. I'm my own staff doctor. I have to look up the answers, chase down the weird symptoms."

  "In other words, now you're a grownup."

  Elena realized that what she felt wasn't a longing for the life she'd left behind. What she really missed was the feeling of security that fled with Mark's death. And she had no idea when-or if-that would come again.

  "Enough about me," she said. "How about you? What's new? When will you be coming here? Can I do anything to help you get settled in?"

  They talked on and on. That was one of the things she missed about having David near. They never seemed to run out of things to talk about.

  "And have you heard that Dean Dunston is retiring
?" David asked.

  "Oh, I have some insider news on that front," she said. "It seems-"

  She heard a click on the line and saw there was another call ringing through. The Caller ID read Sum Gen Hosp. "David, the hospital's calling. I'm covering the ER for Cathy, so I need to take it. I'll call you tomorrow."

  She pushed the button to answer the new call. "Dr. Gardner."

  A familiar voice responded. "Doctor, this is Glenna in the ER. The EMTs just brought in an elderly man found unconscious by his wife. They don't have a family doctor. Could you come in?"

  "I'll be there in five minutes. Meanwhile, please-"

  "We'll get an IV going, start him on oxygen, draw blood for a stat CBC and chemistries, put radiology on standby for an MRI of the head. Anything else?"

  "Glenna, you're a wonder. I'm on my way."

  Thirty minutes later, Elena turned to Glenna and said, "I think he's had a stroke. And with his obesity and his uncontrolled hypertension, it's probably a hemorrhagic one. Let's get that stat MRI of the head, and I need to contact a neurosurgeon. Do we have one in town?"

  "The closest one is Dr. Shelmire in Denton. Shall I try to get him on the phone?"

  "Please ask the ward clerk to do that. Then I need some Labetalol. I'll give 20 milligrams slow IV push to see if we can drop his pressure some."

  Glenna had the vial in her hand almost before Elena finished speaking.

  Twenty minutes later, Elena cradled the phone against her shoulder as she reached for her cup of ultra-strong coffee from the ER break room. "I've got the MRI right here," she told Dr. Shelmire. She scanned the images. The story they told wasn't good. "It's definitely an intracerebral hemorrhage. I'm guessing a ruptured aneurysm or AVM."

  "Okay, I'm leaving now," Shelmire said. "Talk with the family and tell them he's probably going to need an emergency craniotomy. And you might prepare them for the worst-case scenario."

  Elena ended the call and headed for the waiting room where the patient's wife and two adult children waited. Although what Shelmire undoubtedly considered a worst-case scenario was death, she knew of an even worse outcome.

  Elena swallowed hard to choke back the bitter taste of bad coffee and bile. She knew what she had to do. Talking with the family would be hard, but she'd done it before. Dealing with the consequences of the stroke and the surgery could be even harder, for them and for her.

  Elena hovered behind Dr. Shelmire and admired the way he knelt to be on eye level with his patient's family. "Mr. Lambert is in the recovery room," he said. "A vessel in his brain burst, and the accumulation of blood pressed on some vital structures. Even though we got him to surgery within a couple of hours of the injury, some irreversible damage may have occurred."

  The thin, elderly woman sat frozen as Shelmire delivered this news. A middle-aged man and woman flanked her, leaning in as though to keep her from falling. "How much damage?" she asked.

  "We won't know until he begins to wake up… if he does. I don't look for him to regain consciousness for at least twenty-four hours. If he doesn't, we simply have to wait. Sometimes these patients surprise us."

  And sometimes, they don't. Elena turned away and stared into the semidarkness of the waiting room. A television set mounted high in the corner, its sound muted, pelted the area around it with flickering strobes of color. Life moved on in the outside world. But here, for this family, life had come to a dead stop. Now all they could do was wait. Elena wondered if they'd pray, as she had. And if there was no apparent answer to those prayers, would these people ask her or Dr. Shelmire to end their loved one's misery?

  Shelmire was patient with the family's questions, the answer to most of them being a simple "We have to wait and see."

  He gave Elena a meaningful look, and she returned an almost imperceptible nod. He rose and nodded toward her. "Dr. Gardner practices here, and she'll be looking in on your husband. I'm in Denton, but I'll make it a point to come by every day. We'll consult freely by phone, and if I'm needed I'll come right over."

  Elena spoke for the first time. "I haven't had time to have cards printed, but I'm entering the practice of Dr. Cathy Sewell. I'll write down my name and number for you. Feel free to call me anytime." She looked at her watch. A little past 1:00 a.m. "I'd suggest you go home, get a little sleep. This isn't a sprint. It's a marathon. We'll call you if something changes."

  An hour later, Elena rubbed her eyes and yawned. Mr. Lambert's condition was stable. What seemed to be an excellent ICU nursing staff was monitoring his status. Maybe she could drive home for a quick nap-at least a shower and a change of clothes-before morning.

  "If you need me in the next few hours, here's my cell phone number." Elena handed a card with the information to the charge nurse.

  "Thanks, Dr. Gardner. We'll call you if there's any change. But we both know that's pretty unlikely."

  Elena wove her way through the dark corridors of the hospital toward the parking lot where she'd left her car. As she stepped through the door, her cell phone chirped. Someone must have called while she was in the hospital and out of cell phone range. She leaned against the doorpost, luxuriating in the feel of the night air against her skin, and pressed the button to retrieve a voice mail message.

  "You have one new call," the electronic voice proclaimed. "Wednesday, 12:01 a.m."

  Elena wondered who could have called this late when she heard a whiskey alto voice that made her shiver despite the late June heat. "Don't think you can escape. I know what you've done, and you'll pay."

  12

  Since you don't have any scheduled patients, you should have slept in a bit," Cathy said. "No need to get to the office this early after a late night."

  Elena gripped her coffee cup like it was the last life preserver on the Titanic. "No, I've pulled all-nighters before. If I skip out every time I get a late-night call, I won't be

  much good to you, will I?"

  Cathy tried to reassure her new associate. "Listen, you're not on trial here every minute of every day. Relax. Loosen up. You're doing fine."

  "Apparently not in my choice of friends," Elena murmured into her cup.

  "We've discussed that, and as far as I'm concerned, the matter's closed. Just be careful."

  Elena touched the bottom of her cup to the bit of coffee she'd spilled on the break room table and began to form interlocking rings. "There… there may be some other problems too."

  "Before I forget about it, this came for you. It must have arrived at the medical school after you cleared the campus, so they forwarded it here."

  The return address on the legal-size envelope grabbed Elena's attention: Texas State Board of Medical Examiners. "This reminds me, I need to give them a change of address."

  "Tell Jane. She'll take care of it for you," Cathy said.

  Elena pulled out the single page, scanned it, and felt a hollowness in the pit of her stomach she hadn't experienced since her first roller coaster ride. "This must be some kind of terrible administrative foul-up."

  "What?" Cathy asked.

  Elena worked to stop the trembling of her hands so she could read. "We have received your request to voluntarily surrender your license to practice medicine. Please reply to this letter, advising in detail your reasons for this request. We must warn you that we are obligated to report any possible criminal activity associated with your actions."

  "I take it you didn't make that request."

  Elena swept her arms wide in a gesture of innocence, sending her coffee cup to the floor, where it shattered. "This is just one more bit of harassment. I thought that when I moved here it might stop."

  Cathy decided that, as usual, her husband had been right. "Want to talk about it?"

  "Not really. But I think I need to. You know about the phone calls I got after Mark's death?"

  "I remember. From your mother-in-law."

  Elena nodded. "That's what I thought. But before I left Dallas I got a letter from a lawyer. Lillian's dead. And she's been dead since shortly after Mar
k's death. Unless her obituary was some kind of sick hoax, there's no way the calls could have come from her."

  Cathy took a moment to think that over. "So we don't know who was making the calls. Still, they should stop now that you've moved away from Dallas and changed your phone number. You did change it, didn't you?"

  "I had my home phone disconnected. I gave this office as my forwarding address, and limited even that. As for my cell phone, I didn't think it was necessary to change it. Probably…" She ticked off numbers on her fingers. "Probably half a dozen people have the number, and I trust them all."

  "So you're through with the calls."

  Elena pushed her cup away and put her fingertips to her temples. "Apparently not. I got another one at midnight last night-the same voice. It said, 'Don't think you can escape. I know what you've done, and you'll pay.' "

  "But you've done nothing wrong."

  "Evidently my caller doesn't hold that opinion."

  "Let me talk with Will," Cathy said. "Maybe the investigator he uses can find out who's harassing you."

  Elena moved her hands to the back of her neck and began to knead the muscles there. "There's more to it than that. I don't think I've done anything wrong. But there's a very real chance that I might in the future. I guess it's time for me to get some help."

  Will made sure everyone was settled comfortably in his office. Elena and he had diet soft drinks, Cathy sipped from a bottle of cold water. He took a seat behind his desk, centered a fresh legal pad on the blotter, and uncapped a fountain pen. "Cathy has filled me in on what you all shared this morning, Elena. Suppose you tell us what it is that makes you afraid you'll do something wrong."

  "I've told you about Mark's death. But I glossed over exactly how he came off life support. I stepped away from his ICU room for a bit. When I came back, they were removing his IV, EKG leads, everything. He was dead. I presumed he'd died in the short time I was gone. But later Mark's doctor, who was the chairman of Neurosurgery, called me on the carpet. I'd waffled about withdrawing life support, and when I finally made up my mind to allow it I wrote the DNR order myself."