Prescription for Trouble - 03 - Diagnosis Death

by Richard L Mabry

  "Dr. Gardner, this is Josh Samuels. How may I help you?"

  How could anyone help her? Elena did her best to give Samuels a concise summary of her situation.

  He listened without interruption. When she wound down, he said, "Two questions. First, why tomorrow? And second, what do you hope to get from the session, assuming I can hypnotize you and regress you to the times in question?"

  "The first is easy. I've taken over the practice while Dr. Sewell is confined to bed, and tomorrow afternoon is the only time I can get away. Besides, I'm afraid that if I delay this, I won't go through with it."

  "Fair enough. I can see you after my scheduled patients. Be here at five. Do you need directions to my office?"

  "I'll see Cathy tonight. I can get them from her. And thank you for seeing me."

  "I asked two questions. What's your answer to the second one?"

  What did she hope to gain? To find that she'd caused the death of two patients, one of them her husband, while in a fugue state? To learn that she was a danger to those she was sworn to help? She turned it over in her mind for another thirty seconds while Samuel waited patiently on the other end of the line. Finally, she said, "I guess I've decided that knowing, even knowing something bad about myself, is better than wondering for the rest of my life."

  "Good answer. Once we know what's wrong, we'll work on fixing it."

  After she hung up, Elena sat with her eyes closed, searching for encouragement to go through with what she'd set in motion. A phrase began to percolate to the top of her mind like the first bubble of coffee in an old-fashioned pot. She made her way to Cathy's office and looked in the bookshelf behind the desk. Yes, there it was, right where she remembered seeing it.

  Elena took down the book, opened it, and thumbed through the pages until she found the one she wanted. There it was, Psalm 139. She slumped into Cathy's chair and let the words soak in. This was a modern translation, unfamiliar to her, but that only seemed to make the words more powerful.

  "Investigate my life, O God, find out everything about me;

  Cross-examine and test me, get a clear picture of what I'm about;

  See for yourself whether I've done anything wrong—then guide me on the road to eternal life."

  That was it. She'd let Josh Samuels investigate her life, look in the hidden corners, peek into the dark closets. Then she and Samuels would have a clear picture of what she was about. After that, the two of them—and, yes, God, if He was still interested—could set about fixing what was wrong in her life.

  Elena looked at her watch and quickened her steps. Her last patient had taken more time than anticipated, but the end result certainly justified her efforts. The woman beamed when Elena assured her that an adjustment of her medication would almost certainly provide relief from the headaches that plagued her. Sometimes you do something that makes it all worthwhile.

  In the ICU, it was the work of a moment to remove the breathing tube from Mr. Lambert's throat. Although he was improving daily, Elena warned his wife there was no guarantee he wouldn't awaken with a neurologic deficit that could range from mild to severe. "He's not out of the woods, by any means. And you should prepare yourself for the possibility that he might need institutional care for the rest of his life."

  "I entered this marriage for better or for worse, and I'm not about to back out now," the woman said.

  As Elena hurried down the hall toward the hospital exit, she thought back to the time when she prepared herself to take care of Mark, no matter how severe his impairment. Would she have been so eager if she'd known about his unfaithfulness? Was it even possible that she had some inkling of it before his stroke? And could that have affected her taking him off life support? Perhaps it was a case of I was prepared to take care of you forever, no matter the cost to my own life—but no more. Better for both of us to end your life right now. Was that how it went down?

  She shrugged without slowing her steps. Tomorrow afternoon she'd know more about what she'd actually done. Until then, no need to worry about it.

  Her car was in the ER parking lot. She was halfway there when tones from her cell phone told her she had a voice mail message. Maybe there was something she could do—maybe get a different phone or change carriers—to allow calls to reach her inside the hospital. Meanwhile, it was a real inconvenience.

  She stabbed at the button to retrieve the message and beeped her car unlocked as she waited. When she recognized the voice of her caller, she rolled her eyes and looked skyward. How much more did she have to suffer at the hands of this megalomaniac?

  "Doctor Gardner, this is Doctor Godwin. Please come by my office as soon as you get this message. I'll be here until six this evening."

  That was it. No explanation. Not a request. A command.

  Elena scrolled down the numbers on her phone and put in a call to Will's cell. Maybe she could catch him and not disturb Cathy. She counted five rings, and was about to end the call when he answered.

  "This is Will."

  "Elena here. I was on my way to your house when our administrator issued a summons to his office. Sorry, but it looks like I'll be a little late."

  "No problem," Will assured her. "We'll save you some food. I'd offer to delay eating until you get here, but Cathy's in that 'I'm pregnant and if you don't feed me I can't be responsible for the consequences' mood."

  Elena managed a brief smile. "I'll call you when I'm on my way."

  Five minutes later, she tapped on the door of Godwin's office.

  "Come." In that one-word response, Godwin managed to convey the image of a man wrestling with the problems of the world, resigned to interrupting his important work to deal with a supplicant.

  She advanced and stood before his desk. He looked up and motioned her to sit.

  "What's so important?" Elena heard the irritation in her voice. Then again, that's how she felt.

  "I've been advised today that during your residency training you were suspected of irregularities in the death of two critically ill patients. Is that correct?"

  Wham! Where did this come from? Who could have done it? She started to go down a mental checklist, but Godwin interrupted her.

  "I asked you a question, Doctor."

  "Your information appears to be flawed," she replied in a cool voice. "My husband was in a coma from which there was no hope of recovery. I was involved in the decision to remove him from life support."

  "And the other instance?"

  "A patient in a similar circumstance was taken off life support. I was assisting in that patient's care. I left my residency without any blot on my record. My chair released me two weeks early because Dr. Sewell needed me." She paused a beat. "And, since she's now on bed rest and I've taken over her practice entirely, that was probably a good thing."

  Godwin sat silent for a moment. "I'll be looking into the circumstances of those deaths. Meanwhile, to prevent any such incidents at this hospital, I'm going to suggest that the chief of staff temporarily suspend your privileges in the ICU." He picked up his pen and pulled a stack of papers toward him. "That's all."

  17

  Will did what he'd learned to do best. He listened, filed away information, and waited for the speaker—in this case, Elena—to run down.

  "More shrimp fried rice?" Cathy asked.

  Elena shook her head. She chewed, swallowed, and said, "No, that's plenty." She turned to Will. "What can Godwin do? Can he suspend my ICU privileges?"

  "With the usual lawyer's disclaimer that I don't have all the facts, it seems that Godwin's within his rights to investigate a complaint against a physician. He should, and probably will, consult Marcus Bell. I don't know how those lines of authority are drawn now." He saw Elena's mouth open and stopped her with an upraised palm. "But I'm betting that he can't curtail your ICU privileges. First, I'm pretty sure the Credentials Committee would have to be involved, and any action would require a hearing. If I were representing you—and I'd be happy to do that if you like—I could make a pretty c
ompelling case that Godwin is interfering with your right to practice."

  Elena shoved her plate aside and folded her napkin. "So, what should I do?"

  "I'd call Marcus Bell and give him a heads-up. It's better that he hear your side before Godwin gets hold of him." Will leaned back in his chair. "And I'd call him now. Don't embellish. Don't do too much explaining. Simply tell him what you told Godwin."

  Cathy pushed her chair back from the dining room table. "I agree with Will. You can call from our bedroom. Meanwhile, we're going to move to the living room, where it's more comfortable."

  Will helped get his wife settled into an armchair. "Shouldn't you go back to bed?"

  "Milton said I could be out of bed. I just can't exert myself." She wiggled in the chair. "Don't make me more of an invalid than I am." Another wiggle. She looked down at her bulging belly. "But I'm sure ready for our offspring to make an appearance. It's like carrying around a medicine ball inside me—a medicine ball that kicks."

  In a couple of minutes, Elena joined them. "You were right, Will. Marcus said not to worry. He thinks Godwin's flexing his administrative muscles."

  Will retrieved a legal pad from the end table beside him. "Why don't we get down to the business I wanted to discuss?"

  "I'm sorry," Elena said. "I got so involved in my problems I forgot that you asked me here."

  Will waved that away. "Five days ago, I engaged an investigator to look into your Tuesday night phone calls." He held up the legal pad. "He called me today and gave me a verbal report."

  "He actually traced those calls?"

  "Yes. He's identified your caller." Will consulted his notes. "The calls came from—"

  "Wait." A flush painted Elena's face crimson. "Slow down. I'm not sure I'm ready for this. How did he get this information?"

  "I asked my investigator not to be too specific when he reported. After all, I'm an officer of the court."

  "You mean he may have done something illegal?"

  "More likely he got someone to bend the rules a bit." Will waited to be sure there were no more questions. "I gave him your former home number in Dallas and your cell phone number. What I suspect he did was search the call logs of your carriers until he found the calls to those numbers at midnight on the dates in question. If they all came from the same number—and apparently they did—he had his answer."

  "The number, but what about who made the call?" Elena asked.

  "Once he had the number, it would be simple to identify who owned the phone. The only problem would be if the call were made from a so-called disposable cell phone. Fortunately, your caller wasn't that devious."

  "But every time my Caller ID showed the number as 'private,' or 'anonymous,' or something like that."

  Will smiled. "That means you, as the party on the other end, can't see it. But nothing is hidden from the phone companies."

  "The first calls were to my home phone. That's an unlisted number. Then, after I arrived here, she called my cell phone. How did she get those numbers?"

  "There are several ways, but I suggest you ask her that the next time she calls." He noticed that Elena's high color had faded a bit. "Are you ready to know the identity of your midnight caller?"

  Elena wondered why she was so hesitant to hear Will say the name. Maybe it was because to this point the midnight caller was only a disembodied voice, popping up once a week to torture Elena. But once Will gave the name, the voice would become a real person, someone she had to deal with. She wasn't sure she was ready for that. She knew it wasn't logical—but what was logical about the merry-go-round her life had become?

  The ring of her cell phone brought her up short. She looked at the display and started to ignore the call. Not now, David. But she pushed the button. "Hello, David."

  "Elena, I need your help. This is an emergency."

  She sat up straighter and pressed the phone to her ear so hard it hurt. "What?"

  "I'm doing an induction on Mrs. Gomez. She's the lady you referred, the one with preeclampsia."

  "I remember. What's the emergency?"

  "We started the Pitocin drip this afternoon. Things were slow at first, then she started making some progress. But now she's bleeding and having constant contractions. Fetal heart tones are rapid and getting fainter."

  Elena quickly connected the dots. Abruptio placenta. A premature separation of the placenta, the organ that nourishes the fetus, from the wall of the uterus. More common with preeclamptics. "Abruption?"

  "Grade three. I don't think we can deliver her fast enough to save her or the baby. I'm taking her for a stat C-section."

  "What do you need from me?"

  "I need an assistant. My partner's delivering breech twins, and has another woman in labor after that. The other OB in the area, Tom Denson, is tied up in Bridgeport."

  "I just talked with Marcus Bell. Call him."

  "I did. While I was on the phone with him, he got a second call—a patient with a perforated peptic ulcer. He's probably on his way to the OR by now."

  Elena was already on her feet. "Guess it's me, then. I'll be there in fifteen minutes."

  She saw the puzzled looks from Will and Cathy. Elena rattled off a brief explanation as she snatched up her purse and headed for the door.

  "Here," Will ripped the page off his pad and stuffed it into her purse. "You can read this later."

  The tension in the operating room was like an over-tight violin string.

  "How's the baby?" David worked to keep his voice steady.

  The pediatrician didn't look up from the fetal monitor. "Fetal heart tones weaker and slowing. We need to get that baby out of there."

  The anesthesiologist's voice was strained. "Her pressure's dropping, pulse up to one twenty. I'm running a unit of blood in each arm, full open."

  David held out his hand, and the nurse slapped a scalpel into his palm. He looked across the operating table. "Ready, Elena?"

  She nodded. He knew she was nervous. But he also knew she was well prepared. This wasn't her first C-section, nor was it his. But still, his pulse was racing, and he suspected the same held true for Elena.

  "Fast as you can, David," the pediatrician said. "This baby's in trouble."

  David did what he'd always done in emergency situations. He put his mind on automatic pilot and let muscle memory and hours upon hours of study translate to actions. Elena kept up with him, step-by-step, her hands working in unison with his.

  "Opening the uterus," David said. A gush of blood spilled out into the operative field.

  The anesthesiologist said, "I can't get the blood and fluids in fast enough to keep up."

  David willed himself to work steadily. In a moment, he held up the baby, clamped and cut the cord, and passed the infant into waiting arms. "Okay, let's get this bleeding under control."

  David removed the placenta, but the bleeding continued unabated. "Are those coagulations studies back?"

  The reply came from the anesthesiologist. "Yep. No abnormalities. And I'm having a hard time keeping her stable. BP's at shock levels."

  "Emergency hysterectomy?" Elena asked.

  "Not if I can help it. This is a young woman. Maybe she and her husband want a brother or sister for this baby." He pointed with a hemostat. "Find the aorta and compress it."

  Elena reached gingerly into the abdominal cavity.

  David tapped the back of her hand with the instrument. "Don't be tentative. Find it by feeling for the pulsations, then use gentle pressure to shut off blood flow. Just be careful. We don't need a ruptured aorta to deal with."

  Seconds passed like hours until Elena said, "Got it."

  In a moment the bleeding slowed. David quickly identified and tied off first one uterine artery, then the other. Smaller vessels would nourish the organ, but ligating these arteries should stem the tide. "You can release your pressure now." He held his breath.

  Elena withdrew bloody, gloved hands from the wound and let them rest, clasped together, at her waist.

  B
lood still oozed into the operative field, but it was nothing like the flood of five minutes before. David exhaled, then refilled his lungs. "That's better. Now let's clean up all the other bleeders and get this wound closed."

  Elena showered in the nurses' locker room and changed into street clothes. She borrowed a white coat from a hook on the wall and headed for the ICU. David was at the bedside of Maria Gomez. The breathing tube was still in her throat, and a ventilator puffed oxygen into it at a steady sixteen breaths per minute.

  "What do you think?" David asked.

  The anesthesiologist shook his head. "Her pressure got pretty low. I tried to keep her well-oxygenated, but with the blood loss and poor perfusion, there's no way to know how much brain damage there might be."

  "I'll keep the blood going until we get her back to more normal levels. Will you be around if I need you again tonight?"

  The anesthesiologist yawned. "Sure. You've got my cell phone number." He extended his hand to Elena. "I'm Charlie Tandy."

  "Nice to meet you. I didn't know I was signing on for this when I came to Summers County General."

  "We're large enough to have every specialty you might need, but small enough that the docs sometimes have to pitch in when it's crunch time." He grinned. "You did fine."

  Elena dropped into a chair at the doctor's charting station. In a moment, David joined her. He nodded toward the door leading to the waiting room. "Now I've got to go out there and tell Maria's husband that his baby girl is fine, but there's a chance his wife won't wake up from the operation."

  "You did everything you could," Elena said. "All you can do is play the cards you're dealt. And we don't know yet what the outcome will be." She ran her fingers through her still-wet hair. "You'll keep her here in the ICU, won't you?"

  "Yeah. One nice thing about this hospital—we have lots of ICU beds." He managed a wry grin. "Of course, this is going to drive Nathan Godwin up the wall. The payment we get for an uninsured OB isn't much, and there's no way it's going to cover time in the ICU."