by Robin Cook
“No problem,” Jeanne said. “I’m available if you need me.”
He switched lines and greeted his mother.
“Why don’t we all go to the funeral mass and burial together like Hannah suggested?” Aimée said with no preamble. “We could pick you and Juliette up on our way to the Church of the Good Shepherd. And tell Juliette that Grandma would love to see her in that new blue dress that—”
“There’s a problem,” Brian said, interrupting. “Juliette woke up with a high fever, and we are again back at the Emergency Department waiting to be seen.”
“Mon Dieu! I’m sorry to hear,” Aimée said. “How is she feeling now?”
“At the moment she’s asleep,” Brian answered. “Even that’s not normal behavior for her.” He didn’t mention that the temperature was significantly lower now.
“Goodness gracious! This is not good news. What do you think; will you be able to make the church service?”
“It’s totally dependent on when Juliette will be seen and then how she feels,” he said. “I’m hoping she’ll at least be seen soon, since we’ve already been here more than an hour.”
“I certainly hope you and Juliette make it,” Aimée said. “You’ll be sorely missed, and I know Hannah will be beside herself if you don’t. But will you come even if Juliette isn’t up to it?”
“I’ll try my best,” Brian said, feeling a bit guilty that he wasn’t being entirely up front. Not knowing how he felt about any of the funeral rites or how his wife might have felt, he wasn’t as disappointed as he guessed his mother and Hannah would be if he and Juliette couldn’t make the funeral mass or, perhaps, even the interment at the cemetery. Although he certainly wanted to honor his wife’s memory and not offend anyone, so far the funeral rituals seemed to be more of a challenge to his emotional stability than a help. At the same time, he recognized the mass and the burial might be consoling on some level as a kind of closure and certainly not as upsetting as the wake. Brian desperately wanted himself and Juliette to remember Emma with the vitality that she embodied rather than as a cold, unresponsive shell staged with makeup to look as if she were merely sleeping.
“Well, I hope Juliette is seen soon,” Aimée said.
Suddenly Juliette woke up as if from a bad dream and began crying.
“Uh-oh,” he said. “I have to go. Juliette’s awake and not happy.”
“Okay, try to keep me informed, my dear,” Aimée said and rang off.
“What’s the matter, Pumpkin?” Brian asked soothingly as he pocketed his phone. Juliette was looking around, seemingly orienting herself.
“I’m hungry and I want to go home,” she managed to say, choking back more tears.
“I’m glad you are hungry,” Brian said as he got out the graham crackers and mentally thanked Camila for suggesting them. “But we have to stay until the doctor sees you and tells us why you have a fever. What about watching something fun?”
“I want to go home,” Juliette repeated, obviously becoming more cranky.
“I do, too,” he said. He got out the collection of DVDs he’d brought. Thankfully Juliette started pawing through them while munching on a cracker until she came across a Pink Panther DVD. Without saying anything, she handed it to Brian and with a sense of relief that she had found something, he set her up watching it.
With Juliette occupied, he sat back and tried to be patient, but as time passed, he found himself getting progressively irritated. Finally, after a total of two hours, at which point he knew the funeral mass was probably beginning, he couldn’t sit still any longer. After making sure that Juliette had significant time remaining on her current DVD, he walked back to the information desk.
On this occasion, Brian had to stand in line before getting to talk with one of the clerks, and it wasn’t the woman whom he’d spoken to earlier. It was a youthful man with hair down to his shoulders.
“My daughter, Juliette Murphy, and I have been here for more than two hours,” Brian snapped, tired of forcing himself to be polite. “I’m beginning to think we are being purposefully ignored. I want to be reassured that is not the case and find out when we will be seen.”
The clerk treated him to an overtly questioning expression that was obvious even with his mask. After telling Brian to wait a minute, he got up and stepped over to speak with one of the free triage nurses. Brian watched them converse and had the impression the clerk was new to his job. After checking her tablet, it was the triage nurse who came back to speak with Brian.
“We’re sorry you’ve had to wait, Mr. Murphy,” she said consolingly and with respect. “We try our best to see everyone as quickly as we can, but with the Covid-19 pandemic, we’ve been stressed, as I’m sure you have heard.”
“That I understand,” Brian said, struggling to keep the anger out of his voice but not succeeding. He told her he’d seen people arrive after them and already be seen, and voiced concern that he was being treated differently because he had outstanding hospital bills.
“Oh, heavens, no!” she said. “I can assure you that we have no idea of your financial situation with the hospital. We see the sickest patients first. Some of those people you’ve seen most likely came in for something very easy to solve, like a prescription refill. We will get to your daughter as soon as we can.”
Feeling frustrated and questioning that people might come into the ED just to get prescriptions refilled, he went back to Juliette and tried to rein in his growing anger. Despite what the triage nurse had said about the ED not being influenced by financial considerations, he still had his doubts. With Charles Kelley so focused on profits, such an orientation and culture had to trickle down into all corners of the hospital. He was sure of it.
It wasn’t until three-quarters of an hour later that Juliette was called, and by then Brian was fit to be tied. To him, as angry as he was and for having been forced to miss his wife’s funeral mass, there seemed to be no explanation other than that they were being overtly discriminated against.
To Juliette’s chagrin the nurse who greeted them wasn’t Olivia, but she quickly established herself as being equally as good with children. After leading them back to the same exam room they’d visited the day before, Nurse Jane pretended to take Jeannot Lapin’s vital signs as she took Juliette’s. And when Juliette asked for a hemostat to play with, Jane happily complied. She also acted impressed when Juliette demonstrated how well she could use the instrument by attaching it and releasing it at various locations on Jeannot Lapin.
“What’s the temperature?” Brian asked after the nurse took it. He made a distinct effort to keep his voice from reflecting his irritation.
“98.2,” Jane said happily. “Same with the rabbit.”
With this surprising news and despite his annoyance, it was time for Brian to roll his eyes, feeling mildly embarrassed as well as exasperated that the main reason for coming to the ED had vanished just as it had the day before. Of course, he was pleased the fever was gone, but he was also perplexed. Had she really had a fever or could the thermometer at home be malfunctioning? But then he reminded himself of the perspiration on Juliette’s forehead. That had been real, meaning something must have been wrong. Particularly because of his EMT training, he knew more than most people about symptoms and signs of disease, and a disappearing fever of 102.2 made no sense to him, nor did it make sense that Juliette’s sore throat had vanished when Jane asked her about it. The only symptom that remained was the headache. When Jane asked Juliette where she felt the pain and whether it was localized, Juliette motioned all over her head.
With the vital signs retaken, Jane said that the doctor would be in to see Juliette in a few minutes and left. Yet it was more than a few minutes; it was twenty minutes, long enough for Juliette to start crying, saying she wanted to go home, and long enough to allow his befuddlement to morph back to anger. In his mind, having been forced to wait three hours, two days i
n a row, couldn’t have been by chance. It had to be punitively deliberate, not to mention inconsiderate and unethical.
Suddenly there was a loud knock on the door and before Brian could respond, in walked an ebullient Dr. Robert Arnsdorf along with Jane. He was an athletic-looking physician, who Brian guessed was in his fifties, comparable in height with Brian but slenderer and with a bit of white hair protruding from beneath his surgical cap. A stethoscope was casually slung around his neck. Brian was relieved it wasn’t Dr. Kramer.
“Ah, I see Miss Murphy is a little unhappy,” Dr. Arnsdorf said friskily, seemingly for Juliette’s benefit. “What’s the problem today, my chickadee?” Without waiting for an answer, he looked down at his tablet and began reading.
In his agitated state Brian found the doctor’s breezy attitude and seeming unpreparedness galling rather than playful and certainly not endearing. Juliette didn’t buy it, either, and continued crying until Jane got her reinterested in playing with the hemostat.
“The problem is we’ve been waiting for over three hours,” Brian blurted out.
“Sorry about that,” Dr. Arnsdorf said simply. “Let me finish Dr. Kramer’s note.” After a moment he put the tablet down on the desk. “Okay, seems that we’ve had a repeat from yesterday: A phantom fever and sore throat along with a single episode of vomiting and diarrhea yesterday afternoon. Interesting.”
“I hardly think ‘interesting’ is an appropriate description,” Brian said.
“First, let me extend my sincere condolences about your wife,” Dr. Arnsdorf said, continuing to ignore Brian’s displeasure. “It’s entirely understandable that there have been psychosomatic symptoms, including a fever. But, to be on the safe side, let’s take a look.” He nodded as if agreeing with himself. Then after a brief wash of his hands, he quickly examined Juliette, starting by first looking into her mouth, throat, nose, and ears. He then listened to her chest and let her listen to his. Finally, he palpated her abdomen while she was lying on her back, managing to get her relaxed enough to elicit a little laugh. Brian watched the rapid exam and stayed quiet throughout although he already was concerned that the doctor had a low index of suspicion.
“You are in perfect health,” Dr. Arnsdorf declared to Juliette while playfully touching her on the tip of the nose with his index finger. He then turned to Brian. “I think she is fine, very healthy in fact. And I’m impressed with her size, having been a preemie. My guess is she’s out there on the positive side of the bell curve development-wise for her age.”
“What does her having been a preemie have to do with anything?” Brian asked. In his hypersensitive state, it seemed like a statement out of the blue, like trying to change the subject.
“Nothing, really,” Dr. Arnsdorf said. “The doctor’s note from yesterday noted Juliette was a tiny baby when she was born. We’ve seen a handful of Dr. Bhatt’s patients over the last couple of days. He’s a fine pediatrician. Did you meet him when he was a resident at Columbia-Presbyterian Children’s Hospital?”
“Yes,” Brian said. He relaxed a twinge, realizing he shouldn’t fault doctors for being thorough even though Juliette’s current situation had nothing to do with her spending the first month of her life in a NICU at Columbia. She’d been transferred there from MMH Inwood right after delivery.
“My advice if these phantom symptoms continue is to consider having her talk to a pediatric social worker,” Dr. Arnsdorf said, picking up his tablet as if he was about to leave. “Also, perhaps you should make an appointment to see Dr. Bhatt when he comes back after his vacation.”
“Wait a second,” Brian began. “I’m not comfortable assuming her symptoms are psychosomatic. She hasn’t been acting herself even before my wife’s passing, and this morning she woke up with a real fever. She had perspiration covering her forehead. Especially with this pandemic still going on and a second wave expected, I at least want her to have a Covid test. I’d also like to see if her blood count is normal.”
“I disagree,” Dr. Arnsdorf countered. “I agree with Dr. Kramer. Your daughter also complained of a sore throat, but her throat looks perfectly normal. Likewise, her ears. And her temperature at the moment is actually low, not high.”
“I want her to have some blood work,” Brian demanded, losing patience. “And a Covid test at a minimum.”
“The hospital is backed way up on its Covid testing,” Dr. Arnsdorf said with exasperation. He’d been making an effort to placate Brian but was beginning to resent his insistence.
“There’s something not right with my daughter. This is the second time in two days we’ve been here.”
“Calm down, Mr. Murphy,” Dr. Arnsdorf said, forcing himself to be calm as well. “We’ve been asked by our lab on a temporary basis only to do testing on patients with a strong indication, who have sustained symptoms, or have been exposed to someone with Covid-19, or are being admitted to the hospital. Your daughter doesn’t fit in any of these categories. Covid-19 symptoms vary from patient to patient, but they don’t come and go over a few hours in the same patient, not in our experience. As for doing a blood count or any other blood work, I don’t see any rationale whatsoever. Subjecting a child to a phlebotomy, which can be a traumatic experience, shouldn’t be done unless there is a strong indication.”
“Does your reluctance to do the little I’m asking have anything to do with this hospital suing me for the bill to treat my late wife’s EEE? Are you people all so damn worried I won’t pay whatever outrageous price you’ve put on these tests?”
For a second Dr. Arnsdorf stared at Brian in shocked surprise. “Absolutely not!” he said, finding his voice. “That’s an insult. You are one paranoid individual, Mr. Murphy.”
“Of course I’m paranoid,” he retorted. “It’s hard not to be paranoid in this day and age dealing with healthcare. Don’t tell me you aren’t fully aware that your CEO is one hell-bent profit-motivated individual intent on keeping prices high and costs low to justify his multimillion-dollar salary.”
“I’m a doctor!” Dr. Arnsdorf retorted. “I take care of people, not business.”
“That’s a cop-out if I ever heard one,” Brian snapped. “Yes, you are a doctor, and MMH Inwood is a hospital, which is supposed to be your house and not Charles Kelley’s gravy train.”
“I’ve had enough of this conversation.” Dr. Arnsdorf turned back to the sink and rewashed his hands before swiftly leaving the exam room.
Equally fed up and sensing he was getting nowhere, Brian turned to Juliette and scooped her up in his arms. He ignored Jane as she said goodbye to Juliette. On their way to the waiting room, Brian struggled to get out his phone, and while walking and carrying Juliette, he used Siri to call Camila.
“My, you have been there a long time,” Camila said immediately as she came on the line.
“Don’t remind me,” Brian said. “Can you come and get us?”
“Of course! I’ll be there shortly. How is Juliette doing?”
“She’s doing fine,” he said. “I’m the one who’s struggling.”
CHAPTER 30
September 2
Once Brian and Juliette were in the car, Camila briefly tried to get both to talk to find out what had happened, but it quickly became clear to her that neither was so inclined. With Juliette it was because she was busy getting the laptop out of the backpack to return to the DVD she’d been watching earlier. With Brian it was apparent from the outset that he was seriously irritated. In Camila’s experience, he rarely got upset, but when he did, she’d learned it was best to let him mull over whatever was bothering him, which usually didn’t take long. And true to form, by the time they drove out of the hospital grounds, he let out a protracted sigh and said with a shake of his head: “Well, that was another exercise in futility.”
“I’m sorry to hear,” Camila said. “What happened? What did they find?”
“Nothing,” Brian answered with
disgust. “But in their defense, by the time we were seen after another three-hour wait, once again her fever had vanished along with most of her symptoms. I think she still has a headache, but that’s it, and apparently even the headache is better. It clearly hasn’t hindered her from watching videos.” He glanced over his shoulder to see if Juliette was back to watching, and she was. “The doctors are convinced it’s all psychosomatic, fever included.”
“I suppose that’s possible,” Camila said. “Did they do any tests this time to make certain?”
“None,” Brian said. “That’s what irked me. I tried to get them to do even a routine blood test, but no go with the excuse they’re backed up with their Covid testing. It’s all very suspicious to me. I’m worried that they didn’t do any tests because they’re afraid they are not going to get paid since I already owe them so damn much money.”
“Do you really think that is a possibility?” Camila asked.
“I do,” Brian said. “Having to wait to be seen more than three hours two days in a row and then refusing to do anything I asked speaks volumes. And this morning when we first arrived, the triage nurse acted put out when I asked her to repeat Juliette’s temperature.”
“Next week Dr. Bhatt will be back.”
“Hallelujah,” he said. “I can’t wait.”
“By the way, a Grady Quillen stopped by and left you a large manila envelope. He said that you would know what it was about. It’s on your desk.”
“I do,” Brian said. “It’s a list of people like me and Jeanne who he’s served.”
When they pulled into the driveway and stopped, Juliette said she was hungry.
“How about you, Brian?” Camila asked as they all got out of the car. “Want to join us?”
“You guys go ahead. I’ve got to call my mom. I’m afraid Juliette and I have missed at least the funeral mass.”