by Robin Cook
Carlos pulled George aside while the technician got the ultrasound machine up and running next to Laney’s bed. “What should I be doing here? I feel like the odd man out.”
“Once Shirley starts the study, I want you to handle the probe yourself so you’ll have a better feel for how the study is done. Actually doing it will help your interpretation immensely. Just be patient! I felt the same way you did back when I was starting out.”
22
EMERGENCY DEPARTMENT
L.A. UNIVERSITY MEDICAL CENTER
WESTWOOD, LOS ANGELES, CALIFORNIA
THURSDAY, JULY 3, 2014, 10:41 A.M.
Clayton strode into the ER looking for George. When he didn’t see him, he went directly into the radiology imaging room. There he cornered another radiology resident who happened to be using the ER imaging room even though he wasn’t officially assigned to the ER.
“You know where George Wilson is?”
“I think so. I believe he’s performing an ultrasound in the back. Can I help you—”
Clayton walked off without a reply, clearly preoccupied. He went back out to the main desk and got Debbie’s attention.
“Could I have a moment to talk with you in private, Miss Waters?” Clayton asked. Although there was a comparative lull, the ER was still busy. The main desk was a beehive of activity.
“Of course, Dr. Hanson,” she said, and told one of the other nurses to take over. Debbie led Clayton back into a windowless storeroom and closed the door.
“Well, how was it?” Clayton asked, abandoning any pretense of formality. “As bad as you expected?”
“Pretty much. He’s boring. He drinks too much and can’t handle his liquor. It was like going out with a frat boy. I’m done with those days, Clayton.”
“It couldn’t have been all bad.”
“Actually, he seems like a nice enough guy. How’s that?”
“Better. How much do I owe you for the drinks?”
“Nearly a hundred.”
“One hundred! Christ!” Clayton handed over the cash. “You must have drunk up a storm.”
“I didn’t. He did. And I had to do all the talking.”
“He’s still grieving,” Clayton said impatiently. “His fiancée just died, for God’s sake. As far as I know, this was the first time he’s gone out. Be a little more sympathetic! More important, what were you able to learn?”
Debbie frowned.
“Okay, I’m sorry,” Clayton apologized. “I appreciate your making the effort. Just getting him out was a big positive. Thank you.”
“I did it for you. Just remember that.”
“I do, but what did you learn? What was his response to DeAngelis’s death? Is he taking it in stride or not?”
“The jury’s still out. One thing that I did learn was that he saw you going into the morgue. He was trying to get a look at the body, but he was turned away.”
“Shit! That’s inconvenient, him seeing me. I didn’t see him.”
“What were you down there for?” Debbie asked.
“It’s not important,” Clayton replied. “Administrative stuff.”
Debbie shrugged. “There is more. A couple of things are bothering George about his neighbor’s death. The first is that he’s worried that the dead guy’s sisters haven’t been notified.”
“I’ll make sure that happens.” Clayton hadn’t been aware that DeAngelis had relatives. “What else?”
“The other thing is the gossip about suicide from the ‘self-inflicted’ wounds.”
“Well, that’s not so good.”
“He also said something about wanting to know which of the ER residents was in charge of DeAngelis’s case.”
“Did he say why?”
“He said he wanted to inquire about the self-inflicted wounds.”
“Did you tell him which ER resident was involved?”
“No, and I don’t think he is going to remember about last night. He was three sheets to the wind. Why do you care what he thinks, anyway? I didn’t get the impression that he and his neighbor were really friends. They had nothing in common.”
“In terms of what you know, less is better, Deb, trust me. Did you guys talk about iDoc?”
“A little. I think everything is okay in that department. He said he thought iDoc was a big plus for DeAngelis.”
“Well, that’s good,” Clayton said. “Listen, I really appreciate your help in this. I want you to continue seeing George socially, to keep track of what he’s thinking and doing about DeAngelis’s death.”
Debbie’s eyes narrowed. She wasn’t happy. “I thought that this was going to be a onetime mission.”
“I need to continue to monitor his mind-set. It’s not like I’m asking you to do anything onerous, and I’ll pay the tab.”
“You promised me we would get together! You and me!”
“We will. We will. What about this weekend? It’s the Fourth of July holiday. That might work.”
She looked at him askance, as if she didn’t trust him.
“Just let me look at my schedule, and I’ll get back to you. But . . . it is important that you keep tabs on George for me. I want to know if he is going to keep stirring the pot about his neighbor’s death.”
“All right!” she grumbled, though she wasn’t thrilled. At the same time she knew she would do just about anything to win Clayton back. She had been devastated when he had moved on from their short but intense affair.
23
EMERGENCY DEPARTMENT
L.A. UNIVERSITY MEDICAL CENTER
WESTWOOD, LOS ANGELES, CALIFORNIA
THURSDAY, JULY 3, 2014, 10:56 A.M.
The ultrasound test on Laney progressed smoothly. Carlos was a bit tentative at first but quickly gained confidence. On the monitor they could see the clear image of a baby boy. George made sure that Laney could see everything, too, since the child meant so much to her.
All of a sudden George and the technician saw something that made them both start. George immediately rotated the monitor so that it was out of Laney’s line of sight. Both Laney and Carlos sensed the change in atmosphere.
“Is there anything wrong?” Laney asked anxiously.
“No, everything is fine,” George mumbled as he motioned to Carlos to hand over the probe. Surprised but happy to oblige, Carlos gave it to him and stepped aside. George moved the probe’s tip to Laney’s left side while staring at the monitor to guide him. He pressed in firmly, moving the tip in small arcs, and kept it up for almost five minutes. “Okay,” George said finally, lifting the probe off Laney’s abdomen. “All done. We have what we need, Laney. Now, just try and relax! There will be a wait for the OB consult because of so many deliveries. They’re knee-deep in newborns up there,” he added, smiling weakly.
The metaphor fell flat. Laney was in no joking mood. She watched George closely as he handed the probe to the technician. “Take advantage of the quiet and get some sleep if you can,” George added. He knew the medication they had given her to alleviate her stomach pains would have a sedative effect.
Turning to Carlos, George said, “Help Shirley clean up, then meet me in the imaging room.” He gave Laney a quick smile and a reassuring squeeze of her arm, and then left.
George retreated to the imaging room to be alone for a few minutes. He was stunned at Laney’s bad luck. It seemed unfair that she had to endure such horrific medical problems.
A few minutes later Carlos joined him. “So what’s up? I saw your reaction. What did you see?”
“Grab a seat,” George said as he pulled up the study on the monitor. He zeroed in on the fetus’s head. At first Carlos couldn’t see the problem. “Look at how much the fetus’s head is distorted,” George said, using a pen as a pointer. “Look how it slants back right above the orbits. Do you know what that means?”
“Not really,” Carlos responded.
“It’s a condition called anencephaly, meaning essentially no brain and probably no spinal cord. There’s no hope. It’s tragic, especially with Laney’s reluctance to have an abortion, but this changes everything. Her life is too much at risk to give birth to a child who will either be stillborn or die within days of birth.”
Carlos nodded in understanding as he stared at the image on the monitor, digesting the terrible implications.
George got up and went to look for Kelley. He found her busy suturing up a laceration. At his insistence she stepped out into the hall, keeping her gloved hands clasped to her sterile gown as George explained the bad news.
Kelley was stunned and dismayed. “The poor woman. Can you go back and tell her?”
“Sorry, but I don’t think that would be appropriate. That’s the purview of the doctors taking care of her, meaning you or your resident. Actually, the diagnosis is not official until it is read by an attending. I’m sorry. Of course you could wait for the OB consult to tell her. It’s your call. You and your resident.”
“I have several more lacerations after this one.” It was clear she wanted help.
“Talk to your resident when you’re finished. I hope you understand; information like this is not for the radiologist to give to the patient.”
“Okay, I understand,” she said reluctantly. “I’ll let my resident know. My guess is that he’ll want to wait for the OB consult.”
“Whatever! But it’s important for the OB resident to know the results of the ultrasound before seeing Laney.”
“Of course,” she said.
“I could handle that part for you if you want.”
“That would be great. Thanks.” She tried to smile but her lips twitched.
“What I’ll do is get a radiology attending to review the case immediately so that it will be part of the record. That way, when the OB resident comes down, it will be available. But I’d still like to talk to whomever it is first.”
“Got it,” Kelley said, then added, “In some respects this could be a blessing in disguise. With the condition of Laney’s heart, I doubt if she would live through giving birth. Do you think the OB people will now be able to convince her to have an abortion?”
“We can hope.”
“God! What a tragedy. As a woman, I can really relate.”
“I can well imagine. I’ll get the final read on the ultrasound and we’ll go from there.”
“I appreciate your taking the time to come and tell me. Thank you.”
“You’re welcome. My pleasure. By the way, I happen to think you are doing a bang-up job after being here only two and a half days.”
“Thank you again.”
“I mean it,” George said. “Now, get back to your suturing. We’ll talk later.”
George poked his head into the imaging room and got Carlos’s attention. “Everything hunky-dory?”
“No problems, boss,” Carlos reported cheerfully.
“I’m going to get an attending to sign off on the ultrasound. Text me if there are any problems.”
Carlos gave a thumbs-up.
Back in the ER proper, George saw Debbie carrying on as usual at the main desk. As he passed, he caught her eye, and to his surprise she actually smiled back. Maybe he hadn’t done anything to upset her last night, after all.
There were a number of radiology attendings who could sign off on Laney’s ultrasound, but Clayton, an authority on ob-gyn imaging, was probably the best. For George it represented a degree of irony, considering the man’s womanizing. He made a beeline for Clayton’s secretary. “I need to see Dr. Hanson.”
“He’s finishing a cardiac catheterization. I can tell him—”
“That’s okay. I’ll find him. Thanks!” George knew the cath room Clayton preferred. Just as George approached, he was snapping off his sterile gloves.
“George!” Clayton said. “What brings you to this neighborhood?”
“I was hoping you had a moment to look at an ultrasound on a gravid young woman in the ER. I’d like to get it into the record before she has an OB consult.”
“Sure. I have a moment right now.” He waved for George to follow. “How many months pregnant?”
“Around seven,” George said. He then gave an encapsulated version of Laney’s case, including what he thought the ultrasound showed.
“Geez,” Clayton commented. “Poor thing!”
They went into an empty reading room. George sat down at one of the terminals and began entering Laney’s hospital number.
“I ran into Debbie Waters earlier,” Clayton said. “She said she had a really good time, which I was pleased to hear.”
George was skeptical. “Did she actually tell you that?”
“Of course. She had a good time and looks forward to doing it again. You are in luck, as I happen to know she is in between boyfriends.”
George was frankly disbelieving. “She barely gave me a sideways glance this morning. I admit I had more to drink than I should have. I was worried that I had offended her.”
“She didn’t mention anything other than she had a good time.” Clayton pulled over a chair and sat down to watch as the video of Laney’s ultrasound began. He watched it several times, freezing the frame at key points. Finally he said, “Unfortunately I totally agree with your impression. Definitely anencephaly. For sure the fetus is doomed. I’ll sign off now.” As he did so he added, “They’ve got to get her to abort. No sense risking the mother’s life.” When he was finished he turned to George. “Done. Anything else?”
George shrugged. “That’s it. I appreciate your time. Thanks.”
“Glad to be of help.” Clayton smiled and stood up. “But don’t let Debbie Waters’s workday persona put you off. I’m telling you, she had a great time last night. And tell me the truth: Did you enjoy yourself or what?”
“I did. She is very personable outside of the ER.”
“There you go,” Clayton said. “You follow up on her. She has talents you wouldn’t believe.” Clayton clapped George on the back. “Always looking out for you, buddy.”
George beat a hasty retreat back to the ER. After what Clayton had told him about Debbie, George wanted to catch her before her lunch break. He was in luck. There was a relative calm in the ER activity.
“Hey there,” Debbie said, grinning as she saw him approach. “Where have you been this morning?”
“I’ve been here,” George said. “You didn’t see me?”
“No, but I’m not surprised. It’s been hectic. I wish this heat wave would let up.” She cupped her hands around her mouth and leaned toward George over the countertop. “How do you feel?”
“A little worse for wear,” George admitted. “Sorry I drank so much last night. I hope I didn’t say anything inappropriate.”
“You were a perfect gentleman. We have to do it again. You game?”
“Yes, but with a lot less booze.”
“Now, what can I do for you, or are you just saying hello?”
“There is something specific. I think it would be a good idea for the OB consult on Laney Chesney to come see me first. The fetus has anencephaly.”
“Ouch,” Debbie said in dismay as she wrote down the request on a sticky pad. She glanced around to see if anyone was watching them. No one was, so she added: “I really did enjoy our evening together. You were gracious to all my friends, which I appreciated. I do hope we can do it again soon.”
“Me, too,” George said, though in reality he wasn’t entirely sure he was up for a repeat.
He headed back to the imaging room, where Carlos was going over a new batch of films to review. As there were no surprises, at least according to Carlos, George suggested they put them off until after the radiology conference.
24
EMERGENCY DEPAR
TMENT
L.A. UNIVERSITY MEDICAL CENTER
WESTWOOD, LOS ANGELES, CALIFORNIA
THURSDAY, JULY 3, 2014, 1:14 P.M.
George walked back into the emergency room. He wanted to find Kelley and check Laney’s condition. The ER was really busy, not quite as bad as it had been early that morning, but with the heat wave still going strong it was busier than usual for the time of day. Kelley and all the other ER doctors were just trying to keep their heads above water. It took George a few minutes to locate her and ask if the OB consult had seen Laney. He had expected to have been paged if the consult had shown up, but it hadn’t happened.
“They are still busy upstairs, so not yet, but the resident slotted to do the consult called about fifteen minutes ago and said that she would be down within the hour. They’re wrapping up a couple of final deliveries.”
“Did you tell Laney . . . about the ultrasound result?” George asked.
“My senior resident did. I just couldn’t handle it. But he did a good job, and it was a good learning experience for me. She took it better than I feared.”
“I hope you don’t feel that I copped out.”
“Not at all. I understand. Actually at one point I thought about going into radiology to avoid such situations. We’re doctors, but we’re human, too. But in the end, the drama of ER medicine was too much to pass up. I felt that after all those years of schooling I wasn’t about to shortchange myself.” She stopped and glanced up at George. He had stiffened up on that last comment. “I’m sorry. I didn’t mean it like that.”
George put up his hands. “Don’t apologize. I’m not offended.” But in truth he was, a little. He took a step away but then turned back, remembering something else. “One more thing. Do you know offhand which of the ER residents was in charge of DeAngelis’s case?”
“I don’t know, but I can find out.”
“Please do. I want to ask about the self-inflicted wounds.”
“I’ll find out the name for you.”
“Thanks. Hope you guys catch up before the evening commute.”
Kelley nodded before heading back into the fray.