by C. J. Zahner
“Hence, the reason my malpractice insurance premiums are so high.” She ran the edge of her hand along a lopsided pile of papers on her desk, subconsciously lining their ends, forcing them into a perfect stack.
“Exactly. I do believe their expert witness will find you used reasonable care. Should be clear to them from the get-go that negligence will be hard to prove. Her attorney knows his chances of making a lot of money on this case are slim, so he’ll want to settle.” He jiggled the knot of his necktie upward and winked. “It’s a little like poker, playing the odds.”
“So, I won’t have to testify?”
He released his tie and grimaced, moving his head back and forth in contemplation.
“They’ll probably depose you, but don’t worry. We’ll go over the questions they’ll ask. We’ll be prepared.”
“I want to be prepared.” She understood the importance of preparation. She’d practiced until her voice was hoarse for interviews out of med school. It was easier if you rehearsed. “Over prepared.”
“You will be.” He removed his glasses, slumped his shoulders, and put one hand in a pocket.
“Emma, I want to change direction, but I’m not sure how to broach this subject with you.” He hesitated, pinched his nose, sighed, looked down, and said, “I think Matt McKinney has feelings for you.”
Her gut reaction was that if true, his behavior would be incestuous. He’s not my brother. He’s not my brother.
“You’re wrong,” she said, trying to sound firm. “He’s dating Heather Richards.”
“She left two weeks ago. Began a new job in Georgia.”
Emma sat up in her chair and tried to look surprised. Truth was she knew it. Her friend Carol had told her. Not that it mattered. She wasn’t sure why she hadn’t told Giff. It wasn’t like she believed Matt was in love with her.
“Now I need to ask you something, Giff.” She bit her lip and changed the subject. “Can they bring up the fact that I wondered if they were my birth family? If I’m called into a deposition, I am under oath, right?”
“Yes, you are.”
“I’ll have to admit I thought I might be a McKinney. They’ll say it skewed my judgement.”
“Did it?”
“I don’t know.”
“Then let’s get out those transcripts and go over them until you do know.” He put his glasses back on and leaned onto her desk. “We are going to have Ally read the files and Rebekka read the files and Doctor Cameron read the files, and they are going to come back and say you did everything accurately.”
“What if I don’t believe it?”
“Then you are going to read their statements and review your records over and over until you can raise your right hand and state, with unwavering certainty, that you followed reasonable procedures. Because, Emma, you went above and beyond providing standard care. Everyone knows that, and by the time you get to your deposition, you’ll know it, too.” He winked and nodded at her. “Trust me.”
She closed her eyes and tilted her head backwards. “But what if this really is my fault?”
He reached around and put his hands on her forearms.
“Look at me. Mary’s suicide isn’t your fault. Some people can’t be helped. No matter what you do for them, when it comes right down to the wire, it’s all about their choice.”
But Emma knew that was only partially true. In the final hour, it was about choice, environmental influences—and genetics.
Chapter 37
Wednesday, June 17, 2015
Game changers.
A week later, Emma’s own choices weighed her down as she pushed her mom through the halls of St. Mary’s. A physical therapist had asked if she wanted to extend her mother’s stay for additional rehab. Ralph Cameron had called to see if she was interested in applying for a psychiatric position opening at UPMC. Giff wanted to know if it was okay to book August reservations in Pittsburgh for his family reunion. Doctor Christy was waiting for her yes or no to medication.
And she was having an awful time signing her divorce papers.
Josh had dropped them off, and with her world swirling like a carnival ride, apprehension twisted her. She roamed St. Mary’s halls with the absent stare of a child—already too long at a park—trying to choose her next ride. And she hated amusement parks. Didn’t like the sticky cotton-candy asphalt, deafening game bells, creepy clowns, and rickety old roller coasters speeding up and slowing down over wobbly track, her hanging on for dear life.
She clenched her mother’s wheelchair as if the grips were a ride’s lap bar, and she pleaded with life not to eject her from her seat. She wished her withering frame could settle into space on a sluggish, smooth ride that never left the ground, like a train. She pushed her mother down one hallway and up another listening to her sweet voice, comparing their stroll to that train ride.
At St. Mary’s, life was slow. Maybe not as bad as once perceived. Not as good as living an independent, healthy life, but the nursing home was safe and peaceful and a good place to mend. Every few minutes, Heidi stood from her wheelchair and took a few steps like the doctor ordered. Determination ran in her mother’s family. Not mine.
She sighed. Everything led back to life’s secrets. She trudged toward her mother’s room, the full day ahead bringing her pensiveness to a screeching halt. She helped her mom into an easy chair by the window.
She noticed them then—the flowers on the sill.
“Mom? Did Dad send you flowers? How sweet.”
“No, I thought you knew,” she replied, tugging the corner of her overbed table toward her, lifting her water cup, and sipping. “Josh sent them.”
“Josh?” Emma turned abruptly.
She ambled to the rose and lily combo, sniffed its scent, and removed the little card, fully expecting her mother was confused. Words in Josh’s handwriting jumped at Emma: Mom, hope you are feeling better. Love, Josh.
Emma stood stunned for a moment and then gently placed the card back in the envelope and turned toward her mother. Heidi said nothing. Emma turned away. It was the first time Josh had sent her mother flowers, and the first time he had called her Mom.
Chapter 38
Tuesday, July 7, 2015
Opening moves.
On a muggy Tuesday morning, a certified letter arrived. Minnie had filed a formal complaint. Fifteen minutes after Sharon scribbled her signature and yanked the mail piece form the carrier, Ally, Rebekka, Sharon, Giff and Emma gathered in a front-office scrum around the pithy parcel to assess the damage. Sharon ripped the edges off and pulled out the pages. Emma tried to pry them from her, but Sharon refused. She began reading.
“ ‘Minnie McKinney, executor for the estate of Mary McKinney, the plaintiff, versus Doctor Emma Kerr, the defendant, in Erie County.’ ” She hesitated to read silently. The others huffed and moaned.
“Okay, okay, it says a bunch of general crap before getting to the allegations.”
Emma couldn’t stand her hesitation; she snatched the document from Sharon at a weak moment. Sharon sighed, defeated.
“ ‘On October 29th Mary McKinney became a patient of Doctor Emma Kerr’s.’ ”
“They must prove there was a valid patient-doctor relationship,” Giff explained. “There was.”
Emma continued, “ ‘Doctor Kerr failed to act with reasonable care and was negligent in the employment of proper counseling procedures. Doctor Kerr failed to prescribe the proper medication to the plaintiff.’ ”
“That’s bullshit.” Sharon crossed her arms and clamped her lips together into a sagging half moon.
“ ‘Doctor Kerr failed to adequately notify the McKinney family members of the gravity of the plaintiff’s depression…failed to obtain informed consent… failed to listen to plaintiff…failed to schedule adequate sessions…failed to keep adequate records.’ How many complaints can they make?”
“As many as possible,” Giff told her. “So the insurance company is more apt to settle.”
“ ‘Failed to re
cognize prescription drug abuse.’ Seriously?”
“Are you kidding?” Sharon interrupted. “They wouldn’t take anything. I felt like writing them a prescription myself and forcing it down their throats when they played musical chairs on the days they waited for each other.”
Sharon bent over her desk and grabbed her cigarettes, pounded them angrily against her wrist. “They needed drugs but refused everything.”
“Oh, you’ll like this, Sharon. Something for you.” Emma plucked a tissue from the box on Sharon’s desk, patted her wet face and then tossed the tissue in the wastebasket. “ ‘Failure to establish proper office standards for staff.’ ”
“What?” Sharon ripped the complaint from Emma with her free hand. “After I put up with all their shit? I’ll give them proper office standards.”
“It’s a formality.” Giff reached and snagged the document from Sharon, ending their little legal assembly line. “We’re done. I’ll contact your insurance and help prepare the reply.”
Giff took a step back, folded the complaint into its envelope, and tucked it in an inside suit pocket. Rebekka, Sharon, and Emma realized they were still huddled together. They separated quietly.
“What are the next steps?” Sharon hollered to Giff as he stomped out the door.
None of them understood his response, but all of them knew what he meant. The game had begun.
“Shuffle, cut, burn.”
Chapter 39
Sunday, July 19, 2015
Practice.
With its renovations completed, Giff’s second-floor conference room flaunted a formal, regal ambience that made Emma uncomfortable. The chandelier was too big. The crown molding, too ornate. The walls, too white. From the recently-hung fifty-five inch TV to the newly-mounted guest internet-access plaques beside the node power outlets, every inch of space cried efficiency, yet solemnity. The room’s sharp angles cut into her mind, and piercing thoughts slipped in and out of her head like a needle on fabric: No hang-up calls in three months. Mary, dead for two. The peeping Tom, still lurking. Not a word from Mathew McKinney.
Giff talked, but she couldn’t hear him. Her mind spewed memories, a conveyor belt of facts that never stopped coming: April 8, Minnie said her grandmother hadn’t killed her sister. April 15, Mary wanted to know what Minnie said about the baby. April 22, Matt said both Melissas were murdered. April 25, Minnie said Mary gave her ring away. May 4, Mary said she didn’t. May 10, Mary dead.
“Did you complete a suicide risk assessment?”
Giff’s raised voice reminded her this was important. She was practicing for the deposition.
Her gaze shot toward him. He didn’t look like himself. His edgy reading glasses—not his cheap ones, his deposition ones—were perched firmly on the end of his nose, and he flaunted a calculated, cold business mien even in jeans and a t-shirt. How intimidating it was going to feel to answer questions in a different office from an unfamiliar attorney clad in suit and tie. His case notes in front of him. Her career at his fingertips.
“Emma, did you complete a risk assessment?” When he repeated the question a third time, his voice was nearly a shout.
With another brief hiccup in concentration, she decided he must intimidate his clients a bit.
“Yes, I did—several.” Her own emphatic tone surprised her. But he had drilled the response into her, hadn’t he? “They had a family history of suicide; however, both twins stated they were not contemplating killing themselves. Mary said she and Minnie would never commit suicide.”
“Were there warning signs?”
“Some. I noted them.”
“Were these new signs?”
“Not really.”
“Stop.” Giff held up his hand. “Remember? Say no.”
She cleared her throat. “No, not new. The twins did not exhibit—”
“She,” he corrected. “Only refer to Mary.”
“Oh, right. Mary did not exhibit any new signs. She did draw up a will along with her sister and several coworkers.”
“But the family did not take exception to her drawing up a will.”
“I’m not sure.”
“Emma, neither Mel nor Minnie were concerned enough to mention the will in their summaries. Your insurance attorney will argue they did not take exception.” He adjusted his glasses. “Did you witness any expression of intent?”
His abruptness was nerve-wracking. She didn’t know if she liked this Giff.
She winced. “No.”
“No facial expressions.” He shook his head. “Remember, straight face, simple answers.”
“Sorry.” She nodded rapidly, relaxed her face. “No identified intent—I feel more comfortable saying identified—no display of hopelessness, expression of remorse, self-harming behaviors.”
“Then what made you scowl?” He sat back, smoothed his paper on the table with thick, straight fingers, and laid his glasses on top of it. He folded his hands. “Just between you and me.”
What had made her scowl? The McKinney oddities or Giff’s unyielding sternness?
“I don’t know. Those twins were so odd I had to constantly evaluate low-risk factors.” She decided to respond.
“Give me an example.”
She fixed her eyes on the glass crystals of the chandelier and thought for a minute. “They couldn’t say the word suicide. Blessed themselves anytime anyone mentioned it.”
“Did you factor that into your assessment?”
“Yes, I researched psychological word aversions. Noted it as a low-risk factor brought on by past trauma. The evaluation is in one of my summaries.”
“Good.” She watched him go back into character. “Did you communicate risk factors to family members in writing?”
“Always. I provided a care plan.”
“A care plan?” He placed his glasses back on the end of his nose.
“Yes. I advised Mel and Matt to remove all firearms in the twins’ apartments and to complete a family risk assessment of each twin monthly, identifying changes in behavior, physical or mental aggression, disruptive behavior.”
“Did they remove firearms?”
“No, they both laughed. Said the twins had a repugnance to guns. I noted it.”
“Did they complete the monthly assessment?”
“Mel did faithfully, and nothing ever jumped out at me.”
“Strike the nothing jumped out at me. Say she never identified major concerns.”
“Mel and Minnie never identified major concerns on assessment forms—I feel comfortable saying that. However, they did call about the ring.”
“Don’t offer that information unless they ask. Neither wrote anything down about Mary giving Ruby that ring. Any other risk considerations?”
“But, Giff, Mel confirmed to Doctor Christy that Ruby had Mary’s ring.”
“Number one, you are not supposed to know that. Number two, Mel is not listed on the complaint. We are not sure she believes Minnie. Didn’t she say Minnie frightened her?”
“Yes, she said—”
“Then don’t bring up the ring. If they depose Melanie, she may not either unless they ask specifically and then your insurance attorney will argue Minnie could have given that ring to Ruby. Mel admitted Ruby cannot tell them apart. Now were there any other risk considerations?” His voice rose and fell with irritation. He appeared downright angry with her.
She sunk her front teeth into the skin below her bottom lip, glanced away from him, and tried to squelch the feeling that she did not know this man sitting across from her. She forced herself to pondered other concerns about Mary. “Yes, some. I’d have to go back and check my summaries—”
“Stop.”
“I mean, if there were any low-risk factors, you’ll find them noted in my summaries.”
“If there were any?” He tilted his head, hesitated, and then finally, she witnessed a small inkling that the old Giff still lingered somewhere inside that stern being staring back at her; he winked. “Perfect.”
He sat back. “Will any other issues ‘jump off’ those summaries?”
“Mary’s preoccupation with IQs and Minnie’s obsession with Ernest Hemingway.”
“Strike Minnie’s obsession—again, if they don’t ask, don’t offer,” he said. “Never lay your cards on the table.”
“Spoken like a true poker player.” She squeezed out a smile. She didn’t like that she felt awkward around him. “You said poker players make the best attorneys.”
“They do.” He reached across the table and laid a cold hand on hers.
She forced a smile. He winked again and then withdrew his hand. She watched him curve his long backbone into his seat and relax. She attempted to do the same.
They had contacted a law-school buddy of his who worked strictly with medical malpractice claims. That friend hand fed them the biggest blunders he’d seen and insisted as long as Emma hadn’t breached reasonable care that led to the suicide, they had nothing to worry about. His friend’s best advice to Emma had been practice for the deposition.
She’d complied. This was their second mock deposition after dozens of dialogues at home, in the car, on the phone, and during runs. She hoped it proved a waste of time.
“There was no negligence.” Giff broke the room’s silence and looked Emma straight in the eye. “You did everything right.”
“I pray they don’t call about a deposition,” she said.
But they did.
Chapter 40
Sunday, July 26, 2015
Overtime.
She thought her lack of patience—her inability to remain focused as the game lingered on—might be her demise in the end. Not this fruitless lawsuit. Her insurance carrier protected her assets. Who protected her mind?
Sleep fought her. Giff annoyed her. The days passed like the pages in a long, technical medical book—slowly and painfully. On Sunday, they sat down for a final, formal practice after church, Giff in a tailored suit, Emma in the dress she would wear. The plaintiff’s attorney had scheduled an August deposition.
“Emma, you’re prepared.” Giff’s attire hugged him perfectly, not a crease befell him. She had more wrinkles around her eyes than he had in those clothes. “A deposition is nothing.”