“Someday,” Jason said, “I’d like a home in the hills. I never tire of the view.”
“How long have you known Mike?”
“We trained at UC for three years. We ran together for a while.”
“Ran together?”
“You know, tennis, parties, and dates. Mike’s a great guy, and now with Lisa, a lucky one, too.”
“Well, if I were you, Doc, I wouldn’t depend on luck, tonight.”
“You’d better talk nice to me, Phoebe, or you won’t get me into bed.”
“Oh, yes I will,” she smiled.
Three months later, Phoebe and Jason moved in together. Although they were in love, Phoebe hadn’t lost her unique outlook on life. Lisa and Phoebe remained as close as ever and the couple became close friends.
Lisa couldn’t wait to be with Mike at work or at home. She’d flush with emotion each time he appeared, and sensed that all was right in the world. In contrast, when he was absent or late, she’d worry. It’s stupid—ridiculous, and useless, she thought. The legacy of life with father that she’d overcome someday.
Those were the moments that brought forth her worst fears, and she remembered Madame Helene, her crystal ball’s view of Mike, and the despair in her eyes.
Lisa shared her fears with Phoebe who, she knew, would have a few choice words for fortune tellers and crystal ball readers, yet Phoebe’s reaction surprised her.
“Life gets to us in one way or another,” Phoebe said. “I used to think that if you watched TV and paid attention to the news, that you’d conclude our lives are full of misery and strife. It isn’t that way. Then, if you took the time to look closely at the lives around you, agreeing with Thoreau would be easy, that most people ‘lead lives of quiet desperation’.”
“Where are you going with this?”
“I don’t know, but for me, it’s a matter of choice, and as long as I can choose, I choose to think that I love you and Mike, I love Jason, and I love my family. I don’t know how long any of us will live, or if I’ll lose someone’s love, so I choose to enjoy it all, to stay in the moment, and not fret about what might happen in an uncertain future. Convince me that anguish can change the future, Lisa, and we’ll worry together.”
Chapter Twenty-Five
After a year, Lisa and Mike decided to forsake convenience for lifestyle, and moved to a home in Pleasant Hill, twenty-five miles from Brier Hospital. Their early hours put them ahead of the commuter traffic, and gave them a house in the country with plenty of outside space for a family.
Mike and Lisa had grown up with dogs, so after a visit to a local animal rescue operation, they returned with Daisy, a twelve pound, one-year-old terrier mix. It was love at first sight.
Lisa had always wanted children of her own, as did Mike, but after trying for six months, he said, “It’s time to find out why you’re not getting pregnant.”
“I hate the poking and prodding,” Lisa said, “but I expected to be with child by now.”
She went to her gynecologist, Harvey Russo, who examined her and ran some routine tests. Everything was normal.
Harvey Russo was the last of his generation of obstetricians/gynecologists (OB/GYN) who still delivered babies. At age sixty-two, when most OB/GYNs dumped the OB part of their practice on the younger physicians in the group, Harvey refused to abandon the activity that had drawn him to the specialty in the first place.
The son of an Air Force master sergeant, he’d grown up on military bases around the country, but the Alameda Naval Air Station had been the family’s longest stay in one place.
Harvey went to Berkeley High, and then entered the University of California, Berkeley campus, in the midst of the student unrest of the 60s.
Far more liberal than his father, Harvey participated in the demonstrations, but refused a student military deferment.
Harvey, the son of a career NCO, excelled in Basic Training, especially in hand-to-hand combat. He thanked his father for his insistence on years of Martial Arts training. Afterward, he enjoyed nine months in Austin, Texas, training to be a combat medic, and then spent the next year in the Central Highlands of Vietnam. He’d grown to hate the war, the deaths, and devastating injuries to so many young men, and despised the victimization of the indigenous Montagnard tribesmen by Americans, as well as the Vietnamese governments, both north and south.
Harvey worked as a corpsman for Eddie Hawkins, a West Virginia OB/GYN, drafted into the Army, made an officer by act of congress, and sent to Vietnam as a battalion surgeon.
“An obstetrician is an interesting choice for your job, Eddie,” Harvey had said.
Eddie smiled. “Never doubt the wisdom of the US Army.”
“I hate this war, Eddie. What keeps me going is helping our guys and working the Civil Action Patrols (CAP) with you.”
The CAP’s allowed them to helicopter into Montagnard villages to treat the injured and sick. It was a useful, but dreadful business; an awkward meeting of Iron Age and modern culture. Simple medical and dental treatments often earned the kind of appreciation that American sought, but rarely achieved in other venues.
Harvey’s epiphany came on one CAP when a Montagnard woman dragged them into a smoke-filled hut that sat on stilts where a thirteen-year-old girl had been in labor for three days. It was only through the authoritarian demands of their translator that the women permitted Eddie to examine the girl.
“This is a big baby, in the breach position. If I can’t get this baby in the right position and out soon, they’re both going to die.”
“Tell me what you want me to do,” Harvey said.
“Get me a sterile scissors, antiseptic, and a local anesthetic. We need to do an episiotomy to make room for the baby.”
Harvey watched in awe as Eddie applied gentle traction to the baby’s hips, then manipulated and delivered the shoulders, one at a time. “Here’s where I need you, Harvey. I want you to feel her belly. Find the baby’s head, and push as I deliver it.”
Harvey pushed with gradually increasing force, until Harvey shouted, “Enough, Harvey. I don’t want it to pop out. I’ll do the rest.”
When Harvey moved to look over Eddie’s shoulder, the baby’s head slowly, but fully, emerged. Seconds later, the baby coughed, and then let out a loud scream.
“That’s incredible,” Harvey said. “I’ve never seen anything like that before. I think I’ve found my calling.”
Harvey used the GI Bill and loans for medical school. The Army offered to pay his tuition if he’d serve a year for each year they’d paid, but he declined their ‘generous offer’. Two years in the military was enough for a lifetime.
His path was clear from day one of medical school. Following graduation, they accepted Harvey in the OB/GYN program at UC Medical Center. Afterward, he took a position in Berkeley with Clarence Potter, the OB who’d delivered Moses. In ten years, he’d be senior physician in the group.
“Six months is early to conclude that you have a problem,” Harvey said to Mike and Lisa as they sat across from his desk. “Let’s give it another six months.”
“Is there anything else we can do now?” Mike asked.
“You guys know all the tricks, don’t you? Basal body temperatures, timing of intercourse, attention to ovulations, positioning, etc. Do you know when you ovulate, Lisa?”
“Yes, I can usually tell.”
“Well, if there’s any problem there, we have ovulation kits and some new high-tech stuff that can pinpoint nearly the exact time.”
“The phone’s for you, Dr. Cooper,” the NICU ward clerk said.
When Mike picked up the earpiece, he heard Harvey’s voice. “I have a patient, Marla Mayfield, who’s in labor at 24 weeks, and,” he hesitated, “I think she’s going to deliver a preemie soon if I can’t stop her labor.”
“That’s what I do, Harvey. I’ll be there when she delivers. Is there anything else I need to know?”
Harvey’s hesitation caught Mike’s interest.
“What is it
?”
“This may be terribly unfair, and don’t quote me. Marla and her husband, Donald, are personal injury attorneys, specializing in medical malpractice litigation.”
“That’s great, Harvey.”
“Well, at least you know it up front. Get ready to dot your I’s and cross your T’s.”
Mike knocked on the door of Marla Mayfield’s private room, and then entered.
Marla, a beautiful woman in her early thirties, laid in bed with a fetal monitor on one bedside table, and flowers on the other. Marla substituted a shiny designer nightgown for Brier’s blue striped hospital gown.
Donald Mayfield, a handsome, tall man, in a dark-gray pinstripe suit, rose to greet him. “You must be Dr. Cooper. We’ve heard good things about you and the NICU that you and your partners run.”
Mike met Donald’s aggressive grip with a crushing one of his own, looked down at the man, and then approached the bed. “How are you feeling, Mrs. Mayfield?”
“Please, call me Marla. I’m feeling better now that the contractions have eased.”
Mike glanced at her slightly rounded abdomen. Clothed, nobody would even notice her pregnancy.
He pulled a chair next to the bed. “Harvey’s been through this situation with you. I want to know that we’re on the same page.”
“Go ahead, Doctor,” Donald said.
“Harvey’s going to do everything he can to prolong this pregnancy. Every day, every week, gives your baby more of a chance to survive, and to come through this unscathed. I don’t know how much you know about what we call Extremely Low Birth Weight Infants (ELBW), but those babies are born too early, and have poor mechanisms for survival.”
“Let me stop you for a moment, Doctor,” Donald said. “It would surprise me, considering the doctors’ underground network, if you didn’t know that we make our living suing physicians. We go through this eventually, in anything more than a trivial encounter with a doctor.”
“They don’t exactly run for the door when they see us,” Marla said, “but it does place an extra burden on the doctor-patient relationship. Hell, if I was a doc, I wouldn’t be happy treating someone who is likely to sue me.”
“Are you likely to sue me?”
“Not if you don’t screw up.”
“That’s reassuring. I’d be lying if I told you that I hadn’t heard about you two. We’re pros here, and I can assure you that we all want the same thing, a healthy mother and baby.”
“Let me finish my thought, and then you can go on, Dr. Cooper,” Donald said in an officious manner. “We know many doctors, good and bad. We want an open, friendly relationship with the docs at Brier. I don’t want any of you to do too much—you guys call it defensive medicine—or too little. I don’t want any docs draping crepe, making things sound worse than they are, to protect yourself against litigation. We don’t like it. It’s dishonest. If you do your job, regardless of the outcome, then you have nothing to fear from us.”
Smooth, practiced; the patina of reason designed to influence a jury. It all sounded great, Mike thought, but would I buy a used car from him?
“Thanks, Mr. Mayfield,” Mike said.
“Call me Don.”
“Okay, Don. I’m going to give you a packet of information sheets outlining the problems we see with babies born prematurely. It’s more information than you want to know, but our own attorneys say that we should tell too much, rather than too little. I’ll go over these with you the next time we meet. Meanwhile, let’s keep both you and the baby at rest. The medication that Dr. Russo started will help your baby’s lungs mature, so that if he enters the world early, it will be with better odds.”
Mike visited again the next day, and went over the information sheet. He had nothing more to do until she delivered.
Chapter Twenty-Six
The first hint of potential problems with the Mayfields came with their suggestions. To everyone else, they were demands. The meals were unhealthy; could they bring in their own? Why didn’t they wait until Marla was awake before they took her vital signs? That orderly looked like a street person. Why didn’t the hospital provide more premium channels on TV?
Soon, the staff counted the days, not toward her delivery, but to her discharge.
Harvey sat with Mike for their usual morning coffee in the doctor’s lounge.
“It’s amazing,” Harvey said, “that intelligent people like the Mayfields can be so blind about the effect they have on others.”
“They’re not blind, Harvey, they just don’t give a damn. They don’t relate to others as fellow human beings, except to use them as objects for their own satisfaction. That makes them narcissists. I’ll bet you a dinner at Chez Panisse that if this delivery or this baby isn’t perfect in every way, we’ll be meeting the Mayfields in court. By the way, I’m taking the next month off.”
“Me too.”
They pointed fingers at each other, and laughed. Then Harvey said, “Then give them a perfect baby, Mike.”
“Okay, Harvey. I will, if you get Marla to thirty-eight weeks, or more.”
Two weeks later, Harvey called. “Marla Mayfield is in labor.”
The problem of trying too much becomes a double-edged sword. Practitioners saw it all the time when they took care of other physicians or their families. Every experienced physician said, “Treat them like everyone else and things will go well. Try too hard, and something will get screwed up.”
Mike came into the delivery room and greeted the Mayfields. Between contractions, he talked with them. “Twenty-six weeks is a lot better than twenty-four. The baby’s about three and a half pounds, and, so far, we see no signs of fetal distress. The baby’s small for his gestational age.”
“What’s the plan?” Donald Mayfield asked.
“I’ll be right here during the delivery.” He turned and pointed to the door, “That’s Lisa Cooke, one of our NICU nurses. She’ll be here with me. We’ll do a quick assessment, and then move the baby to the NICU.”
Marla’s labor progressed well, but soon the baby showed an ominous slowing of his pulse rate and the amniotic fluid showed the presence of dark green material, the contents of the baby’s intestine, called meconium.
Mike wanted to implore Harvey to get this baby out, but said nothing—so much for treating the Mayfields like everyone else. Nevertheless, Harvey knew exactly what was on Mike’s mind.
Fetal distress and the presence of meconium in the amniotic fluid increased the risk. A baby so small and in distress would likely need a tube placed in its windpipe.
With a last push, Marla finally delivered her son.
Mike looked at the tiny, green-stained, limp baby, and knew that the infant was in trouble. They suctioned vigorously, and then Mike said, “Get ready to intubate, Lisa.” Ten minutes later, with the tube in the baby’s the trachea, they prepared to move the baby to the NICU.
“How’s my baby?” Marla asked.
“It’s too soon to know. He’s having breathing problems. We need to get him to NICU right away.”
Donald Mayfield’s cold stare startled Mike as he and Lisa rolled the baby out of the room. So much for that “open and friendly relationship”.
When they reached the NICU, Lisa settled in with the baby. They inserted IV lines, drew blood, ordered x-rays, and attached an oximeter to the baby’s foot to monitor his oxygen saturation.
As Mike sat before the monitor, looking at the baby’s x-ray and studying his lab data, Donald Mayfield entered the NICU. Mayfield stood behind the plate glass window, then raised his hand and flexed his index finger in a ‘come here’ gesture. Mike felt summoned, so he raised his own index finger in a ‘wait a minute’ gesture.
Two minutes later, Mike sat with Mayfield in the waiting room.
“What was his APGAR at birth, and at five minutes?” He demanded.
Here it comes, Mike thought.
“His APGAR at birth was zero. At five minutes, it increased to three, but we look at a broad spectrum of clinical indic
es to judge the baby’s risk. Remember, Don, that no index of any kind at this stage will interfere with all out maximal effort on our part.”
“That’s fine, Doctor, but what about his neurological status?”
“Clinically, assessment is difficult, but I have the ultrasound tech on his way to look at your son’s brain.”
“What about an MRI?”
“I’ll order one when I think it’s needed.”
“When you think it’s needed?”
“Yes. I’m not moving your son to an MRI unit when he’s so unstable and I can get the information I need right at the bedside.”
“I see.”
“I hope so, Mr. Mayfield. You’re an intelligent and well-informed man, but sometimes a little knowledge can be dangerous.”
Mike looked for some type of reaction, but Mayfield’s face remained impassive.
“I’d like another neonatologist to consult on my son’s case, if that’s okay?”
“Of course. Whom do you have in mind?”
“I was thinking Ira Greenfield from UC Medical Center, or Sharon Andrews from Stanford.”
“They’re both great choices. I trained with Ira, by the way.”
“I know.”
“I’ll call Ira first, as he’s closer, and then I’ll call Sharon. These are busy people and I don’t know how available they might be to come over and see your son. If any consultant is to help with your son’s case, the earlier they see him, the better. You might consider some local neonatologist if these people are too busy.”
“Yes, I’ll do that. In the meanwhile, please keep me informed. As much as possible, I’d prefer that the information about our son come directly to me. I want my wife to avoid this additional stress for as long as possible.”
Mike stood by the incubator for the next two hours. The ultrasound study of the baby’s brain showed no abnormalities. For the moment, baby boy Mayfield’s condition remained stable.
Trapped Page 12