Harvey couldn’t blame his partners for being upset at the threat of litigation. Malpractice suits were a pain in the ass. Skillful trial lawyers easily manipulated medically naive juries in malpractice cases to sympathize with the alleged victims, and ignore whether or not the physician had done anything wrong.
“I told you,” Kirby Dornan said, “that these Medi-Cal cases are nothing, but trouble.”
“Maybe so,” Harvey said, “but I didn’t hide the fact that this practice accepted these patients when you joined me.”
Turning to the other junior partners, Kirby said, “That’s true, Harvey, but we’ve been here long enough to have a big stake in what happens to the practice. We’ve talked about it. Hear us out.”
“Go ahead.”
“You’re a great guy, Harvey, and a compassionate one, too. That’s part of what drew us to join the practice.”
“Thanks, guys. I’m waiting for the ‘but’.”
“We get paid shit from Medi-Cal. We could live with that as part of our obligation to some form of public service, but look what comes along with the package. Obviously, this doesn’t apply to all patients, but it does to enough, so it matters. These patients are more demanding, less appreciative, less likely to follow treatment recommendations, and, as we’ve seen, more likely to sue. We’ve had enough of it, Harvey.”
“You think I don’t understand?” Harvey said. “I’ve been doing Medi-Cal for years. I know the problems, the drug addicts, the alcoholics, and the many HIV cases, and I agree with what you’ve said, but, if practices like ours don’t accept some Medi-Cal patients, who will? Take some time to look at the county prenatal care programs of the Medi-Cal ‘mills’ where they push through patients like cattle.”
“Harvey, you need to think on this. We’re not happy.”
“Don’t take this the wrong way, Kirby, but I’m not here to make you happy. I don’t have that many years left in me. After I’m gone, you guys can do anything you want with the practice.”
Chapter Thirty-Six (Weeks 1-6)
How long can this go on? Lisa thought as Mike entered his third week in the ICU. Each day has become a mirror image of the day before.
Carter Reynolds showed his first signs of humanity through his own frustration with the same questions. He said something that brought as much hope as despair. “I want to find a way to say something positive, but I won’t sacrifice my credibility. You need to trust me as we go along in treating Mike.”
“I understand,” Lisa said.
“Traumatic Brain Injuries (TBI) resulting in coma offers the greatest chance of recovery when compared with other causes of brain damage. The problem is that it takes time, many months, or even up to a year, to be sure.”
“A year?” Lisa asked. “We may not know for a year?”
“It’s possible, although the longer this goes on, the poorer the outcome.”
Lisa helped most mornings with Mike’s care. After Phoebe took his vital signs and assessed his neurological status, Lisa bathed Mike, scrubbing him vigorously, as she told him about her day, and shared an edited version of her thoughts. Afterward, she helped Phoebe change his hospital gown and the linens.
Eyes are iconic of life, the entry to the soul, and a reflection of our emotions. While Lisa managed to ignore the tubes, the drains, the IVs, and even his coma, she could not abide his eyes. The first time, and every time the nurse removed the tape over Mike’s lids to check his eyes and apply lubricants to protect his cornea, Lisa shuddered with their lifelessness.
Lisa stood across from Phoebe as they completed the change of linen.
“I talked with Eileen Baker,” Lisa said. “I’m going to take a shift in the NICU from time to time.”
“I can’t believe she asked you to do that.”
“She didn’t ask. I volunteered. I know we’re doing a lot with Mike, but I’m going stir-crazy. I need a break—a diversion—or I won’t be any good for Mike, the baby, or myself. I’m here seven days a week.” She paused. “It’s time I made myself useful.”
“Just don’t overdo it.”
Lisa was right. She felt an enormous sense of relief when she returned to work. The pace of NICU didn’t allow much time to dwell on Mike, or her future. She discovered that when she returned to Mike’s bedside after working she felt more energized than ever.
Away from the hospital, Phoebe managed to strike a balance, allowing Lisa the reflections of her private moments, maintaining her commitment to their efforts on Mike’s behalf, and driving Lisa to deal with this new phase of her life.
Dwayne Keeler, the respiratory therapist assigned to the day shift in NICU, had hit on Lisa when she first arrived at Brier. A good-looking man, he had started with slight touches, pats on the arm, and then moved to, “I give great neck and shoulder massages.”
His coarse off-color jokes made Lisa wince, and finally, she had said, “You appear to be a nice guy, Dwayne, but I’m not interested.”
When he walked away and muttered “bitch” under his breath, Lisa had followed him outside.
“If you come near me, or if I hear that word again, you’re going to lose your job. Be smart, Mr. Keeler, you work with women. Remember who runs this unit.”
Later that day, Lisa discussed Dwayne with Sharon Bridges.
“He’s a great tech,” Sharon said. “I’d hate to lose him.”
“I’m not asking you to do anything right now, but I wanted you to know what was going on.”
When Lisa mentioned Dwayne to Phoebe, she said, “I know the type. Keep away from him.”
Lisa had gone through a week of Dwayne’s sneers counterpoised against ultra-formal courtesy—an adolescent game—but when she and Mike had gotten together, he had lost interest.
The phone calls began a week after Lisa returned to work. The first time he called, it was heavy breathing. Lisa laughed at first, and then said, “Cut it out, Phoebe, it’s not funny.” Then came the electronically distorted voice spewing obscenities. When Lisa realized what was happening, she slammed down the phone, held herself, and shivered.
After the third call, Lisa notified the phone company, and they connected her to the annoyance desk.
“Notify the police, so it’s on the record,” the clerk said. “We’ll set up a trap to see if we can nail him.”
After another call, the phone company called, “It’s a disposable cell phone. There’s no way we can trace it. We’re assigning you a new number.”
Dwayne approached to adjust the respirator on one of Lisa’s preemies. “I was so sorry to hear about Dr. Cooper.”
“Thanks, Mr. Keeler.”
“Please, call me Dwayne.”
“Listen, Dwayne, I don’t…”
“Don’t say it, Lisa. I was a jerk. That was a bad time for me. I’d separated from someone I’d been with for three years, and I was angry. Let me apologize.”
Leery at first, Lisa noted that Dwayne found excuses for lingering with her and her babies. No subtlety there, she thought.
The next day when he entered the NICU, Lisa said, “Come into the nurse’s lounge, Dwayne.”
Fortunately, the room was empty. Lisa pulled out a chair and sat, indicating that Dwayne should sit across the table.
“Let me make this as clear as possible, Dwayne. I’m not interested in having anything but a professional relationship with you…”
“Wait just a minute…”
“No, you wait. You’re a good tech, Dwayne, and we’d hate to lose you, but that’s what’s going to happen if you keep this up.”
He reddened, and then suddenly stood, violently throwing his chair against the wall. He stared icy hatred at Lisa, and left the room.
When Lisa explained what had happened, Sharon Bridges said, “That’s it. He’s got to go.”
As Lisa prepared to leave for the day, she looked at Mike, ran her hand over his cheek, and kissed him on the lips. She grabbed her purse, and then left the ICU for the parking garage and home. It had been another frus
trating day. She searched the second floor of the darkened parking garage for Phoebe’s car. Lisa’s car was in the shop, and Phoebe had agreed to drive her to pick it up. After walking to the far end, she saw the red Celica convertible, and smiled. A Phoebe car for sure, she thought.
Lisa walked to the wall, and looked down at the plaza entrance to the garage, waiting for Phoebe to appear.
When Lisa heard the sound of footsteps approaching, she said, “It’s about time, Phoebe…” but when she turned, Dwayne Keeler stood twenty feet away.
“Oh, you frightened me, Dwayne. I didn’t see you.”
“Don’t give me that Dwayne shit, you bitch. You cost me my job.”
Lisa felt her legs weaken, and her mind transformed the images of Dwayne into Rudy, her father.
“Don’t do anything that will make things worse, Dwayne. If anything happens to me, you’re number one on the list.”
“I don’t give a shit,” he yelled as he approached.
Lisa scanned the area for a route of escape, but he’d trapped her between Phoebe’s car and the wall.
“I’ll scream,” she chirped, barely able to get the words out.
“Go right ahead.”
From behind Dwayne came a strong voice. “What the hell’s going on here?”
It was Phoebe in her scrubs, carrying an armful of books. “Is this the Dwayne creep you told me about, Lisa?”
“Keep out of this, bitch, or you’ll get yours.”
Phoebe lowered her load onto the trunk of her car, and, in a soft voice, said, “I think you’d better leave while you can.”
“You’re out of your fucking mind,” he shouted as he approached Phoebe, who by now had assumed the fight stance with elbows at her side, and clenched fists up to her chin.
“You’re kidding,” he laughed, and then swung at Phoebe, who sidestepped, and delivered a left jab to Dwayne’s nose, which erupted in blood.
He grasped his nose, then looked at his bloody hand, and said, “I’ll kill you.” He rushed toward Phoebe, arms open to crush her.
Instead of retreating, Phoebe stepped inside his grasp, and delivered a right hand to Dwayne’s belly, sending him doubling over instantly.
Lisa looked into Phoebe’s eyes and knew what would come next. “Don’t, Phoebe,” she shouted.
Phoebe’s eyes remained fixed on Dwayne, and when he stood and again approached her, she spun and delivered a roundhouse kick to a point below his ear. Dwayne Keeler’s head reeled back, suspended in space for a second, and then he collapsed to the cement floor with a sickening thud.
Lisa and Phoebe embraced.
“It’s incredible that you came in time,” Lisa said.
“Yes,” said Phoebe, smiling. “And that really felt good.”
Chapter Thirty-Seven (Weeks 7-11)
Hundreds of white sails dotted the blue-grey waters of San Francisco Bay as Lisa stared through the west-facing ICU windows.
“I don’t like the way he looks this morning,” Lisa said, turning as Jack and Phoebe arrived at Mike’s bedside.
“I don’t know what you mean,” Jack said, scratching his head. He flipped through the clipboard. “His vital signs are stable and his temperature is ninety-nine degrees.”
It was Mike’s fifth week, and his IV lines had become a perpetual source of infection. Jack placed him on intravenous nutrition as each time they tried tube feedings into his stomach, he’d develop one problem or another.
“Maybe he’s developing an infection,” she said.
“We remain healthy largely because our body’s integrity,” Jack said. “Every natural orifice has its own protective mechanism that works well until we insert a tube or a catheter. The most effective protector is the skin, and each time we breach it, the risk increases.”
Lisa stared at Mike. “I look at all this, the IVs, the endotracheal tube attached to the ventilator, and the drains from his head and his abdomen. I understand them, but the rubber catheter protruding from his penis feels like an invasion of his persona, some kind of primitive violation.”
Jack rolled his eyes. “Every man winces with the sight of that tube. It’s like talking about a circumcision.”
Phoebe brought the lab results to Jack. He reviewed them and said, “His white blood cell count is up. He’s got an infection somewhere.”
Jack carefully examined Mike, checking each IV and drain site. “I don’t see a thing, Lisa. I’ll get the lab to culture his blood and all the sites, just to make sure.”
As they pulled up the sheet to cover Mike, the blood pressure monitor alarmed. The flashing red LEDs read 86/40.
“Shit,” Jack said. “He’s got to be septic, maybe it’s staph.”
Lisa grabbed her abdomen. She grunted in pain and collapsed into the lounge chair by the bedside.
“Are you okay?” Jack asked.
“I’ll be fine.”
“Phoebe, get her out of here,” Jack said.
“No, Jack,” Lisa said. “Don’t.”
“Get her out. I can’t worry about her, too.”
Phoebe sat Lisa in the nurse’s lounge. “I’ll keep you posted. Try not to worry.”
“You’re kidding.”
Jack increased the IV rate, and then added blood volume expanders. Mike’s pressures were now in the 100/60 range. “I want those blood cultures, stat, and then I’m writing antibiotic orders.”
Thirty minutes later, after the first infusion of powerful antibiotics, Phoebe said, “Where is the source of infection, Jack?”
“Pick a place. He has so many possibilities. Your guess is as good as mine.”
Lisa paced the nurse’s lounge waiting for Phoebe to return. Suddenly, the pain recurred. She held her lower abdomen, feeling the cramps. When she went to the ladies room, the pinkish blood stains on her panties jolted her. Oh, my God, this can’t be happening.
She dialed Harvey Russo.
“Come right over to the office,” he said.
She left a message in ICU for Phoebe to meet her.
As Lisa sat in the waiting room, Phoebe hurried in, and hugged her. “Don’t worry. It’s probably nothing. Spotting is common in early pregnancy.”
“How’s Mike?”
“We started him on antibiotics. He may be septic.”
“Septic?”
“We have it under control. His pressure’s up. Let’s worry about you, for the moment.”
Harvey came into the waiting area, and escorted Lisa and Phoebe to the examining room. He obtained a sample of Lisa’s urine, and then performed a quick physical and pelvic examination. Afterward, he said, “I can’t find anything wrong, Lisa.”
“Then why am I bleeding?”
“I don’t know for sure,” Harvey said. “About a third of women bleed during the first trimester from several causes, including inflammation of the cervix, to implantation, to some retained menstrual tissue, as well as other rare causes. They’re all benign and shouldn’t put your pregnancy at risk.”
Lisa braced herself.
“What are my chances of losing the baby?”
“Don’t talk that way.”
“Harvey, please, the chances?”
“We used to think about 30 percent, but recent studies put it in the range of 5 percent. I’m going to order some hormone levels and tomorrow we’ll get an ultrasound.”
Lisa stood. “I’m going back to see Mike.”
“Hell you are,” Phoebe said. “You’re going home.”
The nurses called her every hour or two on Mike’s condition, which remained stable.
Lisa fell asleep on the couch with Daisy, and awoke at 2 in the morning. She felt relieved when the night nurse reported, “No change.”
When they returned the next day to Harvey’s office, Lisa said, “I’m still spotting, but it’s not as much.”
Harvey took her into the ultrasound room. “Your hormone levels are increasing as they should. Let’s take a peek at your baby.”
Lisa lay on the hard gurney while Harv
ey applied the cold jelly and ran the probe over her belly. She watched the screen and recognized the sac. When Harvey turned up the volume, her baby’s heart beat reverberated through the room. Suddenly, Lisa flushed with emotion. “Can you tell if it’s a boy or a girl?”
“No, it’s too early, but I’m pleased to say that everything looks great.”
When they left Harvey’s office for ICU, Phoebe held Lisa’s arm, preventing her from breaking into a run. When they reached the unit, Lisa slid open the door, expecting the worst. The atmosphere was calm as she walked to Mike’s bed, finding it freshly remade. As usual, he looked asleep. She stared at the monitors, especially the blood pressure numbers, and when the monitor read120/70, she felt a great sense of relief.
Lisa awoke the next morning with no further bleeding.
Lisa read everything she could put her hands on. She scanned the internet for sites seeking advice on how to preserve her pregnancy. They ranged from standard recommendations about general health, rest, and diet to alternative approaches, including herbal medications and acupuncture.
Absent bleeding, and with Mike’s condition, stable, Lisa felt much better.
“Anything’s better than the fatigue, Phoebe,” Lisa said. “You can deal with almost anything if you have energy.”
“You amaze me, sweetheart. They’d be sponging me off the floor, or I’d be in a padded room by now. I don’t know how you do it.”
“What choice do I have?”
“I guess it’s true when they say: what doesn’t kill us, makes us stronger. I used to think people like you were simply brave. Now I know that you can’t help yourself.”
“Can’t help myself?” Lisa said. “Am I not the master of my own fate?”
“The captain of your soul?”
Lisa laughed. “Invictus.”
“Who really is? Look at you,” Phoebe said, smiling. “If you survived Sandy and Rudy, you can get through anything.”
“I survived, but like the Peanuts character, I carry a dark cloud over my head. Mike did his best to blow it away, but he never really succeeded.”
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