Neither of you said anything on the trip down the hall away from the room after the procedure that seemed to be over before you were even aware that it had started, or when she stopped at the reception desk and left you to go bring the car around, or on the ride home, or even as she held your arm as the two of you went in the back door of your childhood home. You just went to your room, slipped on a loose-fitting gown that any young girl might wear, crawled into your bed and tried to go to sleep.
Convinced that you would never be able to fall asleep, you were surprised when you woke up to see your dad sitting at the small desk in your room. He was reading a book, and you watched him turn several pages before he noticed that you were awake. You closed your eyes and hoped that he had not seen that you were awake.
“Hey,” he said. “You’ve been asleep quite a while. Are you okay?” He asked, gently shaking one of your feet beneath the covers.
You nodded.
“Your mom made some dinner. Are you hungry? I could bring it to you.”
You shook your head.
“I’ll leave you alone.” he said. “Call me if you need me.” He stood slowly like it was difficult for him to stand because of some undiagnosed arthritic condition, but you both knew that he was searching for something to say that he couldn’t say. He turned off the desk lamp and closed the door behind him when he left the room. You felt a sense of relief that he was gone—that the conversation had only been superficial, that the procedure was over, that you were no longer pregnant. Then you felt guilty for feeling the relief.
You lay there in your bed watching as evening settled on the Henry Link white wicker furniture that your mom had painstakingly collected to decorate your room. The twilight that peeked through the white plantation shutters on your window blended with the peach-colored, Laura Ashley floral comforter that you pulled up tight around your chin. Your mom had tried so hard to give the room a feminine feel; you had always been her little girl. Now you didn’t feel feminine, you certainly didn’t feel like a little girl, and the Jacobean white room just felt desolate and cold.
Even at the time you wondered what would have happened if your dad and you had talked at that point, and you continued to wonder that to this day. You didn’t want to talk to him then and not much after that. He might have been a psychiatrist, but he wasn’t your psychiatrist. He was just your dad. What could he have said that would have really helped? In retrospect, it seems like you just floated through the end of the high school year and the summer that followed, out of the white wicker room and into the shabby, institutional setting of the dorm room with the blocky wooden furniture and dingy tile floors at your first year in college, without saying anything.
It would be hard to determine at what point you swam up from the darkness, devoid of conversation beyond the compulsory “how are you?” and “can I get you anything?” that settled over what used to be a little girl’s bedroom that evening, but fortunately, you continued to do well in school. Scholastic success had always come easily for you, and sometime along about your third year you decided to apply to medical school.
Your dad, the doctor, of course thought that was a grand idea and he told you he was proud of you, but you continued to see your parents less and less. Now, they lead separate lives on the other side of the country from you and your little family of two physicians and a blueeyed boy. You wondered what they might be doing and tried to recreate your parents’ daily routines, and you realized that you don’t know much about their routines over those last few years. You had started to notice that your dad repeated stories, even during short telephone calls, and when you did see your parents he seemed to read the same section of the newspaper over and over, well before your mom decided to sell the house and move to a campus setting that offered different levels of care ranging from apartments to assisted living to Alzheimer’s care to hospice.
You think to yourself that maybe you should call them later in the day. What if Jaybird grew up and never called you? It is hard to imagine a time when he won’t need you or your husband just to get through a day—to feed him, to bathe him, to entertain him, and to help him learn. But that day will come you guess. He will grow up and go off to college and meet someone. That’s what you hope for him, isn’t it? Independence? He will probably stop calling home about the same time that your parents stop recognizing you. That will be your independence. Hopefully, your husband will still be there. You think to yourself that all living is assisted living, even if you reject it at the time.
It was in the first few weeks of medical school when you began to enjoy yourself again, maybe for the first time. The classes were challenging, the professors were interesting, and you became intrigued with the intricacies of the workings of the human body. Of course, you related all the materials and lectures to your own body, imagining yourself with whatever maladies and deformities you happened to be studying at the time, considering the known side effects of the prescribed remedies and weighing the risks versus the benefits if you really were diagnosed with a disease or condition and had to take the cure.
There was so much to learn, so much to memorize, and so much to read. You poured yourself into it, and you were good at it, especially the memorization part. But you were concerned that rote recitation would have little application when you actually had to assist real people. By the time you graduated, you were near the top of your class and had your pick of residency opportunities around the country. You chose Houston because you liked the program and without any regard for where you thought you might someday want to live. As it turned out, Houston was the best thing that could have happened to you for two reasons: you met your husband, and you met Dr. Nathan.
In many ways, Dr. Nathan became a third parent to you. You trusted him and it was easy to talk to him. Of course, he had made a good living in his life, but he didn’t seem to care about the money. All he cared about was his patients, and he wasn’t all that concerned about the volume of patients that he had. He was the one that made the transition from memorization to real-world application for you. Of course, at his age, he had seen everything, and he was willing to let you make your own mistakes and introduce new modalities. He was also always there to rein you in if you ventured too far afield.
As an adjunct professor, he spoke to your group a few times at grand rounds, and eventually you got the opportunity to shadow him at his office and at the hospital when he did deliveries. You bonded with him as a mentor and tried to do things like he did or as you imagined he would do. You called him all the time, and he was patient with you.
You had hoped that he might ask you to join his practice when you completed your residency, but he told you that he was just going to close his office if and when he ever retired. However, you reached an arrangement with him where you would cover for each other if one of you was sick or on vacation. Dr. Nathan encouraged you to go in with some younger doctors who would be more aggressive in trying to obtain patients and make fees. He had been right to give you that advice and your practice was doing well, even if you didn’t enjoy so much the administrative side of things and you certainly didn’t like the once a year “partnership” meetings where you divvied up profits and set goals for the next year.
You were upset the evening before when Dr. Nathan’s office called and asked you to cover a delivery for him because of his stroke. You promised yourself that after you got home, and had a nap, you would call his wife so that you would be fresh and upbeat when you talked to her. From what little you had heard, it sounded bad, and you wondered if he would recover. You decide to call your office on the off chance that somebody would be there who might have heard more news about how Dr. Nathan was doing. You lean against the wall and dial the number on the speed dial. You are surprised when somebody answers.
“Trudy?” You ask. “What are you doing there this early on a Saturday morning?” You knew that if anybody was going to be there it would probably be Trudy. She was the best nurse in the group and worked harder than a
ny of the doctors ever worked.
“I had some stuff to finish up from yesterday and I didn’t want it to wait until Monday,” she says.
“Has there been any more news about Dr. Nathan?”
“No. Nothing else. We did get the chart in on Dr. Nathan’s patient that had the baby last night. How did that go?”
“Not well,” you say. “I had to do an emergent C-section and it doesn’t look like the baby is going to make it. The family is with the baby now.”
“Oh God,” Trudy says and you can hear her flipping through the chart while she is talking to you.
“I don’t guess that there is anything in there that suggested the woman might be a candidate for a C-section, is there?” you ask, confident that there is not. You feel your heart start to race as Trudy is silent on the other end of the line. You feel like you do whenever a police car pulls you over for speeding. Only this is worse. Much worse. Your stomach rises up in your chest and your breathing quickens. The confidence then completely disappears. “Trudy, did I lose you?”
“No, I’m here. I’m sorry. I was just trying to read this note from one of the last office visits. It is difficult to make out. It’s written in Dr. Nathan’s handwriting and it looks like he had a discussion with the father. There is something about likely needing to do a C-section, but it is difficult to read. I guess that it’s a good thing that you did one,” Trudy says.
“I guess,” you say, and think to ask her to read the entire entry to you because you are suddenly worried about getting sued—then you feel a sense of panic sweep over you. Wasn’t everyone in that family a lawyer? But you think better of asking Trudy to read the entry to you, and you tell her goodbye. The chart says what it says and you never got a chance to read it for yourself before you were called in. You had told yourself some time ago that you weren’t ever going to treat patients from the standpoint of worrying that you might get sued. That was Dr. Nathan’s philosophy—no unnecessary tests or defensive practices. Just treat the patient and try to help her.
As you drop the phone back into your coat pocket, you wonder what it was that would have prompted Dr. Nathan to scribble the note in the chart. If only you had gotten a chance to see the chart before the patient showed up at the hospital. With all of the hi-tech gadgetry around, it seemed like there would be some means of instantly transmitting a patient’s records to the doctor that had the responsibility for seeing a patient at any given point in time. Despite medical breakthroughs and technological advances, too much of your job was still dependent upon chance and circumstance, and was reactive based on the most likely event and probable outcomes. While this specific situation would probably never present itself again, you’d make sure that next time somebody in your office would see the chart before you saw the patient in the hospital, even if you had to send Trudy over to the other doctor’s office to read the file.
“We are the solution to our problems,” Dr. Nathan would have said—hopefully would say.
You thought about calling your husband again to tell him that you thought you might get sued. Instead you walk to the nurses’ station and pour yourself a cup of coffee. He would just tell you not to worry about that and just plan for what you are going to have to do next. You know that you won’t have to wait long. Waiting is all you can do right then.
27
WHILE SITTING AT THE nurses’ station, you begin to contemplate the fact that it will be incumbent upon you to fill out the death certificate on the Jessie child. That’s something you don’t have to do often. You tell yourself that you’re in the life business not the death business. You usually fill out birth certificates not death certificates. You’re not even certain what information needs to go on the form. You think about getting the pediatric infectious disease guy to do it, but it looks like he has already gone home. You ask one of the nurses to pull you a form and you get yourself another cup of coffee. The coffee is not very good and you used to not even like coffee, but the warmth of it is comforting, and now you drink it all the time. You sip the coffee and stare at the form. It reminds you of a tax return.
The biographical information at the top of the page will be easy enough to ascertain. It’s the middle section, listed as “Paragraph 33. Cause of Death,” that has you concerned. The paragraph divides into two parts. In Part 1, the form tells you to “Enter the chain of events—diseases, injuries, or complications—that directly caused the death. Do not enter terminal events such as cardiac arrest, respiratory arrest, or ventricular fibrillation without showing the etiology.” Then there are a series of blank lines (“a.” through “d.”) with words between the lines that read “due to” or “as a consequence of.”
Beside the first blank line (“a.”), the form tells you to list the “IMMEDIATE CAUSE (Final disease or condition resulting in death).” You assume that the words “respiratory arrest” will eventually go there. Then the other blank lines follow with the words “due to” or “as a consequence of” between them. You wonder what you should put there. How far down the chain of events are you supposed to go?
The form instructs you in the margin that as you fill in the blanks “Sequentially list conditions, if any, leading to the cause listed on line ‘a.’ Enter the UNDERLYING CAUSE (disease or injury that initiated the events resulting in death) LAST.” You think about “(a) respiratory arrest; due to or as a consequence of (b) herpes viral infection; due to or as a consequence of (c) parental transmission; due to or as a consequence of lack of communication; due to or as a consequence of (d) shame and guilt.” Should lack of communication come before shame and guilt? Should you handwrite in two more lines and add “(e) sexual transgression; due to or as a consequence of (f) isolation and loneliness”? Should “isolation” and “loneliness” each get a separate line?
In Part 2 of section 33, the form tells you to “Enter OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH BUT NOT RESULTING IN THE UNDERLYING CAUSE GIVEN IN PART 1.” Obviously, that is where you discuss things like “loss of faith,” “inadequate role models,” “nihilism,” “narcissism,” and “inappropriate alcohol consumption.”
After you finish the second cup of coffee and part of a third, you see the nurse assigned to the Jessie child signal to you with a slight raise of his head that it is time to go back to Michelle Jessie’s room. You drop the incomplete form into the chart and place the folder under your arm. Sunlight is beginning to shine through the outside windows, but you can’t help feeling a sense of gathering darkness as you start walking back down the hall. The male nurse pauses at the desk to look at some paperwork before following behind you.
Earlier you had been reminded of leaving the little clinic in Pasadena with your mother. Now, as you walk alone down the hall to the Jessie room, you are reminded of the two of you, you and your mother, going down the hall with a nurse to where the procedure would be performed. Now, years later, you would still not let yourself remember being in that room, although you recognize the fact that from time to time in your life you will still remember that walk with your mom and the nurse. Maybe you don’t remember the room because your eyes had been clenched shut most of the time you were there, closing that particular box tightly shut. You tell yourself that you will come out on the other side; that you have come out on the other side.
For the longest time, even most of the way through college, you didn’t realize that you were reliving that walk, but now you see it clearly and you have learned to recognize it each time it thrusts itself up to your consciousness. Usually, you can leave that hallway by focusing on the Jaybird and whatever he is doing or by asking your husband to explain the significance of some inane event that just happened in the world of sports.
Jaybird, of course, has no idea how he is helping you. He is just exploring his little world, playing with his toys on the floor, coloring in a book, or singing along with Barney on the television. Your husband seems to know, however, that you don’t really care whom the Cowboys drafted or what position so-and-so plays, that
you are really asking him to take your mind off of whatever it is that is haunting you. And he tries.
You are jealous of the fact that he can have such passion for something other than work. You laugh at his explanation that everyone in the stands wishes that they were out on the field and everyone on the field is trying to earn for themselves a “normal” life that will permit them to sit in the stands and enjoy a game.
You stop at the door to the patient’s room and sit down in the plastic and metal chair outside to wait for the male nurse to join you. When you sit down, a man’s jacket that has been hung over the back of the chair falls to the floor, and some hand written pages spill out of the breast pocket. You pick up the pages and try to put them back in order. As you do so, you start to read the pages. You have some difficulty making out the handwriting.
La Aguada
“I enjoy the shooting, but the killing is a bit much.” She shouted loudly enough that she thought he could hear her. She rested the slim, double-barreled 28-gauge on her hip. He removed his earplugs and looked at the dead, blue-grey “eared” dove littering the barren field around the water tank in front of them. They were each standing thirty yards from a fence corner which formed a right angle between them. Behind them were giant trees, which looked to her like eucalyptus, that followed the fence line in both directions.
He was shooting a rented, semi-automatic Beretta 20-gauge that held four shells, including the one in the chamber. He was firing rounds more than twice as fast as she was, but he doubted that he had killed as many doves as she had. She fired two more shots. She broke open the side-by-side. Two thin shells ejected. Her “bird boy” dropped two new shells into the barrels.
A Minor Fall Page 35