Priscilla rattled off the recipe for the Cho-free formula plus the polycose that Mindy was receiving. When Sara had recently changed the percentage of polycose to be added, Priscilla and Debby had figured out the new recipe together—it was the kind of thing Priscilla liked to help with on the ward.
In a few minutes, Christine was back with the newly mixed formula and some fresh NG tubing.
“Why new tubing?” Priscilla wanted to know.
“Oh, Dr. Carte told me to,” Christine answered. “Apparently he’s testing the formula for sodium levels and to be on the safe side, he told me to change the tubing, too.”
Priscilla shrugged. It did not seem important, she would later claim. But of course later, when Priscilla was to go over the events of that Saturday, February twenty-fifth, again and again, trying to reconstruct everything that had happened, every word, every nuance of expression and action, then it would seem terribly important, and its significance clear.
When Dr. Carte next entered the room, at about 11:30 that same morning, he wore a strange, set expression on his small face. Priscilla noticed it immediately.
“I need to talk to you, Mrs. Phillips. Please come out in the hall.” He gestured her through the door ahead of him, and then held out a hand to indicate that he wanted her to walk down toward the end of the ward, away from the nurses’ station so that no one could hear them.
Puzzled, for they were not given to privacy around the hospital, Priscilla followed.
Without preamble, Carte said tightly, “I’m moving Mindy to the Intensive Care Unit.”
“What?” Priscilla went dead white. “Why?”
“Because we’ve just gotten back a blood test result on her and she’s got a sodium level of a hundred sixty. That’s in the danger area.”
Priscilla’s eyes filled and her voice, when it came, was high and loud. “But that’s not so high! Tia had sodium levels much higher than that and you never put her in ICU!”
“Yes, well, we feel Mindy will be better off there. You know her sodium level shouldn’t be above one-forty-five. She’ll be better off there,” he repeated.
The tears were spilling now, and Priscilla made no effort either to hide or control them. “But Sara promised! She promised there would be no changes this weekend. There have been so many already. And my husband’s supposed to bring my sons to visit Mindy this afternoon—we’ve been planning this for days now. And Mindy’s better; you saw her this morning! How can you say she needs to be in ICU?”
“I’m sorry. But it’s a medical decision.”
“But why? I don’t understand why!”
“I’ve told you. High serum sodiums can be dangerous. They can lead to convulsions.”
“I don’t believe this! I don’t understand it!” She was sobbing. “I’m going to call my husband.” And she walked off—half running—down the hall to Mindy’s room and the telephone. In a few minutes she was back.
“My husband’s coming. But I still don’t understand. Couldn’t the test be wrong? Couldn’t you repeat the test? I’m sure the test is wrong. Mindy’s better. It’s clear she’s better.”
“No, I think the test is accurate,” said Carte.
“Well, maybe I can’t accept the fact that I have a really sick child, but she doesn’t look that bad. And she’s never had high serum sodium before!”
“I don’t believe that’s true, Mrs. Phillips.”
“It is true! You can check back! It is true!”
Carte leafed back through Mindy’s chart. “Yes, well, you’re right. Although her stool sodiums have been high, her blood sodiums have been all right until now. But now they’re not.”
“But, please! ICU is an adult unit. They don’t know about children there. I know I won’t be able to stay with her as much. She needs me to be with her. She’s not even used to this country yet! She hasn’t even been here five months. And so much has gone wrong with the medicines in the wrong tube and everything. And Sara said there would be no more changes this weekend. She promised me!”
Carte shook his head. “It’s better for her,” he said again.
“I want to talk to Dr. Callas.”
“Why don’t we wait till your husband gets here?” said Carte. “We can arrange a meeting then.”
“All right.” She thrust a hand distractedly at the tears running steadily off her chin, then turned and ran back in the direction of room 503 and the haven of her daughter.
She did not see Carte go to the little desk where the doctors wrote out their orders. His hand slightly shaky, he filled out the order for Mindy Phillips:
Sodium output appears far greater than intake. Maintain IV and transfer to ICU.
He checked his watch and added the time. 11:36 A.M. Then he headed for the elevator.
In Mindy’s room, Priscilla, huddled in the steel and vinyl chair, sobbed until even the nurse outside heard her and came in.
“Can I do anything for you, Mrs. Phillips?” Christine asked from the door.
“Don’t they see? It’s so unfair. Mindy’s so difficult to please. She’ll be so scared! All the things they’ll do! She needs me so much. What will it do to her? What will it do to me!” Priscilla cried.
“I’m sure it will be better for your little girl or they wouldn’t do it.”
Priscilla shook her head.
“Oh, I wish one of your friends was here,” Christine added helplessly. She hoped Mr. Phillips was on his way.
10
Steve wandered about their three-bedroom stucco and frame house with an eye toward straightening it. Pris would be madder than hell if she saw it like this, he thought. She was an unbelievable stickler about neatness and they’d had some whoppers over that issue in their day. She could never accept the fact that when he came home from work, he just wanted to relax in front of the TV with his feet up; Pris always wanted him to help her clean up.
He eyed the living room furniture, much of it recently purchased. The short sculptured yellow and green carpet badly needed vacuuming, he decided. It made sense to do that last. He picked his way through some of the Fisher-Price toy people Jason had abandoned on the floor and pushed a solid forefinger into the soil containing the huge philodendron that they kept by the glass doors leading out to the small strip of backyard. They had planted it in a huge concrete urn they had carted into the living room from outside. Now the plant had crawled and plaited itself so high they had draped it over the ceiling beam. It was a great conversation piece.
He filled the green plastic watering can and circled the living room moistening the plants; most were baked dry. Then Steve headed for the bedroom, stopping for a moment to straighten one of Priscilla’s diplomas on the wall in the little anteroom of their bedroom. She had practically a whole wall of framed honor society documents from Winthrop College, and her master’s of Social Work from Berkeley. He was proud of that lady—she had one fine head on her shoulders, and a memory like a damn computer. His army discharge hung there, too, and his diploma from Sonoma State College. Hell, he was pretty damn proud of that one, too, he thought. He had sent his high school counselor a copy of it, and a copy of every time he made the Dean’s list. That sucker had said he wasn’t college material, and Steve had never forgotten or forgiven that.
He made the dark oak, Spanish-style double bed. He wandered back through the little hall, past Mindy’s bedroom with its specially chosen wallpaper—big cats, elephants, and donkeys made out of daisies.
They had had a hell of a time hanging that paper over the old brown-stained walls, Steve remembered. After picking out all this special decor for Tia, they had never changed it for Mindy. Some of it, like the green, yellow, white, and rust tweed sculptured shag carpet, was practically brand-new. They had added it while Tia was still in the hospital.
He moved back into the living room, passing the boys’ room. They were curled up in the mahogany-paneled family room watching TV but he didn’t stop to straighten in there. It was hopeless keeping up with those two. He settl
ed for a minute on the sofa, his big body comfortably splayed, his head curved back against the wall. He studied the raisin tray painting they had found at Northgate Mall.
He remembered the day they had bought it, finally ending up with two of the paintings; they had liked them so much. They had spent more than they meant to, but something about those paintings was irresistible. The artist had explained how she had painted the nature scenes—one of yellow and orange flowers against a fence, another of a yellow flower vase—directly onto slats of wood that had once been racks for drying raisins. The result was unusual. Instead of a flat surface, there were small gaps between the slats and the painted image was broken up and distorted by those spaces. It was like a natural scene that somehow wasn’t natural.
To him that was a good symbol for all of Marin County. He had never really wanted to live there; it was a place that counted its Porsches and BMWs. But they had moved there when Priscilla had landed her job with the county’s Social Services department in 1969, working their way up through a series of apartments and a town house until they had been able to afford this house three years ago.
He supposed Marin County was reasonably decent if you were going to settle in California. It was undeniably scenic. Terra Linda stretched and ambled through mounds of hills and planned open space. In fact they had a hill right behind their house. And of course Priscilla liked being so close to San Francisco, though that was not an attraction for Steve. He was your basic small-town boy. All the houses around them were identical, built by a developer named Eichler in the fifties. Everybody joked about the houses in Terra Linda all facing back in on themselves. There were no windows in the front of the house, and concrete walls and high planting blocked off any side view. It wasn’t his style to live that way, nor was it Pris’s for that matter. She was a joiner, always organizing some group activity—a church picnic, a nursery school dinner, a women’s issues group. And they welcomed other people. They always liked friends in their home, and social activities arranged with other families. It wasn’t their way to live all shut in on themselves. But if you wanted to live in Terra Linda—and it was a great place to bring up kids—you pretty much had to settle for an Eichler house.
Frankly, he wasn’t all that fond of the people out here, either. They had some great friends, but in general, he’d take South Carolina any day, where a person was just who he said he was. Over here they all made themselves out to be nonprejudiced, but half the time they were talking out of two sides of their mouth. Hell, when they had first adopted Tia, some sucker at work had asked him if they were planning to get an eye job on her, to make her eyes round. It was unbelievable.
Steve picked himself up and went back into the family room. The Saturday morning cartoons scampered across the screen and he stayed to watch them. Priscilla hated TV and thought he watched too much of it. She was always after him to turn it off. But it was keeping the boys quiet, and since Mindy’s hospitalization, he had pretty much had to take over with the boys, and with the house, too.
He had promised the boys a trip to the hospital to see Mindy—Priscilla had planned it days ago—and it was still enough of an adventure for them that they were trying to behave. He had also promised to take them fishing this afternoon with Skip Schaefer, one of his best friends. The Schaefers lived right around the corner; they had met when Nancy and Skip joined the babysitting co-op Priscilla had helped found in 1975. Nancy was a nurse in the intensive care nursery at Children’s Hospital in San Francisco, and she’d taken care of Tia on Thursday mornings. They had always trusted her completely with Tia, even when Tia was sick.
Now he hated to think about babysitting. Since Mindy’s CMV had been discovered and their babysitting co-op had voted to throw Mindy out, they’d had to start a new co-op. What a goddamned mess that had been! Pris had tried to reassure the other families that CMV was everywhere in the community. Ninety percent of the adult population had already been exposed to it, Sara had told them. But the other mothers were worried. There were pregnant women in the co-op and others who planned to become pregnant, and if a pregnant mother came down with CMV, it could attack the fetus. Apparently that’s what had happened to Mindy. But Sara believed the risk of contagion was negligible. Priscilla had arranged for her to come speak to the co-op about it, but at the last minute she’d canceled—scared to speak in front of all those people was how Pris had seen it—and sent Dr. Arnhold instead. But even though Arnhold had told them they just needed to practice basic hygiene and wash their hands after changing Mindy’s diaper, the co-op had still voted to expel Mindy.
Priscilla had fought like a hellcat. Steve grinned at the memory. She didn’t want Mindy denied access to the community. But then suddenly it seemed like she had to battle everyone. The organization that Sara had referred them to, Aid to Infant Development, wouldn’t take Mindy either because she was still contagious. Pris was in the middle of fighting them, too, or had been before Mindy’s hospitalization, and she’d win. Steve smiled again. When Pris got off on one of those things, if you knew what was good for you, you’d best stay out of her way.
It was becoming increasingly apparent that Mindy’s cytomegalovirus was going to cause considerable problems. After Sara told them about the CMV, he and Priscilla had faced a difficult decision. Friends started asking them if they were going to keep Mindy in light of the sacrifices raising her would force upon them all. It would be particularly hard for the boys, who had already lived through considerable hell due to Tia’s illness and death. At that point Mindy had only been with them two months. Sara could give them no prediction regarding the future effects of Mindy’s CMV, but she tended to downplay potential problems. Still they knew that Mindy might be retarded; certainly they could expect some learning problems.
In the end they had handled it the way the Phillips family always handled problems. They yelled and argued, fought and disagreed and looked at it from all sides until finally they arrived at a decision they could all live with. When she had told them about the CMV, Sara had reminded Priscilla that Mindy needed her more than ever, and that’s what they all decided. They’d fought to enroll her in all the programs to which she was entitled, whatever sacrifice that involved.
Steve wanted to talk to Skip about his problems at work. He had a boy who was breaking every rule in the book. He had a difficult schedule, with ten-hour days that were killing him, and some counselor had been accused of raping one of the girls. It went before the grand jury and the Juvenile Justice Commission was down all over them. The pressure was incredible.
But there was one little thing that was beginning to worry him about Mindy, he realized. He knew, because of Tia, that when you start adding and subtracting IV fluids and electrolytes, you can cause more problems than you solve. And that’s what Kaiser was doing now.
And that is why, when the phone rang and Priscilla was yelling and crying about them putting Mindy in ICU, his first thought was: What have they done now? Had they screwed up? Because, like Priscilla, he knew it wasn’t normal procedure. No way.
11
Evelyn Callas had spent a very busy morning in the Emergency Room. It was an accepted statistic in pediatrics: children were always sickest in February. It had been particularly difficult to concentrate. For a moment she acknowledged a tiny feeling of relief that she had been stationed at the E.R. today and Estol on the ward. Otherwise she would have been the appropriate person to tell Mrs. Phillips. She frowned guiltily and turned back to her patient. Later Evelyn checked the clock. It would soon be noon. When she looked up again, Dr. Carte stood in the doorway.
“Estol, what happened?” He looked pasty and tired. “Here, sit down.” He did, perching like an exhausted sparrow on the edge of the examination table.
“I told her and she’s very upset. She’s furious. She said Sara told her there would be no changes this weekend. She said something about how her kids were supposed to visit this afternoon. She kept asking me why. So I told her about the serum sodium that just came back fr
om the lab. It’s a hundred sixty, Evelyn.”
“Really? Well, I’m not surprised. Have you got her moved out yet?”
“No, but the order’s been written. They’re working on it. Turns out there’s a pregnant nurse working ICU today, and they’ll have to transfer her out because of Mindy’s CMV.”
Outside the door of the Examining Room, Evelyn saw a nurse hovering with a buff-colored patient’s folder in her hand.
“Estol, I’ve got to get back. It’s a madhouse here this morning.”
“Yeah, me, too. Oh, Mrs. Phillips wants to meet with us and her husband. Shall I set something up for this afternoon?”
“Yes. Let’s do it at one-thirty. We can meet for lunch at one o’clock and discuss what we want to say. Tell her the Quiet Room across from ICU, and I’ll meet you at the cafeteria at one.” She pushed herself up and walked him to the door.
“Evelyn?”
“Hm?”
“On a hunch I took a sample of Mindy’s formula down to the lab and had them run a sodium on it. I just got the results back. It’s loaded. I’ll tell you about it later.”
“Yes, okay,” she answered. Her mind did not focus on this information. She was already thinking about her next patient, and worrying about what to say to the Phillipses at one-thirty.
The proof of this particular pudding, and this was how she looked at it, lay with the patient. If Mindy Phillips recovered in ICU, that would be proof.
Later, when so many people asked Evelyn why it never had entered her mind to have the formula tested, she could only shrug. It just had never occurred to her, to any of them, until it occurred to Estol Carte. She had thought only how to make the patient’s body reveal the information, how a test on the stool would disclose the presence of a foreign substance. She was not a detective. She was a doctor.
12
Priscilla Phillips, her eyes still red from weeping, her broad, fleshy face sunken and bleached, watched as her husband and Christine King eased Mindy’s portable hospital crib into the elevator.
A Mother's Trial Page 4