A Mother's Trial

by Wright, Nancy

  Dr. Carte had told her to meet them at one-thirty in the Quiet Room, and it was her impression that they were going to discuss the move to ICU. But they were moving Mindy now. They weren’t waiting to discuss it. They didn’t care how she felt, or Steve, she realized. They didn’t care how Mindy might react.

  Mindy was thrashing and screaming, her little face bright red. As they entered the elevator, the IV suddenly broke apart, and at once the watery liquid began puddling on the floor. Christine bent over the IV site on Mindy’s arm.

  “It’s infiltrating again,” she said.

  “Oh, I can’t stand it—not again!” cried Priscilla. The needle had come out only a short time before, while Mindy was still in her room, and Priscilla had collapsed in tears while they tried to reinsert it in the cut-down. If they lost this site, only the vein in the other arm remained. And now the needle was out again.

  Finally they arrived at the second floor. Christine still held the dripping IV while Steve maneuvered the crib out of the elevator and down the hall to the door of the Intensive Care Unit. Christine rang the bell, and one of the ICU nurses came to admit them. There were eight separate rooms in the unit that ringed the central nurses’ station.

  Steve and Priscilla helped push Mindy’s crib into her room. Priscilla had not had much time to talk to Steve. When he had arrived following her frantic phone call, he had been furious.

  “Damn it—can’t you see it’s just the same old Kaiser runaround, Pris?”

  “Calm down, Steve—”

  “Hell, no! I’ve had it up to here with these jerks! That’s just the kind of crap they were pulling at the end with Tia.”

  “This has nothing to do with that.”

  “Maybe not, but it’s all the same kind of power-hungry play. Goddamn hospital. I hate these places.”

  “The point is Mindy—what all this is going to do to her. They can’t do this to a one-year-old—”

  “Yeah, and—”

  “She needs me,” Priscilla interrupted heatedly. “I’ve got to make Carte and Callas understand.”

  “Well, good luck, lady! That Carte’s a cold sonovabitch and Callas doesn’t strike me as too much better.”

  Priscilla nodded. They didn’t say much after that, as though consciously deciding that it was more important to focus their energies on the upcoming meeting.

  The ICU Quiet Room was about eight feet square, with a small sink in one corner and room for a few chairs. Four chairs had been drawn up, two on one side of the room, two on the other, like the start of some elaborate game. Steve and Priscilla took chairs next to one another against the far wall. Dr. Callas and Dr. Carte came in, their faces expressionless. Priscilla noticed that Dr. Carte locked the door. For a moment no one spoke. Then Dr. Carte began.

  Later, Priscilla could recall only the highlights. She remembered that she cried her way through the half-hour meeting. Dr. Carte never looked at her or at Steve. Formal and stiff, he told her first that they wanted to isolate Mindy because she was receiving sodium from somewhere. That it was important to change and monitor everything about Mindy’s treatment—the formula, the equipment, the nursing staff, everything.

  “But the same nurses work ICU as Pediatrics,” Priscilla said at once.

  “Everything will be much more rigidly controlled,” Carte answered.

  “But I still don’t understand—”

  “It’s simple, Mrs. Phillips. Mindy is getting excess sodium from somewhere—” began Carte, looking at the floor.

  “What are you saying?” Steve broke in.

  “Steve—”

  “No, Pris—I want to know. If you’re saying what I think you’re saying, someone’s going through the wall!”

  “Mr. Phillips—”

  “I just want some answers, Dr. Carte.”

  “Mr. Phillips, we believe this excess sodium is what Mindy had all along,” Dr. Callas said.

  “No,” Priscilla protested, her voice shaking. “Mindy just had the flu at first. We all had it. Now maybe it’s from sodium, but not at first.”

  Dr. Callas shook her head but didn’t answer.

  “Well, what about visiting?” said Priscilla. “Can my sons visit Mindy? We’ve had this planned for so long. Sara said—”

  “I’m afraid not, Mrs. Phillips,” Dr. Callas said. “The visiting in ICU is very restricted. Children are not allowed. You and Mr. Phillips can visit five minutes an hour.”

  Priscilla started screaming then.

  “She’s a baby! You can’t do that! She’s had so many changes!”

  “It probably won’t be for long, only a couple of days,” Dr. Callas said.

  “Can you at least make the time cumulative?” Priscilla’s voice was shaking uncontrollably. “Fifteen minutes every three hours?”

  “No,” Dr. Callas said.

  13

  It was like dealing with a couple of two-year-olds, Evelyn thought. You say the same thing, slowly, over and over again, patiently, calmly, and you let them scream and cry and drum their little heels on the floor until eventually they hear you, and stop. Or just stop out of exhaustion or a sense of futility.

  It was the way Evelyn had designed the meeting, but it was still difficult to live through. At lunch she and Estol had discussed strategy over a sandwich in the cafeteria. They had already reached the decision to transfer Mindy, and that was not to change. So the purpose of this meeting was really twofold: primarily, Evelyn felt, it should be a meeting for the parents to ventilate their feelings. She expected a mammoth explosion because that’s what you always got with those two. She and Estol would just have to sit there and take it.

  Secondly, Evelyn had decided that she wanted to provide the Phillipses with the minimum possible amount of basic information about why they were moving Mindy to ICU. And that was going to be the hard part. Because by now she knew a great deal more than she had this morning when she had made the decision to transfer Mindy.

  Estol had been brilliant, really. He’d made a quantum leap she had never considered. He had looked at Mindy’s intake and output of sodium and realized that the natural place to start was not the output but the intake. She was getting the sodium from somewhere, obviously, so why not start with the formula?

  He had told her what he had done—taking a syringe full of Mindy’s formula to the lab and ordering a sodium test. When he had returned for the results, the lab tech informed him that the formula contained 4,480 milliequivalents per liter of sodium.

  “I told her that was in the direction I expected, but seemed awfully high,” Carte had said at lunch. “And she called me back with a corrected figure of four hundred forty-eight. She’d forgotten to put in the decimal point. Still, of course, that was an unbelievable figure!”

  “What’s the expected sodium content of Cho-free?” Evelyn asked.

  “Fifteen milliequivalents. I looked it up.”

  “So, what did you do next?”

  “Well, I contacted the nursing supervisor and asked her to witness what I was going to do. Then back at the ward I took the whole bottle of Mindy’s formula out of the ward refrigerator and brought it back to the lab. I told the technologist to label it, make sure no one threw it out, and keep it in the lab refrigerator.”

  “And then?”

  “I returned to the ward. The nurse was already mixing new formula for Mindy, so I instructed her to change all the tubing, and keep the new stuff in the Medication Room—not to let it out of her sight. Then I thought I’d better get a control sample tested, so I took some of the newly mixed formula and ran that down to the lab. I haven’t received the results back on that yet, but when I got down there, they handed me the slip on Mindy’s most recent serum sodium. Since it was one hundred sixty, I figured I might as well use that as an excuse to move Mindy to ICU, as we’d discussed. And that’s what I did.”

  “But what made you think to test the formula?” Evelyn was stunned at the simplicity of it.

  “I don’t know. I guess maybe it was on m
y mind somehow—the fact that Mrs. Phillips was involved with that formula. You know, on Monday I heard Debby Roof on the phone to Mrs. Phillips, asking about mixing the formula. I thought Debby was talking to Sara. When I found out the nurses had to turn to the mother for what should be normal care in the hospital—I thought it outrageous. I told Debby, and wrote it in the orders, that no one but the nurses were to mix the formula. I didn’t make any real connection then. But it must have been floating in the back of my head.”

  There was one other thing of paramount concern to Evelyn, especially in view of what Estol had discovered about the formula. It might occur to the Phillipses to check Mindy out of the hospital against medical advice. And to keep them from doing that, Evelyn realized she would have to be prepared to call security.

  It did not occur to her that she and Estol might be the ones to need security. She expected anger from the parents, but later she was struck by the inappropriateness of their response. She saw Steve Phillips react way out of proportion to the situation. He seemed to burst into a towering rage.

  She had always thought that Steve Phillips, at best, was a rather frightening sight. Not only was he mountainous, but he was naturally somewhat menacing, with brown eyes too small for his face, and very thin lips which narrowed and disappeared when he was angry, revealing yellow teeth. He had a short, meaty nose, and several small white scars around his brow and chin. And she couldn’t help herself: his strong southern accent made her wince.

  And Steve was furious. When he screamed that threat about someone going through a wall, Evelyn had to swallow against a sudden chunk of fear hardening in her throat.

  And why were the Phillipses so angry? she wondered. Why weren’t they more concerned? Why weren’t they worried that she and Estol thought Mindy’s health to be so jeopardized that they were insisting on the Intensive Care Unit? Wasn’t this how normal parents would react?

  And why did it seem to matter so much that the boys couldn’t visit their sister? Instead of being scared, the parents fought. That was what was so strange. They argued, claiming that 160 was not so high, that it didn’t justify the ICU.

  And then Steve Phillips had talked about enemies. He said that with his job and his wife’s, they were sure to have made lots of enemies over the years. It wasn’t a normal dialogue, Evelyn thought. The small room began to ring with the sound of raised voices. It was hard to tell what Mrs. Phillips thought, what anybody actually believed. All they were getting was pure, shimmering rage.

  But Evelyn knew what really mattered to Mrs. Phillips. It was the part about the limited visiting. And that just added to Evelyn’s suspicions. Mrs. Phillips hadn’t really been all that upset until then, she thought. And in ICU, the woman’s every move would be supervised. She would never be alone with Mindy.

  Evelyn’s hands shook as she unlocked the door of the Quiet Room to let the four of them out. The irony of the room’s name suddenly struck her. Never had that room, she was certain, been less quiet than it had been for the last thirty minutes.

  Still, the meeting had accomplished what Evelyn had hoped. The Phillipses had harangued and screamed and cried, but they had not signed Mindy out against medical advice, and the situation had not escalated.

  14

  Steve Phillips knew an accusation when he heard one. And he had heard one here. All that pussyfooting around about “someone” doing “something” with that sodium, and changing all Mindy’s routines. It was horse manure, he thought.

  “Look, Pris, don’t you see what they’re saying?” he said again in the van on their way home from the hospital.

  “Steve, you’re crazy.” She looked at him in disbelief. He felt himself go red.

  “Pris, you idiot. You’re so goddamn naive sometimes! They’re saying you put something into Mindy.”

  “But they didn’t say that. They said there was more sodium going into her than they could account for. They’re worried about the high sodium, that’s all.”

  “Right, Pris. They’re not saying it up front, but that’s what they mean. They practically accused you right out! Goddamn those idiots; they’ve got their head up their behinds.”

  “Steve, I don’t think they’re saying anyone gave something to Mindy. How could they be saying that? Who would do that?” said Priscilla.

  “That’s just what I was trying to get at in there. If someone did it, we gotta think who it might be. Because we know it wasn’t you and we know it wasn’t me. So maybe it was someone I sent up to C.Y.A. sometime, or someone you refused benefits to. I’ve gotta get a list of Kaiser employees out of those suckers, see if maybe there’s someone on there I recognize. You know how these kids are always threatening to do me in or come after my family. Well, maybe one of them did.”

  “Oh, Steve!” She spoke through her hands.

  “Well, you got a better idea?” He pulled the camper off Woodbine Drive in a vicious left turn into their driveway.

  “No, but I still think you’re wrong.” She was crying again. “I wonder how Mindy is doing.”

  “You want me to cancel the fishing?”

  “No, no. The boys are counting on it. You’d better go pick them up.” She pushed herself off the high step of the van, landing heavily, and started for the front door.

  “Okay. See you later.”

  She didn’t answer. He watched her sturdy duck-footed walk as she passed under the bottle brush that sheltered the walk. She usually walked everywhere fast and head high, but she suddenly looked old and worn out.

  Steve backed the camper out of the drive and headed for the neighbor where he had hastily dumped the boys after Pris had called him. Then he’d stop over at Skip’s and go out for some fishing along Point San Pedro Road. He wasn’t ready to tell Skip about it because he needed to pull his thoughts together.

  He had no doubt the doctors were saying that someone had put something into Mindy, and that pretty damn soon they were going to be saying it was Priscilla. He was sure they were laying the railroad tracks right to her door. So he was going to have to work and head them off because he knew damn well that Pris hadn’t given anything to Mindy. They were probably trying to hide something, he thought. But Kaiser was a pretty damn big operation to be taking on as an adversary. There was just one vague glimmer of hope, and Steve clung to it now. Maybe when Sara came back, she’d straighten it all out. Maybe it was just one giant mistake.

  15

  Priscilla stood in the shower for a long time. She had lurched into the bathroom in time to throw up into the toilet. But now she couldn’t stop crying. She had been crying all afternoon in her bed, immobilized.

  Lifting her swollen face to the jets of water, she let it all pour down her. A river of tears, she thought. They could not do this to her. They could not. The hot orange rug reflected back at her, mocking her with its cheerfulness. The water turned cold finally, and she shut it off.

  She dressed in her room, choosing at random a dark corduroy dress to go over slip, nylons, and fresh underwear. She pulled a comb through her wet hair and fluffed at it with her fingers, wondering vaguely if she should set it. In the mirror her face was a ruin, her eyes red and sunken in their puffy lids. Her eyes seemed to weigh her whole face down.

  She had decided to see Carte again to find out what he meant. She could not live like this, not knowing, shut out.

  She couldn’t see Mindy again till four o’clock, when they would allow her five minutes, like some prisoner in jail. So at four, she was at the door to the ICU, ringing the bell to be admitted.

  She couldn’t believe what she saw. The naso-gastric tube was gone. There was no IV. Priscilla looked over at the nurse who had come on shift while Priscilla had been at home. It was ridiculous, she thought. It was Lesley McCarcy, the same nurse who had been on Pediatrics with her the night before.

  “So much for the change of staff Carte mentioned,” she muttered to herself. “Where are Mindy’s NG and IV?” Priscilla asked aloud.

  The nurse shrugged. “She pulled th
e NG out right after I got here, about an hour ago. And the IV kept infiltrating, so Dr. Carte ordered Pedialyte. She’s taking it really well. She’s been just fine since she’s been here, Mrs. Phillips,” she added reassuringly.

  “I knew it! I knew she’d do something like that if I wasn’t with her. She’s been trying to pull out the tube since she got it. But I don’t understand these changes. Do you know where I can find Dr. Carte?”

  “Well, you could try the pediatric ward. I believe he’s on duty up there today.”

  “Yes, I know.”

  Priscilla finally tracked down Dr. Carte, who agreed to meet her again in the Quiet Room.

  So, for the second time in that room, and for the third time that day, Priscilla and Dr. Carte confronted one another.

  “Dr. Carte, I’ve just been in to see Mindy. She has no IV and no NG. If she’s so sick, why doesn’t she need these? I don’t understand.”

  “Well, she pulled out the NG and the IV kept infiltrating. There’s only one site left for a cut-down and I don’t want to use it if I don’t have to. Her diarrhea is improved so I started her on Pedialyte. That’s just an oral solution of what’s in the IV—”

  “I know. What I don’t understand is if she’s so sick that she needs to be in ICU, why doesn’t she need an IV? I mean, why keep her in ICU?”

  “She’s doing all right on the Pedialyte, Mrs. Phillips. So far. I’ve already explained to you why the ICU is necessary. I really don’t have anything to add.”

  He did not tell Priscilla, nor did she find out until much later, that although he’d ordered only a small amount of the solution be given to Mindy, the nurse, seeing how eagerly Mindy had taken it, how thirsty she seemed to be, had let her have the whole bottle of Pedialyte. He did not tell Priscilla how dangerous that could be. If a child with a high serum sodium level is rehydrated too quickly, it can cause the brain to swell with fluid. And when that happens, there is no place for the brain to expand, encased as it is in the hard shell of the skull. So brain damage can result, as can convulsions and even death. But they had been lucky with Mindy: she had tolerated the large amount of fluid well.