by Peter Elkind
Dr. Holland left the emergency room to tell the McClellans, who were waiting outside. Sobbing, Genene removed the IV and began cleaning Chelsea up. She wrapped the body in a blanket. Then she took it out to Petti, who rocked her daughter’s body and stroked it. “She’s been through this before,” Petti told everyone. “She’s just asleep. She’ll wake up in a few minutes.”
The procession of cars, driving slowly this time, headed back to Sid Peterson. The staff there awaited them. Everyone in the emergency room had listened with horror as the ambulance radioed news of Chelsea’s respiratory arrest, the decision to head to Comfort, and the child’s death. Genene Jones had cradled Chelsea’s body throughout the trip back to Kerrville; when the ambulance got back, Genene, still sobbing, carried it in her arms down to the morgue in the hospital basement.
Determined to find out why Chelsea had died, Dr. Holland asked the child’s parents for permission to arrange an autopsy. Reid McClellan signed the papers. But the results from that procedure would not be complete for several weeks. When Dr. Holland filled out Chelsea’s death certificate, she listed the cause of her fatal cardiac arrest as a seizure and said that the seizure had been caused by a disorder of “undetermined etiology.”
Three hours after Chelsea McClellan’s death, Lydia Evans arrived at Dr. Holland’s office with her mother, her father, and her five-month-old son, Jacob. Lydia, nineteen, worked as a lawyer’s secretary. She lived in Llano, sixty miles from Kerrville, with her husband, Shane, who was a welder. Lydia was bringing Jacob to the doctor because of his crying spells, which had been going on for a month. She was taking her baby all the way to Kerrville at the urging of her sister, Elizabeth Winn.
Lydia had complained to Elizabeth about Jacob’s crying during a phone conversation on Thursday. The doctor who delivered Jacob had dismissed the problem, saying he probably was just teething, but Lydia, a first-time mother, fretted that something might be wrong. Elizabeth raved about the new pediatrician in Kerrville, to whom she had already taken her own baby. She told Lydia that Dr. Holland was smart and friendly, a physician without pretensions; she even encouraged parents to call her Kathy. Elizabeth Winn urged her sister to give the doctor a call.
Before she could do so—less than an hour later—Dr. Holland’s office phoned Lydia Evans. Elizabeth Winn had notified them she would be calling, explained the doctor’s receptionist, Gwen Grantner. Jacob’s crying sounded as if it needed attention. Did she want to make an appointment? Lydia arranged to bring Jacob in the next morning.
Early Friday, Lydia drove with her parents, Lora and Donald Lardie, to Kerrville. They arrived for a quick visit at the home of Elizabeth Winn. There they learned that Dr. Holland’s receptionist had called to cancel Jacob’s appointment; the doctor was transferring a patient to San Antonio. A short time later, Gwen called again. The doctor and her nurse would be returning because the patient they were transferring had died. They could see Jacob that afternoon.
Lydia Evans appeared with her parents and son at 3:30 P.M. Dr. Holland’s receptionist greeted them and explained that Dr. Holland was still at the hospital but that her nurse would begin examining Jacob. Genene Jones introduced herself, then took Jacob, Lydia, and Mrs. Lardie back into the clinic. Mr. Lardie, who was blind, remained in the waiting room. The nurse chatted cheerfully with the adults as she weighed and measured the baby and took his temperature. Lydia explained her complaint. She said that Jacob had been very irritable; at times he would start to scream and she felt there was nothing she could do to please him.
Genene placed Jacob on the examining table and began looking him over. She felt the baby’s fontanel, the spot on top of his head where the skull bones meet; among infants, it is soft because the bones have not yet fused. She told Lydia it seemed larger than normal for a baby Jacob’s size, that it should have closed up more. Then Genene began studying Jacob’s eyes. “She said she noticed that his [right] eye did not respond to light properly, that the pupil was sluggish, and that the [left] eye seemed to be all right,” recalled Lydia. “I said that I had never noticed any problem.” As she examined the baby, the nurse spoke to him: “Don’t have nystagmus, Jacob; that is not any fun.” Lydia later learned that nystagmus is a medical term for jerky, involuntary eye movements, which often signal a serious illness.
Genene Jones left the room for several minutes, then returned to say she had spoken with Dr. Holland, who was still at Sid Peterson. The doctor wanted to transfer Jacob to the hospital, said the nurse, and had ordered her to draw some blood for tests. Genene also wanted to start an IV. “I asked her why,” recalled Lydia Evans. “She said it was in case he went into a seizure while they were running tests, so they could give him medication right away. I looked at my mother and said, ‘Jacob’s never had any seizures.’” Genene then asked Lydia and Mrs. Lardie to wait outside. “She said, ‘Now, I’m a mother, I know what it’s like to see your baby crying while someone takes blood from him. Why don’t you leave the room?’” Lydia recalled. A few minutes passed. Then the adults in the waiting room heard Jacob start screaming. He screamed six or seven times, then—in mid-scream—there was dead silence. Gwen burst out of the treatment room and dialed Sid Peterson. “Page Dr. Holland—stat!” she told the hospital operator. “Something has happened!” declared Mrs. Lardie. The baby’s blind grandfather wore a look of horror. “Honey,” he said sadly, “Jacob is gone.”
Mrs. Lardie jumped up and headed for the treatment room. Gwen tried to grab her. “You can’t go back there,” the receptionist said. But Jacob’s grandmother had reached the hallway. She could see into the treatment room, where Genene was giving Jacob mouth-to-mouth resuscitation. Lydia began crying. A doctor and a nurse from the adjacent office ran in through the front door. Lydia heard Genene Jones hollering orders: “Give me suction; he’s vomiting!”
The doctor, a family practitioner named Phillip Webb, arrived in the treatment room to find a blue baby lying limp as a rag doll on the examining table. Two paramedics and Dr. Holland’s nurse were already there. The doctor took charge. The baby wasn’t breathing; Webb slipped a tube down Jacob’s throat, then began pumping air into him with a respiratory bag. The paramedics carried Jacob out to the ambulance. As they loaded him in, Kathy Holland arrived on the scene.
Dr. Holland had remained at Sid Peterson after returning from Comfort with the body of Chelsea McClellan. Busy arranging the child’s autopsy, Holland notified her office to send her next patient, Jacob Evans, directly to the hospital; she wanted to examine him there. Holland heard nothing further from her clinic until she walked down a corridor past the hospital switchboard. “Dr. Holland,” called the operator. “Your office has been trying to reach you—stat!” Holland raced to the clinic and pulled up behind the building. An ambulance was there, with a baby in the back. When Holland appeared, the EMS driver honked his horn, and Dr. Webb jumped out. “The kid arrested,” said Webb. “I had to intubate.” Holland climbed in. Genene was bagging Jacob Evans. “What the hell happened?” Holland asked.
The ambulance arrived at Sid Peterson at 4:36 P.M., and Genene carried Jacob into the emergency room. By then, the baby’s breathing tube had fallen out. Although Jacob’s color seemed good, Holland wanted to reintubate anyway. As the pediatrician struggled to place the tube, Genene pushed her fingers over the baby’s trachea to give her boss a better view of his airway. Finally, Holland gave up. But Genene kept her fingers in the airway; Jacob began to turn blue. Dr. Richard Mason, the emergency room physician on duty, pulled Jones’s fingers out of the baby’s throat.
After Jacob’s condition had stabilized, Genene came out to speak to Lydia Evans. “She was shaking all over,” said Lydia, “and she was sweating very badly. The expression in her eyes [was] like she was almost in a utopia…her eyes looked very excited—a happy excited. She looked like she was in her element.” Lydia’s husband, Shane, arrived at the hospital about 9 P.M. She introduced him to Genene, explaining, “This is the woman that saved our son’s life.”
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nbsp; After conducting her first examination of Jacob, Dr. Holland told Lydia and Shane Evans that she didn’t know what had caused their son’s seizure but that meningitis was a possibility. On Jacob’s emergency room record, she listed “probable meningitis” as her admitting diagnosis. Holland also started Jacob on Dilantin to prevent more seizures. Jacob Evans remained at the hospital for six days, three in the ICU and three on the floor. Tests showed nothing to explain the episode in the office. After Jacob left the hospital, his parents, at Holland’s suggestion, took him to a pediatric neurologist in San Antonio. The neurologist conducted more tests, which revealed no sign of any problem. He advised Jacob’s parents that there was no reason to keep their baby on Dilantin.
“What the hell happened?” Kathy Holland had asked her nurse. Why hadn’t Jacob been sent to the ER, as she’d ordered? Genene told her boss that the baby had arrived at the clinic with a bulging fontanel, then quickly turned blue and had a seizure. In an interview later, Genene denied examining Jacob in the office. She said she took one look at the baby in the waiting room, found him “blue and spaced out,” and immediately summoned help. But Genene’s own nursing notes on Jacob’s visit belie her account. They describe an assortment of medical problems—most of which doctors later said didn’t exist. Genene detailed a “bulging fontanel,” eyes that were “large with nystagmus,” a rapid heartbeat, and “tremoring” extremities. In her narrative of events in the office, Jones wrote: “Jittery, hyperactive child in good spirits. Child with obvious nystagmus and periodic neuro-stare”—a blank look—“with tremor of upper extremities. Fontanel bulging, sutures spread. R pupil sluggish to light, L pupil brisk. MGM [maternal grandmother] states child has had two blue spells, one lasting 20 min.” (Mrs. Lardie later denied ever making such a comment.) Genene then described Jacob’s seizure and respiratory arrest, including the arrival of Dr. Webb. She told Dr. Holland that Webb had ordered her to give Jacob 180 milligrams of Dilantin to halt his seizure, but that she had given Jacob only 80 milligrams because she knew 180 was too much. Dr. Webb later swore he never made any such error. In fact, said Dr. Webb, he never instructed Genene Jones to give Jacob Evans any Dilantin.
Saturday, September 18
Kathy Holland had planned to spend the weekend with her husband, Charleigh. They would stay that night on the site of their still-unfinished new home in Centerpoint. Charleigh had devoted himself almost full time to the project. He and Kathy rarely saw each other during the week; she tended to her practice, he to their future homestead. But because Charleigh refused to hire help, the work was going slowly; the house remained a skeleton. They would sleep together in a pup tent beneath the stars.
Holland was eager to flee Kerrville, eager for the comfort of her husband. The events of the previous day had left her shaken. For a month, she and Genene had been heroes to parents, rescuing their children. Now, suddenly, their magic touch had disappeared; another child had stopped breathing, and this one had died. Petti McClellan’s reaction had made it even more awful. She kept saying Chelsea was just sleeping, that she would wake up in a minute. Holland had tried to tell her that Chelsea wasn’t going to wake up—that she really was gone. But Petti couldn’t accept it. Kathy finally had to give her a shot of Valium to make her relax. Holland, of course, had lost patients before. But this was the first time it had happened to her in private practice—and she hadn’t a clue why. The doctor felt helpless. What had she missed?
As the number of emergencies grew, Holland had tried hard to take it all in stride, to maintain the public appearance that nothing extraordinary was going on. When someone at Sid Peterson remarked, “You sure are having a lot of sick kids coming out of your office,” the doctor had responded coolly: “We have a lot of interesting kids.” But privately, Kathy Holland was overwhelmed and a little frightened. She felt surrounded by sick children. In residency, there had always been someone to talk to about the patients, someone to offer perspective. Here there was no one—no one except Genene. The hours they spent together, isolated in their odd little world on Nixon Lane, were reinforcing the doctor’s blind faith in her nurse. You’re the town’s new pediatrician, a specialist, Genene told her. Why should anyone be surprised that we’re seeing lots of sick children? The rash of unexplained arrests, Genene’s lame explanations of what happened, even Chelsea McClellan’s inscrutable death, did nothing to open Holland’s eyes. She continued to embrace her naive belief with the conviction of the converted: All the kids were sick; each case was different; there was no pattern.
Elizabeth Winn had heard about the problems her sister’s son, Jacob Evans, had experienced on Friday. She thought it fortunate that Jacob was in Kathy Holland’s office when he stopped breathing. Elizabeth and Donald Winn had been taking their own infant, Anthony, to Dr. Holland since his birth three weeks earlier. They felt certain of her ability to provide excellent medical care. They didn’t just like Kathy Holland; they believed in her.
The Winns had met Holland and Genene Jones even before their son was born. Donald had learned of the new pediatrician’s arrival through the grapevine at Sid Peterson, where he worked as a data-processing manager. After an appointment with the doctor, the Winns decided immediately to have her provide their child’s newborn care. When Anthony arrived on August 25, they were not disappointed; even though there were no complications, Holland remained with the baby for hours after his birth. In the next few weeks, the Winns, naturally quick to call a doctor, came to know the pediatrician and her nurse well. They were jumpy first-time parents. Kathy and Genene seemed to understand; they didn’t treat the Winns as if they were crazy. Dr. Holland regularly called them to check on Anthony’s progress. She and her friends even baby-sat for him at the house on Nixon Lane. In less than a month, the Winns had come to regard Kathy and Genene as close friends.
Now, on a Saturday night, Anthony seemed to be having some problems, and the Winns were worried. Although it was almost 10 P.M., Elizabeth called out to Nixon Lane for Dr. Holland, seeking a word of reassurance. Genene answered the phone. Kathy was in Centerpoint with her husband, the nurse explained. What was wrong with Anthony? The Winns told Genene that their baby was crying a lot and had mucus in his stools. Genene, sounding concerned, told them to meet her in ten minutes at the clinic.
When the Winns arrived at the Fine Medical Center, Genene explained that she’d been unable to reach Dr. Holland. She unlocked the doors, led them into the treatment room, and began examining Anthony herself. Genene told the Winns that Anthony had a staph infection and that she was going to test his blood-sugar level. The nurse pulled out a dextrose test strip—a length of chemically treated paper that provides a rough measure of blood sugar—pricked the baby’s toe, and smeared a drop of his blood onto the strip. Anthony’s blood sugar was dangerously low, Genene announced. If they didn’t get some sugar in his system soon, he would go into a coma.
In an interview, Genene would later claim that Anthony’s fontanel was sunken and he was so lethargic when she saw him that he appeared to be asleep. “I couldn’t get him to wake up,” she explained. The dextrose stick, Genene said, showed his blood sugar was “next to nothing.” She had no choice but to move swiftly. “You get no sugar on a dex stick, that kid’s going to die very quickly.” The Winns were alarmed to hear that their baby’s condition was so critical. He hadn’t seemed that sick; everything was happening so fast. Elizabeth and Donald clutched their son as Genene started an IV in his left foot. Genene then left him with his parents and called EMS.
By then, the clinic’s answering service had finally reached Dr. Holland, who had been asleep in Centerpoint, fifteen miles away. The phone there sat on a tree stump; Kathy stumbled out of the tent to answer it. “There’s a call for you from your office,” explained the operator. “Your nurse wants to talk to you.” The pediatrician dialed her clinic.
“Anthony Winn is here,” Genene announced.
“What the hell is Anthony Winn doing in the office at this hour?” demanded Holland. “Take hi
m to the ER. Don’t do anything else.” The doctor jumped in her car and headed for Sid Peterson.
Genene called the emergency room and spoke to RN Marilyn Martinez-Green, the charge nurse that night. “Believe it or not, we are still here,” said Genene, suggesting her boss was present. Explaining that she was coming in by ambulance with another sick child, Jones began issuing orders. She told the ER nurse that she would need an IV with several special fluid preparations; the baby was hypoglycemic, had an elevated temperature and bloody diarrhea. The ambulance carrying Anthony Winn arrived at the hospital at 10:54 P.M. The baby’s terrified parents followed in their own car. Was Anthony going to live?
When the child appeared in the emergency room, Marilyn Martinez-Green was surprised to find him alert and awake. He didn’t even seem hot. Genene had told the nurse the child’s blood pressure was low. But when Martinez-Green took it herself, it was normal. As they waited in the emergency room, Genene paced up and down, muttering anxiously: “Come on, Dr. Holland, hurry!” Martinez-Green didn’t understand what was going on. This didn’t seem to be an emergency at all. Shortly after Dr. Holland showed up, Jacob had a bowel movement; there wasn’t any blood in it.