The Patient

by Michael Palmer

  Gradually, though, as it usually did, her practice lifted her spirits. Her patients were all improving, or at least were no worse. Sara, though still unconscious, continued to show signs that her coma was becoming lighter. Shortly after rounds, Jessie successfully revised a spinal fluid drainage shunt in a long-term tumor patient—a nice procedure when it went well, simple and life-saving. And finally, Marci Sheprow had gone home, and with her went the stress of avoiding eye contact with her mother. The fallout from her surgery would go on indefinitely, but at least that chapter was closed.

  Jessie had expected the worst from her job as escort to Tolliver. In fact, their time together proved a most pleasant surprise. He was distinguished looking, with dark, intelligent eyes, hair graying at the temples, sharply cut features, and perhaps ten pounds of excess weight. In addition, he was charming, urbane, and intelligent, and best of all, a seasoned bridge player.

  Over crab Louis at the Sandpiper, they talked about the game, about his six years as executive director of the MacIntosh Foundation, and of course about ARTIE and Carl Gilbride. In what seemed like only minutes, an hour and a half had flashed by. During that time, Jessie had used her cell phone to answer a half dozen pages, the last few dealing with the burgeoning group in her waiting area.

  “It’s really enjoyable talking with you,” she said, “but I’m afraid that if I don’t show up at my office soon, the patients waiting for me are going to unionize. What time this afternoon will you be meeting Carl?”

  Tolliver absently twisted his thin gold wedding band and looked at her strangely.

  “I assumed you knew,” he said.

  “Knew what?”

  “I spoke with Dr. Gilbride by phone this morning shortly after I arrived at the hospital. Apparently last night he was invited to be on the Today show tomorrow morning. He’s leaving directly from his commitment at the medical center and flying down to New York to meet with the producers. He’ll be back at noon, right after the show. Meanwhile, you were right there to wine and dine me as he promised, and as you have done most charmingly.”

  “I … I’m really sorry I didn’t know,” she said. “And did he say I would be your hostess until he gets back?”

  Tolliver’s expression suggested he was used to the conflicts and spur-of-the-moment schedule changes that accompanied dealings with highly successful people.

  “He did say something like that,” he replied, “yes.”

  “Eastman, I’m a little embarrassed. I would have loved to have spent the afternoon and evening with you, showed you some of the city, or even played some bridge. But I’m on in-house call tonight.”

  “Actually, as I told Dr. Gilbride, I have no problem starting the formal part of my visit tomorrow, because I really could use a bit of rest and relaxation. Maybe I’ll stop back this evening and follow you around. But most likely I’ll see you in the morning after I watch Dr. Gilbride on television.”

  “Either way would be fine.”

  Jessie said the words sensing that she wasn’t being perfectly honest. She really did prefer he stay at his hotel tonight rather than come back to the hospital to follow her around. Alex’s shift would be starting at three.

  “Are you sure you’ll be all right?” she asked. “For obvious reasons, I can’t have you in to see patients. But you can wait in the lab with our robotics technician until I’m done. After that I’ll be happy to show you around the hospital.”

  “I promise you I am very resourceful. Besides, I came to the hospital straight from the airport. I’d like to check in at the bed-and-breakfast where I’ll be staying.”

  “Not a hotel?”

  “Wherever possible, I prefer to have the foundation’s funds go toward medical research. Besides, this place comes highly recommended by our travel people. I have been promised that it is warm and charmingly decorated.”

  “Where is it?”

  Tolliver referred to a sheet in his jacket pocket.

  “Hereford Street. They said it was walking distance from the hospital.”

  “Only if you really love to walk. It’s in the Back Bay, not far from where I live. With luggage, I’d suggest a cab; without luggage, good shoes.”

  “A cab it will be. I have been told that this B-and-B has a small but well-equipped exercise room. I think I shall avail myself of it this afternoon. Looking fifty in the eye is powerful motivation.”

  “Exercise … exercise. I vaguely remember once knowing what that was. I’m jealous.”

  They walked the three blocks back to the hospital.

  “Well, thank you,” Tolliver said after retrieving his bag from Jessie’s office. “I believe I’m going to enjoy my days here. And I hope Carl Gilbride knows what a jewel he has in you.”

  “Oh, he tells me all the time,” Jessie replied.

  WHEN JESSIE HAD finally finished seeing the last of her patients, Alice Twitchell brought in yet another stack of messages, hospital charts, and other Carl Gilbride—generated flotsam.

  Jessie flipped through the pile.

  “Lord,” she said. “There’s a couple of hours’ worth of work right here. Well, at least I’m through with the outpatients.”

  Alice grinned at her sheepishly.

  “I’m afraid I have to tell you that there is one more patient for you to see. He and his wife have been here for almost two hours. His name is Rolf Hermann. He’s a count or something from Germany, and he has a brain tumor. Apparently his wife spoke with Dr. Gilbride by phone. Now they’re camped outside his office, and she’s insisting that they’re not moving until they see him. Dr. Copeland, he’s staying over in New York tonight.”

  “I know. Goodness, a German count. Talk about your HCs.”

  “Pardon?”

  “Nothing. Nothing. Listen, you go ahead and get a TV moved up to your office so we can watch the boss tomorrow morning. I’ll go talk to the Count.”

  “He’s an impressive man. And his wife is very beautiful.”

  “Thanks for the info. Dr. Gilbride didn’t say anything at all about this fellow to you?”

  “No. As you know, he’s been forgetting to mention a lot of things lately.”

  Kill!

  “Well, take the rest of the day off as soon as you can, Alice,” Jessie said sweetly. “I’ll see you in the morning.”

  While Jessie and the other surgeons in the department used the Harvard chairs lining the corridor as their waiting area, Gilbride had an anteroom of his own—a walnut-paneled, leather-furnished space across from his equally elegant office. The Count and his wife looked born to be in rooms as richly appointed. Seated across from them were two men and a woman in their late twenties, each of them trim, athletic, and dressed expensively. They were presented by Hermann’s wife as the Count’s sons and daughter—not her children, Jessie noted, but his. None of them stood to greet her.

  Rolf Hermann, powerfully built, could have been forty but, judging by his children’s ages, was at least ten years older than that. He was square-jawed and craggy, with thick, jet black hair, pomaded straight back. He shook hands with Jessie and greeted her in heavily accented English. His wife, who introduced herself as Countess Orlis Hermann, was stunning. In her early forties, perhaps even younger, she had a high fashion model’s bearing and figure. Her fine porcelain face was perfectly offset by straight sun-blond hair, artistically cut just above her shoulders. Her beige suit almost certainly owed its existence to some exclusive designer. From the first moment of their meeting, the Countess’s pale blue eyes remained fixed on Jessie’s like a magnet, leaving no doubt in Jessie that this was a woman accustomed to having life go her way.

  “Well,” Jessie began, clearing her throat, “it’s very nice to meet you both. I’m … an assistant professor of neurosurgery here at Eastern Mass Medical.”

  “That’s very nice,” Orlis said in fluent English, much less accented than her husband’s, “but we came to see Dr. Gilbride. I’m afraid an assistant anything just won’t do.”

  Rolf stopped her wit
h a raised hand and spoke to her forcefully in German. Orlis calmed visibly.

  “I’m sorry,” Jessie said, “but Dr. Gilbride is in New York until tomorrow afternoon.”

  “But that’s impossible,” Orlis said. “He said we should come today.” She held up an envelope of X rays. “My husband has a tumor in his head. Dr. Gilbride said he would remove it.”

  Jessie could tell from the Count’s expression that he was taking in every word.

  “In that case,” she said, “I’m certain he will. But until tomorrow, he’s two hundred miles away.”

  “This is just not acceptable.”

  Clearly the calming effect of the Count’s words had already worn off.

  “Countess Hermann,” Jessie said, “for the past week Dr. Gilbride has been extremely busy. For the same reason you heard of him all the way across the Atlantic, so have others from all over the world, many of them very seriously ill. I have been helping with the initial evaluation and scheduling of most of these new patients. I will be happy to do the same for your husband. But not here in the waiting room.”

  This time, Rolf Hermann leaned over and spoke softly into his wife’s ear. He squeezed her hand, completely enveloping it in his massive paw.

  Orlis’s lips tightened. Finally, she nodded and passed the X rays over.

  “Where do you want us to go?” she asked.

  “My office can hold the three of us,” Jessie replied. “Your family would best wait here, or else in the chairs in the hallway just outside my office.”

  Orlis gave the orders in German, and the Count’s children nodded.

  “They will come to your office,” she said. “They and their father are very close. They are very concerned about him.”

  Jessie led the entourage down the hall. Rolf Hermann walked rigidly upright with determined strides, although there was, Jessie noted, the slightest hitch in his right leg. She left the younger Hermanns in the corridor and motioned the couple to the two chairs by her desk. Orlis evaluated the space disdainfully, but finally took her seat.

  “My husband understands English perfectly,” she said, “and he can speak it, although not as well as I. For that reason he has asked me to tell you his story.”

  “That’s fine, as long as you know, Count, to speak up at any time. This is no school exam or contest here. It is your health. I promise you will not be graded on your English.”

  For the first time, the Count’s smile held genuine warmth.

  “Thank you very much,” he said carefully. “Orlis, please.”

  “Two and a half months ago,” she began, “my husband had a fit—a shaking all over during which he soiled himself and became unconscious. What do you call that?”

  “A seizure.”

  “He had a seizure. We took him to our doctor, and he ordered those X rays.”

  Jessie placed two of the MRI films onto the fluorescent view boxes on the wall to her right. The dense tumor, almost certainly a rather large subfrontal meningioma, glowed obscenely amid the much darker normal brain tissue. The location was dangerous, and the shape of the tumor suggested that it was the type of meningioma that was poorly contained, with extensions infiltrating the brain tissue surrounding it. An ARTIE tumor if ever there was one.

  “The tumor is right here,” Jessie said, pointing it out.

  “Yes, we know. Our doctor referred us to a brain surgeon, but he gave us no confidence that he could remove my husband’s tumor without causing a good deal of damage. Our doctor then suggested we search for a surgeon in London or in the United States. We were in the process of doing that, and already had Dr. Gilbride’s name on a very short list of candidates, when he performed his miraculous operation on that young gymnast.”

  “I see. Well, I’m sure Dr. Gilbride can help you. But you must know that surgery such as this is risky. Parts of the tumor are situated right alongside normal brain tissue. The dissection is extremely difficult. There may well be residual neurologic deficits.”

  “We would prefer to speak with Dr. Gilbride about that.”

  Jessie felt overwhelming gratitude that the Count would not be her patient.

  “Very well,” she said. “He should be back sometime tomorrow afternoon. You can come back then.”

  “Excuse me, Dr. Copeland, but we have traveled a long way, and we have no intention of leaving this hospital.”

  “But—”

  “My husband has had two seizures. If he has another, I want him here. We intend to pay in cash, so we will have no problem with your insurance or your health care system. I will be happy to leave enough money with your hospital administrator in advance to cover all the expenses of our stay, including my husband’s surgery.”

  “Mrs. Hermann, I don’t know if we can do this.”

  “Then I suggest you speak to the director of your hospital. I will be happy to speak to him as well.”

  “I guess I’d better do that.”

  Jessie went down the hall to Alice Twitchell’s temporary office, and was rather easily able to reach Richard Marcus, the hospital president. A few minutes later, she was back in her office. Marcus had confirmed what she already knew—running a hospital was all about money.

  “The president of the hospital will be happy to meet with you in his office. We have a private room available on Surgical Seven, the neurosurgical floor.”

  “Actually, we will need two. The Count’s children plan to stay near him as long as he is in the hospital. I assure you they will make it their business to be in nobody’s way. We will pay whatever rate you charge.”

  Jessie knew better than to argue, and it was clear from the way the Count held his arms tightly folded across his chest that he had no intention of intervening again.

  “Countess,” Jessie said, “if Dr. Marcus says it’s okay, and we have the room, you get the room.”

  “And private nurses.”

  “We have agencies that can provide you with that. The head nurse on Surgical Seven will know how it’s done. Anything else?”

  “Yes. I wish to know when my husband’s surgery will be performed.”

  “Now that I absolutely cannot tell you. For one thing, that’s Dr. Gilbride’s decision. For another, our MRI-assisted neurosurgical suite is booked solid. It may be some time before your husband can be fitted into the schedule.”

  Countess Orlis Hermann’s smile was patronizing in the extreme.

  “We shall see about that,” she said.

  IT WAS AFTER seven when Jessie caught up with Alex in the cafeteria. He and another security guard were sitting together. She was about to head back to the floor when he spotted her and waved her to join them. Wanting not to seem too eager, she grabbed a salad, some chips, and a decaf, and stopped to say a few words to a resident she barely knew. By the time she ambled over to Alex’s table, the other guard had left.

  “I was going to call you to meet for dinner,” he said, “but some guy went berserk in the ER, and Eldon and I had to deal with him. Then Eldon insisted we take our dinner break together.”

  “Why did he leave?”

  Alex’s grin reminded her of Clint Eastwood’s.

  “I guess he left because I asked him to,” he said.

  “Oh,” Jessie managed, hoping she looked more composed at that moment than she was feeling. “Well … how’s your day?”

  “Actually, they’ve scheduled two too many guards on this shift, so it’s been pretty light. They offered me the chance to go home.”

  “And you didn’t take it?”

  “The choice was an empty apartment and a Mel Gibson video versus the chance to get together with you, and get paid for it.”

  “Oh,” she said again. “I like that you say what’s on your mind.”

  “That may be why I’ve never won any popularity contests. How’s your day been?”

  Jessie’s beeper went off before she could answer. She glanced at the display.

  “It’s the ER,” she said. “Hold that last question.”

  In
less than a minute she was back.

  “Trouble?” Alex asked.

  “Big-time. An eight-year-old boy’s being brought into the ER by ambulance right now with a gunshot wound to the head.”

  CHAPTER 14

  FROM THE MOMENT THE CALL CAME FROM THE RESCUE squad that they were on the way in with eight-year-old Jackie Terrell, the clock began ticking. Jessie and Alex left the cafeteria and raced to the ER.

  “Mind if I come and watch you work if my supervisor okays it?” Alex asked.

  “If it’s okay with him, it’s okay with me, so long as you don’t expect any attention.”

  “I’ll go call him.”

  Jessie had already instructed the ER nurse to mobilize the OR, CT scan people, and blood bank, and to locate the neurosurgical resident on call.

  The twin dragons they would be battling for the child’s life were tissue damage and blood loss. Either could be lethal. The rescue squad had reported heavy bleeding, typical of a gunshot wound to the organ in the body with the richest blood supply. As usual, the paramedics and emergency medical technicians had done their jobs well. Two IV lines were in, plasma volume expanders were running, and pressure was being applied to the obvious bleeding points. But to Jessie, the most important piece of information they had radioed in was that although the boy was unconscious, there had been some definite purposeful movement on his left side. In neurosurgery, movement meant hope. And hope demanded speed.

  Throughout Jessie’s training, there was an unofficial competition among the residents to see who could get a head trauma patient with an open skull fracture or gunshot wound through labs and CT and into the OR the fastest. Anything over ten minutes from ER door to OR table was automatically disqualified from consideration.

  The ER was bedlam on two fronts, neither of which had anything to do with Jackie Terrell. A full cardiac arrest was being worked on in the major medical room, and in one of the trauma rooms, the surgical residents were dealing with a stabbing victim. Jessie knew that what she needed most right now was an experienced nurse who knew her way around head trauma and around EMMC. What she got instead was a new grad named Larry Miller, eager to please but very green.