Harvest

by Tess Gerritsen

  “We’ll be transferring you out of the SICU,” said Abby. “You can go to a room on the ward. It’ll be quieter there. Not so many disturbances.”

  No answer. Just a deep breath, a long sigh.

  Abby left the cubicle feeling more defeated, more useless than ever. There was so little she could do. An absence of pain was the best she had to offer. That, and a promise to let nature take its course.

  She opened Mary’s chart and wrote: “Patient expresses wish to die. Will increase morphine sulfate for pain control and change code status to Do Not Resuscitate.” She wrote the transfer orders and handed them to Cecily, Mary’s nurse.

  “I want her kept comfortable,” said Abby. “Titrate the dose to her pain. Give her as much as she needs to sleep.”

  “What’s our upper limit?”

  Abby paused, considered the fine line between comfort and unconsciousness, between sleep and coma. She said, “No upper limit. She’s dying, Cecily. She wants to die. If the morphine makes it easier, then that’s what we should give her. Even if it means the end comes a little sooner.”

  Cecily nodded, a look of unspoken agreement in her eyes.

  As Abby started toward the next cubicle, she heard Cecily call out: “Dr. DiMatteo?”

  Abby turned. “Yes?”

  “I . . . just wanted to tell you. I think you should know that, well . . .” Nervously Cecily glanced around the SICU. She saw that some of the other nurses were watching. Waiting. Cecily cleared her throat. “I wanted you to know that we think you and Dr. Chao did the right thing. Giving the heart to Josh O’Day.”

  Abby blinked away an unexpected flash of tears. She whispered, “Thank you. Thank you so much.”

  Only then, as Abby looked around the room, did she see all the nods of approval.

  “You’re one of the best residents we’ve ever had, Dr. D.,” said Cecily. “We wanted you to know that, too.”

  In the hush that followed, a pair of hands started clapping. Another joined in, then another. Abby stood speechless, clutching a chart to her chest, as all the SICU nurses burst out in loud and spontaneous applause. They were applauding her. It was a standing ovation.

  “I want her off the staff and out of this hospital,” said Victor Voss. “And I’ll do whatever the hell it takes to accomplish that.”

  Jeremiah Parr had faced numerous crises during his eight-year tenure as president of Bayside Medical Center. He’d dealt with two nursing strikes, several multimillion-dollar malpractice suits, and militant Right-to-Lifers rampaging through the lobby, but never had he faced such outright fury as he saw now in the face of Victor Voss. At ten A.M., VOSS, flanked by his two attorneys, had marched into Parr’s office and demanded a conference. It was now close to noon and the group had expanded to include Surgical Residency Director Colin Wettig and Susan Casado, the attorney representing Bayside. Calling Susan was Parr’s idea. As yet there was no talk of any legal action, but Parr couldn’t be too cautious. Especially when dealing with someone as powerful as Victor Voss.

  “My wife is dying,” said Voss. “Do you understand? Dying. She may not survive another night. I lay the blame squarely on those two residents.”

  “Dr. DiMatteo is only in her second year,” said Wettig. “She wasn’t the one who made the decision. Our chief resident did. Dr. Chao is no longer in our program.”

  “I want Dr. DiMatteo’s resignation as well.”

  “She hasn’t offered it.”

  “Then find a reason to fire her.”

  “Dr. Wettig,” said Parr, calmly. Reasonably. “We must be able to find some basis for termination.”

  “There’s no basis at all,” said Wettig, stubbornly holding his ground. “All her evaluations have been outstanding and they’re all on record. Mr. Voss, I know this is a painful situation for you. I know it’s only normal to want to lay blame somewhere. But I think your anger is misdirected. The real problem lies in the shortage of organs. Thousands of people need new hearts and there are only a few to go around. Consider what would happen if we did fire Dr. DiMatteo. She could lodge an appeal. The matter would go to higher review. They look at this case and they’ll ask questions. They’ll ask why a seventeen-year-old boy didn’t get that heart from the beginning.”

  There was a pause. “Jesus,” murmured Parr.

  “You understand what I’m saying?” said Wettig. “It looks bad. It makes the hospital look bad. This isn’t the sort of thing we want to see in the newspapers. Hints of class warfare. The poor getting the short end of the stick. That’s how they’ll play it up. Whether or not it’s true.” Wettig looked questioningly around the table. No one said a thing.

  Our silence speaks volumes, thought Parr.

  “Of course we can’t allow people to get the wrong impression,” said Susan. “Outrageous as it may seem, even the appearance of human organ deals would kill us in the press.”

  “I’m just telling you how it looks,” said Wettig.

  “I don’t care how it looks,” said Voss. “They stole that heart.”

  “It was a directed donation. Mr. Terrio had every right to specify the recipient.”

  “My wife was guaranteed that heart.”

  “Guaranteed?” Wettig frowned at Parr. “Is there something I don’t know about?”

  “It was decided before her admission,” Parr said. “The match was perfect.”

  “So was the boy’s,” countered Wettig.

  Voss shot to his feet. “Let me explain something to you people. My wife is dying because of Abby DiMatteo. Now, you people don’t know me very well. But let me tell you, no one screws me or my family and gets away with—”

  “Mr. Voss,” interjected one of his attorneys. “Perhaps we should discuss this in—”

  “Goddamn it! Let me finish!”

  “Please, Mr. Voss. This isn’t in your best interests.”

  Voss glared at his attorney. With apparent effort, he broke off his attack and sat back down. “I want something done about Dr. DiMatteo,” he said. And he looked straight at Parr.

  By now Parr was sweating. God, it would be so easy just to fire that resident. Unfortunately, the General wasn’t going to play ball with them. Damn these surgeons and their egos; they resented anyone else calling the shots. Why was Wettig being so stubborn about this?

  “Mr. Voss,” said Susan Casado in her silkiest voice. Her tame-the-savage-beast voice. “May I suggest we all take some time to think this over? Rushing into legal action is seldom the best course. In a few days, we may be able to resolve your concerns.” Susan looked pointedly at Wettig.

  The General just as pointedly ignored her.

  “In a few days,” said Voss, “my wife may be dead.” He rose to his feet and regarded Parr with a look of contempt. “I don’t need to think this over. I want something done about Dr. DiMatteo. And I want it done soon.”

  “I see the bullet,” said Abby.

  Mark redirected the light beam, focusing it on the posterior reaches of the thoracic cavity. Something metallic glinted back at them, then vanished behind the inflating lung.

  “Sharp eyes, Abby. Since you spotted it, you want to do the honors?”

  Abby took a pair of needle forceps off the instrument tray. The lungs had expanded again, blocking off her view of the cavity. “I need deflation. Just for a sec.”

  “You got it,” said the anesthesiologist.

  Abby plunged her hand deep into the thorax, following the inner curve of the ribs. As Mark gently retracted the right lung, Abby clamped the forceps tips around the metal fragment and carefully withdrew it from the cavity.

  The bullet, a flattened twenty-two, clattered into the metal basin.

  “No bleeding. Looks like we can close,” said Abby.

  “This is one lucky guy,” Mark said, eyeing the probable trajectory. “Entry hole just right of the sternum. Rib must have deflected it or something. And it tumbled free along the pleural space. All he gets is a pneumothorax.”

  “Hope he learned his lesson,�
�� said Abby.

  “What lesson?”

  “Never piss off your wife.”

  “She was the shooter?”

  “Hey, we’ve come a long way, baby.”

  They were closing the chest now, working together with the companionable ease of two people who know each other well. It was four P.M. Abby had been on duty since seven that morning. Already her calves ached from standing all day, and she had another twenty-four hours on duty to go. But she was on a high right now, buoyed by the success of this operation—and by the chance to operate with Mark. This was exactly how she’d pictured their future together: working hand in hand, confident of themselves and each other. Mark was a superb surgeon, swift yet meticulous. From the very first day she’d scrubbed in with him, Abby had been impressed by the comfortable atmosphere in his OR. Mark never lost his cool, never yelled at a nurse, never even raised his voice. She’d decided then that if she ever had to go under the knife, Mark Hodell was the one surgeon she’d want to be holding the scalpel.

  Now she was working right beside him, her gloved hand brushing against his, their heads bent close. This was the man she loved, the work she loved. Just for this moment, she could forget Victor Voss and the crisis shadowing her career. Perhaps the crisis was over. No ax had yet fallen, no ominous message had been issued from Parr’s office. In fact, Colin Wettig had taken her aside this morning to tell her, in his usual gruff way, that she’d received outstanding evaluations for trauma rotation.

  It will all work out, she thought as she watched the patient wheeled out to Recovery. Somehow, this will all turn out just fine.

  “Excellent job, DiMatteo,” said Mark, stripping off his OR gown.

  “I bet you say that to all the residents.”

  “Here’s something I never say to the other residents.” He leaned toward her and whispered: “Meet me in the call room.”

  “Uh . . . Dr. DiMatteo?”

  Abby and Mark, both flushing, turned and looked at the circulating nurse, who’d just poked her head in the door.

  “There’s a call for you from Mr. Parr’s secretary. They want to see you in Administration.”

  “Now?”

  “They’re waiting for you,” said the nurse, and she left.

  Abby shot Mark a look of apprehension. “Oh God. Now what?”

  “Don’t let ’em rattle you. I’m sure it’ll be OK. Want me to come with you?”

  She thought it over a moment, then shook her head. “I’m a big girl. I should be able to handle this.”

  “If there’s any problem, page me. I’ll be right there.” He gave her hand a squeeze. “That’s a promise.”

  She managed to return the thinnest of smiles. Then she pushed through the OR door and headed grimly for the elevator.

  With the same feeling of dread she’d felt last night, she stepped off onto the second floor and headed up the carpeted hall to Jeremiah Parr’s office. Parr’s secretary directed her to the meeting room. Abby knocked on the door.

  “Come in,” she heard Parr say.

  Taking a shaky breath, she stepped inside.

  Parr rose from his seat at the conference table. Also in the room were Colin Wettig and a woman whom Abby did not recognize, a fortyish brunette in a nicely tailored blue suit. Nothing she saw in those faces gave Abby the slightest clue as to the purpose of this meeting, but every instinct told her this session would not be a pleasant one.

  “Dr. DiMatteo,” said Parr, “let me introduce you to Susan Casado, the hospital’s corporate attorney.”

  An attorney? This is not good.

  The two women shook hands. Ms. Casado’s grip felt unnaturally warm against Abby’s icy skin.

  Abby took a chair next to Wettig. There was a brief silence, punctuated by the lawyer’s rattling of papers and Wettig’s gruff throat clearing.

  Then Parr said, “Dr. DiMatteo, perhaps you could tell us what you recall about your role in the care of a Mrs. Karen Terrio.”

  Abby frowned. This was not at all what she’d expected. “I performed the initial evaluation on Mrs. Terrio,” she said. “Then I referred her to Neurosurgery. They took over her case.”

  “So how long was she under your care?”

  “Officially? About two hours. More or less.”

  “And during those two hours, what did you do, exactly?”

  “I stabilized her. Ordered the necessary labs. It would be in the medical record.”

  “Yes, we have a copy,” said Susan Casado. She patted the chart lying on the table.

  “You’ll find it all documented in there,” said Abby. “My admitting notes and orders.”

  “Everything you did?” said Susan.

  “Yes. Everything.”

  “Do you remember anything you did that might have negatively affected the patient’s course?”

  “No.”

  “Anything you should have done? In retrospect?”

  “No.”

  “I understand the patient expired.”

  “She’d suffered massive head trauma. A motor vehicle accident. She was declared brain-dead.”

  “After you cared for her.”

  In frustration, Abby glanced around the table. “Could someone please tell me what’s going on?”

  “What’s going on,” said Parr, “is that our insurance carrier, Vanguard Mutual—that’s your carrier as well—received written notification just a few hours ago. It was hand-delivered and signed by an attorney from Hawkes, Craig and Sussman. I’m sorry to tell you this, Dr. DiMatteo, but it appears as if you—and Bayside—are about to be sued for malpractice.”

  The air went out of Abby’s lungs in a sickening rush. She found herself gripping the table, fighting the sudden nausea rising in her stomach. She knew they were waiting for her to respond, but all she could manage was a shocked look and a disbelieving shake of her head.

  “I take it you weren’t expecting this,” said Susan Casado.

  “I . . .” Abby swallowed. “No. No.”

  “It’s only a preliminary notification,” said Susan Casado. “You understand, of course, that there are a number of formalities that lead up to any actual trial. First, the case will be reviewed by a state screening panel to determine whether or not this is, in fact, malpractice. If the panel decides there was none, this whole thing may stop right there. But the plaintiff still has the right to proceed to trial, regardless.”

  “The plaintiff,” murmured Abby. “Who is the plaintiff?”

  “The husband. Joseph Terrio.”

  “There has to be a mistake. A misunderstanding—”

  “Damn right there’s a misunderstanding,” said Wettig. Everyone looked at the General, who had, until then, sat in stony silence. “I’ve reviewed the record myself. Every page of it. There’s no malpractice there. Dr. DiMatteo did everything she should have done.”

  “Then why is she the only doctor named in the lawsuit?” said Parr.

  “I’m the only one?” Abby looked at the attorney. “What about Neurosurgery? The emergency room? No one else was named?”

  “Just you, Doctor,” said Susan. “And your employer. Bay-side.”

  Abby sat back, stunned. “I don’t believe this . . .”

  “Neither do I,” said Wettig. “This isn’t the way it’s done and we all know it. Damn lawyers usually take the shotgun approach, name every M.D. who came within a mile of the patient. There’s something wrong here. Something else is going on.”

  “It’s Victor Voss,” said Abby softly.

  “Voss?” Wettig gave a dismissive wave. “He has no stake in this case.”

  “He’s out to ruin me. That’s his stake.” She looked around the table. “Why do you think I’m the only doctor named? Somehow Voss has gotten to Joe Terrio. Convinced him I did something wrong. If I could just talk to Joe—”

  “Absolutely not,” said Susan. “It would be a sign of desperation. A tip-off to the plaintiff that you know you’re in trouble.”

  “I am in trouble!”

&nbs
p; “No. Not yet. If there’s really no malpractice here, it will all blow over sooner or later. Once the panel rules in your favor, chances are the other side will drop the suit.”

  “What if they insist on going to trial anyway?”

  “It would make no sense. The legal expenses alone would—”

  “Don’t you see, Voss must be footing the bill. He doesn’t care about winning or losing! He could pay an army of lawyers, just to keep me running scared. Joe Terrio may be only the first lawsuit. Victor Voss could track down every patient I’ve ever cared for. Convince every single one of them to file suit against me.”

  “And we’re her employer. Which means they’ll file suit against Bayside as well,” said Parr. He looked ill. Almost as ill as Abby felt.

  “There’s got to be a way to defuse this,” said Susan. “Some way to approach Mr. Voss and cool down the situation.”

  No one said anything. But Abby, looking at Parr’s face, could read the thought going through his head: The fastest way to cool this down is to fire you.

  She waited for the blow to fall, expected it to fall. It didn’t. Parr and Susan merely exchanged glances.

  Then Susan said, “We’re still early in the game. We have months to maneuver. Months to plan a response. In the meantime . . .” She looked at Abby. “You’ll be assigned counsel by Vanguard Mutual. I suggest you meet with their attorney as soon as possible. You may also consider hiring your own private counsel.”

  “Do you think I need to?”

  “Yes.”

  Abby swallowed “I don’t know how I’m going to afford to hire an attorney . . .”

  “In your particular situation, Dr. DiMatteo,” said Susan, “you can’t afford not to.”

  For Abby, being on call that night was a blessing in disguise. A flurry of calls and pages kept her on the run all evening, attending to everything from a pneumothorax in the medical ICU to a postop fever in the surgical ward. There was little time for her to brood over Joe Terrio’s lawsuit. But every so often, when there was a lull in the phone calls, she would find herself hovering dangerously close to tears. Of all the grieving spouses she’d comforted and counseled, Joe Terrio was the last one she’d expected to sue her. What did I do wrong? she wondered. Could I have been more compassionate? More caring?