The Sixth Sense (Brier Hospital Series Book 3)

by Lawrence Gold

  The Sixth Sense

  Lawrence W. Gold, M.D.

  The Sixth Sense 2012 © by Lawrence W. Gold, M.D.

  All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without permission in writing from the publisher.

  This book is a work of fiction. Characters names, places, and incidents either are the product of the author’s imagination or are used fictitiously, and any resemblance to any actual persons, living or dead, events, or locales is entirely coincidental.

  A Grass Valley Publishing Production

  To order additional copies of this book, e-mail

  grassvalleypublishing@gmail.com

  Cover Art©2012 by Dawne Dominique

  Dedication

  To my wife, Dorlis. Her dedication and support made this work possible.

  Acknowledgments

  Donna Eastman of Parkeast Literary Agency who helped make this possible.

  Joseph Barron, a true renaissance man, my writing buddy. Gone but not forgotten.

  Writers groups on both coasts. WOW in Palm Coast, Florida and Sierra Writers Fiction Critique Group in Grass Valley, CA

  I want all my senses engaged. Let me absorb the world’s variety and uniqueness.

  Maya Angelo

  Nothing is understood, which was not first perceived by some of the senses.

  John Locke

  The first condition of understanding a foreign country is to smell it.

  Rudyard Kipling

  Other Works

  By

  Lawrence W. Gold, M.D.

  Fiction:

  Brier Hospital Series:

  First, Do No Harm

  No Cure for Murder

  The Sixth Sense

  Tortured Memory

  The Plague Within

  Trapped

  Other Novels:

  For the Love of God

  Rage

  Deadly Passage

  A Simple Cure

  Non-Fiction:

  I Love My Doctor, But…, a lighthearted look at the doctor/patient relationship

  All available in print and in Kindle

  Chapter One

  I stared through the bay window as the sun’s first rays broke over the east bay hills, scattering the early morning San Francisco haze. I turned and slid my arm under Lois’s waist. Her soft breathing hesitated as her body struggled against awakening and then resumed its regular rhythm. Awake or not, she raised her hips to accept my arm, and a moment later rolled over to face me. Lois sensed my mind and other body parts and whispered. “Quiet, Arnie. Please, they’re still asleep.” The sun angled through pale-yellow curtains and streaked across the foot of our bed. We embraced and all extraneous thoughts surrendered to the intense physical desire of lovers still hungry for each other after twelve years of marriage.

  We collapsed in sweaty exhaustion just in time.

  The hall toilet flushed, and a moment later tiny feet padded toward our bedroom and Amy, our five-year-old daughter, jumped into bed.

  She squirmed her way between us and Lois pulled her close. “Hi, sweetie.”

  Thirty seconds later, she was asleep.

  I turned to the nightstand clock that read 6:10. I leaned past my sleeping daughter to kiss Lois. “It’s about that time. I have a busy morning and better get an early start on hospital rounds.”

  “Don’t make too much noise. If I’m lucky, Becky will sleep for another thirty minutes. Disturbing that girl is like stepping on a nest of fire ants. Give me a few moments before I fuss with her about getting ready for school.”

  By the time I finished my shower and shaved, both girls were at the kitchen table with their bowls of sugarcoated cereal—our dentist forever grateful.

  I kissed my wife and daughters goodbye and drove through light morning ground fog to my Berkeley office near Brier Hospital. I parked in my space with the sign, “Arnold Roth, M.D., Family Practice.” I grabbed the morning newspaper and entered the converted Victorian we’d purchased. I shared it with a child psychiatrist and an optician. I threw the paper on my desk, grabbed my white coat and stethoscope, and left for morning rounds.

  Brier Hospital grew from the turn of the century Brier Hills Convalescent Home to a private, not for profit community hospital. It sat in the hills, west of the University of California, Berkeley.

  For three weeks, the hospital was running near 100 percent occupancy due to an epidemic of viral encephalitis and influenza. Too many patients and not enough beds put the hospital in emergency mode, canceling elective surgery, and admitting only the sickest patients.

  I had two patients with encephalitis. One, Henry Cass, had suddenly developed severe headaches after what initially looked like the flu. Henry’s recovering. The other, Samantha Goldstein, was another story. The carefree, healthy twenty-year-old Berkeley student hovered near death in a deep coma. I watched her rapid deterioration over thirty-six hours—a child carried out to sea on a cruel riptide, my worst nightmare.

  I resisted the elevator’s seduction. Its open portals beckoned, but I heeded my own advice for exercise by climbing five flights and then walked the long corridor toward the ICU. The entire west wall was floor-to-ceiling glass windows with an imposing view of Berkeley, the Oakland-San Francisco Bay Bridge, and the Golden Gate to the northwest. The city glowed orange in the distance, the last wisp of fog yielding to the bright morning sunshine.

  I approached the ICU’s door labeled, AUTHORIZED PERSONNEL ONLY, and pushed the call button.

  “Can I help you?” the ward clerk’s voice crackled over the loudspeaker.

  “It’s Dr. Roth.”

  “Good morning, Arnie. Come on in,” she crooned as the door lock clicked open.

  The ICU’s ambiance was unique. I felt it each time I entered. When peaceful, it had the serenity of a chapel. When turbulent, the staff struggled to preserve the aura of calm control. The unit was silent this morning except for a single ventilator clicking and whirring next to bed five across from the nursing station. Several nurses, having completed the night shift were coming out of morning report while the 7 a.m. to 3 p.m. shift prepared for the day ahead.

  The Intensive care unit had twelve beds in the open and three isolation rooms for patients with infectious diseases or for those who needed protection from the bacterial sewer that was our world. We called that reverse isolation. Each open-space bed was on the unit’s periphery and paralleled large windows facing to the west and north.

  Jack Byrnes was ICU’s director. He sat at the nurse’s station talking with his wife Beth, the unit’s Director of Nursing. Years of working with them as colleagues had moved us from a professional relationship to a close personal one—we were good friends.

  Jack and I were polar opposites on medicine’s spectrum. After entering practice, I discovered that every physician griped about their work and envied the lives of other practitioners. It was a professional grass-is-greener affliction.

  Jack smiled and taunted me. “I don’t know how you primary care docs do it, Arnie. How do you keep up with every advance that comes our way in medicine?”

  “Obviously, I don’t. I do what I can and hopefully I’ll know when and who to call for help.”

  “Sometimes I wish I’d chosen primary care. My life would be simpler. I can’t keep up with the information overflow in intensive care medicine.”

  “Not to worry, Jack. By definition, a specialist is one who knows more and more about less and less. Eventually you won’t have to know a thing.”

  He laughed. “Righ
t. I think I’m there already.”

  “In my senior year, I had decided to be a specialist. Then I came to my senses and chose family practice. Not an easy decision since General Practitioner had become only slightly more reputable than chiropractor or podiatrist.”

  “Not anymore,” Jack said. “The worm (pardon the expression) has turned and you guys have the power. You decide what tests to order, what specialists your patients see, and which medications to dispense. You’ve ascended into the highest echelons of medicine’s priesthood.”

  “Right. When they pay me more, I’ll believe it.”

  “Sooner or later, that will change.”

  “Not in my lifetime. The label, ‘Family Practitioner’ rather than GP, is more than spin, but most patients don’t understand. They still insist on seeing specialists and requesting procedures they don’t need. That hardly puts Family Practitioners in the stratosphere of prestige. Insurers embrace us as gatekeepers, but I hate that phrase and its meaning. It puts me between my patients and the medical care they need, costly or not. According to insurers, I should be a team player. I should go for the greater good, but that only works if you don’t have a conscience.”

  Jack and Beth made an attractive couple. Jack was in his late thirties and about six one, three inches shorter than I am, but he didn’t have my husky build. Everyone loved Beth at first sight. She had a beautiful smile and a charismatic personality.

  Jack hugged his wife. “I can never get enough of this woman.”

  Beth smiled and caressed Jack’s cheek. “He’s good, isn’t he? Jack knows how to keep a woman happy.” She turned to me. “Good morning, Arnie. How are Lois and the girls?”

  “Everyone’s fine. I’m finally getting used to living in a woman’s world.”

  I glanced across the room at Samantha Goldstein. “Have you seen her this morning?”

  “I just examined her. It’s bad. She’s still unresponsive.”

  We gave her Acyclovir, an antiviral medication, though we weren’t sure this would attack the virus causing her encephalitis. We hadn’t identified the specific virus, and that left us with general supportive measures and cortisone to lower the pressure on her brain. We both understood that this was a pathetic counterattack on a virulent virus intent on destroying Samantha’s central nervous system.

  When I approached the isolation room, Richard and Marion Goldstein, Samantha’s parents, were in gowns and gloves. They were sitting at her bedside. Pleading, tear-filled eyes mirrored their desperation.

  I had struggled under the burden of Samantha Goldstein’s tragedy each day since I admitted her. Death was death, and tragedy was tragedy, but for me, certain cases were most heartbreaking. Samantha, so young and with so much life ahead, was my toughest case.

  When I was a medical student, I spent the summer between my second and third years with Simon Katz, a pediatric hematologist.

  Each day, we made rounds at several hospitals. In those days, childhood malignancies and leukemias were uniformly fatal. I still recoil from the image of Simon, a gentle, caring man, struggling to find a way to speak the unspeakable to parent after parent—that their child was going to die. I don’t know how he did it. I couldn’t.

  Life cut short at any age was tragic, but even now, after years in practice, I still cringed at the thought of death in the young. When you lived each day with death and disease and remained healthy, it was easy to believe that it couldn’t happen to you or to your loved ones. Yet each time I saw a child die, I knew that these beliefs were nothing but dangerous illusions stretched on the fragile threads of certainty.

  Richard turned to me. “What’s happening, Arnie?”

  “I talked with Dr. Byrnes. Nothing has changed.”

  I spent ten minutes examining Samantha. The ventilator initiated each breath, an ominous sign as it said that her severely damaged brain was unable to trigger breathing. I performed a detailed neurological examination that revealed abnormal reflexes, but no response to painful stimuli.

  Marion grasped Richard’s hands. “Tell us what you think.”

  I signaled them to follow me into the anteroom.

  Talking to someone whose face was hidden behind a mask was like concealing a fine work of art, wholly unsatisfying. Speaking in front of a patient thought to be comatose could prove embarrassing when they awakened and recalled details of your bedside conversation.

  We pulled off our masks and surgical caps.

  Why did I study their faces when I already understood what they were feeling? I’ve seen about every reaction to medical tragedy from helplessness to waning hope to anger, but impassivity and denial in the last hours of their daughter’s life was the least intuitive response and left me uneasy.

  Marion stared into my eyes and whispered. “You must do something.”

  “I can’t begin to tell you how sorry I am. We’re doing everything possible, but this is an aggressive virus and it’s already done extensive damage.”

  “Extensive damage?” Marion cried collapsing in tears into Richard’s arms.

  How stupid of me to use such careless, crushing words, I thought.

  I hated the next step, but it was unavoidable. I would not allow any oblique phrase to obscure my meaning. “If we don’t see signs of improvement soon, we’ll need to reassess what we’re doing and whether we should continue treatment.”

  Marion stiffened, and then reeled backward as if someone had slapped her. “What are you talking about? Stopping treatment! Are you out of your mind?”

  Today wasn’t the time to fight this battle. It would come soon enough. At least I had fired the first volley.

  “Nobody’s recommending stopping anything, but if Samantha doesn’t improve, we should consider what she would want.”

  “What Samantha would want?” Richard asked. “Do you really think a twenty-year-old has thought that through?”

  I softened my voice. “In light of events like the Terri Schiavo case, and the publicity surrounding end of life issues, everybody’s been forced to think about that.”

  Jack Byrnes had told me of a similar case at Brier Hospital. He’d consulted for a plastic surgeon who’d managed to perforate a woman’s abdomen during a routine liposuction. For days, the surgeon refused to diagnose the perforation and the subsequent peritonitis, as if denial would make it go away. The patient was in shock when they finally admitted her to ICU. She never regained consciousness and within five days, it became clear that she never would. Her clinical examination and all tests including CT head scans and electroencephalograms, demonstrated brain death.

  “I thought we had covered all bases,” Jack said. “We had the patient’s signed Advanced Directive for Health Care that gave her husband the responsibility to decide what treatment was appropriate and when support should cease. As we got into a discussion about terminating life support, her estranged daughter arrived from out of town and demanded that we do everything.”

  I shook my head. “How could she force a decision contrary to her mother’s wishes and the legal document empowering her father to decide?”

  “It’s like a lawsuit, Arnie. You can sue although you don’t have a chance in hell of prevailing. Everybody, especially hospitals, are risk averse and will try anything to avoid going to court even when they know they’ll win. If that wasn’t bad enough, the daughter went to the media and to the Evangelical community’s fanatic fringe. For a while, we had a mini Terri Schiavo case.”

  “What happened?”

  “I tried my best to convince the daughter that she was doing her mother a disservice, but she refused to hear me. The hospital, smarting from the daily demonstrations at its door and all the media coverage, went into full defensive mode and stopped us from terminating care. Fortunately, nature was more sensible than we were, and had the good grace to stop the patient’s heart and resist our obscene and futile efforts to resuscitate her.”

  “I can understand and forgive the daughter, Jack, and the hospital, but the outsiders piss me
off. To paraphrase John Galsworthy—the idealistic beliefs of these meddlers increases in direct proportion to their own distance from the problem.”

  Jack looked up at me. “I like the Latin proverb best: beware the tyranny of the minority. Those watchwords are more significant today than ever.”

  Chapter Two

  I returned to my office at 8:30, poured coffee, and pushed aside stacks of charts to make room for the morning paper.

  My office would have consisted of a large desk and bookcases if they’d left the decorating to me. It’s a good thing I had Lois. She knew that understatement and practicality suited me best. I had a large teak desk, bookcases and she’d added a soft leather sofa, end tables, and comfortable upholstered chairs. I’d insisted on a credenza behind my desk chair, but Lois objected. “You’re going to stack things on it. It’ll look awful.”

  Of course, she was right. I could tell by her groans each time she entered my office and saw piles of charts, journals, and magazines behind me.

  She had my framed diplomas on one wall and several Ken Hornbrook landscape photographs on the other.

  Each time I saw Arnie Roth, M.D. Family Practice at the entrance to my office, it amazed me that things had turned out so well. My father died when I was young, and I grew up in the loving embrace of three women, my mother, and two older sisters. I’d worked hard for everything in my life. My sisters were academic stars, straight A’s, but I didn’t read until the third grade and often confused words and spelling. Teachers and counselors whispered about my learning disability. I felt relieved when I first heard the term dyslexia, a word that sounded a hell of a lot better than retarded.