And when it was over, when the girl who loved to ride horses walked away from the hospital and from the split second that could have paralyzed her forever, he would take that moment and bankroll it in his mind as vindication for all the years and all the anguish, and as a hedge against those outcomes yet-to-be which would not bring smiles and handshakes and pats on the back—outcomes that, as long as they were unavoidable, were no less a part of medicine than this one.
“That’s it, Stacy,” he cooed as he tightened down the last of the screws. “That’s it. You’re doing perfect. We’re all doing perfect.”
With the elective surgery schedule now an hour behind, O.R. 2 was emptied out as soon as the last screw was in place and the proper position of the halo was verified. Zack accompanied Stacy Mills to the east-wing room where, for a few days, she would be observed for signs of spinal cord swelling or compression.
“Well, you just take it easy, Stacy,” he said. “I’m going to go talk to your folks, and then I’ll send them up. I’ll be back to see you at the end of the day. Wearing this device won’t be the most fun you’ve ever had, but like I said, it won’t be forever.”
“Dr. Zack,” the girl called out as he was leaving, “in the operating room I said that I wasn’t scared. Well, now that it’s all over, I can tell you that I really was. I just didn’t want to sound like a baby.”
Zack returned to the bedside and smiled down at her.
“In that case,” he said, “I’ve got something to tell you—something I’ve never told any patient before.” He bent over her bed and whispered, “I’m always a little frightened and a little nervous when I operate.”
“You are? Really?”
“The truth. I think it helps my concentration never to forget that it’s always possible that something could go wrong. There, I said it, and … hey, Dr. Mills, I feel better already!”
“You’re very silly, do you know that?”
“I hope so,” he said.
As he was leaving the girl’s room, Zack spotted Maureen Banas approaching down the corridor. She was in her late forties or early fifties, he guessed, with short, graying hair that looked as if it had been cut by an amateur. Although she carried herself with authority, the tension etched into her face and the lack of attention to ten or fifteen excess pounds hinted at a life that had, perhaps, not been an easy one.
“Congratulations, Dr. Iverson, and thanks,” she said with an almost clinical lack of emotion. “Stacy is a very special child to a lot of people. We all owe you a great deal for what you did.”
In that case, he wanted to say, tell me about the nail you helped hammer into Guy Beaulieu’s coffin.
“Listen,” he replied instead, “just seeing her moving those arms and legs and piggies of hers is enough to get me through six months of the usual neurosurgical nightmares. Besides, it’s Wilton Marshfield you should be thanking. I was just the technician.”
“Nonsense. I know he missed those fractures. Sticking up for him was a very kind thing for you to do, especially with the altercation you two had last week. Wilton’s really a sweet old guy most of the time. But he misses too much.”
He misses too much. The opening, however slight, was there.
Zack glanced past the nurse. The corridor was quiet. There might have been a more appropriate time and place, but one day after Guys funeral, and only hours after reading his diary, thoughts of the man were too close to the surface for Zack to walk away from this opportunity.
“Sort of like Guy Beaulieu in that respect,” he said. “Yes?”
Maureen Banas looked at him queerly. “I beg your pardon?”
“I was asking about your impressions of Guy Beaulieu. I was with him when he died, you know.”
“Of course I know.” Her strange expression had not faded. “I thought a lot of Dr. Beaulieu. To die the way he did was … was very tragic.” She averted her gaze and peered around the comer into Stacy’s room. “Well,” she said, “I guess I’d better check on my niece and get back to the emergency ward. Thank you again, Doctor.”
“Mrs. Banas, wait, please,” Zack said.
The woman stopped, her back still to him, her posture rigid.
“Please?” he said again.
Slowly, she turned to face him. Her arms were folded grimly across her chest.
“Yes?”
“Mrs. Banas, I … I read the letter you wrote about Guy.”
What little color there was drained from the nurses face.
“Your brother had no right to go passing that around,” she said.
“Why?”
The woman looked about restlessly.
“Dr. Iverson, I think I’d better go.”
“Mrs. Banas, just a minute ago you said that you owed me a great deal for what I did for Stacy. Well, I don’t usually call in markers like this, but I need to know about Guy—what he’s been like these past two years; what he did that prompted you to write those charges. Please. It’s terribly important to me … and to his family.”
Maureen Banas’s reaction was far from the anger or defensiveness Zack would have anticipated. She began to tremble, and quickly grew close to tears.
“I … please, I don’t want to talk about it. Your brother said he would speak with me before showing that note to anyone. He had no right to give it to you.”
“Look,” Zack said. “I didn’t mean to upset you. I’m just trying to get to the bottom of things—to the truth.”
It took several breaths before the nurse began to regain her composure.
“Dr. Iverson, I’ve got three children, one of them retarded, and an ex-husband who hasn’t sent a dime of support in ten years. I’m sorry I wrote that letter, but … but I had to. I had to. Now, you’ve got to leave it alone. For my sake. For my family. Leave it alone. I beg you.”
“I can’t, Mrs. Banas … Maureen, I don’t want to cause trouble for you or for anyone, but I’ve got to know if that letter contained the truth about Guy.… Please.”
The woman said nothing.
“What is it?” he asked. “Did someone pressure you to write it? Threaten to take your job away?”
The nurse bit on her lower lip. Her eyes had filled with tears. She glanced nervously about. Two nurses were approaching down the hall.
“Come with me,” she said softly.
There was a small sitting area at the end of the corridor—a colonial-style maple settee and two matching chairs arranged beneath a huge picture window that faced southwest, toward the mountains. Maureen Banas took one of the chairs and motioned Zack to the edge of the settee closest to her.
“Dr. Iverson, I meant what I said about my family,” she began in a hoarse whisper. “If you speak of this conversation to anyone and I lose my job, you will have hurt a number of people who do not deserve to be hurt.”
“You have my word.”
“I … I’m terrified about doing this.”
“Please …”
“At the beginning of the summer, I quarreled with Dr. Beaulieu in the E.R. We never got along all that well to begin with, but I think we more or less respected one another. It doesn’t make any difference what we fought about. The whole incident was actually pretty mild. But there were a number of witnesses.
“A week or so later, there was an envelope stuck under my door at home. In it were ten one-hundred-dollar bills, a copy of the note you saw, and instructions that when I copied the note over in my own hand and sent it to Mr. Iverson, I would receive a second, equal payment.”
“No hint of who the note was from?”
Once again, the nurse seemed close to breaking down.
“None.”
“Well, did the note say what would happen if you refused?”
“It said that trouble would start happening in my life, and that I could count on being fired. Dr. Iverson, I know what I did was awful, but … but I had been doing so poorly with the kids, and the damn bills just keep coming in, and—”
“Please, Maureen. You don’t
have to explain,” Zack said. “I understand that you did what you had to do. Do you still have the note?”
The nurse shook her head.
“I … I was afraid to keep it.”
“Any sense at all as to who sent it? Do you think it was my brother?” Zack felt sick at the thought.
“I … I don’t believe so,” she said.
“Why do you say that?”
“Well, whoever wrote me added at the end that if Frank Iverson learned my note wasn’t really my idea, he would be fired just as quickly as I would be.…”
She began to cry.
“You see why you can’t say anything to anyone about this?”
“Yes, Maureen. I see. Telling me what you did was a very brave thing to do. I promise you that I’ll honor your confidence.”
“Th-Thank you.”
She dabbed at her eyes with her uniform sleeve and then hurried back down the corridor.
Feeling more sadness toward the woman than anger, Zack propped his foot on one of the chairs and gazed across at the Presidential Range.
Hiking … climbing … camping … unique challenges in the office and in the O.R.… The projected life that had drawn him back to Sterling suddenly seemed so remote, so naive.
Guy, it appeared, had been right all along. Someone at Ultramed was committed to driving him from practice—and in the ugliest of ways. Zack was grateful that that someone did not appear to be Frank. But in the end, would it really matter? In Sterling, at least, Frank was Ultramed. And when push came to shove, it was hard to imagine him lining up against the company.
The situation was so crazy, so far removed from a patient needing help and a physician trained and ready to render it.
But for better or worse, Zack acknowledged, he was in it to stay. He had chosen this town and this hospital. And now, if he had to do battle with Ultramed to justify that decision, then battle there would be.
All he needed to complete the circle, to place himself once and for all squarely where Guy Beaulieu had stood, was proof—if not proof from Maureen Banas, then perhaps from the Ultramed system itself.
If Guy was right, if the policies and the climate created by the corporation were so ruthless and self-serving, if compromises were being made and corners cut in the name of profit, then somewhere there was the medical tragedy such a philosophy must inevitably bring. Somewhere, there was that emotional focal point that would translate possibilities and abstract concerns into flesh and blood.
And if such a tragedy existed, Zack vowed, sooner or later he would find it.
From his position at the nurses’ station on West 2, Donald Norman, MD, propped Annie Doucettes chart on his ample lap and peered over the top of it at a Rubenesque young nurse named Doreen Lavalley. She was standing on tiptoes atop a small stool, stretching over her head for a bag of IV solution. The skirt of her uniform was at her mid-thigh and rising.
Doreen was the sexiest, most desirable woman in the hospital, at least to the Ultramed-Davis Chief of Staff. For months he had been cultivating her with small talk, friendly pats on the shoulder, an arm about the waist, and impromptu teaching sessions.
Since his arrival at the hospital four years before, Norman had gone out of his way to keep his reputation spotless and to portray the perfect, responsible family man and community servant. The powers at Ultramed rewarded such behavior just as vigorously as they punished actions that brought negative publicity down upon their house.
But after four consecutive yearly merit awards, he believed that the company would tolerate a few slips. And with his wife gaining weight and growing more involved with her school committees and steadily less involved with their physical relationship, Doreen Lavalley had become worth the risk.
Besides, Norman reasoned, Frank Iverson was rumored to have made it with half the decent-looking women in the hospital, and he had been made a member of the Golden Circle and had twice won the highest administrators award that Ultramed offered.
Just as her skirt was about to reach the base of her panties, Doreen located the right IV solution and hopped down from the stool.
Donald Norman cursed under his breath.
“Morning, Doreen,” he said, tugging at the small bulge that had materialized behind Annie Doucettes chart. “How goes it?”
“Oh, Dr. Norman, hi.”
“Hey, I told you,” he whispered, with a conspiratorial wink, “when no ones around you can call me Don. Listen, I’d like you to make rounds with me, if that’s okay. Mr. Rolfe has some interesting findings in his chest, and that … that harpy, Mrs. Doucette, should still have her murmur.”
The nurse glanced about.
“Well, I’m a little behind in my work, and—”
“Oh, come on,” he urged. “I just have those two on this floor. It shouldn’t take long.”
“I … well, okay. As long as it’s just two. And Dr. Norman, Annie’s a nice lady. Really she is. Just give her a chance.”
“It’s Don, remember?” Norman said. “And as far as Annie Doucette goes, she may be a sweet old lady to you, but she’s been a harpy to me.” He checked the three by five file card he carried on her. “Besides,” he added, “it’s all academic to all intents and purposes, she’s out of here.”
“You’re sending her home?” Doreen asked with disbelief.
Norman shook his head.
“Not home,” he said. “To the Sterling Nursing Home, provided they can clear out a bed. Remember, under the Diagnostically Related Group system—you know, the DRGs—medicare pays by the diagnosis, not the length of the hospital stay. Our job is to get patients out as quickly as possible.”
What Norman did not mention, although they were certainly on his mind at that moment, were the Ultramed incentive points awarded for discharging patients before the end of their DRG period, and the even greater number offered for a transfer to a Leeward-owned nursing facility.
“I don’t think Annie’s going to like that idea,” the nurse said. “She’s very independent.”
“Well, then,” Norman said, tucking her chart under his arm and adjusting his tie, “we’ll just have to reason with her, won’t we? Bring your order book along just in case. By the way,” he added as they started off, “I’m giving an in-service on hepatitis next Thursday evening. I hope you’ll be there.”
“Well, actually, I—”
“I think Flo Bergman, the Ultramed nursing director, will be up from Boston. I’d like her to meet you. With the Ultramed director of nursing and the Davis chief of staff on your side, there’s no telling what opportunities might open up for you.…”
Annie Doucette flipped off the quiz show she had been trying to watch, settled back on her pillow and stared up at the ceiling.
The pains in her chest, little more than twinges throughout the previous day, had begun to intensify, and for the first time since the horrible night of her admission, she was frightened. There were gaping holes in her recollection of that night, but not gaping enough to erase the agony and the humiliation she felt, to say nothing of the disruption she had caused Cinnie Iverson, the Judge, and their family.
She should never have accepted their invitation to dinner, she told herself. Never. After twenty-odd years of doing her work proudly and well, of being the glue that held the Iverson household together, she had become nothing but a burden—an imposition and source of worry for everyone.
If only she could have just gone as her husband had, quickly and painlessly in his sleep.
She chewed two Rolaids from the pack her son had bought for her and tried to focus her thoughts on the sweaters for her grandchildren and the afghan for the church bazaar—unfinished projects waiting for her at home in her flat.
All she needed was a few moie days—a week, maybe—in the hospital, and everything would be okay. She had not given in to the aches and pains and the passing years yet, and she would not this time. The rumblings in her chest were probably nothing more than indigestion, anyhow.
Annie closed her ey
es as bit by bit the discomfort yielded to a gentle sleep.… A week … That was all she needed.… A week to get her strength back.… Then everything would be okay … everything would be back to normal again.… It felt so good to nap.… So good to drift off … so good …
“So, Mrs. Doucette, how are we doing this morning?” Donald Norman boomed.
Startled, Annie felt another, slightly more urgent twinge in her chest.
“We have felt better, Dr. Norman,” Annie said, opening her eyes only after the last vapor of sleep had drifted away. “Oh, hello, Doreen, dear.”
“Hi, Annie.”
“And what seems to be the trouble?” Norman asked.
Annie debated whether or not to repeat what she had already told the nurses about the pains. Donald Norman had never paid much attention to her complaints, anyway.
“I’m getting some pains,” she said finally.
Norman thumbed through her chart.
“Doreen, look. Here’s the description I wrote of that murmur. Right here. A grade-two systolic. Let’s listen and see if it’s changed.”
He slipped his stethoscope down Annie’s nightgown, listened for a few moments, and then guided the nurse to the bedside with his arm around her waist and gave her a turn.
“Hear it?”
The young woman looked at Annie uncomfortably and nodded.
“Dr. Norman,” she said, “Annie’s been having chest pain on and off since yesterday morning.”
“Of course she has,” Norman said, as if he and the nurse were the only two in the room. “I would bet dollars to doughnuts that they started right after I mentioned her discharge from the hospital. It happens all the time. People get anxious. Did you order an EKG?”
“It’s right there in the front of her chart.”
“Good,” he said. “Good work.” He scanned the tracing. “Well, it shows nothing to be alarmed at. Just the same T-wave changes in the anterior leads. Here. See? Right here. I’ll explain how they’re different from other T-wave changes after we finish seeing these two patients.” He turned back to Annie. “So, if everything else is okay, I think we should begin to plan for your discharge.”
“I’m not feeling well enough to leave yet, Dr. Norman.”
Flashback (1988) Page 17