First Do No Harm

by L Jan Eira

  “Mitral valve,” answered Peter rapidly with an air of confidence.

  “Correct. What does this blue color represent?” asked John of the students as he turned on the color Doppler. No one answered, the students’ eyes burning an impression on the ultrasound screen with their intense analysis of the images.

  After a pause, John came to the rescue. “Blue color represents blood flow away from the transducer, whereas red indicates blood flow towards it. The blue jet you see here is showing blood flowing from where to where?” asked John again demonstrating his point using his pen.

  “That blood is flowing from the left ventricle to the left atrium. That’s the wrong way,” said Chris pensively, not knowing exactly what to say next.

  “That must be mitral valve incompetence,” said Peter.

  “Right,” said John. “Indeed that is mitral regurgitation. This is caused by the heart attack we gave the little guy. In a few days he’ll have florid CHF,” said John.

  “CHF?” Claire appeared confused.

  “Congestive heart failure,” said John. He pushed another button and a new image appeared, this one brighter and with much more detail.

  “As you can see, this wall is much less bright than the others. This is the area of the heart attack. These images were obtained after we injected the bubbles. Aren’t the pictures better?” asked John.

  “It’s like HD-TV,” remarked Taylor in admiration. “Even I can read this study. It’s so much clearer.”

  As John continued to ooh and ah the visitors with the ongoing research efforts, an older man peered through a glass window. His eyes met John’s and the young doctor paused, his muscles tensing. Suddenly and briskly, the door to the lab opened and Dr. Rupert entered.

  “What are you doing here?” demanded the director with an air of arrogance and irritation.

  “I was just showing Dr. Norris and his students—” John started to speak, timidly explaining his behavior as if he was just caught with his hand in the cookie jar.

  He was rudely interrupted by the commanding voice of Dr. Rupert.

  “I can see that. I need you to finish your work and I do not appreciate interruptions and delays.”

  Caught totally by surprise, Claire, Jack and the medical students retreated leaving John to receive the tongue lashing alone.

  Even as the door to the research lab closed, Rupert’s voice could still be heard.

  A man passed them on the way out. He stopped, noticing the situation.

  “Oh my. Dr. Rupert is on a rampage again. I am so sorry. I’m James Miller. I’m the chief technician here in the lab. I’m sorry about the yelling. Dr. Rupert is under a lot of pressure and gets disturbed easily,” said the older man noticing the facial expressions of disgust on the lab visitors. James Miller was a portly man in his sixties, with scant gray hair and a protruding belly. His attempts to put the retreating group at ease, by explaining the poor behavior demonstrated by his boss, was admirable.

  “He yells a lot, but he doesn’t mean anything by it. He’ll be okay. Don’t any of you worry about it,” continued James in a soothing fatherly voice. “Let me go in there and rescue poor Dr. Connor.” With this, James smiled and disappeared behind the lab door.

  “Thank you, Mr. Miller,” said Claire, not sure if he had heard her at all. “What a nice man. He reminds of my grandfather, so kind and attentive,” she said to the group as they walked away.

  “What an idiot, that Rupert,” said Jack. All remained silent, not sure what to say.

  *****

  5:04 PM

  Jack and Claire were happy to be home. Rupert’s angry words were still bothering Jack. In the shower, Jack’s thoughts were of the outburst displayed in the research lab.

  “Just like a child, having a temper tantrum. He has no right to behave like that,” he contemplated to himself. “I don’t care if he is the research director. What an asshole.” Deep down Jack was furious. The longer he thought about the events in the lab, the worse he felt.

  After his shower, Jack put on comfortable clothes and joined Claire, who was cooking supper, in the kitchen. On his arrival, she was singing.

  Jack sat down in front of the TV.

  “Hey, what did you do with the money?” he asked her.

  “What money?”

  “The money your mother gave you for singing lessons.” A kitchen towel hit him on the head.

  “I used it for throwing lessons,” she replied.

  “I’m still fuming about Rupert—”

  “Can we please stop thinking about him? Let go of it. He’s a man under a lot of stress and—”

  “Okay, let’s drop it. Your psych analysis, too.”

  “Fair enough. We are creating a new section within the Department of Psychology at the hospital. Cardiac Psychology. I’m thinking of taking the position. I would work solely with the psychological issues and problems of cardiac patients. I’ll need your help in learning about cardiac problems. What do you think?” asked Claire after an uncomfortable long moment.

  “If you think that would make you happy, I think you should do it. Of course, I’ll help you with whatever you need. I do think cardiac patients are complex and unique and having someone that would deal only with cardiac patients would seem beneficial. I love the idea.” A smile appeared on Jack’s face. He would love to be able to work more closely with Claire.

  After a short silence, Claire continued, a dreamy look in her eyes: “After I get this new program started and you finish your fellowship, we can—”

  “Here we go again,” interrupted Jack.

  “Well, what do you think? Won’t it be time to add to our little family?” asked Claire, with a smile.

  “Yes, you’re right. We’ll get a puppy. A Vizsla puppy.” Jack’s enthusiastic words were suddenly cut short. Claire had thrown a small couch pillow that hit him squarely in the head. She had walked over to the couch where Jack was sitting. They wrestled playfully and laughed for several seconds ending up with a long amorous kiss.

  *****

  Fourteen days ago

  September 17

  7:44 PM

  The score was two goals to one. The Old & Arthritic, a team consisting mostly of physical therapists, had been the only team to beat the Heartbeats the previous three seasons of the coed indoor soccer league. As such, the Heartbeats, a team captained by doctors Jack Norris and John Connor, remained in second place. Jack hoped that bringing up these facts right before the game, would give his teammates the burning fire necessary to get the win.

  The Old & Arthritic had proven to be formidable opponents as they scored two well-orchestrated goals. Right before the half, a questionable handball inside the box by one of the Old & Arthritic defenders had led to a penalty-kick, which resulted in a goal for the Heartbeats.

  The time clock ticked downwards. It was now a minute and a half before the end of the match and the Heartbeats knew it was now or never. Vera and Jennifer were playing midfield. Jack, playing right fullback, had passed the ball to the women advancing the point of attack to the middle of the field. Seeing the right corner of the pitch unattended, Jack ran up the field. A relatively inexperienced Old & Arthritic left defender had come up to defend the midfield. Vera saw the possibilities unfold, even before the ball was played. Jennifer had passed her the ball. With a precise one-touch pass, Vera placed the ball in front of Jack, now in full gallop. John Connor saw it, too. From his left forward position, John tracked to the middle of the field, anticipating a pass from Jack to quickly change the point of attack with a shot on goal.

  Jack collected the ball near the corner and had a quick decision to make. He could either kick the ball on goal or pass the ball to John, now positioned a few feet in front of the goalkeeper but well guarded by the left fullback.

  Jack kicked the ball on goal. The Old & Arthritic goalkeeper dove to her left and smothered the ball, yet again denying the Heartbeats from scoring. Several more seconds later, a loud buzzer resonated, proclaiming the end of
the game.

  “We’ll get them next time,” said Jack to Vera and Jennifer with a wink. The Old & Arthritic troupe shook the hands of the Heartbeats players, repeating the usual rhetoric.

  “Good game.”

  “Good game,” came the reply.

  “Jack, I need to talk to you,” said John with a serious look.

  “I know I should have passed that ball to you; I thought I could—” John interrupted Jack.

  “No, not that. I really need to talk to you. I have been trying to decide if and how to tell you this. I need your help.” John’s face was serious.

  “Yeah, sure. What’s up?” asked Jack.

  “Great game, guys. See you next week,” said Vera, going by the two doctors walking in her socks, her indoor soccer shoes in her hands.

  “Yeah, you too, Vera. You were great today. Good game. We’ll get ‘em next time,” said Jack who then turned to John with a look of concern. John had remained still and quiet.

  “Jack, I think there’s something wrong at the Research Lab. I need to talk—” John was interrupted again.

  “Hey, Jack, what’s the league fee? I forgot to pay last week. I’ll do it right now,” said one of the team members.

  “Sixty dollars, Brooke.” Jack looked back at John.

  “Jack, I can’t be here next week. We’re going to Atlanta,” said another member of the team who was passing by.

  “Okay, Brad. Can your brother cover for you?” asked Jack

  “No, he’s going, too,” answered Brad.

  “Don’t worry. I’ll get somebody to play for you. Have fun. Come back safely.” It became clear that Jack and John could not have a serious conversation—not here, not now.

  “Jack, can we talk tomorrow? There is something bothering me and I need to discuss it with you. Claire, too.”

  “Come over tomorrow for dinner, after work. Can you?” asked Jack, worried about his friend.

  “Yeah. That’s great. Let’s talk tomorrow.” John walked away. Jack tried to follow him but before he could, he was mobbed again.

  “Good game, Jack.” It was Fred, the best player on the Old & Arthritic. They touched knuckles. Five of his players accompanied Fred.

  “Yeah, yeah, yeah. We may never be able to beat you guys. But, we’ll keep trying.”

  “It’s just our luck. We always have a close game against you,” interjected one of the opposing players.

  “You guys have an awesome goalkeeper. What’s her name?” inquired Jack.

  “Anna Diaz. She is pretty good,” answered Fred.

  “Your team has a wonderful defense line. Are you playing outdoor at all?” asked one of the players.

  “No, I’m getting too old for outdoor,” said Jack.

  “Listen to you, too old! If you change your mind, let me know. I’m getting an outdoor team together and could use you,” solicited Fred.

  “Okay, I’ll ask my people if any of them are interested,” offered Jack.

  “Want to go get a beer?” asked another man in the group.

  “I can’t. Gotta get up early tomorrow.” Jack raised his hand to signal he was leaving and walked fast to the parking lot. His feet and thighs ached as he rushed but he hoped he could see John. He did not. The space where John parked his car was now empty.

  *****

  Thirteen days ago

  September 18

  6:02 AM

  The air was cool, increasing the airplane’s lift characteristics. The takeoff had been accomplished with textbook precision and the aircraft climbed effortlessly at a thousand feet per minute to seven thousand feet. Jack scanned the airspeed indicator to ascertain that the pull on the yoke was just right. It was. Once at six thousand feet, the warning buzzer alerted him that the time to discontinue the climb was near. He had filed this flight to seven thousand feet; seven thousand and one would be legal but in bad form, if you asked Jack. He made all the necessary yoke and trim changes and soon the airplane stopped climbing. He leaned the fuel and air mixture and positioned the prop lever at its correct setting. Immediately beneath him, he could see the fluffy material of a large cloud being overtaken by the speeding aircraft.

  Being the senior cardiac electrophysiology fellow caused Dr. Jack Norris’ already busy daily schedule to become even more hectic and sometimes unbearably so. The time he could devote to fly the Beechcraft Bonanza became ever so scarce. His Bonanza was to him as a pacifier to a baby. The airplane had belonged to his dad, from whom Jack had acquired the love of flying and aircrafts. He would make every effort possible to get up at five o’clock in the morning at least every other week so that he could take her for a flight into the clouds. He loved that best. To direct the Bonanza into the fluffy whiteness of a calm cloud relaxed Jack to the point where the expected troubles of the rest of the day would become meaningless. He would fly just above the clouds until it was time to return home. A plunge into the white swirls of cotton-like mass would make instrument flying necessary. He felt challenged but in control.

  His beeper vibrated alerting him of an incoming message. Jack knew he had to return to the airport. He had flown for forty-five minutes though it seemed like only forty-five seconds had passed. Evidence of a busy day ahead was mounting as his cell phone quivered.

  “Evansville Tower, niner-eight-gulf-kilo ready to return home,” he requested of the bored airport tower controller who sipped black coffee. Niner-eight-gulf-kilo were the call letters identifying his aircraft. The Beechcraft Bonanza was a six-seater, three hundred horsepower beautiful machine fully equipped with instruments for all meteorological flying conditions and autopilot. Today, like so many others, had been a training sortie. He would not engage the autopilot, although it was set and ready to take over with a touch of a button, should it become necessary to do so. It had not. He wanted to hand fly the airplane and fly it as well, or better, than the autopilot. The airplane was beige and brown and the envy of all the general aviation pilots in the hangar of the small airport of Evansville.

  “Roger, niner-eight-gulf-kilo, any special requests this time, doc? Nobody in the pattern, so you can approach however you’d like. State intentions,” replied the man on the other side of the microphone.

  “Yeah, niner-eight-gulf-kilo, ILS-36 approach with vectors. This will be a full stop,” Jack returned in a commanding reassured voice. The ILS, or instrument landing system, is an aviation process that facilitates landings, especially crucial in conditions of poor visibility. Using this would expedite his arrival on the ground and hasten his ability to answer his pages and return the phone calls. By now, the pager and phone had vibrated yet again.

  “Roger, niner-eight-gulf-kilo, fly one-nine-zero and descend at pilot’s discretion to three thousand feet,” commanded the controller. Jack repeated the instructions to announce he had understood and would comply.

  By the time the Bonanza came to an almost complete halt at the second intersection of the runway, Jack had received two more pages and another phone call. Although not atypical for a busy doctor to be summoned so often during the workday, it seemed unusual for this to happen before eight o’clock in the morning. This piqued his curiosity. He had not had a chance to see who was trying so persistently to contact him. He would wait until the airplane was parked and secured on the tarmac before examining his pager and cell phone.

  Jack checked his beeper’s numerical display first. Four pages from the same extension at the hospital appeared. His cell phone’s Missed Calls display indicated the same number had tried him three times. One of the numbers was from the cardiology department office. He dialed it. An excited Dr. Stanley Mansfield answered on the first ring. Stan was a young looking, thin junior cardiology fellow who Jack tolerated despite his constant nervous demeanor and obvious lack of confidence.

  “What’s up Stan?” said Jack into the receiver.

  “Where the hell are you, Jack? This place is going to hell in a hand-basket. That patient we admitted yesterday, what’s his name, Butterfield or Butterhands or—”<
br />
  “Butterworth,” interjected Jack in a composed controlled voice in an attempt to calm down the nervous young doctor on the other side of the phone call.

  “Yeah, that’s it. He just shot John Connor dead, and a whole bunch of people at the hospital. Right here in our CCU. Oh, my God! There’s blood all over the place,” continued Stan, obviously distraught.

  “What? John’s dead?” Jack was devastated. He felt like his heart had just dropped to his feet. He couldn’t believe what he had just heard. “I’m on my way. Calm down, Stan, and give me the details,” continued Jack as he hurried to his car, cell phone to ear.

  *****

  7:38 AM

  The trip to the hospital seemed longer than ever. Stan was of no help. He was too disturbed and troubled to give any useful accounts of what had happened. Jack decided it was best to hang up and concentrate on the drive. In the distance, he could hear sirens blaring. He was in shock, barely able to grasp what he had just been told.

  It can’t be John that was murdered! Who would want to do that, anyhow? He just talked to me last night. Actually, he tried to talk to me last night. He couldn’t, I didn’t make time for him. With this last thought came a river of tears. Jack recalled the events of the previous evening at the soccer game. John attempted, without success, to discuss something with him.

  I was not there for him when he needed me. What if what was troubling him was what got him killed? Oh my God, what have I done? Jack wept, as he dialed Claire’s cell phone.

  “Honey, something terrible has happened,” he said when his wife answered the call. He took a deep breath and continued, “John Connor has been shot at the hospital. I received a call while I was flying. Stan said John’s dead, Claire. Also one of the CCU nurses, Heather. I’m on my way to the hospital now. Please call your supervisor at Newton Memorial and see if they want you to come in. They may want to keep as many people away from campus as possible. If you do come in, call me before. And please be careful.” A pause. A sniffle. Claire’s words were comforting.