In retrospect, her problems had been going on for years. Symptoms, so vague and fleeting, and their lives so busy, she never gave them more that a moment’s thought.
“Everybody has unexplained symptoms, Ben. Doctors don’t evaluate unless they are more serious or persistent.”
“Still,” said Ben, “you had the numbness before the last two pregnancies, and then you had the vertigo.”
“They went away each time. I feel fine.”
Ben shook his head, and then caressed her cheek. “You’re not fine, sweetheart. Something’s wrong. You’re having difficulty with the morning Sudoku puzzle.”
She stared at him. A tear ran down her cheek, then she whispered, “I know. I’m frightened. When you’re a medical professional and you live with disease each day, you wonder why you’re the lucky one. Maybe I’ve run out of luck.”
“Don’t do this to yourself. Make an appointment to see Arnie Roth.”
The rest happened in a flash. Blood tests, MRI, neurology consultation, spinal tap and finally Arnie’s diagnosis. “You have relapsing-remitting Multiple Sclerosis.”
Kate felt dizzy as her intestines contracted in shock.
She took a deep breath. “Me and the West Wing president.”
“Right, except the writer’s need for drama made things worse than it’s likely to be for you.”
“I’ve cared for MS patients, Arnie. I know what that disease can do.”
“Of course. I understand, but remember, you only see the sickest of the sick. The ones who need hospitalization. I see the good part of it, MS patients who are doing well, and I’m telling you that after many years in practice, odds are in your favor to have a normal life.”
“I can’t say the diagnosis surprises me. I don’t know if we have an increased incidence of MS or if it’s more in the public’s consciousness because of magazines and television.”
“We’ll start you on interferon. You’ll give yourself an injection once a week.” He hesitated and stared at Kate. “MS isn’t a reportable disease, Kate, but we need to consider its effects on your work.”
“My mind is fine, Arnie, but I’ll notify nursing administration.”
“That’s smart, and responsible. I’m sure they won’t have a problem. I’ll support you in any way possible.”
She leaned over and kissed him on the cheek. “Thanks, Arnie. You’re the best.”
While experienced medical personnel eventually tired of the frustration in dealing with chronic alcoholics, the lies, excuses, and destruction of the individual and their families, the staff at Brier never abandoned hope for Nathan Seigel. He maintained a great sense of humor, treated the staff with respect, and blamed only himself for his problems.
When Nathan appeared in Brier Emergency three days ago, Jacob Weizman admitted him and called Sharon Brickman for a consultation. Jacob tried to handle most problems himself, but Nathan’s heart irregularities had proved difficult to impossible to control on prior occasions.
Sharon shook her head in disgust. “I’m going to keep him on Lidocaine to control his irregular heart rhythm, but one of these days we’ll be too late.”
Jacob shared her frustration.“Tell me something I don’t know already.”
Patients in the step-down unit had their hearts monitored by telemetry. Each patient’s heart tracing appeared on a central station where computers and a trained technician scanned the screen for abnormalities.
I check my watch as I enter Nathan Siegel’s room. It’s 3:15 p.m., the perfect hour for my visit.
How much time, energy, and dollars have we spent on a man determined to kill himself with alcohol?
As he sleeps, I see that rosy, vein-streaked face and that bulbous nose and hear his soft snore.
The nurses have mounted the sophisticated infusion pump on an IV pole next to the bed. I check the label on the plastic infusion bag. It reads: Lidocaine, Do Not Exceed 50 mg per minute.
The bag is about half full...perfect.
I study the drop as it grows in the drip chamber then falls into the fluid level about one drop every two seconds.
I smile as my gloved hand reaches for the infusion rate entry keys and push them repeatedly until they read 999, the maximal setting. The slow drip becomes a fatal fluid flow.
Nathan stirs momentarily, and turns in bed trying to find a comfortable position. My pulse races with excitement.
When the fluid in the bag is almost gone, I pull a 250 cc bag of saline from my Adidas pouch, attach the infusion tubing, a needle at its tip, and restore the original volume in the Lidocaine bag. As my final step, I restore the pump to its initial setting.
His will be done.
I smile then roll up my empty bag and its tubing and place it back into the athletic bag.
I look back at Nathan then move to the door. I peek out, look both ways, toss the athletic bag over my shoulder, smile, and depart.
Another job well done.
The monitor tech turned to Kate. “Something’s wrong with Nathan Seigel. His tracing shows widening complexes like he’s having slow conduction of electrical flow through the heart.”
Kate Planchette stared at the monitor. Alarmed at once, she rushed to his bedside. Nathan looked like he was asleep, and when she shook him, he opened his eyes and slurred his words. “Whasup, Katey?”
Oh my God, she thought. He’s drunk. Won’t you ever learn, Nathan?
She could barely understand his speech. “I’m feeling sick, Katey. I have a metal taste in my mouth.”
“How could you do this, Nathan? Now, where is it?”
Nathan failed to respond. Suddenly, Kate noticed his right eye twitching. Then came the contractions of the entire right side of his face and the right side of his body. In seconds, Nathan’s bed rattled as he convulsed rhythmically. Kate shoved a padded wooden tongue depressor between his teeth then pushed the Code Blue button. She removed Nathan’s pillow, listened for breathing and felt for a pulse. Finding neither, she gave his three quick mouth-to-mouth breaths and began external cardiac massage.
In moments, the room filled with the Code Blue Team, the respiratory therapist, and several physicians who had been nearby. Kate continued external massage while they placed a mask over Nathan’s mouth to ventilate his lungs. The monitor on the defibrillator showed a flat line, no electrical activity at all as Sharon Brickman entered, followed by Ahmad Kadir who ran from ICU.
At that moment, Sharon was all business. “What’s happening?” she shouted. “Someone get hold of Jacob Weizman.”
“The tracings widened,” Kate said, “and when I got in here, he sounded drunk. I don’t know how he got alcohol in here. Then he had facial twitching that quickly progressed to a generalized convulsion. His heart tracing showed no electrical activity, a flat line.”
Sharon stared at the tracings, examined his heart. “Continue CPR and set up an Isuprel drip while I prepare the pacemaker.”
Moments later, Sharon, with the help of Ahmad, inserted a long catheter into a large vein in Nathan’s groin and passed it up to the heart. When she started the pacemaker, she was pleased to see the resumption of the heart’s electrical activity, but in moments, she found her hopes dashed. His heart muscle contractions were so feeble, they failed to support a blood pressure.
Jacob Weizman entered the room. He looked at Sharon who shook her head. “I’m so sorry, Jacob. We did everything possible. Nathan finally ran out of luck.”
The nurses gathered the resuscitation supplies and straightened the room. Kate prepared Nathan’s body for the morgue.
Jacob stood with Kate. “What in hell happened?”
Kate reddened, and then turned away.
Jacob turned to the cardiologist. “Sharon?”
She hesitated a moment. “Don’t know, Jacob. I’d say a lethal cardiac irregularity, but the tracings look funny to me and I can’t explain the seizures.”
“Has anyone called the family?” Jacob asked.
“No. I’ll call if you like.”
“Thanks, Sharon. I’ll do it. In spite of all his close calls, this is going to kill his daughters.”
“I think we need a postmortem examination.”
“No question. I’ll get the family to sign the permit and I’ll notify pathology.”
“Something’s not right about this, Jacob.”
“I know.”
Chapter Thirty
Margaret Cohen tapped on Zoe’s door Friday morning. “Brenda Gomez is ready, Dr. Spelling. She’s in examining room three.”
Zoe frowned. “Why is she here? She isn’t due back for two or three months.”
“You know Brenda...it’s always something.”
Zoe grabbed Brenda’s chart from the door rack and entered.
Brenda, age forty-five, and single, sat on the table, lost in an examining gown three sizes too large. Her body language was a paradox; thin arms crossed her chest said, ‘keep away’, wide, teary eyes pleaded for help.
Brenda smiled. “Hi, Dr. Spelling.”
“What is it now?”
Brenda fumbled with her purse, rummaged through, and then produced five pages of handwritten notes.
“Put those away and tell me what’s bothering you the most.”
“I don’t feel good.”
“Please, Brenda. You must give me more than that.”
Grasping her notes again, Brenda began paging through.
“I told you to put those away. I don’t have all day to waste on every little problem.”
Brenda’s eyes filled. “I need some tests...something’s wrong with me. Please, Dr. Spelling, help me.”
“We’ve run out of tests, Brenda.” Zoe pulled the stethoscope from her lab coat and began her examination. After Zoe finished, she opened the examining room door and stood with Brenda’s chart. “You’re as healthy as a horse, Brenda. Let me see you again in six months.”
“You’re not finished seeing me, are you? You must give me something.”
“You don’t need anything. You’re fine.”
Brenda clutched her wrinkled list. “I don’t feel good. I wrote it all down. Let me tell you a few things.”
Zoe shook her head in disgust. “Give me that.” She grabbed Brenda’s list and placed it in her pocket. “I’ll look them over as soon as I can.”
“Thanks, Doctor. I’ll hear from you soon?”
“Sure.”
While Brenda headed for the front desk, Zoe returned to the examining room. She reached into her pocket grabbed the list, crushed it in her hand, and tossed it into the trashcan.
Margaret Cohen watched from her desk. Brenda may be difficult, but this...?
Three emergency office visits, late patients, and doctors delayed on rounds kept Jacob’s office in a frenzy throughout the day. Finally, it was over. Fridays were bad, this was ridiculous.
Margaret sat in the lounge with the Betty Kaufman, the office receptionist, and Trudy Sims, their bookkeeper. She’d retrieved three cans of soda from the refrigerator.
Betty took a sip. “I’m glad this day’s over. If Jacob asks me to squeeze one more patient into the schedule, I’m going to squeeze him.”
Margaret smiled. “He can’t help it. It’s in his soul. How do you think Zoe’s doing?”
“I think she’s great,” said Betty. “She’s so smart and beautiful. I think she’s a real asset to the practice.”
“She’s a little distant with some patients,” said Margaret. “Don’t you think?”
“Well, Margaret,” said Betty, “we have a few that try the souls of any man or woman. Brenda Gomez is a good example.”
Margaret faced Betty. “You don’t think Brenda deserves our attention?”
“It’s not that, it’s just that she’s so needy...so impossible to deal with, that I understand Zoe’s difficulty with her. Unfortunately, the world produces few saints like Jacob.”
Margaret shook her head. “Jacob’s no saint. He has had his moments, like all of us, but he never takes it out on our patients.
“What do you think, Trudy?”
“She’s charming for sure, but I keep having to remind her to complete the office visit forms for billing and letters that we need to appeal disallowed services...that’s a real headache. I have one other thing...”
“What?” asked Margaret.
Trudy looked back over her shoulder. “Well, technically, Zoe’s an employee, I guess. Nobody’s told me anything else, yet she’s demanding details about all our billing practices, income, and receivables. It’s awkward for me. I feel uncomfortable talking about those things with her. I wish you or Jacob would clarify the situation for me.”
“I’m sorry,” said Margaret. “In the craziness of daily life, Jacob and Zoe have never formalized their relationship, although I know he wants her to be a full partner.” She took another sip of soda. “Maybe I’ve been a one man office manager too long. I want things to go well for us and for Zoe too.”
When Robert Hughes picked up the phone at home, he heard, “Bob, it’s Lola Weizman.”
“Lola, it’s great to hear from you. How’s Jacob?”
“Old.”
“None of us are getting any younger.”
“Don’t remind me...every time I move, my body complains.”
“What’s up?”
“I wanted to talk with you about Sarah.”
“Should I sit down first?”
“Come on, Bob...give the girl a break. She’s doing well, so well, in fact, that I’d like to invite her for dinner. Is that okay with you and Marilyn? We thought of inviting all of you, but that should wait a while longer.”
“Of course it’s okay. Things have really improved since you began seeing her. Maybe you should take on Marilyn and me?”
“I’m good, Bob, but I’m not a miracle worker. Don’t be surprised if everything improves at home.”
Shortly after noon Saturday, Jacob returned from hospital rounds to find Lola in the kitchen making a salad. He removed his coat and hat and sat at the kitchen table, grabbing a pencil and a crossword puzzle.
“How were rounds today?”
“Too smooth. I get suspicious when things appear to be going well. It’s like waiting for fate to slip us a fast one.”
Lola carried the salad bowls to the table. “You’re getting paranoid in your old age, sweetie.”
“Ordinarily, I believe the esteemed psychotherapist in residence, but our lives make it difficult to be paranoid.”
Lola laughed. “I think you’re full of shit.”
“Is that a psychoanalytic term?”
“It means, my love that I see a world of difference between what you say and how you live. I can’t call you irascible, you have too good a sense of humor...maybe you relish your dark side out of habit?”
“Don’t shrink me, Lola. Time and gravity are doing enough of that. When’s Sarah coming over?”
“About three.”
“For dinner?”
“I’m not giving her a free ride. She’s helping me prepare dinner, an ethnic one, chopped liver, matzo ball soup, and stuffed cabbage.”
“Where’s the Milk of Magnesia?”
“You’ve survived my cooking. You’ll survive this.”
Jacob slept in his La-Z-Boy chair with a book across his chest. He was snoring softly when Lola brought Sarah into the kitchen.
Sarah spoke in a whisper, “Thanks for having me, Lola. This is a real treat.”
“Why are you whispering?”
“Dr. Weizman’s asleep.”
“Call him Jacob. A supersonic transport couldn’t awaken him now.”
They worked for an hour and a half before Jacob sat up and shook his head. “Why didn’t you tell me company was here?”
“You needed your sleep, Old Man.”
Jacob rocked back and forth in the chair, then grabbed the footrest lever and jerked to the sitting position. He approached Sarah, extending his hand.
“We’re pleased you decided to come. I hope you can tolerate a
little time with the old folks.”
“You guys are great . . . especially Lola,” she whispered.
“I heard that,” said Lola, “I’m old, but not deaf.”
Jacob walked to the kitchen table. “Why don’t you join me, Sarah. I speak adolonics.”
Sarah looking at Jacob with questioning eyes.
“It’s Jacob, Sarah, call me Jacob. Adolonics...teen talk...you know: chillin’, peeps, tight...I know most of the lingo, thanks to Lola.”
Sarah laughed. “You’re almost as funny as Lola...” she paused, staring at Lola. “I mean that in a good way.”
Lola flapped her hand forward in a ‘forget it’ gesture.
“You can help me with the crossword puzzle, Sarah. It’s the modern culture stuff that stumps me.”
Sarah rolled her chair next to Jacob, staring at the almost completed New York Times crossword puzzle.
“Here’s one. Five letters, ending in an ‘a’. Marge’s twin. I don’t have the slightest.”
No Cure for Murder Page 13