Sarah stood, and then walked to the window gazing out at the brick wall view. She clutched a lock of chestnut hair, twisting it repeatedly.
“Come on, Sarah. I get the message. If you start sucking on your thumb, I won’t be able to stop myself from laughing.”
Sarah returned to her chair, looked at her feet. “You can’t talk to anyone about this, Lola. I’d die.”
“Oh, please. You know that will never happen, and by the way, you’re not going to tell me something I haven’t heard a hundred times before.”
Sarah raised her head and stared into Lola’s eyes. “I’m a lesbian!”
Lola struggled to suppress her smile. “So, you’re a lesbian. Big deal.”
Sarah stared at Lola in surprise. “I mean, I think I’m a lesbian. Well, Kelly and me... you know.”
“No, I’m afraid I don’t know.”
“We did it.”
“Did what?”
“You know.”
“You mean, do I know what lesbians do in their intimate moments? Of course, I do, but I don’t know what you two did. Did you masturbate each other? Did you have oral sex? Did you?...”
“Enough,” Sarah interrupted. “Nothing gross like that.”
“You kissed?”
“Yes.”
“You touched each other?”
“Yes.”
“It felt good?”
“It felt great when we did it, but I felt awful after.”
“Why?”
Sarah studied her feet. “Because it’s wrong.”
“Look at me, Sarah. Is it wrong in general or wrong for you?”
“I don’t know. It feels wrong.”
“I’ll skip the big lecture. Many girls your age experiment with each other. For most, it’s just that, experimentation. You may feel close to Kelly. You may love Kelly, but when you have your sexual fantasies, is it with boys or girls?”
“Boys.”
“Who are you attracted to, boys, or girls?”
“Boys.”
“I hate to tell you this, Sarah, but you’re not a lesbian. You can throw away your ‘lambda’ tee shirts.”
“Are you sure?”
“At this point in your life, I’m sure. Will you ever develop an interest in women or men and women, it’s possible, but I doubt it. Whatever you do sexually, if the couple enjoys it, and nobody is injured or demeaned, it’s okay by me.”
They chatted for another twenty minutes, then Lola rose indicating the end of their session.
As they approached the door, Sarah embraced Lola. “Thank you. I feel so much better.” After she released Lola, Sarah stood in thought. “When Carleton Dix found out about us, he told Kelly that she’d be writhing forever in the fires of Hell...that’s part of what led to her breakdown, I think. It’s difficult to believe that these vicious things could come from a man who lives his life by the tenets of the Bible. And, by the way, he also threatened to expose us.”
“Jacob and I know, first hand, what those who subvert the Bible are capable of. If hell exists, Sarah, Carleton Dix and his ilk will find themselves right at home.”
Chapter Forty-Seven
Jacob sat at the head of the table for the Quality Assurance meeting. “Is this really necessary?”
“I’m afraid so, Jacob,” said Arnie Roth, the committee chairman.
“Are you going to give me a Miranda warning?”
Arnie, in spite of his decision to be all business, smiled. “You’ve reviewed physicians’ practice and behavior before we had QA committees. It’s an essential function for the medical staff. We all need to support it.”
“You’re right, of course,” said Jacob, “but I’d like to know if this is pro-forma, following up on complaints, or does the committee have problems with the way I practice?”
“Both,” said Warren Davidson, who’d come in his role as department chief. “The recent events at Brier have put us under additional pressure. We’re looking at all adverse outcomes, especially unexpected deaths. A few of your patients fall into those categories.”
Jacob shook his head in disbelief. “You want to know if I killed any of my patients. Should I call an attorney?”
“Don’t get melodramatic on us, Jacob,” said Warren. “We have some gripes with you…you know all about them, but nobody, except the bizarre Marion Krupp, thinks such a thing is possible.”
Jacob stood. “Well, thank you gentlemen. I have work to do.”
“Jacob, please,” said Jack Byrnes. “Don’t get sensitive in your old age. You know that everyone who watches you work only marvels at your abilities and experience.”
Jacob shook his head, and then returned to his seat. He smiled. “See how easy it is to seduce me. Okay, let’s have it.”
Arnie opened his folder. “When we studied unexpected deaths or complications at Brier over the last eighteen months, among a few dozen, we came up with five of your cases: Shannon Hogan’s death was a surprise to all, but we don’t see evidence of foul play; P.J. Manning and Joshua Friedman were terminal. Note that I’m ignoring Marion Krupp’s complaints.”
“I appreciate that.”
“Nathan Siegel and Harry Rodman are a different story. Both suffered complications of medications and Nathan Siegel died.”
“You think I had something to do with their deaths?”
“Please, Jacob,” said Warren. “We just want your help.”
“It doesn’t sound like it. You can’t have it both ways. When I’m ultraconservative with medications, and ultra careful, you call me a therapeutic nihilist. Now your suggesting I’ve been careless with medications. Make up your minds.”
“Are you going to help us or not?” said Arnie. “We can fight about philosophical differences in practice later.”
“Of course I’ll help,” said Jacob.
“I’ll ask you the same question I asked of the Siegel and the Rodman family,” said Warren. “Do you know of any reason someone would set out to injure either patient?”
“No.”
“Could someone be out to hurt you, Jacob, through your patients?”
Jacob adjusted his bow tie. “I can be annoying, for sure, but getting at me by hurting my patients, that’s more than bizarre. I’ve had my run-ins with docs and a few nurses, but...no, I can’t see it...sorry.”
“Getting back to philosophical differences in using medications,” said Warren, “it isn’t merely a question of style.”
Jacob studied Warren. “I’m not sure what you mean.”
“Everyone respects you, Jacob, so when you take such an extreme position against medication, it makes us question our own practice. Nobody likes to think that they’re wrong.”
“That’s not my intention,” said Jacob as he stood. He cast his gaze on each member of the committee. “Look at this face. It’s not pretty...hell, it never was an attractive face, but with the wrinkles, hopefully, comes an element of wisdom. I believe in an extraordinary level of wariness in prescribing medication and I’m equally skeptical about their effects. I practice the way I do because I believe in it, but I see that I’ve been a bad advocate for these principles by questioning the physician rather than the medication. That wasn’t my intent.”
“C’mon Jacob,” said Jack, “controversy has been part and parcel of physician training forever. That’s not the issue. I see...we see great benefit in the use of the medications you disdain.”
“Disdain isn’t the right word, Jack. It’s fear. Let me mention a few names: Fen-Phen, Propulsid, Vioxx, and DES among many. One study in the Journal of the American Medical Association showed that more than half of the dangerous side effects of drugs are detected only after they’ve been on the market for seven years or more.”
“Medicine isn’t perfect, Jacob,” said Arnie.
“You’re right, Arnie, but you’re missing the point. In 2001, the drug companies used more than 600 lobbyists, outnumbering lawmakers. In 2002, they spent $22 million on campaign contributions and untold millions on
advertising to the profession and directly to the public. Don’t tell me they spent this much money without getting something in return.”
The room remained silent.
Jacob scanned the room. “Let me ask you a question. Does anyone remember the name Frances Oldham Kelsey?”
“It sounds familiar,” said Warren.
“It should. In 1960, Chemie Grünethal, a German Pharmaceutical firm, through an American company, applied to the FDA for approval of a drug. The approval wasn’t expected to be controversial, but when it reached the desk of the FDA’s newest reviewer, Frances Kelsey, she refused to clear it until she obtained better documentation of it effects and especially some reported neurologic effects. Despite increasing pressure, Kelsey held out for more toxicity studies until the effects of this medication on developing fetuses around the world became obvious.
In 1962, they awarded Kelsey the President’s Award for Distinguished Federal Civilian Service for preventing thousands of deformities in the United States from the drug thalidomide.”
Jacob stood, then headed for the door. He turned to face the group. “Do you know what would happen to a Frances Oldham Kelsey in today’s FDA? They’d fire her ass.”
Chapter Forty-Eight
Terry Wilcox leaned back in his office chair with his legs raised on the desk. He looked out the window at the falling South Dakota snow and sighed.
This sure ain’t California.
The ringing phone shook him out of his reverie. “Wilcox Detective Agency,” resounded his bass voice.
“Terrence, is that you?”
“Who wants to know?”
“It’s Jacob Weizman. What’s the matter, is business so bad you have to answer your own phone?”
“Hey, Doc, I was just thinking about warm California. It’s sure great to hear your voice. Are you in town?”
“No, Terry. You know I never go north of latitude 37 degrees.”
“The family really misses you, Doc. We’ve seen a few jokers in this town, but nothing the likes of you.”
“You’re too kind. How’s Sally and the kids?”
“They’re great, except they hate Sioux Falls, especially in winter. If I get the chance, we’ll head back to the bay area in a flash.”
“I was wondering if I could impose on you, Terry?”
“Impose away. We can never repay you for your help and especially your kindness and understanding.”
“Do you work elsewhere than Sioux Falls?”
“Anywhere the money takes me, Doc. What can I do for you?”
“I need background information on someone who worked in Rapid City. Do you go that far?”
“Been there many times. What do you need?”
“I want to know about a man named Carleton Dix who had a ministry in Rapid City. I want to know all about him, and I’d like to know why he left.”
“When was he there?”
“The mid nineties, I’d guess.”
“How quickly do you need the information?”
“A few days would be okay. Can you do it?”
“I can have the basics in a day, but the dirt...I’m guessing you want the dirt, will take a little longer.”
“I never thought of myself as being in the position of digging up dirt on anybody. It feels...”
“Slimy? Yeah, Doc, it’s the nature of the business. Often when I get home, my first act is to head for a hot shower.”
“What’s it going to cost me, Terry?”
“It’s on the house, Doc.”
“I can’t let you do that.”
“You don’t have a choice, but you can do one thing for us.”
“Of course.”
“Promise you’ll live long enough for us to return to your practice.”
“I’ll do the best I can.”
Just as Jacob placed the receiver into its cradle, Margaret knocked on his door, then entered.
“What’s up?”
“I had to sign for this, Jacob. I hope it’s all right.”
She handed him the thick envelope and when he saw the return address, Malvin & Lutz, Attorneys at Law, he knew that he’d been served.
“This is just what I need.”
“What is it?”
“Another damn lawsuit. We managed to practice for fifty years before I got my first malpractice suit. It’s not because I’m perfect, I’m not. It’s not because I don’t make mistakes, I do, and it’s not because tragedy hadn’t hit our patients unexpectedly, it has.”
“You may think that it’s all luck, Jacob, but I know better. Our patients always knew, they were certain, that you were on their side and felt their losses almost as much as they did.”
“Maybe. At first, I took each lawsuit personally. I refused to accept that any of my patients believed the things alleged in their complaints.”
“They didn’t and still don’t,” said Margaret. “It’s money, greed or opportunistic trial lawyers. Don’t take it personally.”
“I don’t know any other way to take it,” he said, holding up that first fifteen-page complaint. “If any of this is true, they should have me on the first boat back to Austria.”
Jacob stared at the envelope. He grabbed his cherry wood letter opener and pulled out the thick bundle of pages. He scanned the first few pages. “It’s about Nathan Seigel, a wrongful death suit, from the plaintiff, the estate of Nathan Siegel and from his daughter Patricia Seigel Clark.”
“I didn’t know he had another daughter,” said Margaret.
“Not one that he ever talked about.”
“How many years did we treat him? How many times did you run into the hospital in the middle of the night? And, how often did Patricia Seigel call in to find out how her father was doing? It makes me sick to think that she’s suing you now.”
“Well, Margie, we’re in good company. She’s suing Brier Hospital, Sharon Brickman, Zoe Spelling, Ahmad Kadir, Kate Planchette, and my favorite ‘one hundred unnamed physicians’. I think they simply listed all the names that appeared on any of his charts.”
“Has Zoe been sued before?” asked Margaret.
“I don’t think so. I hope this doesn’t upset her too much. She needs to deal with this, it’s part of medical practice today.”
When Jacob brought the papers in for Zoe, she grabbed them. She studied each page, then placed it face down on her desk. After she finished the last page, she reddened. “What a load of crap.”
“It’s okay, Zoe. Don’t tell me that you’re a malpractice virgin?”
“No...I mean yes...I mean...I never saw Nathan during that last hospitalization. Why me? It’s not right...I didn’t do anything.”
“Right or wrong, guilty or not guilty, responsible or not responsible, none of it has meaning in a medical malpractice case. You’d better get used to it.”
Ida Rosenthal hated hospitals, the idea of hospitals, their smell, their uncertainty, their threat. Of the last three people she knew who were admitted to Brier Hospital, only one came home.
If she hadn’t fallen, hitting her head and fracturing her hip, they’d have never gotten her past the Emergency Room doors. At the age of eighty, this was only her third stay in a hospital, each time before she returned home with a baby. Now, if she survived, she’d return home with a walker.
“All that security frightens the hell out of me,” she said to her nurse. “I don’t like to think about all that stuff in the newspapers about a serial killer.”
“Don’t worry, Mrs. Rosenthal,” said the nurse. “Nobody can get near you who doesn’t belong. Do you need anything for sleep?”
“A couple of codeine pills would be nice. They make that hip pain disappear.”
Ida dozed into the early hours, waking every forty-five minutes to an hour. She’d look around wide-eyed then managed to fall asleep. When she last stared at the clock, the red LED’s read 2:45 a.m. She must have nodded off because when she opened her eyes, she saw the dark shadow bent over in the corner of the room doing something.
Is this real or am I dreaming?
“Who’s there?” she tried to say, shaking her head awake, but her mouth, lips and tongue were cotton dry.
“Desculpe-me, señora,” came the thick, coarse voice.
“Who!
“What!
“Leave me alone!” she screamed as the shadow moved closer to the bed, then, “No...No...No!”
Suddenly the room flooded with intense overhead light as the nurse and the uniformed policeman entered.
“Yo no hice nada,” screamed the middle-aged janitor, standing with his back against the wall, a plastic bag filled with garbage in one hand. “I didn’t do nothin’.”
“Don’t move,” ordered the policeman as he turned the janitor to face the wall. He quickly frisked him. “He’s clean.”
The nurse held Ida as she cowered in bed. “It’s all right. He’s just the janitor...it’s all right, he won’t hurt you.”
Afterward, the policeman released the janitor and said to the nurse, “For Christ’s sake, don’t let these guys skulk around in the dark. With the tension around here, someone’s going to get hurt.”
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