“Tetracycline?” Huttner interrupted. “I called in a stop on that order days ago. They’re still giving it to him?”
Behind Huttner, in David’s line of vision, the charge nurse nodded her head in vigorous confirmation.
“Well, no matter,” Huttner said, hesitating slightly. David could almost hear him asking himself whether he had actually called in the stop order or had just meant to. “The culture reports have all been negative. Why don’t you write an order to take him off tetra. Go ahead and get another culture if you want to.”
David was about to comply when he noticed a culture report at the bottom of the lengthy computer printout that listed all results obtained on the patient to date. It read
“9/24, STOOL SPEC:
MODERATE GROWTH, S. AUREUS,
SENSITIVITIES TO FOLLOW.”
Staph aureus, the most virulent form of the bacteria. David closed his eyes for a moment, hoping that when he looked at the sheet again the words would be gone. He took several seconds in making the decision to say nothing about his discovery and to correct the problem later. The hesitation was too long.
“What is it, David?” Huttner asked. “Have you found something?”
“Dammit,” David cursed to himself. A dozen possible responses poured through his mind, were evaluated and rejected. There was going to be no comfortable way around it. No place to hide. Out of the corner of one eye he saw the two nurses standing motionless at the end of the bed. Did they know that in the next few moments the success of the evening and possibly of David’s career might vanish?
The whole scene became strangely dreamlike for him. The hand slowly passing Merchado’s chart to Huttner, the finger pointing at the offensively impersonal line of type—they were someone else’s, not his.
The look David had last seen directed at the O.R. scrub nurse sparked in Huttner’s eyes. They locked with his for a fraction of a second, then turned on the nurses. He thrust the chart at the charge nurse.
“Mrs. Baird,” he growled, “I want you to find out who is responsible for failing to call my attention to this report. Whoever it is, nurse or secretary, I want to see her in my office first thing Monday morning. Is that clear?”
The nurse, a stout veteran who had engaged in her share of hospital wars, looked at the page, then shrugged and nodded her head. David wondered if Huttner would actually follow through with what seemed so obvious an attempt to produce a scapegoat.
“Come along, Dr. Shelton,” Huttner said curtly. “It’s getting late and we still have several more patients to see.”
It was nearly ten o’clock when they arrived on Four South to see the last of Huttner’s patients, Charlotte Thomas. For the first time all evening Huttner deviated from the routine he had established. Taking the chart from the charge nurse, he said, “Come and sit down in the nurses’ lounge for a bit, David. This next patient is by far my most complicated. I want to take a few minutes to go over her with you in some detail before we see her. Perhaps someone could bring us each a cup of coffee.” The last remark was transparently addressed to the nurse, who managed a faint smile of acquiescence. “Light, no sugar for me, and for Dr. Shelton …?”
“Black,” David answered. For a split second he had almost said “bleak.”
“Here you go, Doctor,” Huttner said, sliding the chart across to David. “Leaf through it while we’re waiting for coffee.”
Before reading a word, David could tell that Charlotte Thomas was in trouble. Her hospital record was voluminous. He thought back to his residency and a tall, gangly New Yorker named Gerald Fox, who was one year ahead of him. Fox had achieved immortality, at least in White Memorial Hospital by Xeroxing a three-page list of cynical maxims and definitions entitled, “Fox’s Golden Laws of Medicine.” Among his axioms were the definition of Complicated Case (“When the combined diameters of all the tubes going into a patient’s body exceeds his hat size”), Gynecologist (“A spreader of old wives’ tails”), and Fatal Illness (“A hospital chart more than an inch thick”).
Coffee arrived just as David had begun to scan the admission history and physical examination. He heard Huttner say, “Ah, Miss Beall, thank you. You’re an angel of mercy.”
He looked up from the chart. It was not the nurse with whom Huttner had placed their order, but a far younger woman David had never seen, or at least had never noticed before. For several seconds his entire world consisted only of two large, oval, burnt umber eyes. He felt his body flush with warmth. The eyes met his and smiled.
“So, are you with our lady Charlotte again?” Huttner asked, oblivious to the silent meeting that was taking place.
“Huh? Oh, yes.” Christine broke the connection and turned to Huttner. “She’s not looking too well. I asked to bring the coffee in because I wanted to talk to you about …”
“How rude of me,” Huttner interrupted. “Miss Beall this is Dr. David Shelton. Perhaps you two have met?
“No,” Christine said icily. She was well acquainted with Huttner’s lack of regard for the insights and suggestions of nurses. Over the years she had given up even attempting to share hers with him. But Charlotte’s situation was distressing enough for her to try. If Huttner would only agree to let up on his aggressive treatment, to cancel the resuscitation order, she might not intervene even if the Screening Committee approved her proposal. So she had tried, and predictably the man had cut her off—this time with an inane social amenity. Still, she felt determined to speak her mind. It was his tube that was sticking into Charlotte’s nose. His order to prolong her suffering no matter what. He could play puppet-master with his other patients, but not with Charlotte. He would listen or … or have his strings to her cut. Christine swallowed the bone of anger that had begun sticking in her throat.
Huttner took no note of the chill in her voice. “Dr. Shelton will be covering all my patients, including Mrs. Thomas, for a few days,” he said.
Christine nodded at David and wondered whether he might have the authority to back off on Huttner’s overzealous approach to Charlotte, then realized there was no chance the surgical chief would permit that. “Dr. Huttner,” she said flatly, “I would like to talk to you about Charlotte for a few minutes.”
Huttner glanced at his watch. “That would be fine, Miss Beall,” he said. “Why don’t you let us finish reviewing Charlotte’s case and examining her. Then you can go over things with Dr. Shelton here. He’ll know exactly what I want for this woman.” Huttner looked away before the first of the daggers from her eyes reached him. David shrugged his embarrassment, but Christine had already turned on one heel and left the room.
Huttner took a sip of coffee, then began speaking without so much as a word or gesture toward the nurse who had just left. “Mrs. Thomas is a registered nurse. In her late fifties, I think.” David glanced at the birth-date on the chart. She was nearly sixty-one. “Her husband, Peter, is a professor at Harvard. Economics. She was referred to me by an internist because of a suspected cancer of the rectum. Several weeks ago, I performed a Miles’s resection on the woman. The tumor was an adenocarcinoma extending just through the bowel wall.
“However, all the nodes I took were negative. I feel there’s a very good chance that my clean-out may have gotten the whole thing.”
David looked up from the coffee stain he was absently erasing with his thumb. The five-year survival rate after removal of a rectal cancer with such extension was under 20 percent. A chance? Certainly. A “very good chance”? He leaned back and wondered if it was worth asking Huttner to clarify the reasons for his optimism. It would not, he decided, be wise to question him about anything.
Comfortable in the blanket of his own words, Huttner continued his presentation. “As always seems to happen when we work on nurses or doctors, everything that could have gone sour postoperatively seems to have done so. First, a pelvic abscess—I had to go back in and drain it. Next, a pneumonia. And then a nasty decubitus ulcer over her sacrum. Yesterday she developed signs of a bowel obstruct
ion and I had to slip down a tube. That seems to be correcting the problem, and I have a feeling that she may have turned the corner.”
Huttner folded his hands on the table in front of him, indicating that his presentation was done. An almost imperceptible tic had developed at the corner of his right eye. He must be absolutely exhausted, David thought. Uncomfortable and anxious to do anything other than stare, David returned to the chart. “If she needs to be operated on for the obstruction?” he asked, already praying it would not happen.
“Then you go ahead and do it if that’s your judgment. I’m leaving you in complete charge,” Huttner said somewhat testily.
No more questions, David resolved. Whatever you want to know, figure it out for yourself. Just get through this night.
But already another potential problem was becoming obvious. He tried to reason it through, but quickly realized that only Huttner could supply the answer. His resolve stretched, then snapped.
“If she should arrest?” he asked softly.
“Dammit, man, she’s not going to arrest,” Huttner snapped with startling vehemence. Then, sensing the inappropriateness of his outburst, he took a deep breath, exhaled slowly, and added, “At least, I hope she doesn’t arrest. If she should, I want a full Code Ninety-nine called on her, including tracheal intubation and a respirator if need be. Clear?”
“Clear,” David said. He looked down at the chart again. Whatever criticisms might be leveled at Wallace Huttner, undertreating Charlotte Thomas certainly could not be one of them. Thousands of dollars in laboratory work, hospital care, and radiologic studies had already been done. Still, at least on paper, the woman appeared far from “turning the corner.”
“Shall we go see the patient?” Huttner’s tone was more order than request.
David was about to comply when he noticed the report of Charlotte’s liver scan. The words burst from the page: “Multiple filling defects consistent with tumor.” Numbness crept over him as he stared at the reading. Rarely had he heard of a patient surviving long with the spread of rectal cancer to the liver. Certainly, with this kind of disseminated disease, there could be no way to justify the aggressive therapy being given Charlotte Thomas. If, as in the Merchado case, this report had somehow been overlooked, whatever remained of his relationship with Huttner was about to disappear with the finality of a nuclear explosion.
“What is it this time, doctor?” Huttner asked acidly.
“Oh … probably nothing,” David said, wishing he were anyplace else. “I … ah … I was just reading this liver scan report.”
“Hah!” Huttner’s exclamation cut him short. “Multiple defects consistent with tumor, right?” He suddenly looked happier than he had all evening. “Look at the name of the radiologist who gave us that report. G. Rybicki, M.D., the living Polish joke of radiologic medicine. He read the same thing on a scan that we did preoperatively, so I checked her liver out carefully in the O.R. Even sent off a biopsy. They are cysts, David. Multiple, congenital, totally benign cysts.
“I even went to the trouble of sending Rybicki a copy of the pathology report,” Huttner continued. “He probably never even looked at it, as witnessed by this repetition of his initial misreading. Maybe we’d better just tear the report out of the chart.” He crumpled the sheet in a ball and tossed it into the wastebasket. “Now, if you have no further questions, shall we go in to see the woman?”
“No further questions, your honor.” David shook his head in amazement and smiled, grateful to be allowed off the hook. There was something about Huttner’s broad grin that went far toward dispelling the misgivings David had developed about the man.
Shoulder to shoulder, they walked down the corridor of Four South and into Room 412.
CHAPTER IV
The only light in Room 412 came from a gooseneck treatment lamp directed at an area just above Charlotte Thomas’s exposed buttocks. Huttner strode to that side of the bed with David close behind and moved the lamp back a foot. He stiffened, then forced a more relaxed pose. Bewildered and somewhat amused, David stifled a smile at the man’s reaction; then he looked down at the reason for it. The bedsore Huttner had described as “nasty” was far worse than that. It was a gaping hole six inches wide. The walls of the cavity were raw muscle, stained white by a drying poultice. A quarter-sized eye of sacral bone stared sightlessly outward from the center.
Huttner gave the kind of shrug that said, “Nothing worse than other things we’ve dealt with, right?”
David tried to respond, but could manage only a shake of his head. He had seen sores and wounds countless times from every conceivable source. But this …
“It’s Dr. Huttner, Charlotte,” Huttner announced as he flicked off the lamp and turned on the dim fluorescent light set in a cornice over her bed. He drew the sheet up above her waist and stepped to the other side of the bed. David followed, glancing at the I.V. bags and the restraints that held her on her side, at the urinary catheter snaking from beneath the sheet, at the oxygen and suction tubes. He understood the need for them and accepted their presence without a second thought. They were all as much tools of his trade as were the giant saucer lights and variegated steel instruments of the operating room.
However, in those first few seconds the one thing he noticed most about Mrs. Thomas was the emptiness in her face—a static soulless aura centering about her eyes, which were watching him through the dim light with a moist flatness. Even the sound of her breathing—soft, rhythmic cries—was empty.
Charlotte Thomas had The Look, as David had come to label it. She had lost the will to live, lost that extra bit of energy essential to surviving a life-threatening illness. The spark that was often the single difference between a medical miracle and a mortality statistic was gone.
David wondered if Huttner saw the same things he did, felt the same emptiness. Then, as if in answer to his question, the tall surgeon knelt by the bed, slipping his hand under Charlotte’s head and cradling it to one side so that she could look directly at his face. For nearly a minute they remained that way, doctor and patient frozen in a silent tableau. David stood several feet away, swallowing against the heaviness that was building in his throat. Huttner’s tenderness was as genuine as it was surprising—another facet had shown itself in this strange kaleidoscope of a man.
“Not exactly feeling on top of the world, huh?” Huttner said finally.
Charlotte forced her lips together—an unsuccessful attempt at a smile—and shook her head. Huttner smoothed the hair from her forehead and ran his hand over her cheek.
“Well, your temperature is down near normal today for the first time in a while. I think we might be getting on top of that infection in your chest.” He went on, carefully mixing encouraging news with questions that he knew would be answered negatively. “Is the pain in your back any less?” Another shake. “Well, if things settle down the way I expect them to, we should be able to get that tube out of your nose in a day or two. I know what an annoyance it is. While I have you rolled over like this, let me take a listen to your chest, then I’ll put you on your back and see if there ate any new noises in your belly.”
He examined her briefly, then glanced at the fluid levels in the intravenous bags and catheter drainage cylinder before kneeling beside her again. “You’re going to make it, Charlotte. You must believe that,” he said with gentle intensity.
This time Charlotte did manage a rueful smile to accompany her negative response.
“Please, just be patient, have faith and hang on a little longer,” Huttner implored. “I know the pain you’re going through. In many ways it’s as awful for me as it is for you. But I also know that bit by bit you’re turning the corner. Before you know it, you’ll be putting on lipstick and getting ready to see those beautiful grandchildren you’ve told me so much about.” He paused. In the silence David studied the man’s face. His brows were drawn inward, his jaw taut as a bow string. He seemed to be trying, through sheer will, to transfuse the energy of his words and h
ope. The woman showed no reaction. “My goodness, I almost forgot,” Huttner said at last. “Charlotte, you are in for a treat. I know how tired you must be getting of seeing my smiling mug every day. Well, you’re going to get a break from that.
“I’m going off to a conference on the Cape for a few days. This handsome young doctor will be covering for me. He was the chief resident a few years ago at White Memorial. I couldn’t even get accepted for an internship there. His name’s David Shelton.” Huttner motioned David over to the head of the bed.
David took Huttner’s place, setting his arms on the sheet and resting his chin on them, six inches away from Charlotte’s face. It seemed to take several seconds for her to focus on him.
“I’m David, Mrs. Thomas. How do you do?” he said, realizing at the same instant that she had already answered his ill-conceived greeting several times. “Is there anything you need right now? Anything I can get for you?” He waited until he felt certain no response was forthcoming, then made a move to stand up. Suddenly Charlotte Thomas reached out a spongy, bruised hand and grasped his with surprising force.
“Dr. Shelton, please listen to me,” she said in a husky, halting voice that had its own unexpected strength. “Dr. Huttner is a wonderful man and a wonderful doctor. He wants so much to help me. You must make him understand. I do not want to be helped anymore. All I want is to have these tubes taken out and to be kept comfortable until I go to sleep. You must make him understand that. Please. This is torture for me. A nightmare. Make him understand.”
Her eyes flashed for an instant, then closed. She took several deep breaths and settled heavily back on the pillow. Her breathing slowed. It seemed to David that it might stop altogether, but within a minute a coarse, rhythmic stertor developed and held.
All David could manage was a whispered, “You’re going to be all right, Mrs. Thomas,” as Huttner took him by the arm and led him out of the room.
The Sisterhood Page 6