The Sisterhood

by Michael Palmer

  In the hallway the two men faced one another. Huttner was first to break the silence.

  “Quite some night we’ve had for ourselves, yes?” he said, smiling his understanding.

  “Yeah,” David answered. He pawed at the floor with one foot. He would have said more but for a persistent sliver of fear that he was about to come apart in front of the man.

  Huttner scrutinized his face, then said, “David, never forget that many times patients with serious illness express the wish to die when they’re in a stage of weakness and pain. I’ve been around for a long time. I’ve seen many patients as sick or sicker than Charlotte Thomas recover. This woman is going to make it. She is to get total, aggressive treatment and, if necessary, a full-scale Code Ninety-nine resuscitation. Understand?”

  “Yes, sir … I mean, yes, Wally,” David said mechanically, although he was searching his memory for the last time he had seen a sixty-year-old patient recover from the sort of severe, multisystem disease that beset Charlotte Thomas.

  “We’re in agreement, then,” Huttner said, beaming with pleasure at having successfully made his point. “Let’s go write a few orders on this woman, then we can call it a day.”

  As they approached the nurses’ station, David bet himself a guitar and six months of introductory lessons that the last critical moment of the hectic evening had passed.

  An instant later, a portly man dressed in a turtleneck sweater and tweed sportcoat emerged from the visitors’ lounge at the far end of the hall and headed toward them. He was still thirty feet away when David knew with certainty that another wager had been lost. The anger in the man’s jaw-forward stride was mirrored in his reddened face and tight, bloodless lips. His fists were suspended several inches away from his body on rigid arms.

  David glanced over at Huttner, who showed a flicker of recognition but no other emotion.

  “Professor Thomas?” David whispered.

  Huttner nodded his head a fraction, then moved forward. David slowed and watched as the two men closed on one another like combatants at a medieval joust. The grandstand for their confrontation was the nurses’ station, where several nurses, an aide, and the ward secretary fell silent, fascinated spectators.

  “Dr. Huttner, what the hell is going on here?” Thomas lashed out. “You told me there would be no more tubes and I get here to find a red rubber hose coming out of my wife’s nose attached to some goddamn machine.”

  “Now, Professor Thomas, just calm down for a minute,” Huttner said evenly. “I tried to call you last night to let you know what was going on, but there was no answer. Let’s go down to the visitors’ lounge, and I’ll be happy to go over the whole thing with you.”

  Thomas was not a bit mollified. “No, we’ll have this whole business out here and now with these people as witnesses.” He gestured at the gallery. “I came to you with Charlotte because our family doctor told us you were the best. To me the best meant not only that you would be the best in the operating room, but that you would be the best at treating my wife—as a human being, not just as some unfeeling piece of … of carrion.”

  The intensity and pain in Peter Thomas’s voice was startling. Behind the nurses’ station, Christine Beall cautiously turned her head toward Janet Poulos, the evening nursing supervisor. Poulos met her gaze impassively, then responded with an almost imperceptible nod. She was a slender woman, a decade older than Christine. Her coal-black hair was coiled in a tight bun, accentuating her narrow features and dark, feline eyes. A thin scar paralleling her nose gave even her warmest smile a slight sneer and undoubtedly contributed to her reputation among the nursing staff as being uncompromising and humorless.

  Christine saw her in a far different light, for it was Janet who had supervised her initiation into The Sisterhood of Life. The secrecy of the movement was such that Janet remained the only Sisterhood member whom she knew by name and face. The nod acknowledged that Poulos, too, was assessing the drama unfolding before them.

  “All right, Professor,” Huttner said, a thin edge appearing in his voice. “If it is what you wish, we shall discuss matters right here. Do you have more to say or do you want to know exactly what is happening with Charlotte?”

  “Go on,” Thomas said, relaxing his fists and leaning one elbow on the high counter in front of a totally bewildered ward secretary.

  With the condescending patience of one who has learned that sooner or later he will carry the day, Huttner systematically reviewed the developments that had led to his decision to insert an intestinal drainage tube in Charlotte Thomas. Then, more gently, he said, “It may not be obvious to you right now, but I believe that our treatments are starting to take hold. Charlotte could turn the corner any time now.”

  Peter Thomas looked down and retreated half a step. At that moment it seemed to David as if Huttner had, in fact, won the man over. Then, as though in slow motion, Thomas brought his head up, shaking it back and forth as he spoke. “Dr. Huttner, I believe my wife is dying. I believe it and I even accept it. I also believe that because of what you call treatment, she is dying by inches, without so much as a flicker of dignity. I want those tubes pulled out.”

  Behind the counter, a nurse whispered something to the woman next to her. Huttner silenced her with a look that could have frozen a volcano.

  With an instantaneous, almost theatrical change in expression, he turned back, smiling calmly, to Peter Thomas. “Professor, please know that I understand how you’re feeling, I really do,” he reasoned. “But you must understand my position and my responsibility in this thing. We talked about it when you first brought Charlotte into my office, and you agreed that I was to be in complete charge. I offered to arrange for a second opinion, but you felt back then that none was necessary. Now here you are questioning my judgment. I’ll tell you what. We have a built-in second opinion right here.” Huttner motioned David over. “This is Dr. Shelton. He’s an excellent young surgeon who was chief resident in surgery at White Memorial. We’ve just examined Charlotte in great detail because Dr. Shelton will be covering my patients for the next few days. David, this is Peter Thomas. Tell him what our feelings are about Charlotte.”

  David reached out his hand and Thomas shook it uncertainly. During the seconds they stood appraising one another, Thomas seemed perceptibly to calm down.

  “Well, Dr. Shelton,” he said finally, “what do you think of my wife’s chances?”

  David looked down momentarily and closed his eyes. Somewhere in a remote corner of his mind a voice kept telling him that if he could just stall for a few minutes his clock radio would go off, waking him up. With consummate effort he brought his eyes up until they connected once more with Thomas’s.

  “Mr. Thomas, I just reviewed your wife’s hospital record and met her for the first time,” he said deliberately. “It really is impossible at this time for me to assess her whole situation accurately.”

  Thomas opened his mouth to object to what he considered an inadequate answer, but David stopped him with a raised hand. “However,” he continued, hoping that his tone would not give away the fact that he had no desire to continue at all, “I will tell you that I see her as a critically ill woman whose chance of surviving this illness rests not only with receiving the best possible medical and nursing care—which, incidentally, she has been receiving—but also in having the will to make it through. This is the part I cannot assess yet. That strength comes not only from inside her, but from you, from Dr. Huttner, and from the rest of those who love and care for her.

  “I know you’d like to hear a more clinical evaluation of her prospects, but right now I’m just not in a position to give you that.”

  Out of the corner of his eyes he saw Huttner beaming his approval. Holy shit, I got out of it! was all David could think. Then, even before Thomas responded, he felt a spark of anger at himself. He had not given even a hint of his true, bleak feelings about Charlotte’s chances. As Thomas spoke, the spark grew white hot.

  “You really don’t s
ee it, do you?” Thomas said, looking wildly around him. “None of you do. Charlotte and I have been married for over thirty years. Thirty full and happy years. Don’t you feel we should have some say as to what kind of tortures she must be put through to prolong the agony of what has until now been a totally rich and fulfilling life?”

  This time David did not look away. For several seconds a painful silence held. Finally he spoke. There was anguish in his voice, but also the power of conviction. “Dammit, I do feel that way. Exactly as you do, Mr. Thomas. I feel that very strongly.”

  Again there was an agonizing silence. David felt Huttner’s eyes and sensed the world sinking beneath him. His tone mellowed. “But you must understand,” he said. “I am not your wife’s primary physician, Dr. Huttner is. And he is more experienced than I am in every aspect of medicine and surgery. It is his final say as to what kind of treatment your wife will or will not receive. I intend to carry on his therapies to the absolute best of my abilities.”

  Thomas glared at Huttner, then snapped, “I understand, all right. I understand completely.” Spinning so fast that he nearly lost his balance, he stalked down the corridor toward his wife’s room.

  His outburst was the last straw for Huttner. It had been a long and trying day. He stepped back so that David and everyone at the nurses’ station was included in his gaze. “I am going to say this one time and one time only.” His voice was dry ice. “Charlotte Thomas is to be treated as aggressively as necessary to save her life. Have I made myself clear? Good. Now all of you get back to your jobs. Dr. Shelton, perhaps you had better go home and get some rest. Straightening out my practice could prove an exhausting experience for you.”

  With that, he marched down the hall and followed Peter Thomas into Room 412.

  David stood alone in the center of the corridor. The group behind the nurses’ station some fifteen feet away was frozen and silent. He glanced about with the sheepishness of a janitor sweeping center stage when the curtain suddenly opens before a packed house. For an instant he had the impulse to break and run. Then, out of the corner of his eye, he saw Christine Beall push herself off the counter and head in his direction. It was hardly the triumphant moment he would have picked for a second encounter with the woman.

  As she neared, he looked away, inspecting a heel-mark by his shoe. He sensed her eyes measuring him. When they first met, he had been captivated by their gentle power and determination. Now, before their umber stare, he felt vaguely discomforted.

  Moments before she spoke he breathed in her perfume—a muted suggestion of spring. “Dr. Shelton, we’re all very proud of the way you stood up for what you believe in,” she said softly. “Don’t worry. Things have a way of working out.”

  Her words. The way she spoke them. Not at all what David had expected. He repeated them in his mind but could not seem to grasp the feelings behind them. “Thanks … thanks a lot,” he managed, preparing himself for the eyes before he looked up. By the time he did, Christine was gone. Activity behind the nurses’ station had returned to normal, but she was not there.

  David elected to go and write new orders on Anton Merchado before putting the whole ghastly evening to rest. In the morning he would be on his own. As he shuffled away, thoughts of the day to come, of regaining control of his life, sweetened the distasteful events of the past five hours.

  “Things have a way of working out.” He said Christine’s words out loud as he pushed through the door to the stairway.

  CHAPTER V

  Hidden in a doorway, Christine watched David leave Four South. She waited until she was certain he would not return before stepping into the dimly lit corridor. Her shift was nearly over. In the nurses’ lounge, as in similar rooms on every floor in the hospital, the evening staff was compiling notes in preparation for the 11 P.M. to 7 A.M. crew—the graveyard shift.

  In less than an hour 263 nurses would leave the hospital and head for diners or bars or home to mates who would, as often as not, be too tired to respond as lovers. They would be replaced by 154 others, each struggling to maintain biologic equilibrium in an occupation that demanded life-and-death decisions during hours when most of the world was sleeping.

  For a time Christine stood in the deserted hallway listening to the clamorous silence of night in the hospital. The sighs and coughs. The moans and labored, sonorous respirations. Oxygen gurgling through half a dozen safety bottles. The obedient beep of a monitor in duet with the mindless hiss-click of a respirator. And in the darkened rooms, the patients, thirty-six of them on Four South, locked in their own struggle—a struggle not for riches or power or even happiness, but merely to return to the outside world. To return to their lives.

  At night more than any time Christine felt the awesome responsibility of her profession. Like any job, nursing had its routine. But beyond the drudgery and the complaints, beyond the scut work and the deprecating attitude of many physicians, there were, above all, the patients. At times, it seemed, a silent conspiracy existed among physicians, administrators, and nursing organizations whose sole purpose was to expunge from nurses any notion that their primary purpose was the care of those patients. It even included the nurses themselves, many totally drained of the sense of caring and kindness that had first brought them into the profession.

  Christine gazed down the corridor toward Room 412. Silently she renewed a vow that she would never give in to the confusion and the negativism. She would never stop caring. If a commitment to The Sisterhood of Life was the only way to honor that vow, so be it. Somehow she knew that as long as she was part of The Sisterhood, she was safe from the frustrations and heartache that had driven so many out of hospital nursing.

  For Christine the commitment had begun on a Sunday. Outside Doctors Hospital a winter storm raged. Inside the nurses’ lounge on Four South another kind of storm was brewing. Much of its fury emanated from Christine and all of it was directed against a physician named Corkins who had just ordered an emergency tracheotomy on an eighty-year-old woman, the victim of a massive stroke that had left her paralyzed, partially blind, and unable to speak. Christine had spent countless hours caring for her. Although the old woman was unable to move or talk, she had communicated with her eyes. To Christine the message was clear: “Please, let me go to sleep. Let this living hell end.” Now, with the operation, hell would continue indefinitely.

  For nearly an hour Christine had sat in the nurses lounge sharing her tears and her anger with Janet Poulos. Carefully, gradually, Janet had introduced her to knowledge of The Sisterhood of Life.

  Over the two days following the old woman’s tracheotomy, Christine had spent many hours discussing her dismal condition with Janet, while at the same time learning more and more about The Sisterhood. Throughout her nursing career she had been able to find joy in even the most distasteful aspects of daily patient care. But with each minute spent helping to prolong the agony of the old woman, Christine’s frustration grew. Disconnecting the respirator to suction the tube each hour. Frequent turnings. Urinary catheter changes. Deep intramuscular injections. Frantically trying to keep abreast of one incipient bedsore after another. And always the eyes looking at her, looking through her, their message even more desperate than before.

  Finally the commitment was there. Christine followed the direction given to her by Janet Poulos and reported the old woman’s case to the Regional Screening Committee. A day later, she received their approval and instructions.

  Toward the end of her shift she slipped quietly into the woman’s room. The drone of the respirator blended eerily with the howling winter wind outside. In the darkness she felt the woman watching her. She bent over the bed, pressing the tears on her cheek against the woman’s temple. After a few moments, she felt her nod—once and then again. She knew! Somehow she knew. Christine gently kissed her forehead.

  She brought her lips close to one ear and whispered, “I love you.”

  Reaching up, she disconnected the respirator, then waited in the darkness for five mi
nutes before reconnecting it.

  Nearly four hours into the next shift a nurse reported that she was unable to feel a pulse or obtain a blood pressure on the woman. A resident was called and, after finding a straight line on her electrocardiogram, pronounced the woman dead. Later that morning her two sons, much relieved at the end of their mother’s suffering, had the body brought to a local funeral home. By 11 A.M. her bed was filled by a young divorcée in for elective breast augmentation. Like the waters of a pond, disturbed momentarily by a pebble, the hospital appeared as it always had, the last ripples of the old woman’s existence gone from its surface

  “Christine?”

  She spun toward the voice. It was Janet Poulos.

  “You okay?”

  Christine nodded.

  “It looked like you were posing for the cover of Nurse Beautiful.”

  “More like Nurse Troubled.”

  “That scene with Huttner and the Professor?”

  “Uh-huh.”

  “Want to talk about it?”

  “No. I mean maybe a little. I mean you’re the only one who …”

  Janet silenced her with a raised hand. “The visitors’ lounge is empty.” She nodded toward the nurses’ lounge. “From the looks of things in there, you’ve got about ten minutes before report. It’s been sort of crazy up here tonight, hasn’t it? I heard there were some problems after that Mr. Chapman was found dead,” Janet added.

  As they walked to the small visitors’ lounge, Christine described the reaction of John Chapman’s griefstricken widow. Janet shook her head in disbelief.

  “Why do you think she picked on the flowers to throw around the room?” she asked.

  “Oh, she threw other things, too. Not just flowers.” Christine dropped onto a sofa and Janet took the chair across from her.

  “So she wrecked everything?”

  “Almost. We managed to salvage two vases.”