Dude, Where's My Stethoscope?

by Gray, Donovan

  As luck would have it, my favourite cardiologist was on call. We have a very amicable working relationship, in part because I usually screen my referrals well. Most of the patients I send him ultimately prove to have significant coronary artery pathology. After I went over the details of the case with him he gave me two options: I could continue to manage the patient in our community and send her to his office in a couple of weeks for further workup, or if I was really worried about her I could transfer her to his coronary care unit via air ambulance immediately. It was a generous offer, particularly since her vital signs were rock-solid.

  Deep down I knew I could probably soldier on with her a while longer, but my energy levels were low that morning and the thought of trying to unravel yet another medical mystery on what was supposed to be my day off was decidedly unappealing. I was still in the process of figuring out what to do when several of her relatives rushed to the desk to report she was having more chest pain. That did it. I told the cardiologist I’d make arrangements to have her flown down for admission to the CCU.

  A week later she dropped in to see me at my office. “They didn’t think it was my heart,” she said. “In fact, they discharged me the next day. The cardiologist wants me to have a stress test in a few weeks.” I felt a sharp pang of guilt. Not only had I dumped on a colleague, I’d wasted already sparse health care resources by ordering an unnecessary air ambulance transfer. That week her discharge summary from the CCU arrived in the mail. The dictated note was polite, but reading between the lines I could tell the cardiologist was disappointed I had fast-tracked such a non-urgent case.

  Three weeks later she had her stress test and passed it with flying colours. I promised myself I’d never bail out like a nervous rookie again. Nobody likes a sieve.

  A month later I came in to do rounds on a Sunday morning and discovered a patient of mine had been admitted during the night with a diagnosis of pulmonary edema. Judging from the chart notes Mr. Trapper’s course in the ER had been fairly rocky, but things had settled down nicely since his transfer to the ward.

  Mr. Trapper was an elderly bachelor with diabetes. He was a cheerful man who liked to crack jokes. When I went to see him he said he was feeling about 75 percent better. On examination, he still had signs of some fluid on his lungs. His EKG showed non-specific changes, and his cardiac enzymes were normal.

  As I wrote out his new diet and medication orders I toyed with the idea of calling to request a transfer to the CCU. Although my patient had improved considerably, flash pulmonary edema can sometimes be associated with critical narrowing of a major coronary artery. In addition to that, diabetics are at higher risk for silent ischemia. Don’t be such a wimp, I told myself. Look what happened the last time you jumped the gun and flew someone out prematurely. Do you want them to think you’ve turned into Chicken Little? I decided to continue managing him at our facility for the time being.

  By his fourth day in hospital Mr. Trapper was back to normal. A referral letter requesting outpatient investigations was faxed to the cardiologist. I wrote a prescription for his new medications and arranged for him to see me in my office the following week.

  Before he went home I reminded him to call me or return to the hospital if he experienced any further difficulties. He thanked me, packed his belongings into a battered canvas suitcase, and departed.

  Mr. Trapper had a massive heart attack and died alone in his cabin a few days later.

  So Sue Me

  A few years ago I was getting ready to start a shift in the ER when a Code Blue was broadcast on the overhead PA system. I sprinted over to the medical floor. When I got there, a wide-eyed ward clerk pointed mutely at one of the patient rooms. Inside I found three nurses frantically trying to revive an unconscious nine-year-old boy.

  Before I had time to ask what had happened, he stopped breathing. I snatched a pediatric ET tube off the crash cart and intubated him. With ventilation his oxygen sats quickly returned to normal. His pulse and blood pressure held steady, so no chest compressions were required. Within minutes most of my colleagues were at the bedside. Together we formulated a differential diagnosis for the respiratory arrest, initiated a course of therapy and contacted a tertiary care centre. A few hours later he was en route to a pediatric ICU via air ambulance.

  To our dismay he went into shock and died a few days later. The news decimated us. A pall hung over our hospital for weeks.

  I don’t often attend patient funerals, but I felt an overwhelming need to go to his. Not surprisingly, the church was packed. The air was so thick with grief it was hard to breathe. I usually have a firm grip on my emotions, but when the deceased child’s classmates joined hands and formed a circle around his coffin, I cried.

  A few months later I was doing some charting at a workstation in the ER when a briefcase-toting stranger sidled up to me.

  “Are you Dr. Gray?” he inquired.

  “Yes, I am. How can I help you?”

  He fished a manila envelope out of his bag and handed it to me. “This is for you.”

  “What is it?”

  “Notification.”

  “Of what?”

  “You’re being sued for malpractice.” He flashed me a jagged smile, turned spryly on his heel and left the department. Talk about schadenfreude.

  I opened the envelope. Sure enough, it was a lawyer’s letter stating the parents of the deceased child were suing two colleagues and me. Having never been sued before, I was stunned. I contacted my legal representative immediately. After carefully analyzing the case, my attorney came to the conclusion I had been included in the lawsuit solely because my name had been recorded in the boy’s chart. The fact that the only reason it was there was because I had voluntarily responded to the Code Blue and helped with the resuscitation didn’t seem to matter. Apparently, malpractice lawyers like to cast a wide net in order to improve the odds of ensnaring someone. I was advised there was a fair chance I’d eventually be “cut” from the case. There was only one catch – it would take at least a year.

  The first six months were sheer misery. My appetite vanished and I lost weight. I couldn’t concentrate properly and I developed gruelling insomnia. I reviewed the case in my mind so many times it must have worn a permanent groove into my brain. I could understand the existence of the lawsuit, but why me? What would my family and friends think? What effect would it have on my career? I cycled endlessly between fear and indignation. Sometimes apathy would set in, leaving me feeling hollow and indifferent. I became moody and irritable. Even my kids noticed the change in my behaviour.

  In time, the obsessive rumination settled. I started being able to go longer intervals without thinking about the lawsuit. My appetite and sleep improved, and my interest in hobbies slowly began to return. A new steady state was evolving.

  Approximately 18 months after my initial notification I received a letter from my attorney stating I had been dropped from the case. No one on the opposing side bothered to apologize for needlessly putting me through hell for a year and a half. I guess my feelings weren’t very high on anyone’s priority list.

  A month later one of the parents of the deceased child telephoned me at my office.

  “Dr. Gray?”

  “Yes?”

  “Can I transfer my family to your medical practice?”

  “What?”

  “We’d like to switch doctors. Can we start seeing you?”

  “I don’t think that would be such a good idea.”

  “Why not?”

  “Because you just tried to sue me! You ruined a year of my life!”

  “Oh. Okay.”

  Oddly enough, they called back two weeks later with the exact same request. My answer didn’t change.

  Earlier this week I was working in the emergency department when we got word a child who had just undergone surgery was having a malignant hyperthermia crisis. As I ran to the OR to assist our anaesthetist, an unexpected thought popped into my head: For God’s sake, don’t go in there! If
there’s a bad outcome, you’ll get sued! I still went, of course.

  How can things have been allowed to deteriorate to the point where a qualified physician with training, skills and experience is tempted to not get involved when help is needed?

  3:00 a.m.

  Most people rarely witness 3:00 a.m., but I see it all the time. I’m a rural physician, so my schedule is frequently out of synch with the rest of society. Due to the small size of our town, it’s not unusual for my car to be the only vehicle on the road when I leave the hospital in the dead of night. Driving home alone across a frozen landscape at 3:00 a.m. can be depressing. The complete absence of traffic fuses with the darkness, the drifting snow and my fatigue to create a crushing sense of isolation. Sometimes I feel like I’m the last living person on the planet.

  I park in our garage and lug my gear inside. As always, I am struck by how silent the house is at this hour. I hang up my coat and make my way to the kitchen. The supper I missed earlier is waiting for me in the fridge, but it’s far too late for me to have a full meal now. In the end I settle for a bowl of cereal. While I eat, I try to read the newspaper. Tonight the stories seem wispy and insubstantial, as if the events described all occurred in a distant universe. I toss the paper into the recycling bin and retreat to the living room. The curtains are open. An arabesque of silver ice crystals garnishes the edges of the picture window. I sit on the piano bench and watch the moonlit snow swirl across our yard.

  Eventually I head upstairs. Partway down the hall I stop to check on our daughters. They look so innocent asleep in their beds with their limbs akimbo and their stuffed animals scattered everywhere. After retrieving the cast-off blankets, pillows and toys, I tuck the girls in and give them each a kiss on the forehead. The youngest stirs and awakens. “I love you, Daddy,” she murmurs. She hugs me, rolls over and returns to her dreamworld.

  It’s good to be home.

  Carpool Conundrum

  Every Monday evening I sit in the subarctic bleachers of our local arena and watch two of my daughters figure skate. Their lesson runs from 6:00 until 7:00. About 10 minutes before the session ends I slip out of the building and drive halfway across town to pick up my third daughter at Beavers. Beavers also finishes at 7:00, which makes retrieving all three of them on time pretty much impossible.

  If Beavers happens to wrap up early I try to swoop in, collar Kristen and race back to the arena before Ellen and Alanna get off the ice. Unfortunately, Beavers has a tendency to run late. Even when it does end on time, most nights Kristen doesn’t want to leave right away because she’s busy touching up her craft du jour. As a result, we usually wind up getting back to the arena several minutes after 7:00. Ellen and Alanna don’t like it when I’m late, but they try not to complain about it too much because they understand there’s no way I can be in two places at the same time. Jan can’t bail me out of this weekly predicament, either – she directs the town’s community choir every Monday, and as luck would have it, their practices begin at 7:00 p.m. sharp.

  One Monday last October I was waiting impatiently for Kristen to finish off her Beavers’ Halloween project.

  “Come on Kris, we have to go,” I said in that voice parents use when we’re trying to urge our children to get moving and they’re dawdling along as though they have all the time in the world.

  “I just need a couple of minutes, Daddy,” she pleaded. I checked my watch: 6:59. The zamboni will be rolling out any second now. Sigh… .

  When Kristen was finally finished, she held up her freshly minted Play-Doh sculpture for my scholarly opinion.

  “Hey, that looks great, Kris! Ready to go?”

  “Okey-dokey.”

  I helped her gather her belongings. We were just about to make like Elvis and leave the building when I heard an unfamiliar voice call my name. I turned around. A complete stranger was surging across the room towards us. A tiny waif of a girl with pixie-like features trailed in her wake. She looked to be about five years old.

  “Hi, I’m Martha!” the woman trumpeted. “We just moved into the house at the end of your street, and our daughter Frieda joined Beavers tonight. My husband drives transport and he’s out of town every other Monday. Our car is going to be in the garage for the next few weeks. Would you be able take Frieda to Beavers every second week until we get it back?”

  I wasn’t sure what to say. Jan usually used my little two-seater sports car to drop Kristen off at Beavers at 6:00 while I took Ellen and Alanna to the arena in the minivan. If I agreed to pick up Frieda then I’d have to transport all four of the children in the van, which would mean I’d need to leave the house earlier and do a double drop-off. As if life wasn’t complicated enough already! On the other hand, if I said no I’d look like a selfish arschloch. Even if I explained the complexities of our Monday evening schedule to her she’d probably just think I was manufacturing lame excuses. Frieda looked up at me expectantly.

  “Sure, that’s okay,” I said.

  “Are you certain it won’t be a bother?”

  “No bother at all. Will she need a ride next week?”

  “Yes, thanks.”

  “All right, we’ll see you next Monday, then.”

  It’s a bit of a pain, but picking up an extra kid every second week for a month or so isn’t going to kill me, right?

  A week passed and it was Monday evening again. I had assumed Martha would escort her daughter to our house, but when there was no sign of Frieda at 5:50 I dispatched Kristen to go get her. A few minutes later she returned with the wee bairn in tow. Frieda promptly handed me the plastic grocery bag she was carrying.

  “My mommy says for you to give this to the ladies at Beavers.”

  “What’s in it?” I asked.

  “A list of things I’m allergic to.”

  “Oh.”

  “And my EpiPen.”

  “Okay.” Whatever. I ushered the foursome into the van. When they were all settled in I began backing out of the driveway.

  “Excuse me?” came a tiny voice from one of the seats behind me.

  “Yes, Frieda?”

  “I can’t do up my seatbelt.” I stopped, twisted around, and buckled her in. “Thank you,” she said. Very polite, our Frieda.

  As we headed to the arena to drop off the skaters, Ellen initiated a conversation with our new ward.

  “Hi, my name’s Ellen. I’m eight. How old are you?”

  “Almost six.”

  “I’m in grade three. What grade are you in?”

  “I don’t know.”

  “What?”

  “I don’t know.”

  “How come you don’t know what grade you’re in?” Ellen asked, puzzled.

  “I don’t go to school. My Mommy teaches my brother and me at home.”

  “Why?”

  “She’s afraid if we go to school we’ll get beat up.”

  “Oh.”

  After the stop at the arena I took Kristen and Frieda to the Scout hall. Kristen and I exited via the van’s front doors and waited outside for Frieda. She didn’t get out. I reopened my door and stuck my head in to see what the problem was.

  “Excuse me?”

  “Yes, Frieda?”

  “I can’t unbuckle my seatbelt.” I leaned over and extricated her. “I can’t open my door, either.” I did the honours. When we entered the hall I delivered Frieda’s lengthy allergy scroll and her EpiPen to troop leaders Bubbles and Rainbow. I thought they took it pretty well, considering the fact that they’re volunteers, not the staff of a pediatric ER. They did have one question for me, though: “Did Frieda’s mother sign the consent form we sent home last week?”

  “What consent form?”

  “The one giving the children permission to sing at the nursing home next Monday. See?” She pulled one out of Kristen’s coat pocket. Jan had signed it. “If she forgets to send it in, Frieda won’t be able to go.”

  “I’ll let her know when I see her later.”

  After Beavers and skating ended I
chauffeured the girls home. When we got to Frieda's house I unbuckled her seatbelt, opened her door and walked her to the front porch. Several knocks later, her mother appeared.

  “When you take Frieda next week, don’t forget to bring her permission slip for singing at the nursing home,” I reminded her.

  “Would you mind taking her next week? My husband’s going to be out of town again.”

  “Okay.”

  After I drove Frieda home the next week she said, “Thank you,” and then quickly added: “My mom said to ask you if I’d be able to get a ride again next Monday.”

  “Sure Frieda, we’ll see you then.” She made the same request the following week. And the week after that. And the week after that, too… . Finally, one night I went in and asked Martha, “Didn’t you say that she’d only need a ride every second week?”

  “Oh, yes, I did, but since then my husband’s schedule has changed. Now he’s away every Monday. I hope that’s all right with you.” No it’s not all right, it’s bloody inconvenient!

  “Well, I guess so. When did you say your car would be repaired?”

  “Um… we decided not to go ahead and get it fixed after all. We’ve put it away for the winter.” Wonderful.

  So Frieda became a permanent part of our Monday evening routine. Kristen would fetch her at 5:45. Ellen would buckle her in and off we’d go. You just never knew what little misadventure Frieda was going to have. Most of the time she didn’t have her permission slips. She often forgot to wear her winter boots. On the days she did have her boots, she usually forgot to bring her indoor shoes. Once our automatic garage door surprised her and she screeched like a miniature banshee. I’m guessing she had never seen one before. Amish much? Another time her mother gave her $15 to bring to the Beaver troop leaders and she somehow managed to lose it during the 30-second walk from her house to ours. That night Jan and I fretted over whether we should pay it for her. Fortunately, Kristen found the missing money on the road the following morning. On one occasion Beavers was held an hour earlier than usual because the hall was going to be used for some other function between 6:00 and 7:00. I notified Martha of the schedule change weeks in advance. The pickup at 5:00 went smoothly. When I returned to drop Frieda off a few minutes past 6:00, her house was dark and deserted. I asked her where she thought her mother might be.