"Mrs. Gladstone, the biopsies I took confirmed my initial impression of a cancer of your cervix, the neck of your womb. Remember I told you that my examination suggested the cancer hadn't spread, and the imaging studies we did confirmed this. It's what's called a stage zero tumor."
She looked for the first time at Dr. Gladstone. He sat in silence, holding his wife's hand. His jaw was set, his expression grim. He was a man prepared to do battle. Right now, Ernest Gladstone epitomized the downside of being a doctor. He knew too many of the bad things that could happen, and he was powerless to do anything about them.
Cathy looked back at Emma. "There are several treatment options. I'd like to outline them for you and then I'll answer any questions you might have. I'll be glad to assist you in getting an appointment with whomever you choose to treat you."
"Dr. Sewell," Emma said, "this is the diagnosis Ernest and I expected. We're ready to proceed with treatment." She turned to her husband and some unspoken communication passed between them.
"I've been in contact with a couple of my friends," he said. He mentioned the chairs of the Department of Gynecology at two of the most-respected cancer institutes in the nation."I'd like the pathologist who read the biopsies to send the slides to both of them for confirmation, but I have no reason to doubt your diagnosis. Both of them have recommended a wide total hysterectomy. Emma and I agree with that, but we see no need to go elsewhere, since Art Harshman is well-trained and quite experienced in the procedure."
Cathy bit back the comment that leaped into her mind. She remembered how hard she'd worked not to embarrass this dear lady during her examination. She could only cringe at the thought of how Harshman would treat Emma. But there was nothing she could do.
"Very well. I'll arrange for the slides to be sent out today," Cathy said. "Jane will have you sign a release form on your way out, and we'll send copies of your records to Dr. Harshman. I presume you don't need us to set up the appointment for you."
"No," Emma said. "But I do have one favor to ask. Ernest tells me that the surgeon will require an assistant for this procedure. I want you to be that assistant. I want you to be scrubbed in and participate."
"I don't think Dr. Harshman will-"
Emma was firm. "I know. You flinched when I said it before, and I imagine you were hoping I'd forget about it by now. And before you start making excuses, I'm aware you and Arthur have butted heads. There's not much that happens in the medical community that I don't hear, usually from one of the doctors' wives. But I'm convinced you're not only well-trained, you care about your patients as persons. Arthur is a machine. A good one, but without an ounce of compassion. I want someone to balance that out while I'm on the operating table." She leaned back and took a deep breath. "Would you do that for me?"
Cathy turned her head a few inches and looked at Ernest Gladstone for a sign, but found none. This was Emma's decision, and he wasn't about to fight her.
"Of course, Mrs. Gladstone," Cathy said. "I'll mention your wishes to Dr. Harshman when I call to tell him about your case." And wouldn't that be fun?
The settlement for her accident had been enough for Cathy to pay offher old car and make a down payment on a small Chevrolet, last year's model that the dealer assured her was absolutely perfect for her needs. In her heart, she wished she'd been able to afford something bigger, sturdier: a Hummer, perhaps, or a Sherman tank. Nowadays, she imagined that every approaching black SUV edged near her car. Today that sense caused her to repeatedly jerk the steering wheel to the right. She figured that if she made it to Fort Worth and back without being pulled over on suspicion of DUI, it would constitute a minor miracle.
Josh called her into his office right on time. She settled into her chair and immediately poured a glass of water from the carafe on the end table. Her mouth may have been dry, but her palms were wet.
"What's the first thing that jumps into your mind today?" As usual, Josh surprised her with his opening remarks. But she didn't have to think long about her answer.
"I don't know if this is good news or bad. I came to you because I was depressed, but I really was worried that I might be showing signs of paranoia, that I might be moving into the schizophrenia that affected my mother. But now I'm pretty sure that I'm not paranoid. I'm convinced there really is someone out there who's out to get me."
If Josh was surprised, he was too experienced to show it."Tell me."
Cathy took a deep breath and the words started pouring out. As she spoke, she felt a chill that had nothing to do with the air conditioning. She talked about the black SUV, the rumors around town, the altered prescription.
She paused from time to time, hoping Josh would interrupt or ask a question, anything to break the flow of the story and allow her to relax. Instead, he watched with a perfectly neutral expression. His posture gave her no clue as to whether he thought she was a woman pursued or one going mad.
"I don't know which is worse," Cathy concluded. "Thinking I'm going crazy or finding out that I'm a target for someone who apparently hates me enough to try to kill me, then almost kill one of my patients."
"Let's talk about what brought you here," Josh said. "You were having difficulty concentrating and trouble sleeping. You forgot things. It was hard to do your daily tasks. You had no appetite. You found yourself constantly worrying. Right?"
Cathy nodded.
"You were afraid you were becoming mentally ill. Do you know how common such a fear is among physicians?"
Cathy paused to consider it. "I don't know. I guess it's like so much in medicine. We know too much. Every stomach pain is a perforated ulcer. Every bump is a skin cancer. And mental changes make us think we're going crazy."
"Did you ever think about suicide?"
It was like a slap in the face. Cathy had never told anyone about those feelings, even Josh. "After I ended our engagement, I… I actually borrowed sleeping pills from two or three friends so I'd have enough to kill myself." She swallowed hard. "But I couldn't do it."
Josh's face softened. "Cathy, almost four hundred doctors commit suicide each year. And many of those instances are due to depression. Not schizophrenia. Not a psychosis. Just worry, stress, depression. It can be dangerous. But you did the right thing. You sought help."
Cathy started to say something but found that she had no words. She took a sip of water and listened as Josh continued.
"You were afraid that this was the early stage of the same psychosis that your mother had. Do you still think so?"
She ran that through her mind. "No."
"Because you understand what caused your feelings?" Josh said.
"Yes."
"So the depression you were experiencing when you came to see me was probably a reactive depression, not true clinical depression. Right?" Josh leaned forward and rested his hands on his knees. "Cathy, you've had enough psychiatric education to make a pretty good guess at what's behind those feelings. You broke up with your fiance and cancelled your wedding. Big loss. You turned down a prime faculty appointment at the medical school where you trained in order to get out of the town where Robert had his practice. Big loss. Since you came back home to Dainger, you've rejected advances from two men, one of whom was your high school sweetheart and the other an eligible professional man. You're scared to make a commitment because you're afraid you'll lose again. Another big loss. And it all started with the death of your father and mother. Think that could explain your feelings?"
"I guess."
"Why were you so afraid that what you were experiencing was more than simple depression?"
"My mother was schizophrenic," she blurted out the word that had been in her mind but hadn't passed her lips until now. "And it drove my father away from her. At least, I think it did." As her thoughts cleared, she spoke faster and faster."And I was afraid that, just like her, I'd driven away the men in my life because I was mentally ill. I truly thought that there'd never be any hope of my having a healthy relationship with a man."
Josh lea
ned back and tented his fingers. "Let's talk a bit more about your relationships with men."
Cathy looked down and saw that the knuckles of her intertwined hands were white. She made a conscious effort to relax. Finally, she found the courage to speak.
"Dr. Sewell, there's someone in the waiting room to see you. He won't give me his name or state his business. What do you want me to do?" Even though Jane appeared calm, Cathy could read the concern in her nurse's eyes.
"What do you think it's about?"
"He's well-dressed and carrying a little leather portfolio. You know, sort of a mini-briefcase without a handle. He's not loud or insistent. He said he'd sit there until you could see him." Jane ducked her head. "One more thing. He said it would be better if he spoke with you in your office instead of the waiting room."
Cathy had been expecting this. Nevertheless, she could feel her pulse pounding in her ears. She put her hand on the edge of her desk to stand, but sat down quickly when the room went into motion.
"Are you all right? Do you want a glass of water?"
"No, I'm fine. Just feeling a bit weak. I shouldn't have skipped breakfast."
"Let me get you some coffee with cream and a couple of sugars. He can wait." Jane hurried offwithout waiting for an answer.
While she waited, Cathy stared at the thin manila folder sitting on the corner of her desk, where it had been for the past three weeks. Marcus Bell had wanted to keep Milton Nix's chart, but Cathy insisted on returning it to her office, compromising with Marcus by allowing photocopies to be made for the hospital files.
Jane returned with the coffee and a worried expression."Why don't I send this guy packing? Or at least make him set up an appointment."
Cathy shook her head. She took her time sipping the coffee, feeling the warmth start to lift the chill that had seeped into the marrow of her bones. Finally, she could not put it offany longer. She buzzed Jane and said, "Please send the gentleman in."
The man closed the door behind him and walked forward until only the desk separated him from Cathy. She didn't stand or extend her hand. No need for pleasantries. She knew what came next.
Cold gray eyes stared into Cathy's. "Dr. Catherine Sewell?"
"Yes."
The man's expression remained perfectly neutral. Cathy thought he might as well have been delivering a deli order or a daily paper. Instead, he produced a thick, folded document from a slightly worn leather portfolio and handed it across the desk. "You've been served." And he left.
Cathy unfolded the sheaf of papers and let her eyes run down the first page of legalese-"In the matter of Milton Vernon Nix" and "Plaintiff" and "Defendant"- Someone else could interpret the exact language for her later, but there was no doubt in her mind about the meaning of the document. Milton Nix was suing her for malpractice.
She fingered the edges of Nix's file, edges that were already frayed. She knew she hadn't committed an act of medical negligence. But now she had to prove it.
8
Cathy could picture Arthur Harshman's face growing redder with every word. He kept his voice low, but even over the phone it was obvious that anger bubbled beneath the surface.
"Doctor, I'm happy to see Mrs. Gladstone as a patient. I thank you for your courtesy in calling to inform me of her problem and in offering to provide copies of her records. I'd appreciate receiving them as soon as possible." He took a breath and exhaled so forcefully that it sounded like a gale blowing across the phone's mouthpiece. "But-"Another breath, another gale. "But I resent being held hostage by a patient's demand that I allow an untrained physician to assist me in doing a Wertheim procedure."
Cathy tried to pour oil on the troubled waters. "Dr. Harshman, I recognize your frustration. I can see your position. Frankly, I tried to talk Mrs. Gladstone out of her request-"
"You mean demand, don't you?"
"I prefer request, but yes, she was adamant. If it makes you feel any better, during my residency I scrubbed on three radical hysterectomies as second assistant."
Harshman grunted. "So you've seen three of them. Well, bully for you. But second assistant is another name for observer. The first assistant is a different matter altogether."
Cathy decided to make one more stab at civility. "Dr. Harshman, I can assure you that I'll study like a third-year medical student before the surgery. I'll help you, not hinder you."
"You'd better. My secretary will be in touch when we have the procedure scheduled." He slammed down the phone.
Cathy hung up, swiveled in her chair, and pulled two large books from the shelf behind her. She let them drop with a solid thud onto her desk next to Milton Nix's chart. Her worries seemed to be piling up.
"Charles Ferguson."
The voice on the phone sounded reassuring in Cathy's ear. She leaned forward in her chair and moved Milton Nix's chart into the center of her desk, fingering it like a talisman."Mr. Ferguson, I'm Dr. Cathy Sewell in Dainger, Texas. I'm insured by your company, and I've just been served with a malpractice action."
"Have you spoken with anyone about this?" Still calm… still reassuring.
"After the incident, I spoke with the hospital's chief of staff. It appeared to be a medication error, and I subsequently relinquished care of the patient to one of my colleagues, an internist."
Cathy could hear keys clicking as Ferguson called up her file on his computer. She marveled at how quickly the world had shifted from filing cabinets stuffed with paper to a computer processor small enough to fit into a briefcase, yet with the capacity to hold the information contained in several libraries.
"I have your account here," Ferguson said. "It appears that you are indeed covered by us. Your limits are rather low, though. What is the amount named in the suit?"
Cathy thumbed through the thick document to be certain, although the number was one she was unlikely to forget. "One million dollars plus costs."
"Ummm, that's well above your coverage level. But you practice in Texas and there's a cap on damages. The million is probably a negotiating figure." More clicks. "Tell you what. Please photocopy everything you have and send it to me by express courier. Don't discuss the case with anyone. I'll have our attorneys look it over, and we'll see where we go from here."
"There's one thing you should know. I've seen the original prescription at the pharmacy. It's not the one I wrote. It's been tampered with."
"Can you prove that?"
"Not directly, no. But-"
Ferguson's reply was firm and not nearly so reassuring as his earlier words. "Doctor, we have to base our decisions on things we can prove. And it's not our business to spend our resources investigating shadowy plots against our insured. Frankly, if your case isn't strong and we can negotiate the litigant down to a reasonable sum, it's often prudent to settle these things. We'll simply have to see."
A rush of anger made Cathy's blood boil. "I thought your primary duty was to protect me. That's why I've been paying premiums."
Unlike Cathy, Ferguson didn't raise his voice. She guessed that after he hung up he'd have about a dozen more conversations like this today. Her case wasn't special to him-but it was to her.
"Our primary duty is to stay in business while discharging our obligations. We'll do everything we can to protect you, but that does not involve tilting at windmills, especially if the windmills seem stronger than our lances. Now leave it to us. I'll look forward to receiving your records soon."
"Wait! What if I want my own attorney?"
Ferguson cleared his throat. "You have that right. It would be at your own expense, of course, and we'd expect full cooperation and an open exchange of information with whomever you choose."
"That's fine, so long as it works both ways. I'll send the records."
There was a gentle tap at the door. Cathy hung up the phone and called, "Come in."
Jane stuck her head through the door. "Your first patient is here. Are you ready?"
Cathy took a deep breath. This was something she'd been forced to learn early
in her medical training-keeping several balls in the air without dropping one. She couldn't afford any more slipups.
"Be sure his lab reports are on the chart. Put him in a treatment room, get his vital signs, and let him know I'll only be a few minutes." As Jane turned to leave, Cathy added, "Please close the door behind you. I have one more call to make."
Will laid his napkin beside his empty plate, pushed his chair back from the table, and said, "I didn't know you were such a good cook. If I'd known that, I'd have chased you harder and insisted you marry me."
Cathy tried to maintain a poker face while deflecting the compliment. "In medical school, I shared an apartment with two other girls. We took turns cooking, and I learned in selfdefense. Otherwise, they'd have thrown me out."
She rose to clear the table, and Will immediately pitched in. They stacked the dishes in the sink, then moved into the living room.
"You have a nice little apartment here," Will said. "Cozy. Decorated in early packing boxes, with accents by Home Depot."
Cathy laughed. "I'm embarrassed. I've been here more than two months, but so far I've only unpacked enough to get me by." She pointed to the coffee table in front of the sofa where they were sitting. "But I did take your advice and dig that out."
Will picked the Bible offthe table and opened it to the flyleaf. "Your parents gave you this Bible. It must be a nice reminder of them."
"Not really. My folks went to church as a matter of course, and they took me along, also as a matter of course. But we were never really what you'd call religious."
Will thumbed through the pages. "You know, since I was raised as a preacher's kid, I had no real choice about attending church. When I went offto college, I let church and religion slide. I guess a lot of kids do. But I eventually realized an important part of my life had gone missing. That's when I came back to the church, back to God." He laid the Bible gently on the table. "I hope you can do the same. It would help during the tough times."
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