First, Do No Harm (Brier Hospital Series Book 1)

by Lawrence Gold

  “We’ll try not to call you, Dr. Byrnes,” Beth said, looking up at me with the softest blue eyes I’d ever seen; they startled me. She lingered a moment, our eyes still engaged, then she wished me a goodnight.

  I crawled back in bed at 3:15 a.m.

  Chapter Three

  Helen Martin’s next six months passed uneventfully. She worked hard with many hours of overtime, some paid, but most donated to her patients so they could receive the care they needed in spite of limitations imposed by managed care.

  Helen remembered the golden days when she first ventured onto a medical ward, a world with a high ratio of nurses to aids and orderlies, where one nurse cared for three or four patients. With this assistance, she could easily provide needed treatments and procedures, having time during her day to sit and talk with, and emotionally support her patients. Now, because of the increasing use of outpatient care, hospitalized patients were much sicker. Nurses were caring for five to six patients, and the ratio of nurses to ancillary support personnel dropped dramatically.

  “I can’t sleep,” Helen told Chuck. “It’s not just last night either. It’s a pattern.”

  “Maybe it’s too much coffee,” Chuck suggested.

  “No, I stopped coffee weeks ago. I’m tired and weak all the time.”

  Helen blamed her persistent fatigue and lethargy on sleep deprivation, hard work, and thought, I’m no kid anymore.

  Lacking an appetite, she ate poorly, but hadn’t lost weight.

  Chuck looked at these changes through her optimism—trusting her—trusting Dr. Polk.

  Soon, Helen could no longer hide her symptoms.

  As they sat on the family room couch holding hands, Helen’s appearance under the intense light, hit Chuck for the first time. Helen had always radiated good health, but now her physical and psychological decline left no doubt that this illness was taking its toll.

  Chuck had relied on Helen’s reassurances, so it alarmed him to hear her say, “I’m barely able to complete my assignments, and I know my work has been sliding. Something is still wrong with me.”

  Chuck didn’t know what to say. For the first time in their lives, he faced the possibility that Helen might be more seriously ill than the doctor led them to believe. “We’ll talk again with Joe Polk and maybe get a second opinion.”

  Polk, in his most reassuring and authoritative manner, answered their last phone call with, “Trust me, these things take time. I’m happy to send you to a specialist, but I think, it’s a waste of time and money.”

  Polk had reassured them.

  They waited.

  The next four months were more of the same. Helen did not feel right and the change in her status became more obvious to Chuck and the kids.

  Following many calls from Helen and Chuck, Dr. Polk finally agreed to see her in his office. After a brief examination, they sat in front of Polk’s desk while he read her chart. He straightened his bow tie and proclaimed, “Helen, you’ve never looked better.”

  On the first anniversary of Helen’s acute hepatitis, Polk ordered the lab to draw her blood. Two days later, he called to pronounce, “Your liver tests remain slightly elevated, but I expected this. They should subside with time.”

  Helen began having more difficulty in completing her work on the ward. True, the workload under managed care made life difficult, but she’d been a hard worker and couldn’t understand why she’d been falling behind in spite of trying so hard.

  Nurses and aids, trying not to make it too obvious, had taken up the slack. Soon, clear to all including Helen, she could not continue.

  Forced to take a leave of absence, Helen recognized, for the first time, how important work had become to her life and sense of self. She missed nurturing patients, her friends’ companionship, and the sense of fulfillment that accompanied each workday.

  “You’ll be back with us soon,” said her charge nurse, a statement as much as a prayer.

  “I’ve never been a big fan of mornings,” Helen said. “Now they’re unbearable.”

  “How are you sleeping?” Chuck asked.

  “Sleep…Ha. I can’t even call it sleep. The slightest sound or light flicker brings my mind to full attention and by morning, I’m exhausted and desperate. The best I can do is fitful sleep for the hour or so before the sun rises. I remember a time when I awakened feeling good. Now it takes an act of will to get me out of bed knowing that the day ahead won’t bring relief.”

  Chuck and the kids were gone by the time she could get up, dress herself, and come down for the coffee Chuck made for her each morning. Even the old familiar jolt that followed her first large steamy cup of coffee was gone.

  Helen poured herself a cup. She loved the smell of freshly brewed coffee, but lately something had dulled her senses—smell and taste askew. She sat at the kitchen table for her daily morning ritual; reading the newspaper and completing the crossword puzzle. Helen was not a news junkie, but she liked to know about the events of the day and often completed the crossword puzzle within ten minutes. Now, she couldn’t concentrate enough to become involved in the details of the news or editorials, and the puzzle had become just another source of frustration.

  Helen shook her head and pushed herself from the table. She shuffled through the rooms, picking up and preparing to do a wash. As she moved through the house, she’d stop to look into the full-length mirror in the hallway. Helen would only reluctantly admit to vanity, but someone had placed mirrors throughout their home.

  Have I forgotten to look at myself in the mirror? Am I too preoccupied, or too frightened?

  When Helen dared to glance into the mirror, it was a disheartening image. I’m pale and thin, the image of my mother as she approached death.

  Her affect remained flat as she tried a smile she did not feel.

  Helen wept.

  Exhausted by these few activities, she decided to watch a few minutes of The Today Show on television. Again, she couldn’t concentrate enough to engage with the program and felt herself nodding off until she fell asleep on the couch.

  Thus, her days became interminably long. In spite of previously held fantasies of what she might be doing if she did not have to work, Helen faced a new reality, I’m too damn tired to do anything but sit in front of the television or sleep.

  That night, Helen sat, eyes down, at the dinner table. An awkward silence replaced the usual excited exchanges of the family’s day. She lacked interest. Her usual enthusiasm to hear about their activities was gone, and she had nothing to say about her own. It wouldn’t take a shrink to see she was depressed and becoming increasingly withdrawn.

  Chuck was painfully aware of Helen’s status and the marked changes this illness had made in their lives. The contrast between Helen now and the active and vibrant Helen of the past struck him deeply. He loved, supported and worried for her without a trace of resentment, but he sorely missed the essence of this woman, his wife, and best friend.

  Chuck began to entertain the thought his life might have to go on without Helen at his side. He looked around the all too quiet house and saw her everywhere. All those little things she accumulated over the years, and each of her small touches, to which he’d paid little attention, now personified Helen and their life together. It’s easy, when you love someone as deeply as they did, to believe, at the most primitive level, it would always be this way. Intellectually, he knew life carried risk and change, but emotionally their optimism had a spiritual certainty. I can’t lose Helen. I might as well be hit by lightening or run over by a car. One minute you’re whole. The next minute, empty.

  Chuck was about to call Dr. Polk once more when Helen began to look and feel better. He felt relieved, but the improvement was short-lived, lasting about a week when the fatigue and poor appetite returned.

  Chuck Martin monitored Helen obsessively for any alteration in her condition. Each change, however minor, fueled his fears to the point where he became the nervous father of a newborn, checking compulsively, trying to assure
himself his baby still breathed.

  After all that happened in Helen’s disastrous passage, this newest turn of events still shocked him. Chuck understood reality all too well, but held fiercely to an image of her survival, a belief deeply rooted in blind conviction.

  Tuesday morning before he left for work, Chuck entered the darkened bedroom to check on Helen. Immediately, he knew something was wrong. The peculiar odor he’d been noticing in passing for several days had increased in strength. Helen’s respirations were regular but shallow, and when he tried to awaken her, he couldn’t.

  “Helen—Helen. It’s Chuck,” he shouted, his voice echoing with fear.

  “Helen, wake up!” he shouted again.

  Chuck shook his wife’s fragile body more vigorously and when he got no response, he dialed 911.

  Chapter Four

  Laura Larsen’s ambulance with its lights still flashing and siren blaring screeched to a halt at Brier Emergency. White coats whisked her into an acute treatment room.

  An impressionistic view of the room shouted, white, bright, clean, with intense fluorescent lighting, white tiles, and shiny stainless sinks. The walls had the full complement of acute care equipment: oxygen, suction, cardiac monitors, and more intense spot lighting if needed. The room had the capacity for the simultaneous treatment of four patients, each gurney litter separated by avocado drapes in a U-shaped tracks on the ceiling.

  Laura remained unconscious while the emergency staff completed their evaluation—an acute myocardial infarction, a massive heart attack. The ER physician was concerned about her mental state, unexplained by her stable vital signs and he ordered an emergency CT head scan. Perhaps she’d hit her head when she collapsed at the airport. The radiologist read it as normal, and by the time they returned Laura to the ER, and then transferred her to CCU, she started coming around.

  Susan Kennedy, Laura’s nurse, reached into her patient’s purse and removed a California driver’s license.

  Susan turned her back to Laura and asked, “Laura, Laura ... can you hear me?”

  Laura thrashed in the bed, groaning. The leather restraints encircling her wrists and ankles creaked and moaned as she fought against them.

  Susan hated restraints, but understood their necessity. A patient regaining consciousness could be unpredictable. She might grab anything within reach, possibly causing injury by pulling at wires, tubes, or intravenous lines.

  “Laura, my name is Susan. You’re in Brier Hospital. Can you hear me?”

  “Hostipl,” Laura grunted.

  “Yes, you’re in the hospital,” Susan said. “Do you have a doctor?”

  “Dr. Pkkk,” she grunted again.

  “Say it again one more time, honey.”

  Susan’s heart almost stopped as Laura uttered, “Dr. Polk, Joe Polk.”

  Anyone, but Joe Polk, Susan thought.

  The ER assigned Rick Adams, a staff cardiologist, to Laura’s case. After writing orders, he made a call to Dr. Polk’s office.

  “Dr. Polk’s office, can you hold?” Without waiting for Rick’s answer, the phone clicked placing him on hold and listening to the San Francisco Marine Weather Report.

  Eight frustrating minutes later, the secretary returned to the line, “Can I help you?”

  “Yes, this is Dr. Adams at Brier Hospital. I have one of Dr. Polk’s patients here in CCU, Laura Larsen. She’s had a heart attack.”

  “Just one moment, I’ll get Doctor.”

  Two minutes later, Polk picked up the line.

  Rick said, “Dr. Polk, I’ve admitted Laura Larsen with a heart attack…”

  “Don’t do anything else to my patient,” Polk interrupted. “I’ll be over at noon.” The line was dead.

  Rick sat at the chart table staring at the receiver in his hand.

  What the hell was that?

  A few minutes after midday, Polk arrived in CCU. He grabbed Laura’s chart and turned to Susan Kennedy. “Cancel all these orders. I’m rewriting new ones.”

  Susan handed Polk a new set of preprinted CCU admission orders containing the CCU protocols for heart attack and for the treatment of commonly associated heart rhythm irregularities.

  Polk stared at Susan. “What the hell are these for?”

  “These are the medical staff’s protocols for treatment of heart attacks and heart irregularities we commonly see in the CCU,” Susan said, adding, “All our doctors use them.”

  “They won’t be necessary,” Polk, said, “I’m writing my own orders.”

  Not again, Susan thought.

  Polk examined Laura, completed his orders, and sat with the chart, writing his own medical history and physical examination.

  “Who ordered the CT scan? What a waste of time and money.”

  “The ER doctor ordered it, since she remained unconscious for some time without an obvious explanation.”

  Polk shook his head. “The HMO better not ding me for ordering that test. I’ll be in my office if you need me.”

  Laura’s mental state improved. By 1:30 in the afternoon, Susan wrote in the nursing note, “I find Laura alert and oriented.” She removed the restraints.

  Where’s Mac? Laura thought.

  By 1:50 p.m., Susan noted the first series of extra heartbeats. The monitor’s alarm sounded and the screen showed a great deal of variation in the character of her heart beat complexes. Polk’s orders to treat this problem were unusual, but Susan injected the prescribed medication. By 2:15 p.m., the irregularities were more frequent and on occasion, sustained.

  Alarmed, Susan called Polk’s office. “This is CCU. I need to speak with Dr. Polk immediately.”

  Gladys Wolff, Polk’s nurse said, “Dr.’s in with a patient. He’ll call you right back.”

  “It’s urgent,” Susan said.

  “I said he’ll be out in a minute,” Gladys said testily.

  Susan waited by the phone for a few minutes, and then she returned to Laura’s bedside. Her heart irregularities had persisted and began showing more variation in the character and rate. Each time, when sustained, the run of the irregularities caused Laura’s blood pressure to drop.

  Twenty minutes later, Susan picked up the phone and called Polk’s office. “I need Dr. Polk right now,” she shouted, when his office nurse finally answered the phone.

  “What’s so damned important?” Polk shouted through the phone.

  “I’ve followed your orders, sir. She’s not responding. You’d better come over. These runs of irregular beats, I’m not sure what they are, and each time a run occurs, her pressure falls.”

  “I have an office full of patients. No way can I get over now. Repeat the ordered medication, now,” he added then hung up.

  My God, Susan thought, he’s going to kill this woman.

  Susan called her charge nurse, informing her of the situation and the patient’s imminent danger. The charge nurse’s call to Polk received a similar rebuff. Finally, they had Warren Davidson, the chief of medicine, on the line.

  “Not Polk again,” Warren said, as he listened. “Page Rick Adams, stat.”

  When Rick answered, Warren said, “You’re consulting on Laura Larsen’s case per my orders. Do what’s necessary. If Polk gives you any trouble, tell him I’m throwing him off the case.”

  Steve McIntyre sat behind the wheel of a runway transporter arguing with a one of his grounds crew chiefs when his pager sounded. Only Maggie Howell, his assistant, had his pager number. He picked up his communicator. “What’s up Maggie?”

  Her voice trembled as she blurted, “It’s Brier Hospital, Steve. Laura’s in the Coronary Care Unit.”

  A shudder passed through his body focusing in his lower abdomen. He started the motor and headed for his car.

  Laura Larsen glanced down with disbelief at the monitoring leads glued to her chest wall, and then she looked around the Cardiac Care Unit.

  A symphony of disharmonious heart monitor beeps disturbed the silence of the room. They were transmitted from the eight CCU patient
s, all the others at least thirty years her senior. She had, after days of denial, come to disquieting terms with an unfathomable reality; she had, in the course of a few moments, made a metamorphosis from healthy to infirm; from carefree to apprehensive; from a youthful sense of immortality to preoccupation with death.

  Mac sighed with relief with her smile when he arrived. He sat by her bedside holding her hand. “I have a hundred questions.”

  “Me, too,” she replied.

  After Laura’s condition stabilized, Rick Adams tried to explain the inexplicable. Why would a woman at age thirty-three, thin, in great physical condition, and without a family history of coronary artery disease, have a heart attack?

  Rick held her hand. “We only understand about 50 percent of the risk factors responsible for coronary artery disease. Your case, while unusual, does happen on occasion.”

  “I still can’t believe it. I’ve done everything right; I workout, I don’t eat meat, I get regular checkups.

  “What am I doing here?

  “What did I do wrong?”

  The universal question, Rick thought; serious illness demands, insists, on being someone’s fault. Invariably, patients discovered some way to blaming themselves.

  “You did nothing wrong. I’ve seen few patients in my career who have been as attentive to good health as you have been.”

  “I’m feeling much better now, but why am I still weak? Is it the heart attack? Have I been in bed too long? I can’t wait to get out of here. So tell me, what’s the plan?”

  Rick dreaded this moment. He had no technique to tell Laura what she needed to know about her condition. He had no way of softening the blow, or altering her reality.

  “We’ve opened the narrowed arteries supplying your heart muscle. I don’t anticipate any additional injury. It’s the damage already done that concerns me the most.”

  “Damage? How much? It’ll heal, right?”

  Rick hesitated.