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

by Lawrence Gold

  She released Mac’s hand and said, “Please, Mac, I need a few minutes alone with Dr. Adams.”

  “Laura, please ...” he begged.

  “Just for a minute.”

  After Mac left, Laura stared at Rick at first intrigued and impatient, and then she was suddenly frightened. “What is it?”

  “Your heart muscle has been damaged. Most of it occurred with the heart attack, but some injury occurred in the weeks before you came to the hospital. The heart’s a pump that works when its muscles contract. Damaged muscle has weakened your pump, and that could, over time, fail.”

  “What do you mean, fail?”

  “When you are sitting here quietly, the heart can easily keep up with your body’s needs. When you are up and around and when you exercise, your heart needs to work harder. If it can’t keep up, we call it heart failure.”

  Laura suddenly felt dizzy, lightheaded. Her mind whirled with random thoughts, confusion, and terror.

  “I don’t know what this all means for me,” she said sobbing. “I’m thirty-three. I work hard, exercise hard and…I have plans, you know…a life ahead of me…a man I love…and babies; I want to have babies.”

  A bitter taste flooded her mouth. Nausea crept in as Laura pulled the bed sheet over her head and sank into the protective womb of her bed, sobs alternating with raspy deep breaths and dry retching.

  Rick felt his eyes swell with emotion.

  This is awful, tragic.

  He reached over, holding her shoulders, waiting until she regained control.

  Laura sat up in bed, took a sip of ice water, and then dried her face with a washcloth, “I have to know what I’m up against Dr. Adams. I can deal with anything as long as I know.”

  “Here it is, Laura, in a nutshell: damaged heart muscle doesn’t heal well, it scars, and scar tissue doesn’t help your heart pump. It’s too soon to tell how you will be limited physically, but it would surprise me if you weren’t. The future is hard to predict. If you stabilize at a level of heart function, you can live with, then okay. If not, and if things get worse, then we’re up against a number of unpleasant possibilities, including heart surgery to improve function or, in the extreme, heart transplantation.”

  Laura had signed a request for her medical records from Polk’s office. After several days of stalling by Polk’s office manager, Laura’s brother Seth (everyone called him Sonny) appeared.

  “You see this?” Sonny said standing before Polk’s office manager. “This is a signed release for Laura’s medical records. If I don’t get them now, I’ll be back with the police.”

  Laura and Mac sat next to her bed when Sonny and Dr. Adams entered her room this morning, she saw immediately something was up. “What is it now?”

  “We finally got your office records from Dr. Polk and ...”

  More alarmed now, she said, “What does it show? I’m not sure I’m up to more bad news.”

  “Maybe this can wait,” Sonny said. “Dr. Adams doesn’t want you worked up needlessly.”

  “You two have got to be kidding. Sonny, this is me. And, Dr. Adams, you understand by now that not knowing is likely to send my imagination into realms far worse than anything you might tell me.”

  Rick was holding Polk’s office chart in hand as he approached her bed and sat.

  “The office notes confirm what you’ve told us about your symptoms, but Polk never considered your heart as their origin. Frankly, I don’t understand how that’s possible.”

  “I told him to check out my heart,” she said. “I demanded a cardiogram. He studied it and said it looks normal.”

  Mac moved to the other side of her bed. He sat next to Laura, holding her hands.

  “You’re scaring me,” Laura said. “Just get it out.”

  “That cardiogram was anything but normal. Either he did not look at it or he’s misread it. In either case, the tracings reveal unequivocal evidence that your heart was suffering from the effects of insufficient blood supply. We call that ischemic changes, and if I’d seen them, you’d have been in the hospital and in the cardiac catheterization laboratory that day.”

  Laura felt heat rising within, anger, and outrage.

  She tried to speak, but hesitated a moment to regain control of her breathing.

  “You’re not telling me all this could have been prevented, are you?”

  “Laura ... Rick pleaded ...”

  “You’re my doctor. You owe me the truth.”

  Rick’s professional veneer crumbled. When I saw the cardiogram, I nearly lost it.”

  How is this possible? This is negligence, malpractice?

  “I’ve seen the most egregious acts of physicians’ incompetence and negligence. This one is up there with the worst. It’s an embarrassment to me and to my colleagues to share a link in any way to the behavior of Joseph Polk. I’ll fully cooperate with you in any actions you may pursue against this physician.”

  “Too little, too late”, Laura said. “That son-of-a-bitch has ruined my life, destroyed my future, and shattered my hopes. He’ll pay, if it’s the last thing I do on this earth.”

  Chapter Five

  Chuck Martin threw aside the EMT who stood in his way as he boarded the ambulance to join Helen. He sat at her side holding her hand while the ambulance raced through the streets, siren wailing.

  Upon reaching Brier Hospital, Chuck couldn’t believe the incongruity between the frantic race to the emergency room with sirens blaring, and the slow motion level of activity when they arrived—classical hurry up and wait.

  They moved Helen into the examining area.

  “Dr. Polk’s on his way in,” said the ER nurse as she recorded Helen’s vital signs and drew blood.

  Chuck struggled to maintain control He was frozen in place at the bedside holding her hand. His eyes were shifting between Helen and the wall clock’s sweeping second hand.

  He felt relieved when Dr. Polk arrived and began the examination and admission process. Polk’s anxious appearance surprised Chuck. In sharp contrast to his normal, confident manner, Polk’s eyes moved continuously as he spoke in short staccato bursts.

  “Are you okay, Dr. Polk?”

  “What kind of question is that?” Polk said. “I have a life, too.”

  Chuck stared at Polk. “What did you say?”

  “I’m sorry. Didn’t sleep well last night.” Polk stared into space.

  Chuck waited for a full thirty seconds until Polk suddenly brought his eyes back into focus. “I’m fine; just had to rush to get in here.”

  If his appearance wasn’t enough, Polk’s concession further alarmed Chuck, “Don’t know yet what’s going on, but I’m getting a full workup and we’ll see what’s what.”

  They moved Helen immediately to the fifth floor medical unit, her home ward. Though her insurance provided for only a semi-private room, the nursing staff arranged for Helen to have privacy by placing her alone in a two-bed hospital room.

  They took more blood, shot x-rays, and inserted an IV line. If Chuck wasn’t anxious enough, the concerned faces of Helen’s friends from her ward only gave credence to his worst fears.

  He sat at the bedside through the evening, the staff ignoring designated visiting hours. The staff got only a groan from Helen when they stimulated her by talk or positioning. He held her cool, dry hand as he thought about their life together.

  Chuck looked out through the large west-facing window to the bright East Bay lights below and San Francisco in the distance. On reflection, he recognized emotionally and intellectually he’d been living a charmed life. He came from a farm family with loving parents and two older sisters who, with their mother, doted on Charlie, convinced that he could do no wrong. A good kid, Charlie matured with a special affection and appreciation for women. Although far less intimate in his relationship with his father, Charlie never for a moment felt unloved by this hard working, quiet man.

  As he matured, Charlie became Chuck, more appropriate since he had always been big, a natural
athlete and a star in high school. During the first two years of college, he managed to play football with the intensity of a linebacker, but without the killer instinct of the best of that breed. When he suffered a career ending knee injury at the beginning of his junior year, he surprised everyone by the grace with which he adjusted to this loss. In retrospect, he recognized the injury as a blessing in disguise for it led to a highly productive reassessment of his life’s goals.

  Chuck had no illusions about being a professional athlete, but he believed he could find some role in sports, perhaps as a coach. Now, off the field for good, his perception of sports, overall, and his role in it, changed radically.

  “You can do anything,” Helen had said. They’d met and had fallen in love in Chuck’s senior year of high school. “I’ve always thought you’d be selling yourself short with a career in sports.”

  Helen was the supreme manifestation of his good fortune and he cherished each day in the life they shared. They were inseparable. With Helen’s encouragement, Chuck graduated with a degree in Construction Management and Business Administration.

  Chuck never left Helen’s side. He intermittently nodded off through the endless night.

  By the next morning, she was awake but lethargic. Her arms and legs jerked uncontrollably when she tried to use them.

  Dr. Polk arrived by eight a.m. and with a somber look. “Helen’s liver disease has progressed further than any of us expected. What we are seeing now are early signs of liver failure.”

  “Liver failure! What are you talking about?” Chuck said as he stood, taking one step back, and then approaching Polk, aggressively towering over the smaller man.

  Polk stared back, his face frozen, statue-like, and expressionless.

  When he got no response from the impassive Polk, Chuck continued in a more subdued manner. “I’m upset, Doc. I need to know what that means and what we can do about it.”

  “I’ve put her on medicine and ordered a special diet which should help.”

  “What about a liver specialist?” Chuck asked, “There is such a thing, isn’t there?”

  Polk thought for a while then replied, “Sure, we have gastroenterologists on staff, but it’s a waste of time and money. They won’t add a damn thing to Helen’s case.”

  Chuck, still in shock by the words liver failure, blurted out, “Let’s get one anyway.”

  Polk scowled then replied, “Of course. I’ll ask Ken Peters to see her today.”

  Without another word, Polk turned abruptly, hurriedly leaving the room and shaking his head as if in disgust. “I don’t know why I bother,” he said to himself.

  Chuck, Adriana, and Alex spent the morning at Helen’s bedside. Chuck was near panic with fear, but tried to hide it from the kids. Though they permitted no visitors other than family, many friendly faces of doctors and nurses who worked with Helen, appeared at the door, all expressing concern and trying to reassure them. Cards and small gifts, a general outpouring of goodwill and hope, filled her room.

  Dr. Ken Peters, the youthful appearing and affable forty-year-old GI man came to see Helen after lunch. He spent two hours reviewing her chart and examining her. He spent time with Chuck to clarify features of her history and clinical course, since Helen couldn’t remember the details of her recent illness.

  “By the way, Doc,” Chuck said, “what’s that terrible mousy smell around Helen?”

  “We call that fetor and it’s the result of a damaged liver. It will go away once we have this thing under control.”

  Chuck and the kids waited expectantly for Dr. Peters to return from viewing Helen’s x-rays. When he arrived, he asked, “Can I see you in the conference room, Mr. Martin?”

  Chuck sensed bad news.

  “Mr. Martin,” he began, “Helen may have pretty far advanced liver disease that we call cirrhosis of the liver. This resulted from her acute hepatitis that has persisted and continues to damage her liver.”

  “She got over that hepatitis pretty quickly,” Chuck said. “Dr. Polk examined her and ran tests. He said things were going well?”

  “Well, that’s the trouble with many cases,” Peters said defensively, “things can appear to be okay, while damage to the liver continues.”

  Chuck heard the term cirrhosis when people in the media talked about skid row derelicts. It described one of his past employees, an alcoholic, who finally succeeded in drinking himself to death. “She’s never been a drinker. I thought that it was drinking and cirrhosis went together.”

  “No, Mr. Martin, alcohol has nothing to do with your wife’s case. Many other conditions can cause cirrhosis.”

  “Well, what can we do?”

  “Let me chat with Dr. Polk, and then we can discuss our plans with you.”

  Chuck was reluctant to confront a physician, but he was instantly irritated and angry. He aggressively approached Peters. “God damn it Doc, I need to know what’s going on.”

  Peters was taken aback by an angry Chuck Martin who was encroaching into his space. With trepidation, he said, “Look, Chuck, is it all right if I call you Chuck?” After the nod, he continued, “It’s not that I don’t want to talk with you about Helen, it’s just a consultant’s courtesy to Dr. Polk that I discuss my findings and recommendations with him first.”

  When Chuck remained directly in Peters’ face, he paused and then continued, “Sit here for a minute,” pointing to the chair. “Helen’s condition is serious and if we can’t control the hepatitis her prognosis is not good.”

  Chuck’s mouth was suddenly dry. Instantly, he had that hollow sensation in the pit of his stomach and said, “Go on.”

  Peters continued, “Acute hepatitis can persist, all the while injuring and scarring her liver and resulting in cirrhosis. If the damage is far advanced, there’s little we can offer. I’m going to recommend taking a piece of her liver, a biopsy, for examination under the microscope. Once we do this, we’ll have a handle on the amount of damage and how possibly to treat it. Our last resort, if we can’t control her liver disease, would be a liver transplant.”

  Chuck began sweating and felt lightheaded. He leaned forward, tears forming. He’d never felt so helpless and alone before in his life, or so frightened.

  He liked Dr. Peters and his compassionate manner, but all that he’d heard had shattered his long held inherent optimism.

  You can live in a dream world, he thought, until the moment that reality comes up and bites you in the ass.

  “I’ll get together with Dr. Polk today,” Peters said, “and we’ll meet tomorrow morning after I’ve had a chance to review the biopsy and discuss the findings with him.”

  When Chuck returned to Helen’s room, she was staring ahead, eyes drifting. When they finally focusing on Chuck, she smiled, and Chuck melted–the flush of love for his wife and a great sense of relief.

  She looked around. Her eyes assessed each item in the room, the window, the TV, and her nightstand. “This is Brier Hospital, right?”

  “Yes. This is your old ward. You’ll see lots of familiar faces.”

  “What happened?” Helen asked as her uncoordinated hands jerked, trying to straighten her hair.

  “The hepatitis,” he said staring directly into her eyes, “is worse. You’ve been very sick.”

  “Hepatitis?” she replied.

  “You remember…”

  “Where am I again?”

  Chuck signed the biopsy permit and Ken Peters completed the procedure without difficulty or much discomfort for Helen.

  The next morning, Dr. Polk came bounding into Helen’s room all smiles and greeted them as long lost friends. “The liver biopsy showed scaring and a great deal of inflammation. Dr. Peters and I discussed these findings, and I’ll be starting Helen on medications including Interferon, which should reduce this inflammation and prevent further liver damage.”

  Chuck immediately felt relieved and excited. “I liked Dr. Peters. Will he follow Helen after she leaves the hospital?”

  “No, he w
on’t be seeing her,” Polk said. “In my experience, too many physicians on a case as complicated as Helen’s is a bad idea. I’ll call on Dr. Peters again should I need his assistance.”

  Chuck was disappointed. He’d had a good feeling about Ken Peters and had begun to trust him. He was unwilling to confront Polk at this critical time and so he said nothing.

  Helen began receiving IV medication Monday, and they planned her discharge for Wednesday or Thursday.

  The fog over Helen’s mind dissipated. For the first time in a while, she found a clear mind had its disadvantages as Helen began reflecting on an uncertain future. Although anxious, Helen was more frightened, more alarmed over thoughts that Chuck, Adriana, and Alex might have to carry on without her.

  In the care of her sickest patients, Helen often marveled at their tenacity, their tolerance for frustration and disappointment, and their bravery.

  I’m not sure I have what it takes, she thought.

  Food, even hospital fare, had begun to look better to Helen, but gradually, over the last twenty-four hours, the smell or even the thought of food made her sick.

  That morning when Mary Oakes, the head nurse of the ward, made her usual visit, Helen said, “I started feeling better, even felt like eating, but now my appetite is gone and my abdomen’s sore. What’s going on?”

  Mary checked Helen’s temperature. When she discovered a low-grade fever, she said, “I’ll call Dr. Polk and let him know what’s happening. Don’t worry.”

  When Mary finally got Polk on the phone, he said, “Trust me, it’s just the side effects of her medication.”

  What is the man talking about? Mary thought.

  Helen’s pain persisted. Each nursing shift recorded abdominal tenderness when they examined her. They again informed Polk of these findings, but he continued to insist on his diagnosis, adding codeine to control her pain.

  Mary Oakes tried to get Polk to reconsider his diagnosis, or at least get a consultation. He refused. With Helen getting worse, she’d run out of patience and tact. “Dr. Polk, I don’t like what’s going on with Helen. You must do something.”