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

by Lawrence Gold

  “I’ll be there in about twenty minutes. Will you be around?”

  “I’m not going anywhere until things are a bit more settled here.”

  As I walked toward the ICU, shouting and crying came from the family waiting room; the Collins family I assumed.

  When I entered ICU, Beth approached me immediately. She smiled and said, “Hi stranger. I’m glad you’re here. Something funny is going on with the Collins family. I can’t figure it, but they’re overtly hostile, well at least her son, Buddy is, to Dr. Franklin and the staff and he is refusing further treatment for his mother.”

  “Her family will be overjoyed with my appearance on her case,” I said. “Who actually has her power of attorney?”

  “Her youngest daughter, Lila, but good ole Buddy is running the show.”

  Jerry Franklin stood at the bedside examining Mrs. Collins. “She may be lighter now, responding to deep stimulation. Her most recent lab shows her glucose to be falling slightly, but kidney function has diminished further.”

  I sat with Myra’s chart and began a detailed review of her history, examination, and laboratory findings. Afterward, I examined her and checked a specimen of what little urine she had draining from the catheter in her bladder.

  I made myself comfortable next to Jerry. “This marked reduction in urine output suggests she has an obstruction to drainage from the remaining kidney, or that the blood flow to the one kidney is blocked. In any case, we need additional tests. If we can’t find a treatable cause of her kidney failure, she’ll soon need kidney dialysis. How’s this all going to fly with this patient’s family?”

  “Not well, Jack. Let’s try to discuss this with them. Maybe we can discover what’s going on.”

  When we entered the waiting room, a menacing Buddy Collins stood immediately to confront us. Buddy was six feet four inches and three hundred-plus pounds. His beard was dark and he had garish tattoos over his exposed skin and neck. Moreover, he desperately needed a bath. He was the biker, personified. “What the hell’s happening now, and who’s this?” he said, pointing at me.

  “This is Dr. Byrnes. He’s helping me with your mother. We have things to discuss with you regarding her care.”

  Several younger men in their late teens were in the room, plus an elderly man and a slender young woman in her twenties. This had to be Lila.

  Buddy stretched to his full height, a primal aggressive gesture. “We don’t need no more docs and there ain’t nothing to discuss about her care. We’ve decided there ain’t no sense beatin’ a dead horse. We want all this crap you’re doing to her stopped now.”

  “It’s not as easy as that Mr. Collins,” I said. “We think that if we treat her, she has a good chance of surviving this illness and returning to her life at home.”

  “You don’t know what the fuck you’re talking about. At home, she ain’t worth a damn. She just sits around on her ass, complaining and watching those damn soaps on TV. She don’t hardly do nothing for herself. Lila has to feed her and clean up after her. What kind of crappy life is that?”

  “It doesn’t change her situation,” Jerry said. “She has medical problems that we can treat, and she never told me or anyone else that she was ready to die.”

  “What kind of shit is this?” Buddy growled, his face turning crimson, lips parting to reveal discolored teeth and one shiny golden incisor. “Lila here has her power of attorney, and we want all this treatment to stop. We want to take her home…and I mean today.”

  All turned to face Lila, who appeared to shrink before them, eyes down, silent.

  Absent a response from Lila, I continued, “We’d prefer your permission for further testing and treatment, but under these circumstances we’re prepared to go forward without your approval. We’re not going to allow your mother to die based on what sounds like an irrational decision.”

  “Irrational, who d’ ya think you’re talking to? This here is our decision and there ain’t nobody who’s going to interfere,” Buddy said, reddening.

  “Look Mr. Collins,” I said, “we want the family to understand that your mother has a good chance of getting through this illness if we make a diagnosis and treat her.”

  “What part of ‘no’ don’t you understand shouted Buddy? We don’t want no more treatment, capiche?”

  We weren’t getting anywhere with this guy, so I turned to Jerry. “Let’s get a court order for her care. These people don’t give a damn.”

  “Don’t give a damn. Who the hell do you think you are?” Buddy shouted as he pushed me backward into the wall. My head made a loud thump on contact and my vision blurred momentarily.

  “Keep your damn hands off me,” I shouted, pushing the massive Buddy backwards.

  We held onto each other, struggling for control, when two large hospital security guards entered and pulled us apart. They held Buddy solidly in their grasp and then they dragged him out the door as he screamed, “I’m not through with you, you son of a bitch. I’ll be back.”

  Everyone wants to be Arnold Schwarzenegger, I thought.

  Beth entered the room. “I guess I called security just in time. Are you okay Jack?”

  I smiled. “I’m fine—could have taken him any time.”

  Lila looked embarrassed at the confrontation and said, “He’s a hot head. Don’t pay any attention to him.”

  “He’s hard to ignore, don’t you think?”

  I sat next to Lila and restated what I’d said, and awaited some kind of response.

  “Look, he’s not as bad as he seems,” Lila said. “He’s been through a lot; jail, drugs and booze, but he’s going to change this time.”

  “We can’t get into your brother’s problems,” Jerry said. “We have Mom to deal with and I don’t understand why you won’t allow us to treat her. What’s going on?”

  “I know what you’re thinking,” Lila said crying again. “You think he just wants to get at her money once she’s gone.”

  Jerry and I looked at each other, speechless, then I said, “I have no idea what’s on your brother’s mind, and I don’t care. Do you want her to die? Do you want us to pull the plug when she has a good chance of making it?”

  Head down and crying, Lila exclaimed, “No, I love my mother and I wouldn’t do anything to hurt her. Do what you can to help her, please.”

  I ordered a stat kidney angiogram. They injected dye into the artery supplying Myra Collins’ kidney, making the artery visible under x-ray. The x-ray images revealed 98 percent narrowing of the only artery to her kidney. Luckily, the doctors were able to pass a wire through the narrowed segment and open it with a balloon catheter. Before they completed the procedure, Myra had put out ten ounces of urine. By six a.m., her laboratory tests were showing marked improvement in both her kidney function and her diabetes.

  I was finally ready to leave ICU as Beth’s shift ended. We decided to breakfast together.

  In a booth at a nearby pancake house, Beth smiled. “The next time we need security and you’re around, we’ll know whom to call.”

  “Did you see the size of that guy and the sweet disposition to match? Do me a favor, next time, don’t call unless you know I’m armed.”

  “How are you feeling? Hope you don’t have too busy a day ahead.”

  “Right now I feel great, but by about two this afternoon I’ll be remembering I’m not eighteen anymore. Thank God I’m not on call tonight.”

  We decided to meet for dinner after I finished for the day.

  By dinnertime, I was exhausted.

  Beth was irritable, and refused to say why.

  I pushed her for an explanation and finally she yielded to my pleas. “First, I had to work a double shift, that didn’t help. Then, it happened to me again today Jack and though I’m sure you’ll find it amusing, I don’t. I find it irritating and frustrating.”

  I’d better keep my mouth shut, I thought.

  “I took care of Abner Reese today in ICU. You’ve heard about him. He’s the eighty-five-year-old who
had a massive stroke due to untreated high blood pressure. Amazingly, he’s had total recovery and we had planned to transfer him to the medical ward tomorrow morning.

  “When his blood pressure skyrocketed this morning to 220/150, I said, Abner your blood pressure’s up again, I’m going to give you a shot to bring it down.”

  “I don’t want no more damn shots,” Abner replied, obviously agitated.

  “Dr. Davidson left me orders to give you a shot if your pressure went up again.”

  “Are you deaf?” he shouted, “I don’t want no more shots.”

  Beth counted to ten.

  With infinite patience, Beth tried again, “Look, Abner you had that stroke because your pressure went this high before, do you want to risk another stroke?”

  “I don’t give a damn,” he shouted. “I won’t take no more shots.”

  “I’ll have to call Dr. Davidson and inform him that you refused.”

  “Give the shot to him, for all I care.”

  Beth explained the situation when she reached Warren in his office.

  “He’s a cantankerous old fart. That’s how he got into trouble in the first place. Tell him he needs the shot and that I’ll see him at noon.”

  Beth hung up the phone and walked to Abner’s bedside, “I just talked with Dr. Davidson and he wants you to take the shot.”

  “Both of you go to hell,” he said as he turned away from Beth and faced the wall.

  I’ve had it. Beth thought. Let Warren handle him.

  Beth waited anxiously until noon, all the while concerned Abner would stroke out again.

  When Warren arrived at a little after twelve, he walked up to Beth. “Give me that syringe and an alcohol wipe.”

  They walked over to Abner’s bed and Warren said, “Abner, pull down your goddamn pants I’m giving you a shot.”

  What followed next stunned Beth as Abner said, “Yes sure, Dr. Davidson. I’ll do whatever you want.”

  I began laughing, yet had the presence of mind to watch Beth’s response to what I thought was humorous.

  “You’re right Jack. Internally, I went ballistic. All that time and aggravation; all the pleas and explanations; all my frustration and it’s resolved with a single pull down your pants from Warren.”

  I began to speak, but Beth interrupted. “I know, Jack. I know. I just don’t like it.”

  “We’ve all seen it before. It’s a reality,” I said. “Hate it that docs wield the ultimate authority and carry the most weight with patients, okay. Use it when necessary.

  “The joke is that physicians are less respected today in practice and there’s more public antipathy against their authority. That’s tough, since physicians practice better and patients do better when they have confidence in their physicians and a willingness to go along with their recommendations.”

  “Don’t you think,” Beth responded, “there’s justification for skepticism regarding physicians? Look at the Polk situation.”

  “I agree with you 100 percent. Physicians have only themselves to blame. When I think of the downside, both the physician and patient are paying too high a price. Medical decisions can be difficult, but as Yoda said, ‘make them we must.’ Patients are entitled to the advice of physicians they trust. That advice must come with the assurance the physician’s only interest is getting us well. Patients do better when their expectations are high.”

  I began to feel the effect of my lost sleep. I stood, stretched. “I’m beat. I think I’ve had it for tonight. Get me onto this subject again sometime over drinks. I’d better get some rest, see you in the a.m.”

  “Get a good night’s sleep,” she said kissing me softly on the cheek.

  I awakened the next morning with discomfort in my back. Had I pulled a muscle? Was it due to my collision with the wall yesterday?

  I ignored the discomfort, washed, and dressed for the day. Before I left for the hospital, I had a sudden urge to urinate. That was surprising, as was the associated burning. I had no other symptoms to suggest a bladder or kidney infection and I had no reason to suspect urethritis or a sexually transmitted disease, thank God. I’d check my urine when I arrived at the hospital.

  While driving into work, a beautiful, warm, sunny day, I suddenly developed severe pain in the right side of my back, increasing in a crescendo pattern, and then suddenly abating, only to recur. The sudden urge to urinate returned, and I knew immediately that I was passing a kidney stone.

  “That’s all I need now,” I said, grimacing in pain.

  I arrived in the hospital’s parking lot in a cold sweat and had an immediate urge to get up and move around. During my urology rotation in medical school, my professor said, “If you see a man grimacing in pain and pacing in the emergency room, the odds were 95 percent plus he is passing a stone. The pain of passing a stone is on par with labor pains, though you’ll never get women to agree any pain a man might endure could be as bad.”

  I became a believer.

  I sweated profusely, and my face matched the green corridor walls.

  I entered the emergency room and headed straight for an ER bed grunting to the nurse and doctor, “Get me morphine stat., I’m passing a stone.”

  Since the ER staff knew me, I had an IV line placed immediately. I watched the nurse approaching, syringe in hand with the expectancy of a junkie about to get his fix. She injected morphine into my IV tubing, relief coming in a few seconds.

  Incredible drug, morphine, I thought.

  Functional now, I had the staff call Ralph Collier, my favorite urologist, who ordered an Intravenous Pyelogram, x-rays to visualize the kidneys and determine the location of the stone.

  As I waited on the gurney transporter after the x-ray, I looked to the side and through the fog of my illness and the morphine high, the person next to me was someone familiar.

  “Dr. Byrnes, it that you? It’s Frank Barton. What are you doing here, Doc?”

  Though intellectually I understood my own humanity and place on this earth, I felt some degree of discomfort being literally on a level playing field with one of my own patients.

  Am I being arrogant? Am I better than anyone else?

  “I’m passing a kidney stone, Frank. I’ll be fine. How are you doing?”

  “I’m doing great Doc, thanks to you. I’m still going home tomorrow, right?”

  “Sure Frank. If I can’t discharge you, I’ll have someone come in to set you free.”

  Fifty minutes later, I stood with Ralph Collier looking at the x-rays of my kidneys. The images showed a small stone lodged in the upper third of the tube that carries urine from the kidney to the bladder, my right ureter. This tube tapered as it descended from the kidney, becoming narrower as it headed south toward the bladder. Each time the stone passed into the narrow segment, the ureter would object, responding with contractions and excruciating pain, its insistence and its demand that the stone pass through.

  “That stone’s small enough to pass, right?” I asked.

  “It sure looks small enough to me, but you never know,” Ralph said. “You’ll have to stay here tonight as we monitor its progress and dope you up with morphine.”

  I hated the role of patient, especially in my own hospital. They gave me one of those delightful, open at the back, well-ventilated hospital gowns and rolled me to the fifth floor medical ward, where the staff greeted me warmly—maybe too warmly.

  Beyond the true affection and concern of the staff, there might be perverse satisfaction in seeing a physician in a reversal of roles. This proved to be a mixed blessing, for whatever small pleasure they got from seeing a physician as a patient was greatly offset by their often insufferable behavior.

  My special treatment as one of them helped me deal with my frustration and disappointment at being there in the first place.

  Beth visited and tried to deal lightheartedly with a grumpy and unpleasant me. All her offers, backrub, books, music etc., I rebuffed gracelessly. I had the intelligence to understand, but not control my boor
ish behavior.

  Let’s see how sunny you feel while you’re passing a stone, I thought.

  After Beth departed, I lay there in self-pity, in pain, impatient.

  I’d pushed the call button several times—no response. My anger increased, building to a point that would soon threaten my well-crafted, affable reputation.

  After waiting fifteen minutes, and now in more severe pain, I picked up the bedside phone and dialed the operator.

  “This is Dr. Jack Byrnes. Please page the night nursing supervisor.”

  One minute later, Mary Oakes was on the line, “I hate to bother you, Mary, but no one on this ward will answer my call button. I’m in a lot of pain and need my morphine fix.”

  “I’ll take care of it immediately, Dr. Byrnes.”

  Two minutes later, my nurse, a new graduate, entered my room red-faced, contrite, and teary-eyed, “I’m so sorry, Dr. Byrnes, a treatment down the hall had me tied up.”

  I felt like a shit.

  “I’m sorry, too,” I said. “I can be nice—it’s just the stone. Please forgive me.”

  After the miracle of morphine, I went to the bathroom and while peeing into my plastic filter, I heard the distinct click of something solid hitting its side. Overjoyed to see the small black fleck, my kidney stone, I marveled how something so small could cause this much misery.

  Instant cure.

  Chapter Twelve

  Laura Larsen’s mother, Mildred—nobody in their right mind called her Millie—sat by her daughter’s bedside in CCU. Laura’s Dad, Patrick was unable to break away from the responsibilities of his accounting practice and he remained in Denver, but called every evening.

  When she awakened from her nap, Laura sensed her mother’s presence by the strong bouquet of Lavender.

  “Mother?” she asked.

  After the kiss on the cheek and first few perfunctory questions, Mildred sat watching her daughter with a distracted gaze. As usual, they didn’t have much to say to each other.