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

by Lawrence Gold

  Laura recalled Millie’s astral, teary gaze, her foreseeable reaction to most of life’s events. Happiness, never overt, blended with a dark reservoir of anguish. Sadness, a nonstop flight to despair. Laura, the child, never understood this. She interpreted her mother’s responses as disapproval, and finally abandoned her quest for the touch, kiss, and hug she craved.

  How sad–to be full of emotion, yet be unable to express or share it.

  Fortunately, Patrick overcompensated for what Laura missed from Mildred. Laura was Daddy’s girl. Hugging him, sitting on his lap, and walking hand in hand foretold what she, as a woman, would look for in a man.

  Laura drifted into her third week of hospitalization, finally escaping the heartbreaking reality of the Coronary Care Unit. The upbeat, enthusiastic staff tried their best to cast her situation in an optimistic light, a light only strong enough to cast its shadow over a dark and dismal future.

  I’m not depressed, she thought, I’m just facing an unpleasant reality.

  Mac entered her room with a large bouquet of pink roses. He smiled as he placed them on her chest and kissed her softly on the lips.

  She turned her face away.

  “You’re looking great, baby,” he said, as he sat beside her in bed.

  “Look at me,” Laura said as she threw open the nightstand and stared into its mirror. She poked and prodded her skin and studied her face from every angle. “I look and feel like shit.”

  “You look good to me, a little better each day since you came out of the CCU.”

  Laura felt no emotion as she emptied the vase of aging flowers, replacing them with the pink roses.

  “How’s the physical therapy going?”

  “It’s going.”

  “I mean are you enjoying the PT? You love to exercise.”

  Laura stared at Mac. Her eyes flooded with tears that blurred her vision.

  “Mac, you don’t get it. I’m exercising with a bunch of old men, many in their 60s and 70s, and I can barely keep up. What I’m doing now would have barely counted as a warm up before.”

  “Come on, Laura. You know Dr. Adams said this would take some time. Be easy on yourself.”

  She grasped his hands, looking into his soul. “Look, Mac…” she paused, “this isn’t what either of us bargained for. You’re young. You have a full life to live, a life with someone who can share it with you. I can’t be the person you need and the person you deserve. I…” she choked on the words and turned into her pillow sobbing softly.

  Mac pulled their hands apart, stood and glared at Laura. “I can’t believe you’re saying these things to me. What kind of game are we playing? Would you walk out on me if our circumstances were reversed?”

  “I just…”

  “You just what? I love you. I’m committed to us. I’d marry you today if you’d have me. Am I so shallow that you see me leaving the person I love the most because we have problems, even tough problems?”

  “Mac I…”

  Mac stood and paced, “I’ve been sick with fear. Terrified that I’d lost you. Relieved when you seemed to improve, and now this…maybe this final insult is more than I can stand,” he said as he fell into the easy chair in the corner of her room.

  “Please come here,” she said softly extending her hand toward Mac. “Please Mac, I need you.”

  Mac looked up. The power of her outstretched hand pulled him from the chair. He moved across the room and sat beside her. One hand touched his cheek while the other brushed through his curly hair.

  “I love you Mac. It so unfair,” she whispered. “Unfair to both of us.”

  A knock on Mary Oakes’ door interrupted her intense concentration on her staffing chart. The day charge nurse said, “Sorry to be the bearer of bad tidings, Mary, but your favorite doctor wants you to accompany him while he discusses Loretta Harrington’s case with her family. He’s waiting, oh so patiently, for you outside the family waiting room.”

  Loretta Harrington had been part of the fabric of Brier Hospital and had served as Director of Volunteer Services. She was the matriarch of the Harrington family, one of the oldest aristocratic family lines in the San Francisco Bay Area. After graduating from Vassar, marrying Archie Harrington, and bearing two children, she’d fulfilled the demands and expectations of her class, supporting the arts, the church, and thrusting herself into a whirlwind of volunteer activities.

  Loretta’s perfect posture, upward tilting chin, and formal attire, suggested royalty. She would not tolerate sloth or bad manners.

  Her daughter, Janelle, had affectionately characterized her mother as a prickly pear, thorny outside, soft and sweet inside.

  In contrast to this cool, off-putting, carefully crafted image, Loretta was, as her family knew, and many were to discover once they got beyond their initial distaste, a loving and accepting woman, willing to extend herself to help others.

  Loretta had worked hard and had succeeded in creating a volunteer force that had become intrinsic to the successful operation of Brier Hospital. They used her volunteers instead of paid employees.

  Except for Loretta’s slight limp, the residue of her hip replacement that she tried to hide, she’d been healthy, working, and enjoying life until the week before her admission. Her course in the hospital under the care of Joe Polk had been a fiasco from the start. Polk had gone his own way, as usual, ignoring any advice, dismissing the nursing staff’s observations, and refusing consultation. The net effect; Loretta Harrington was on a fast track to the morgue.

  Five days ago, Loretta arrived on the ward by wheelchair, weak and dehydrated. She looked to have aged twenty years since Mary last saw her at Brier only two weeks ago. Everything had gone wrong in her care and now she’d developed severe heart failure.

  When Mary came into Loretta’s room this morning, she couldn’t believe the latest changes in her condition. Loretta barely responded. She was bloated with fluid all over her body, and she gasped for breath. She was pale and blue, and her upper body musculature, the auxiliary muscles of breathing, struggled to bring in more air.

  Mary placed a call through Polk’s answering service, “I need Dr. Polk, stat.”

  She fumed as she waited for Polk’s return call.

  After twenty minutes, he phoned.

  “What is it now?” Polk challenged.

  “It’s Loretta Harrington, sir, she looks awful. Her heart failure is worse. She’s bloated all over, gasping for air. It looks like she’s ready to code.”

  “Well, for whatever good it will do,” Polk said, “increase her oxygen to six liters, give her morphine and a diuretic. I’ll be in later to see her.”

  She injected the morphine into Loretta’s IV tubing and Mary watched as her struggle to breathe suddenly eased, a temporary stay of execution.

  “Gotta go,” Mary said grimly as she moved toward the door.

  “Dead woman walking,” she said to herself.

  Polk paced back and forth in front of the waiting room, arms across his chest, and the usual scowl on his face. “You sure took your sweet time.”

  Mary gritted her teeth. “How can I help you, Dr. Polk?”

  “I’m going in to talk with the Harrington family about Loretta, and I don’t think it’s going to be pretty. I may require your help with the more melodramatic members of her family.”

  Mary turned away and rolled her eyes in disgust.

  Polk stepped into the crowded waiting room, Mary followed.

  Loretta Harrington’s daughter, Janelle’s eyes were red and tear filled. She looked at Polk expectantly. When the rest of the family began circling, Polk raised his arms as if he were about to deliver a benediction and said solemnly, “Please everyone have a seat. We have things to discuss.”

  “Is she dead?” Janelle blurted. Tears streaked down her cheeks.

  These people are laughable, Polk thought. The old lady’s life isn’t worth a damn and I’m sure as hell not going to take the heat for her departure.

  “No, she’s still with
us, but I’m not sure how much longer it will be,” Polk said solemnly. “Her heart has given out and I don’t know how much longer she can last.”

  Several family members began rising, all talking at once. Polk interjected, “Give me a minute, and I’ll answer all your questions.

  “Grandma is extremely sick right now. Her condition is critical and I need the family’s guidance about how much further we should go.”

  Add a little more bait, he thought.

  Gently putting his hand on Janelle’s shoulder as she began to rise again, Polk continued, “We have many tricks in modern medicine that give us the ability to keep patients going when there’s no hope for meaningful survival. What we need now is the wisdom to decide when their use is appropriate. Highly aggressive treatment is not always in the best interest of the patient. Sometimes, the most we can do is to marginally extend life at the cost of adding, at the least, discomfort and at the most, more suffering.”

  Archie Harrington, Loretta’s husband of fifty-nine years looked around the room. “He wants us to pull the plug.”

  “Nobody’s pulling any plug,” Polk said, “but I do need you to tell me how aggressively we should treat her.”

  “We trust you, Dr. Polk,” Janelle said. “What would you do if Loretta was your mother?”

  Home free, he thought.

  Polk paused as if looking upward for guidance. “This is not my choice to make. My role here is to help you decide. I’ll carry out that decision only if I am certain that this is what the family wants.”

  Tears ran down Archie’s face, and choked with emotion, he said, “If she has no chance to get through this, I, we don’t want her to suffer needlessly.”

  “I agree,” Polk said, straightening his bow tie. “Trust me, I won’t be a party to anything that puts her in further jeopardy, but with your agreement, I will order no further treatment except what’s needed to keep her comfortable. Nature will have its way here, as it should. It won’t be too much longer.”

  Janelle collapsed into a chair.

  Once Archie accepted the finality of the situation, he was suddenly transformed and serene. He approached Polk, shaking his hand. “You’ve been a great doctor and good friend to this family and especially to Loretta over all these years. We have no way to express our gratitude for all you’ve done.”

  Polk stood mute, staring ahead then he turned and left the waiting room.

  Well handled, he thought, smiling to himself. All they needed was a little push in the right direction.

  Mary Oakes sat hugging Janelle, and remained with the family to help as best she could. She stared at the door through which Polk left and slowly shook her head.

  Chapter Thirteen

  Five weeks ago, Helen Martin had begun weekly intravenous therapy, the best alternative for the control of her hepatitis. The infusions themselves were tolerable, and she enjoyed visiting her friends in the hospital. Predictably, she’d become deathly ill with intractable nausea and vomiting, lasting for up to six hours. Like being seasick, Helen was afraid she wasn’t going to die.

  Between these infusions, she gradually felt better. It didn’t take much for both Helen and Chuck to regain their lost optimism.

  She returned to work on a per diem basis and found that, absent the daily grind of a full time position, she could work an entire shift and handle the load. The return to work had done wonders for her spirit.

  The day was overcast as Helen entered Polk’s brightly lit waiting room for a routine follow-up visit. The sense of impending doom, that cloud over her, had moved on. While she knew it wasn’t rational, she sensed her condition had stabilized and recovery was near.

  Polk sat behind his immaculate oak desk, his face a mask, “Please have a seat, Helen.”

  His demeanor stunned her. As she sat in front of his desk, the dreaded feeling made a hasty return.

  Before she could ask, he said, in a businesslike manner, “I had hoped the treatments would control the inflammation in your liver, but your tests continue to show they have not.”

  “But, I’m feeling so much better since we started the infusions.”

  “Well, I’m grateful for that, but I cannot ignore these tests that tell me the hepatitis is destructive.”

  She winced at the word ‘destructive’. She wished he’d used some other term, but knew a more sensitive choice of words wouldn’t change the reality.

  “What does Ken Peters have to say?” Helen asked.

  “It’s funny, but he called me this morning, and we went over your case. We both feel the only option left is a referral to UC Medical Center for a liver transplant.”

  While Helen’s mind flashed through everything she thought she knew about liver transplants, she had a ‘this can’t be happening to me’, moment. She hated herself for the tears she felt coming. Helen didn’t have the power to resist the devastation, hopelessness, and disappointment. She could only think of Chuck and the kids and how this would affect them.

  While she sat crying, Polk shifted in his chair, clearly ill at ease, Helen thought.

  Polk became progressively more uncomfortable and finally, after a long pause, he tossed her a box of tissues across his desk to Helen. “Now, now there, everything will be all right.”

  Helen’s tears ended as suddenly as they had begun. They were shocked into hiding as she stared at Polk with disbelief.

  His shallow and condescending platitude was a revelation. Lord knows she tried to reassure and to bring kindness to the care of her own patients, but she resented the thoughtlessness of his words by a fellow professional, especially from someone who knew her so well. She’d made some foolish assumptions about Polk and thought, you can’t trust any relationship until it survives the tough times.

  What little Helen knew about liver transplants came from her training and continuing education programs, and from her occasionally caring for patients who had undergone them. She lacked detailed information. Helen did know all about the side effects of anti-rejection treatments. The cosmetic complications of these medications were especially alarming, with weight gain, acne, and swollen face, common effects of cortisone medications. You don’t have to be vain to dread those.

  Polk spoke in a brusque manner. “I’ve called UC San Francisco Liver Transplant Program and sent them your records. You should hear from them soon.”.

  Helen was too upset to express or process the many thoughts racing through her head. She mindlessly thanked Polk for his help and left.

  She barely remembered the drive home. Scattered across the front seat of her car were tear-soaked tissues. Breaking the news to Chuck and the kids would not be easy. Thinking about it brought Helen to tears again. She dreaded the looks she knew were coming.

  When Chuck arrived home from work, he knew immediately something was wrong. He embraced his wife. “Even if we hadn’t been married for so long, I’d know something’s up.”

  Helen burst into tears in his arms. It wasn’t until she finished that Chuck heard the news about a liver transplant, “I know this won’t be easy, Sweetheart, but this may be our final way out of this situation. We’ve heard a lot about celebrities and athletes who have successful liver transplants and are doing well.”

  “I’m disappointed, devastated. I felt better and I thought we’d finally controlled the hepatitis, and now this.”

  She looked into his eyes, “I don’t know if I have the physical or emotional strength to get through all this.”

  “We’ll get through, whatever it takes,” he said, his own eyes filling.

  “I love you. I don’t know what I’d do without you,” she said.

  “I love you too and for reasons I can’t explain, I know we’ll get through this.”

  The university’s transplant coordinator called the next day. After gathering historical, financial, and insurance data from the Martins, she gave Helen an appointment for Friday afternoon.

  The university setting was a crowded complex of gray and tan high-rise buildings tha
t sat atop Parnassus Heights just south of Golden Gate Park in San Francisco. They arrived as the dense bone-chilling afternoon fog made its way over the heights and into the city.

  While Brier Hospital evoked warmth and a sense of community, Helen felt the coolness of the university as might a visitor in a foreign country. The staff was businesslike and professional, but the general sense of aloofness disheartened her. Hospitals had been like second homes to Helen, even as she did per diem work and rotated through different institutions.

  I’ll never feel at home here, she thought.

  When an aide escorted the Martins into Dr. Dan Cohen’s office, they were immediately pleased with his smiling face and calm demeanor. He sat behind a huge desk piled high with medical charts. Diplomas, awards, framed newspaper articles and photos, many with celebrities, covered the wall behind his desk, all referring to the transplantation program and its achievements.

  Dan Cohen was a superstar, born into privilege in Shaker Heights outside Cleveland. He was a straight A student, Eagle Scout, and class president. He went on to Ohio State and ultimately ascended through the brutal ranks of its surgical training program to become a skilled vascular surgeon. All the accomplishments and accolades had not altered his personality one bit. He remained a kind, generous, and caring physician. When the position in the liver transplant unit opened, he immediately moved to San Francisco.

  The doctor stood and came around his desk to shake their hands. “I’m Dan Cohen, Mrs. Martin, the Liver Transplant program director.”

  He was a big man, nearly as big as Chuck. His large, delicate long-fingered hands never rested. They were the hands of an artist. His red-brown hair, pulled back into a short ponytail, fit San Francisco, but was unusual in the conservative university setting.

  Dan pulled his chair from behind his desk and sat beside them. “I know you are an experienced nurse, but if you permit me, I’d like to run you both through some details of the transplantation program and of the procedure.”