“It’s been difficult for the kids,” he continued, “especially with all the ups and downs in Helen’s condition. Since she has been so sick, we’ve had to discuss her desires, you know, what to do should things get worse.”
Overwhelmed with emotion, tears filling his eyes, Chuck continued with difficulty, “Neither of us wants heroics if she gets so bad there’s no hope for recovery or a meaningful life. She’s signed an advanced directive for health care, so I can fulfill her wishes.” He paused, took a deep breath, “I’m the one who’s supposed to decide when to let her go,” he said, head down, sobbing.
I placed both hands on the big man’s shoulders. “We’re not anywhere near that stage. It’s too early and much of what’s wrong is reversible. I’m not denying how sick she is right now, but we’re not at the point where we need to consider decisions of that sort.”
“I’m a sucker for encouragement, Doc,” Chuck said, “that scares me since I’ve been disappointed so often; each flicker of hope brought with it only pain and frustration.”
Chuck rose from the chair. He took a step closer to Jack. Face to face. “I’m disgusted with myself. I blame myself for staying with Dr. Polk this long?” Staring intently at me, he said, “And how can a physician like Polk practice at a fine hospital like Brier?”
That’s the million-dollar question, I thought.
“This won’t help much since what I’m about to tell you only partially answers your questions,” I said. “Polk made mistakes. We don’t know how many or how serious they were, but one thing for sure, the medical staff will review Helen’s case, and we’ll get to the bottom of it. Right now, let’s focus on getting her well.”
I removed a business card from my wallet, and handed it to Chuck. “Here are my phone and beeper numbers. Call me anytime, day, or night.”
When I returned to the ICU, loud shouts were coming from the nurse’s lounge.
“Polk’s in there,” said the monitor tech, “with Freddie West, our nursing care coordinator.”
Polk’s angry voice roared, “Helen Martin is my patient and has been my patient for years. I don’t give a damn what Warren Davidson says. I’m taking care of my own patient.”
Freddie West stood her ground looking down at the smaller Polk. She spoke in a calm and controlled manner. “Dr. Davidson has turned Mrs. Martin’s case over to Dr. Byrnes, sir. We have nothing further to discuss.”
Perfect timing, I thought.
When I entered the room, Polk turned and came at me quickly, marching with short steps, body rigid, teeth clenched and lips white, his blanched fists giving truth to the cliché of white knuckled. Polk’s approach in this manner reminded me of a cartoon character turning bright red, with smoke billowing from his nose and ears, a pathetic display, ludicrous with all that happened. Keeping my amusement to myself, would be best.
Face-to-face with me, separated by only four inches, Polk shouted, “I’m goddamn sick and tired of your interference in my cases. You and Warren have no idea of what you’re getting yourselves into.”
As I wiped the small droplets of spittle from my face, it surprised me to discover Polk’s intemperate outburst and lack of control only made me calmer, more secure. I knew instinctively to suppress any overt expression of the rage I felt when I thought about Polk’s actions on this case. An outburst on my part wouldn’t be smart. It would only inflame the good doctor even further. In the end, I indulged my anger rather than my good sense. I paused for a beat, and then responded in a calm voice, “Sir, I didn’t ask for this assignment, but someone needed to get involved in Helen Martin’s case since you were going to ignore her ulcer until she bled to death. Neither the Martins nor I need your services. You’re off the case.”
That felt good, I thought as I smiled inwardly.
Polk exploded, “Who the hell do you think you’re talking to, Doctor. I’ve been practicing medicine almost as long as you’ve been living and I don’t need any wet-behind-the-ears superspecialist to tell me how to care for my patients.”
“I’m not telling you how to care for your patients, sir, I’m simply informing you, for the second time, that you’re off Mrs. Martin’s case.”
Polk turned angrily to again confront Freddie West, a woman known for not mincing words. She struggled to maintain control.
“Now listen here Ms….what’s your name again?”
“W-E-S-T,” spelled Freddie, and after getting no further response, she continued, “Dr. Polk, sir, we have no choice in this matter. Dr. Davidson has revoked your privileges to care for this patient. We cannot and will not accept any orders from you. This is out of our hands. Furthermore, sir, I do not appreciate the tone of voice you have used with my nurses and with me. If you do not depart this unit immediately, I will call security and have you forcibly removed.”
Freddie had a gleam in her eye and a slight smile as she uttered that last phrase.
Polk was momentarily stunned into silence and then burst forward with, “We’ll see about this. I’m going to see Bruce Bryant, the CEO of the hospital and I’ll get this resolved.” He stormed away.
Polk glared at me on his way out, his extended index finger pointing, “You’re finished around here if I have anything to do with it.”
Have a nice day, you prick, I thought.
“Oh, one more thing, Dr. Polk,” I shouted as Polk walked away.
He stopped and turned to face me.
“If you see Chuck Martin in the hallway sir, you’d be smart to walk the other way.”
Sure enough, as Polk left the ICU, Chuck was approaching. The doctor began to turn away toward the stairwell when Chuck said in a soft, calm voice, “Dr. Polk, a word please.”
Polk stopped. He stared upward into the menacing red face of Chuck Martin who said, “By-the-way, you bastard, you’re fired.”
“What a jerk that guy is,” Freddie said. “It’s about time we did something about that man.”
I spent the next five hours at Helen’s bedside, then broke away for fifteen to twenty minutes to see one of my outpatients who urgently needed an office visit.
After transfusions, Helen’s condition stabilized. I stood by when Ken Peters did a bedside upper GI endoscopy, looking into her stomach. He discovered a large ulcer in the first part of the small intestine, the site of the bleeding. A large fixed clot covered the ulcer. We were both relieved at the absence of enlarged veins in the esophagus or stomach, a much more serious complication.
By four p.m., Warren arrived in the ICU and after getting my appraisal of Helen’s situation, said, “Bruce Bryant, our CEO, has requested our company. We are to meet with him in his office at five this afternoon. Have you met him, Jack?”
“Just to say hello when I first arrived. What’s he like?”
After thinking a few moments, Warren responded, “Well, he’s the CEO of a large hospital and you don’t get to that position by being a pussycat. He’s smart, and depending on which side you’re on, one might consider him ruthless. Trust him to protect his own and the hospital’s interest first. His ideas regarding how to practice medicine at Brier Hospital may or may not coincide with ours, and surely, they arise from a different perspective. We need to be on the alert and remember whose interests we serve.”
That afternoon, Warren and I exited through the emergency room into the bright, warm sunshine. We crossed to Brier Mansion’s cobblestone driveway lined with ancient Redwoods, many four or five feet thick. We entered the ivy-covered building through the ornate portico, arriving in the administration’s reception area at exactly five p.m. After a fifteen-minute wait, Bruce Bryant arrived and escorted us into his office.
Bryant was fifty-two years old and six feet two inches tall. He looked fit and tanned. He could have easily passed for forty-two or younger. He dressed well in a gray pinstriped business suit, and, except for his engaging personality, one might guess he was an attorney.
Following his graduation from Harvard’s Health Administration Program, Bruce spent his first
ten years at a small Florida community hospital where, almost single-handedly, he transformed the tiny hospital into a near state-of-the-art institution. He received the National Hospital Administrator of the Year Award drawing the attention of national headhunters. The hunt ultimately brought him to Brier Hospital.
Bruce Bryant introduced me to the hospital attorney, Al David, a dour looking man in his fifties sporting a shiny beautifully tailored Armani suit.
“I asked Al to join us today. Maybe he can help us with this situation. It’s better to prevent problems than it is to fix them after the fact. I understand you have suspended Dr. Polk’s privileges to care for his patient, Helen Martin?”
“You bet,” Warren said. “I’ve had it with Polk and all the crap he’s been getting away with at this hospital.”
“We’re not trying to tell you how to run your business Dr. Davidson,” Al David said, “but you must know we have a significant exposure here. I want to make sure we’ve dotted all the I’s and crossed the T’s.”
“I’m not talking about dotting or crossing,” Warren said. “We’re talking about saving a woman’s life.”
Al David gave a mirthless smile. “You’re being a bit melodramatic, I think.”
“Unless you have a license to practice medicine, Al, you’d better listen to me,” Warren said. “Suspending Joe Polk under these circumstances is more than justifiable, it’s mandatory. In addition, we’ve accumulated enough case material regarding the good doctor to push on with more decisive action, including permanently removing him from the medical staff.”
“Wait just a minute,” Bryant said. “Joe Polk is one of the premier physicians in this community and has been so for years. He’s a major admitter and has been a strong force for the hospital in its dealings with the community. Christ, he’s practically our spokesman with his radio program. We have an awful lot to lose if we act rashly.”
Warren produced a wan smile. “I know your position and I have a good idea what this investigation will reveal. We granted Polk privileges to practice at Brier, but I’m not going to stand by while he uses these rights to harm patients. If we don’t stop Polk, we…that mean the medical staff and the hospital, are going to have to answer for it, won’t we, Alan?”
“No question about it, Dr. Davidson. We want to find the best way around this situation. How are we going to deal with this guy? What’s the best outcome for Brier? In addition, I anticipate we have not heard the last of Polk who will seek his own version of justice.”
“Let him seek whatever he wants,” Warren said, “and, we’re not going around anything—we’re dealing with it straight on.”
Al David turned toward me. “You’ve put young Dr. Byrnes here in a difficult position, Warren. You, Dr. Byrnes, and I fear the hospital as well, will be subject to liability claims if Mrs. Martin does not make it.”
I understood Warren well enough by now to know when he’d had it. “You know Alan, you and I have been through a lot in the service of this hospital, but I never recognized before that you’re a real son-of-a-bitch.”
Warren paused for a moment and continued, “We succeed or fail in practicing medicine by circumstances, only part of which are in our control. You can do everything right and the case turns to shit or you can make huge mistakes and luck out. What we don’t need is that bullshit you just heaped on Jack. He’ll be acting in Helen Martin’s best interest and the interest of the hospital and medical staff. He deserves our support, not placed under added stress by your bullshit comments.”
Alan David remained impassive. He smiled. “You’re right Warren, I am a son-of-a-bitch, but you didn’t complain when I was your son-of-a-bitch. I’m doing my job and you should know it.”
Warren stared at Alan. “I know that lawyers don’t take any of this stuff personally. I don’t know why I’m wasting my time attacking a man who lives most days of his professional life in confrontation.
“All that would be fine, Alan, if the net effect of your concern to protect the Polks of the world had an upside, but it doesn’t. Stonewalling can only hurt and I won’t be any part of it. You do know that our restriction of Polk’s privileges is a reportable event to the Board of Medical Quality Assurance of California?”
Bruce Bryant frowned, but remained tight lipped and controlled, “Do what you must Doctor, but please tone down the rhetoric and keep Alan in the loop on Mrs. Martin’s progress. We could use a heads up on anything that’s happening with Joe Polk.”
We were walking back to ICU when I said, “Hanging around you, Warren is making me cynical. They act like they don’t give a damn about allowing this kind of practice to occur in their hospital.”
“They care,” Warren said, “but the administration has convinced themselves that they can manage all problems without rocking the boat and hopefully without public disclosure. In many ways, it’s not too difficult to understand their position. Medical scandal is one bell that can’t be unrung. In a competitive environment, there’s a huge price to pay. What I’m saying is that ultimately the price will be higher if we cannot put our own house in order.”
“Well, this is way over my head,” I said winking. “I’m heading back to ICU to check on Mrs. Martin. I’ll keep you posted.”
Chapter Sixteen
Polk’s bellowing, moaning, and threats did not move Bruce Bryant. “This is out of my hands, Dr. Polk. It’s strictly a medical staff issue.”
“You know me, Bruce. Nobody’s been better for this institution than I have. It’s payback time, don’t you think?”
“Look Joe, as long as Warren Davidson is running the medical staff, my hands are tied. On any other issue I could help, but not on this one, sorry.”
How can my life have changed this much? Brier was my hospital, my world. What’s happened?
Polk recalled, in exquisite detail, that moment eight years ago, that altered his life forever…
Following a pleasant dinner, Marion and Joe Polk were sipping coffee when the doorbell rang. Nobody rang their bell at this time in the evening.
“Who can that be?” Marion said, alarmed.
Joe rose from the table and parted the curtains beside the front door. Two California Highway Patrolmen stood there. Officers had come on a few occasions for emergencies over the years, so his response was concerned, not alarm. When he opened the door, the looks on their faces made his uneasiness cold fear.
“Dr. Polk, I’m Sargent Denton, this is Patrolman Curtis. Can we come in?”
Polk backed away from the door allowing them to enter.
“What is it, Joseph?” Marion asked.
“There’s been an accident, Dr. Polk,” Harris said. “It’s your son, Joseph.”
“What accident?” Marion asked as she approached the officers. “What accident? Who had an accident?”
“Your son Joseph crashed head-on with a drunk driver. He’s on his way to the Trauma Center at the University of California in San Francisco.”
“Joe, what is he saying?” Marion screamed. “Joseph went to register for medical school. What is he saying, Joe? What is he talking about?”
Polk could barely get the words out. Softly, he asked, “How bad is it?”
“It’s not good, Doc, but don’t put me on the spot, I don’t know that much. Would you please, sir, let us escort you to the hospital.”
Polk would carry forever the silent images of flashing lights and the race across the crowded, rain-slicked San Francisco-Oakland Bay Bridge. His mind screamed in frustration and rage each time he saw the brightening red taillights ahead as traffic slowed and stopped.
He recalled it all: the rush across town to Parnassus Heights, the parting of the hospital’s automatic doors, and their rush through the crowded emergency room.
When they entered the brightly lit trauma room, Joe a gurney stretcher was surrounded by an army of white coats and green scrubs. It took him a moment to focus upon the body cocooned within, the vision of his son, his life, comatose on a ventilator with tubes ex
truding from most of his bodily orifices. Heavy gauze and blood-soaked bandages covered the top and back of his head. Rivulets of blood streaked across his son’s lifeless face.
Richard Bruckmeister, the chief of trauma surgery, met Joe as he entered. Over his many years of service, Richard had seen virtually every horror big city trauma could devise. The staff knew him to be calm and controlled under the direst of circumstances. Tonight he was visibly shaken as he placed his arm on Joe’s shoulder and said in a near whisper, “It’s bad, Joe. We’re about ready to take him to surgery and try to stabilize his condition. We’ll be opening both his chest and belly to control internal bleeding. I’ve called our best orthopedic surgeon to stabilize his multiple fractures.”
Barely able to utter the words, Joe whispered, “What are his chances?”
“Don’t know yet, but Joe,” Richard paused, “his head injury is severe…”
Marion, pale and trembling, pleaded, “Joe, you’ve got to do something.”
Head down, she could barely hear his response, “They’ll do everything possible, Dick’s the best.”
Miraculously, or perhaps not so, Joe, Jr. lived. His survival with major and permanent brain damage cost Joe, Jr. everything that made him a sentient human being.
Joe, Jr., with Joe and Marion constantly at his bedside, their hope inviolate, transitioned the varying stages of recovery. He moved from Surgical ICU, to ward, to skilled nursing facility, and finally to Sunshine Manor, a nursing home ten minutes from the Polk residence.
Their devastating loss, depression, and hopelessness replaced their initial joy and hopeful anticipation at his survival as Joe, Jr. remained alive by definition only.
Chapter Seventeen
When you practice medicine, you hope for, but don’t depend on, good fortune. I remembered my recent catastrophic cases and concluded that I was due for some good luck. Helen Martin would be an appropriate beneficiary.
When I returned to ICU at ten p.m. to check on Helen, I found her still poorly responsive. Thankfully, she showed no further signs of active bleeding. Her blood count had been stable for eight hours and the rest of her lab tests were unchanged.
First, Do No Harm (Brier Hospital Series Book 1) Page 13