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

by Lawrence Gold

  “You did this to me, you son-of-a-bitch, you did it,” Carrie shouted.

  “I still don’t know what’s going on here. What did I do?”

  “You gave me gonorrhea, you bastard. You’ve ruined me! You’ve ruined my life,” she said sitting up, sobbing, arms folded across her face.

  I can’t believe this, Richard thought. That one night, four weeks ago at Phil’s bachelor party, he’d given in to the group’s pressure and spent an awkward thirty seconds with the stripper. Now this!

  He was stunned, frightened and at a loss for words except for the ones he should never have uttered, “How do you know it was me?” he pleaded.

  “Oh my God, Richard,” she cried, “Oh my God! It was you! How could you have thought otherwise? Get out of here. I never want to see your face again.”

  Carrie Palmer turned her face into the pillow, weeping.

  Carrie’s family returned to the bedside, each taking their turn hugging her. They’d been frightened, terrified. After their first few probing questions, Carrie had not discussed her condition in more detail. They deferred to her, respecting her wishes.

  At two p.m., the large, gray abdominal ultrasound machine arrived at her bedside. The machine, the size of an upright piano, had video screens, a keyboard and a thousand dials and switches. Kelly Bates, the ultrasound technician was a wiry small black woman. She pushed the huge machine into ICU and sat before it preparing for the test.

  “This won’t hurt at all,” Kelly said, “except if I press too hard on your lower abdomen, the area where you’re tender. Tell me if I’m hurting you, and I’ll apply less pressure. I’m sure we can see everything without much discomfort. Don’t be shy if the pain is too much.”

  Kelly grasped a black wand with a mushroom tip then she covered it with clear jelly-like material. After the initial shock of the cold against Carrie’s abdominal wall, her examination began.

  Kelly moved the probe across Carrie’s abdomen in a pattern, starting in the upper abdomen below her ribs then downward toward her pelvis. She focused with intense concentration as she moved the probe, watched the screens and adjusted the dials and switches on the complex device.

  When she approached the lower abdomen, the probe’s movements slowed. “I’m finding a good bit of inflammation and swelling here, Carrie. I’m going slowly to get as much detail as possible. Tell me if I’m pressing too hard.”

  Carrie winced several times as Kelly began focusing the probe on the lower left side of her abdomen, taking forever to complete her examination in this area.

  Finally, “We’re done,” she said. “You were a great patient. I know some of that had to hurt.”

  “Well, tell me what you found.”

  “One of our radiologists will read the images. Dr. Byrnes will be here soon to go over the results with you,” Kelly replied.

  Disappointed, Carrie begged, “Tell me something, please.”

  “I’ll only say you have a great deal of infection in the left side of your pelvis Carrie. Be patient, we’ll all know more soon.”

  Chapter Twenty-Six

  Carrie spent the rest of the morning chatting with the family at her bedside and waiting for the results of her tests.

  I returned to discuss the ultrasound findings. “If you’re looking for final answers right now Carrie, you’ll be disappointed. The study shows your left fallopian tube and left ovary with severe infection. So far, the infection appears limited to this one specific area of your abdomen. We see no signs of abscess formation, yet.”

  Carrie picked up on the word ‘yet’ right away, “You didn’t slip in the word ‘yet’ without reason, did you Dr. Byrnes?”

  “Too damn smart, these Berkeley students. Infections in the pelvis can go one of three ways; they can disappear from antibiotics, the best result, or the tube or the ovary can form an abscess of infected material and maybe go away with time, or, worse case, the last possibility, remain a source of ongoing infection. The only way we’ll know for sure is by repeating the ultrasound examination every few days to see what’s happening.”

  I could see that Carrie was disappointed. She wanted definite answers. So did I. They weren’t available.

  I explained the findings to Carrie’s family. We’d all have to wait.

  Chapter Twenty-Seven

  Amy Morris came as a surprise to her middle-age parents. They called her their little accident, a phrase that never amused her, even when she heard it for the first time.

  Like her mother Maureen, Amy could barely read by third grade. In her mother’s day they labeled these children as slow or retarded, while today they diagnose many poor readers with a variety of learning disabilities.

  As a child, friends had ridiculed Amy as she looked a bit like Popeye’s Olive Oyl. In addition, as a poor reader, she suffered the cruelty of teachers and classmates. Eventually they made the diagnosis of dyslexia, a mixed blessing, but a hell of a lot better than retarded.

  She struggled in failed attempts to earn what should have been her birthright, the love, and respect of her parents. Though resilient and determined, she’d slip on occasion into debilitating depression.

  When sufferers of dyslexia finally understand the disorder, they eventually reach one of life’s decision points. They choose their role, victim, or victor. Amy’s Sister Ann, also dyslexic, settled for victim and gave up the bitter and frustrating battle with academia. Amy refused to become the disorder. She worked four times harder than anyone else did, achieved straight A’s, and graduated from nursing school with honors. Oddly, her achievement and the actualization of her success remained a facade over a traumatized and fragile ego.

  Why is it so few of us passed the ultimate test, moving beyond our pasts?

  Mitchell Morris was Amy’s husband and best friend. After eight years of marriage and five miscarriages, they had all but abandoned the idea of Amy bearing children. Three miscarriages had occurred early in her pregnancy, but two occurred at eighteen and twenty weeks. The passing months in these pregnancies raised their expectations and lowered their defenses. This served only to make the loss of these babies more difficult and painful.

  Mitch was confident and secure in their marriage, but knew Amy had needs he could never meet. They downplayed and feigned amusement at Amy’s passion for babies of all kinds, baby dolls, kittens, puppies, and especially newborns. For Amy, these images mirrored her craving for a singular kind of love, the unconditional love of her own child.

  “I would have loved neonatal ICU nursing,” Amy said, “but I’m not sure how well I could deal with the inevitable; many sick babies would never make it home.”

  Amy threw open the bathroom door on a run late one afternoon. She thrust the pregnancy dipstick test under Mitch’s nose while he sat reading a magazine and enjoying wine and appetizers before dinner.

  “Look,” she blurted.

  “Whatever it is,” he laughed, wrinkling his nose in disgust, “it’s okay with me.”

  “It’s our baby, dummy,” Amy said, smiling and crushing his head against her chest, “I’m pregnant!”

  “When will dinner be ready?” he said, popping a cracker in his mouth and returning to his reading.

  Amy stared at Mitch in disbelief, and then started laughing as he turned to her smiling, grabbed her narrow waist, and buried his face in her abdomen, delighting in its warmth and softness.

  Amy was in her sixteenth week. Their hopes were high, poised with anticipation.

  With the assistance of her OB/GYN, the Morris’s had taken all steps possible to guarantee the success of this pregnancy. Though her physician felt it was overkill, Amy cut back her ward time to four fifths. She took particular care to avoid heavy lifting or straining.

  Overcoming dyslexia, compensating for dyslexia, did not cure it. Amy still required special care when taking written examinations or receiving telephone orders. Transcribing the verbal orders of physicians was a common source of error in the hospital, but Amy understood her disability and took p
articular care. She had never made a mistake.

  Joe Polk made this routine procedure, accepting and transcribing phone orders, a nightmare for Amy, payback, she believed, for her previous troubled encounters with this doctor, whose mind smoldered over any perceived slight.

  Tonight, he’d admitted a teenage girl with a severe migraine headache. Amy sat at the nursing station, order sheet and pen in hand, feeling tightness in her abdomen. Beads of sweat formed on her upper lip. When Polk reached number twelve on his list of orders, Amy said, “Please Dr. Polk, could you repeat the last two orders and could you please slow a little, I’m having trouble in keeping up.”

  “Are you deaf, or just stupid?” Polk snapped.

  The words struck Amy like a solid fist. Air literally escaped from her mouth as her stomach knotted. She took a deep breath, trying to suppress her nausea, trying to respond, but her emotions overwhelmed her, tears flowing.

  “Dr. Polk,” she tried, “I just need…”

  “Get me your charge nurse, now,” he shouted again.

  “I can do…” Amy tried again.

  “God damn it,” his voice boomed through the earpiece, “You’ve screwed this up enough. If you can’t transcribe simple orders, what the hell are you doing here? Get me someone who’s capable of taking my orders. Get me your charge nurse.”

  Amy turned to the ward clerk and said in a soft, tremulous voice, “Get Mary Oakes for Dr. Polk ASAP, I’m feeling sick.”

  Amy raced to the nurse’s lounge she wobbled into its bathroom. She felt chilled, began sweating, and noted the metallic taste of the saliva in her mouth. She barely reached the stainless steel basin as she began retching, throwing up her partially digested breakfast. The retching continued for what felt like an eternity, but in all likelihood lasted a minute or less. Suddenly, Amy began experiencing lower abdominal cramping, a symptom all too familiar, and felt the gush of warm vaginal blood as it ran down her legs, spreading bright red on the tile floor, staining her white shoes.

  My God, she thought—it’s happening again!

  Mary Oakes sat at Amy’s bedside holding one hand, while Mitch held the other following her D & C, the aftermath of this spontaneous abortion, or so they would label it. While legally it was impossible to assert blame, Mary recognized the shadow of evil that followed Joe Polk’s every step.

  Chapter Twenty-Eight

  Rick Adams discharged Laura Larsen from Brier at the end of her third week. He gave her a list of medications, and made an appointment for the cardiac rehabilitation program at the local YMCA.

  One crowning achievement stood above the nightmarish nature of the entire episode; Laura and Mac’s relationship solidified with new levels of intimacy, love, and commitment.

  She grasped his hand. “I know how well we’re doing by the way I feel when you leave, I miss you right away.”

  Despite her rehab sessions, Laura had too much time on her hands. Her professional life had been a whirlwind of activity; flights, layovers, exercise, and as busy a social life as she wanted. While working, she’d spent about a third of her time at home. Now disabled, she was there 100 percent of the time. She caught up on all the books she meant to read and pursued her long-term interest in cooking.

  Initially, she resented the forced domesticity, but as she rummaged through cooking utensils, some never used, and the Cuisineart Food Processor, used once, she discovered the joyous luxury and the opportunities of time. Laura promised she’d control her demon, the compulsive drive to do it all.

  Laura looked forward to the cardiac class each Monday, Wednesday, and Friday at nine a.m. Those men in her class she’d first disparaged as old had become surrogate fathers, milling around and encouraging Laura at each session. She’d come to love them. Her shapely appearance in black Lycra top and shorts had drawn the attention of the oldsters when she first joined (she’d caught several staring).

  That’s great, she thought, there’s life left in the old guys.

  “Watch it, Harvey,” said Carole Austen, the exercise physiologist, as she observed him checking out the newcomer. “Let’s not put too much a strain on that old heart.”

  “But, what a way to go,” the old-timer said.

  After two weeks, Laura was one of the guys.

  Laura attached the telemetry leads to her chest and joined the group on the gym floor. She stretched and warmed up for ten minutes. Then they did forty minutes of aerobic exercise followed by a ten-minute cool down. Any skipped beat or vague discomfort during exercise forced her to stop and gaze expectantly across the room to the monitoring station, anticipating the worse. She’d spent a lifetime taking her body for granted, a luxury she could no longer afford. Laura became the hypochondriac she’d disdained, terrified at every twinge, every ache. The fact that her fears were reality based, didn’t make her preoccupation any more acceptable.

  Don’t do this to yourself, she thought as she toweled down.

  “You’re doing great,” Carole said, “let’s take it up a notch from here on.”

  My first glimmer of hope.

  Chapter Twenty-Nine

  Arnie Roth had scheduled the special session of the QA Committee for evening to permit enough time for review and open-ended discussion of Joe Polk’s cases. Harvey Ross and Alan Morris had invested many hours of chart review over the last two weeks, not an easy job for two busy practitioners. Fortunately, Polk had no recent admissions so all appeared calm.

  Beth had relented some and managed, without an overt apology, to make things right between us.

  “Come visit me tonight, Jack, after your meeting,” she said smiling. “No politics, I promise.”

  While I still had a disquieting feeling regarding my role in the Polk situation, gradually I’d come to understand, that I can’t control everything. Control is the burden of the high achiever, the Type-A personality, and of too many physicians. Unrelieved, this type of stress could lead to what you’d expect; depression, substance abuse, divorce and suicide. Who’d want any part of that?

  I loved to sail and sought any opportunity to get out on the water. Part of this is aesthetic, but more than that, sailing forces you to accept the world as it is. Once you set and trimmed your sails, the rest was up to wind and tide.

  We met in the boardroom, with its long, highly polished oak table. Stern-faced portraits of the hospital’s historic figures, former CEO’s, Presidents of the Medical Staff, and Chairmen of the Board of Trustees decorated the walls. Even the more recent pictures followed the tradition that even a small grin would somehow offend convention. The kitchen served a fine dinner with several Napa Valley wines. On the surface, everyone appeared to be relaxed.

  After dinner, Arnie Roth stood. “I’m calling the meeting to order. This is the special meeting to review the records of Joseph Polk. I’d like to thank Harvey and Alan for the time spent on this chart review. I’m going to ask them to present an analysis of the records reviewed, the nature of the problems found, and a numerical grade, one for minor deficiencies through ten for the most serious ones. Each presenter has created for us a printed thumbnail summary of each case for reference and discussion. Following each case, we will have a question period and a general discussion. Any questions?”

  “I have several,” Sharon Brickman said. “Will we be able to complete these reviews tonight and if so, are do you expect us to make disciplinary recommendations?”

  “Well, you know committees as well as I do, Sharon. If we can control chatter and recognize when discussion is becoming repetitive and unproductive and move on, we can complete all our work tonight. I won’t take any shortcuts. If we need more time, I’ll schedule another meeting.”

  Alan Morris was preparing to present his first case when the boardroom door opened and Joe Polk entered, silencing the room. With a smile, more a smirk, Polk said, “I’m here to defend myself and to make sure this committee hears the truth, not a one-sided view of these cases.”

  Taking a beat, Arnie Roth responded, “Joe, your attendance here
is totally inappropriate and I’m asking you to leave, now.”

  “What’s the matter,” Polk said as he glared around the table, “are you guys so gutless you’re afraid to confront me directly?”

  “I’ll say this once Joe then you’ll have to leave,” Arnie said. “At this stage of chart review we haven’t decided whether any problems exist in these records. If they do, we will have a free, open, and uninhibited discussion that can’t happen in your presence. We will inform you about any deficiencies or actions and you’ll have a chance to rebut.”

  Turning beet red, Joe Polk replied, “What a load of crap that is. I’m not leaving until I have a chance to defend myself.”

  Harvey Ross rose from the table and took Polk forcefully by the arm. He dragged him toward the boardroom door saying, “This won’t do you any good, Joe.”

  As Polk approached the door to leave, he abruptly pulled his arm from Harvey’s grasp. He spun, facing his accusers, enraged, “You have no idea of what I’m capable of. Each of you will pay.”

  Through the closed door came loud shouting and then silence.

  When Harvey re-entered the room, Arnie looked at him directly and said, “What’s with that guy?”

  “He’s agitated and upset. He’ll cool down.”

  An uncharacteristic tension filled the room, and after a moment of reflection Arnie shook his head and said, “We have a bigger problem than I thought.”

  Arnie took another moment, and then continued, “Although I wish Polk had not come, it does dramatize the gravity of our role tonight and the difficulties we’re likely to face with this physician. If you are ready Harvey, begin your first case.”

  “Medical Record Number (MRN) 190871 is a sixty-five-year-old female admitted in January to the medical service with a diagnosis of bacterial pneumonia. Polk’s hand written history and physical covered six pages. This is a theme that will recur in most of Joe’s admissions, an enormous, but misplaced effort to perform a complete H&P. For instance, this chart is lacking important observations such as where did she acquire the infection? Is she predisposed in any way toward these infections? Had she been given antibiotics before her admission?”