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

by Lawrence Gold

  “Maybe it’s time to cut back? You’ve worked too hard for too long, maybe you should consider some changes.”

  “Forget it. I’d go crazy without work. What would I do with myself?” Polk paused for a moment’s thought, and continued, “It’s so stupid and counterproductive for me to be constantly in conflict with the nurses. If I used a minimum of tact, none of these problems would exist. I can’t control my anger and frustration. Why can’t they see all I care about are my patients?”

  Marion wasn’t buying any of this for a minute. She knew Joe, maybe better than he knew himself and understood how little insight he had into his own behavior. He’d charmed his way through life with a bright mind and supremely crafted people skills, but something was missing at the core of the man. One thing she knew for sure, his devastation at the loss of Joe, Jr. had killed what little affection Joe had left to give.

  Warren awakened to a bright and warm day, the kind of day that ordinarily made him glad to be alive. A morning that was to begin with Joe Polk was, he acknowledged, cruel and unusual punishment.

  He’d left a message at Polk’s office the day before that he urgently needed to meet with the doctor at eight a.m. in the medical staff office where they’d have privacy. Warren watched the clock and at twenty minutes after eight, Polk arrived offering no word of explanation.

  Warren closed the door to the office. “Can I offer you a cup of coffee Dr. Polk?”

  “Cut the crap, Warren. Get to it.”

  Don’t take the bait, Warren thought. After all, I’ve been through with this guy, why do I still sense we can bring him around. It’s contrary to my experience and logic, what a waste.

  Warren continued, “We’ve had this conversation before, you and I. Each time, for reasons that elude me now, I managed to hang on to hope that in spite of your intransigence, you had the ability to learn from experience. I must have been kidding myself.”

  “Say what you have to say, damn it.”

  “The QA Committee of the Department of Medicine voted last night to remove your hospital privileges and pass on to the MEB and the Board of Trustees the recommendation you be permanently expelled from the staff of Brier Hospital.”

  “Well, well, you finally got your way, you bastard,” Polk said with a smirk. “Don’t think for a second I don’t know what’s going on around here. You’ve been on my case for years without one shred of evidence my practice is different from most of the docs around here.”

  “You want me to go through the list of problems you’ve created...?”

  Polk paced back and forth across the small office, eyes down and in a fury, “Don’t bullshit a bullshitter. You can’t stand my independence and my refusal to play along with you, your stupid nurses and your super, or sub specialists, or whatever you damn well call them.”

  Polk looked everywhere except toward Warren and continued, “I was here before you came and I’ll be here long after you’re gone. Don’t think for a minute you’re going to get away with this crap.”

  “I don’t know why I bother,” Warren said, “but there may be one way out for you or at least a chance to improve your situation. You must agree to accept the support of the Physician’s Assistance Committee or agree to see a psychiatrist.”

  The last comment provoked Joe Polk into a rage for another five minutes until he ran out of breath.

  When Warren saw that he couldn’t approach Polk on any rational basis, he said, “Until we settle this issue, one way or another, Dr. Polk, you will require mandatory consultation on any case you admit to the hospital. The hospital operator will have a list of those physicians on call for consultation and you will obtain your consultant’s approval for all diagnostic testing and therapeutics. If you fail to obtain consultation, or fail to comply with a consultant’s recommendation, one time, all of your privileges will be immediately withdrawn. Is this clear?”

  “Yes, damn it, but you haven’t heard the last of me.”

  Following his meeting with Polk, Warren met with Bruce Bryant and Al David, both anxiously awaiting the results of this morning’s confrontation.

  “Well, I can’t say that any of this surprised me,” Warren said, “except his obstinacy and his denial. I’m no shrink, but this all has the flavor of psychopathology to me. There’s no approaching the man.”

  Bruce glanced at Al, and then returned to Warren. “This is a mess. I’m open to any suggestions from either of you.”

  Al David cleared his throat. “It’s public disclosure about problems with Polk that puts us at the greatest risk.”

  “No,” said Warren, shaking his head, “it’s killing patients that puts us at risk.”

  “I’m sorry,” Al said, “and I agree. We slip automatically into defensive mode when threatened. Things have gone too far with Polk and I can’t see any other viable strategy for us except self-defense. We need to be proactive in uncovering any of his hospital cases where a court might sustain claims against Brier. I need your help, Warren for some way of reviewing his past hospital charts.”

  “You better open your checkbook for that one,” Warren said. “You can’t expect that goodwill among the staff will pay for all the time and effort of that task.”

  “Money’s the least of our problems,” Bruce said. “I’ve already heard from several of Polk’s supporters on Brier’s Board of Directors. They’re unhappy, and were less than subtle with their threats.”

  Warren stared at Bruce. “You know the Board and its leaders. Don’t tell me they would ever consider overriding the actions of the medical staff.”

  “In the political arena,” Bruce said, “anything’s possible.”

  Chapter Thirty-Four

  Later that morning, Warren and I were alone in the doctors’ lounge sipping our morning coffees. Warren had recaptured his usual cheery mood. “I had the pleasure of informing the good Dr. Polk that we’ve suspended his hospital privileges pending the action of the MEB and the Board of Trustees and that we’re moving to expel him from the medical staff.”

  “You’re a better man than I. He must have been overjoyed.”

  “For some reason, he didn’t take it well, and accused me, the QA Committee and nursing staff, oh, and I forgot, you too, of organizing a vendetta against him. He believes he’s without fault and that nobody practices with as much skill or cares more about his patients. The nurses are out to get him since he won’t take any of their shit.”

  Warren paced back and forth saying, “I’ve had my run-ins with docs as chairman of the QA Committee and more recently as Chairman of the Department of Medicine. I hated those encounters although I knew they were essential. I’m better with confrontations now, but physicians like Joe Polk still get to me.”

  It felt good that Warren trusted me enough to share his feelings, I thought.

  Warren continued, “I’m not naïve about our ability to solve these problems, look at our experience with Polk and others. Still, I keep butting my head against the wall. What else can I do, withdraw from combat? Become a cynic? Just go through the moves?

  “A major part of my job is dealing with the Polks of the world and it ain’t easy, it never was. With all the frustration in this job, Jack, I’m due for a break.”

  Warren rubbed his neck with both hands. “Talking to Joe Polk was surreal. This is not the first time I’ve had to discipline a physician, but never before have I seen these blatant denials. His paranoid thinking is a normal response if you accept the premise that he believes what he’s saying. It’s not as if I’ve never had to talk with Joe before. I’ve chatted with him ad nauseum about practice issues and his behavior. He found the entire subject and me distasteful, but each time in the past, he’d grudgingly assure me he’d do better. I recall a transient feeling of sorrow for him, though I’m not sure why? Maybe it’s because in his early days Joe Polk was one of the best physicians in this community and if this could happen to him….”

  “You know it’s strange you had that reaction,” I said, “because when
Beth finally heard of our recommendation, her hostility eased, and took on an element of sadness. Some of that for Polk, what he was; what he might have been, but mostly, it’s for all her frustration and the damage to patients. Have you heard anything yet from the administration?”

  “I just came from there. They’re anxious about the exposure and less than sanguine about the Board of Trustees.”

  “I had hoped we’d find some other way to deal with Polk and avoid playing this out publicly. There must be someone, whom Joe respects. Someone who can talk sense into him?”

  “Don’t know,” Warren said. “This will be at the MEB within the week and to the Board shortly thereafter. I don’t see any other way.”

  Two days later, I saw Carrie Palmer in ICU and arranged her transfer to the medical ward. Miraculously, once they removed the infected material, her body rallied, bleeding gone, temperature near normal and no further signs of sepsis or neurological problems.

  Harvey Ross had spent a good deal of time with Carrie explaining possible future problems with fertility, but assuring her she still had an excellent chance of bearing children, one way or another.

  Richard passed messages through Carrie’s family, trying to see her, to explain and to apologize.

  “I’m no longer angry with Richard,” Carrie said to her sisters, “but I don’t know if I can ever trust him again. That’s not exactly a solid basis for a marriage.”

  Helen Martin appeared on my schedule this morning. Chuck requested I take over her ongoing care. I resisted, but finally agreed with the proviso that Ken Peters would follow her, too.

  Helen and Chuck held hands and smiled as they entered the office. “Dr. Byrnes, great to see you,” Chuck said.

  While Helen looked better overall, she remained pale and well below her normal weight. Chuck helped her as she walked, as her balance was still impaired. Her hearing improved and she could talk to me without shouting. After I examined her, they entered my consultation room, and sat across from my disorganized desk.

  I pulled out my chair to sit beside them. “Helen, you look much better and your lab work is improving, except for your blood count that remains low. That’s from the blood loss and your sick liver. With time, it’ll come back. How’s your energy level and what have you been doing with yourself?”

  She glanced at Chuck then replied, “The first week after leaving the hospital was rough. Too much bed rest and the anemia, I think. Gradually, my strength and energy improved, but don’t sign me up for a marathon yet. My appetite is okay and I’m getting enough to eat, but my usual zest for food hasn’t returned.”

  Chuck added, “You would not believe what this little girl could put away. She used to eat like a horse.”

  “I talked with Dan Cohen at the Liver Transplant center and brought him up to date. The recent sequence of events concerned him, but we both feel now you can go on with a liver transplant. For your blood and tissue type, Dan estimated the waiting time for a liver would be about six to eight months. Let’s keep you in good shape until a liver becomes available.”

  Chuck became serious. “I’m having trouble letting it go of this Polk situation. I know we should focus on Helen’s recovery, but each time I reflect on what happened to her, the rage returns. He was our doctor. We trusted him. He betrayed us. I’m not saying that we’re without fault. We’re reasonably intelligent people. Helen is a nurse, yet we allowed this to continue when any objective observer would be screaming for us to get as far away from Polk as possible. You begin to question yourself and your judgment. I never thought we were the kind of people who would consider a lawsuit against a doctor, but now, I just don’t know.”

  “You’re too hard on yourselves,” I said. “Patients do better when they trust me, and I practice better having their trust. Can trust be misplaced? Obviously, but keep in mind that Joe Polk’s portrayal of a caring, intelligent and responsible physician has been at the Academy Award level for years. Until recently, when his performance deteriorated, he had everyone fooled including the medical staff, the hospital, and his own patients. Thank God for the nurses who finally convinced us to take action.”

  How far should I go on this subject? I thought. Am I indulging myself?

  “I can’t put myself into Dr. Polk’s mind,” I said. “I can’t explain his behavior. The medical staff is reviewing Helen’s care and the care of several others. I can’t discuss that with you now. If there should be any malpractice action in your case, my only obligation would be to the truth. I can live with that.”

  After arranging for a follow-up visit, I used my spare time to call Beth hoping she hadn’t gone to sleep, but she mumbled hello as she answered the phone.

  “Sorry if I got you up. I thought you’d still be awake.”

  “No, I was sitting over my morning coffee and nodded off. What’s up?”

  “Just saw Helen and Chuck Martin. She’s doing well and we’re back on for the transplant. They’re pissed off about Joe Polk and Chuck’s considering seeing an attorney.”

  “Well, they have my vote. Besides poor care, they’ve had real losses both emotionally and economically. They surely deserve compensation. Don’t you agree?” she said with a hint of challenge.

  “I agree, but from my own perspective, I wish we could find some other way of compensating patients’ losses. As the system functions now, you are more likely to be sued for a bad outcome, whether or not any malpractice happened, than from genuine malpractice related injury or death. I’ve only been close to a malpractice action once when I was a fellow…”

  I’d been over that damn chart fifty times. It felt like reliving that case from a distance and without the specific details–what I thought at the time. I needed those details to bolster my decisions if this case ever got to court.

  The registered letter, never good news, shocked me when I read, “The Estate of Carla Ware v. Jack Byrnes ... Wrongful Death ...”

  This couldn’t be happening to me.

  I’d never look at a registered letter the same way again.

  My malpractice carrier assigned Harris Barton, an experienced attorney, to defend me. After several meetings, Harris convinced me of his competence and allegiance to my interests. The latter wasn’t a given, since the carrier’s interest was primarily financial, and the physician’s, largely with his or her reputation.

  Harris’ description of the courtroom scene had a surrealistic flavor, both enlightening and frightening. “Malpractice litigation is an adversarial process only peripherally related to the facts of the case and often totally unrelated to the truth. Both sides will use any means to manipulate the jury, so often medically naïve, to their side. Since by definition there has been injury or death, real losses to the plaintiff, the burden on you, doctor, is to prove you are not responsible.”

  “I thought I had the presumption of innocence.”

  “Not in malpractice cases you don’t,” Harris said. “Worse still, is that doctors and institutions have become the whipping boys for all that’s wrong with medicine today. Here’s the kind of advice I’ll give you if this ever gets to court: don’t wear expensive suits; leave the Rolex at home; don’t drive to the court in your BMW or Mercedes, where a juror might see you. We want the jury to see a regular guy, a Marcus Welby, or his 21st century equivalent, not the arrogant pricks they see on TV or in the movies.”

  Although I knew I had done nothing wrong, the outcome of litigation is so unpredictable, you figuratively live under a dark cloud until the case is resolved. I found myself revisiting every assertion and questioning my own actions as though I were at fault. I hope never to go through that again, but since I practice high-risk medicine, critically ill patients will get complications and some will die. Lawsuits are the price we pay for sticking our necks out to save a patient. The irony comes with Catch-22; they’ll sue you if you don’t stick your precious neck out. As Clare Boothe Luce said: No good deed goes unpunished.

  “Jack,” Beth said with resolve, “if we can’t get
rid of the Polks, the situation at Brier is hopeless.”

  I nodded in agreement. “Let’s have a quiet dinner tonight. The first one to use the name ‘Polk’ loses and agrees to fulfill the winner’s every wish.”

  Beth smiled and batted her eyelashes. “I feel the name, ‘Polk’ moving to the tip of my tongue. Tell me what you want me to do first, doctor.”

  That afternoon I’d find the opportunity to stop at the medical ward to give Mary Oakes follow-up on Helen Martin.

  Chapter Thirty-Five

  Mary Oakes found that this afternoon’s nursing report was another dispiriting prospect. The day, like most days of late, had not been of particular distinction either way, just the usual grind.

  Her staff sat around the large oval table in the nurse’s lounge. Their body language expressed their physical and emotional state—they were beat. Hard work had never been an issue for the nursing staff. Their most demanding days often brought euphoria and satisfaction, especially when accompanied by a sense of appreciation and accomplishment. Today, the ward was a make-do world where it was difficult for nurses to fulfill the minimal needs of their patients. While not articulating it directly, floor nurses felt the pressure from all sides, nursing administration, physicians, and patients, who had not yet learned the modern definition of reasonable demands.

  Hattie Brown, a large black woman and a twenty-five-year veteran, turned to Mary Oakes. “I’m doing twice as much now as I did five years ago and it’s still not enough. I’m selling my patient’s short on essential treatments, getting things done quick and dirty. I can’t stand it. Dressing changes and wound care treatments take time I don’t have. Too often, I walk away from each half-assed job with a sense of failing myself and my patients.”