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

by Lawrence Gold

  Sharon took a drink then continued, “I do agree with you about the professionalism in this community, it’s gone. If this staff had one iota left, Joe Polk would be history and we wouldn’t be hearing excuses and apologies for his destructive behavior. I don’t give a shit if Joe is impaired. For whatever reasons, he’s hurt too many patients and has demoralized and demeaned too many of our physicians and nurses.”

  I felt swept away by the pace and intensity of the argument, and responded. “Sharon, you live in a dream world. It’s simple; if we withdraw from the battle, patients will get hurt. Once that happens, once we injure enough patients, once the damaged patients and their families appear on Sixty Minutes, you know what will happen. Instead of a thoughtful attempt to fix the problem, we’ll see a reactionary response by government and insurers, which will only further diminish what little power we have left, while leaving the basic practice problems unresolved.”

  “We’re getting off track,” Paul said. “Let me try to bring this down to the basics. If we admitted your spouse or mother, or even your mother-in-law to Brier Hospital tonight, how many of you would be comfortable having Joe Polk taking care of them; raise your hands?”

  “I wouldn’t choose my mother-in-law as a good example,” said one physician.

  Paul glanced around the room. The Polk supporters were sitting on their hands.

  He continued, “It’s easier to make decisions when they’re personal rather, than abstract, isn’t it?”

  Phil Banks, not completely through in his defense of Polk, took the floor. “Nobody is recommending we allow Joe to practice as he has been. What I am trying to avoid is the destruction of an outstanding career. We owe it to Joe and to others the opportunity to change and to redeem themselves, as long as we can assure ourselves that we can protect patients along the way. I don’t know about yours, but my religion believes in redemption, and so do I.”

  “For redemption, Joe needs another venue,” Paul responded. “I don’t think you will find much support for that approach in this committee. In my mind, and I surmise in the minds of most of you, we feel we have given Polk ample opportunity for change and he’s failed to do so. His attitude, you saw an example of it today, Phil, suggests he sees no reason to alter his practice or behavior. I’m prepared to call the question. Any objections?”

  Hearing none, he continued, “All in favor of the motion to recommend to the Board of Trustees of the hospital that we expel Joseph Polk from the medical staff raise your hands.”

  Almost all members raised their hands.

  “Those opposed.”

  Three members raised their hands.

  “The motion is approved. Meeting adjourned.”

  When we departed from the Board Room, I had expected some sense of relief, it didn’t come. The recommendation to Brier’s Board of Trustees had resolved the Polk issue, or had it?

  Warren growled, “No way in hell can Polk get the Board of Trustees to override a near unanimous decision of the medical staff. I don’t give a damn how many friends he has on the board, he’s finished here.”

  I smiled. “Maybe you could get him a position at the university, teaching medical students the finer aspects of courtesy and civility in the practice of medicine.”

  “Sure, let’s have him teach physician-nurse relations and charm.”

  The decision validated the actions of the nursing staff. Though I knew I should be satisfied, this victory was a mixed blessing, coming late and at too significant a cost.

  The nurses were unabashedly overjoyed. To most, it was vindication and justice done. To others, sweet revenge.

  Beth sat in my chair behind the desk. I sat on the sofa, feet up.

  She was into the revenge, big time. She showed not a hint of embarrassment at the magnitude of her delight in this wicked pleasure. While I hoped Beth could see this whole thing from my perspective, the Polk fiasco being a symptom of a larger problem, she was happy with the simpler truths; Polk would not be around to hurt her patients or berate and demean the nurses. That was enough.

  The last few weeks brought us close. We survived our disagreements. Conflict, painful and uncomfortable, made it impossible to hide from each other, could that be bad?

  Beth thought I was a bit too serious and too focused on pleasing everyone. Maybe she was right. She was more secure and grounded. She was intrigued, and, in a caring way, a bit amused with me. She thought she knew me by now.

  “Isn’t it enough,” Beth said, “to accept yourself as honest, concerned, and responsible? I know you’ve had misgivings about your role in this whole thing. I still carry the scars, but you said what you had to and accepted the risks of an outspoken position on the Polk case. It’s clear to me,” she continued, “that the medical staff and hospital administration are always trying to find an easy out. They flittered around the situation, rather than deal with it directly. Pulling the plug on Polk earlier would have resolved the problem and avoided much of the damage done along the way.”

  “In retrospect that’s true,” I said, “but in some way this begs the question. I want physicians to be optimistic and feel that with effort and goodwill, they can make things better. Carried too far, it paralyzes us, and we can’t deal with the Polks of the world. I don’t want docs to lose their optimism and sense of control. It’s essential for protecting patients and preserving the profession, especially in this environment where economics is all powerful.”

  “Why was it so clear to us that Polk had to go, while the medical staff had to be dragged kicking and screaming to the same conclusion?”

  “Hear me out before you explode. It’s easy to reach obvious conclusions when you don’t have the responsibility, and when you don’t suffer the consequences of your actions.”

  While Beth reddened with anger, and before she had a chance to blow, I continued, “Will you please listen to me for a moment? I won’t put myself in a position of excusing the inexcusable, but there’s a big difference between coercing and convincing physicians to do the right thing. Do we want physicians to practice out of fear of discovery by a QA committee or a malpractice attorney, or do we want docs who practice at the highest level based on a culture of excellence? It looks simple to you, black and white, while to me it’s clear that in the end, better docs are the answer. My only question is how do we get there?”

  Beth forced a smile. “Look buddy, all this still sounds defensive to me. The medical staff had their chances to deal with Polk and blew it repeatedly. Until we reach your utopia, I’ll settle for anything that deals with the likes of him. If that means coercing or threatening physicians to do the right thing, I say, so be it”

  “You’re right, but nurses are part of the problem too. In spite of all the liberating changes in nursing, nurses still buy into the physician myth, that docs have all the answers and are trustworthy. This explains why we have this visceral response to the actions of a Joe Polk. It’s no different from our outrage at the actions of the corrupt judge, rogue cop, or the pedophile priest. The more you entrust individuals in authority, the greater will be the pain of betrayal. Anyway, Warren thinks the Polk expulsion is a done deal. I hope he’s right.”

  “He’d better be, because if that son-of-a-bitch shows up again on the ward, the nurses will walk out.”

  “I’m so glad to see you’re mellowing out. I’m sure Warren is right.”

  “Forget about Polk for a moment. How’s Helen Martin doing?”

  “She’s doing well. She’s had no new problems and her hearing and balance are on the mend. Helen and Chuck have managed to resurrect some of their lost optimism. She’s next up for a reasonably compatible liver. They’re still thinking about suing Polk, but I doubt if they’ll carry through. They don’t have it in them.”

  “You know, Jack, in spite of all Polk had done and the resultant grumbling by the nurses, it was Helen’s case that finally forced the issue. It would have been better if the nurses had consistently taken the high road when it came to our attempts at d
ealing with him, but in retrospect, we should have done more. Our close identity with Helen finally made it impossible for us to ignore Polk’s actions. It shouldn’t have taken a Helen Martin to get us to react so strongly.”

  “It’s the human element in all this,” I said. “It’s messy, inefficient, and complicated by emotional forces none of us completely understands. Someday, computers may do better.”

  Chapter Forty-Two

  The day after the board meeting had not been a good one for Joe Polk. Still smarting from the medical staff’s decision to go to the Board of Trustees and end his career, he felt isolated as he rounded in the hospital and worked in his office. He winced at the sympathy he caught in the eyes of old friends and patients.

  That evening, the phone rang during dinner. “Dr. Polk,” said the service, “we have Brier Hospital on the line.”

  “Dr. Polk here, what now?”

  “We have Willis Harkens, one of your patients, in ER Doctor. He’s complaining of a sore throat and wants you to come in to see him,” the ER nurse said.

  God damn him, thought Polk, an ER visit for a sore throat.

  Polk could give permission for the ER physician to see Willis, but he’d be damned if he’d throw more business at Brier. Fuming, he got in his black Lincoln Navigator and headed east on route four. He loved the Navigator for its size, its power, and the opportunity it gave him to look down on the smaller vehicles.

  Polk drove in the fast lane, as usual, ignoring the horn honks and the flip-offs of those who thought that if you want to drive slow, you should be on the right. He saw the headlights close behind and heard, and then felt, the heavy thump, thump, thump of the rap music blasting. He ignored the car’s flashing lights that insisted he move over.

  Suddenly, a silver Mitsubishi Eclipse, with two couples sped around him and placed itself immediately in front of his Navigator. Windows on both sides were open with four arms upheld, middle fingers extended.

  Who the Hell do they think they are? Goddamn trash–punks!

  Polk stepped on the accelerator and sped into the right lane, pulling up beside them. What else, teenagers.

  They smiled at him and continued their obscene gesturing, laughing to each other. They continued in this way for several miles, and then the Mitsubishi driver flashed his turn signal showing his need to move into the right lane, to exit. Polk continued alongside, accelerating and slowing to prevent them from moving to the right.

  Let’s see how you like this?

  “Move over, old man,” came the scream from the Eclipse.

  Polk laughed, continuing alongside.

  Suddenly, the Mitsubishi’s tires squealed and the car raced forward, cut in front of the Navigator, and headed for the exit ramp. Polk braked suddenly, “What’s that asshole doing...?”

  As Polk braked the Navigator, he looked in the mirror to see a Jeep Cherokee towing a large cream-colored travel trailer approaching, brakes screeching. The Jeep shuddered. The trailer began to yaw and Polk watched as the trailer flipped over the center divider into the oncoming eastbound lanes, followed by the sick sounds of brakes, tortured metal, and shattered glass.

  The doctor pulled to the roadside, stepped out of his car, and looked back at the mayhem.

  That evening, while waiting for Jack, Beth sat in her soft easy chair listening to a Claudio Arrau recording of the Chopin Nocturnes. No matter how much was on her mind, the Nocturnes, spanning the full range of human emotion, had their way with her, moving her outside her own small world.

  She’d been looking forward to tonight as she had been to all her recent dates with Jack. She’d sworn off dating physicians, mostly to avoid the discomfort and ill feelings that often followed a breakup. To Beth, this wasn’t a problem, but for many docs she’d dated, all too achievement oriented, rejection was poorly tolerated and compromised their work relationship. She hated generalizations, but with docs…?

  Jack was the exception, she hoped. She’d always favored tall dark men, on the husky side, so she was physically attracted to him from the onset. That was a good start, but knowing him made it easier. In contrast to many of his colleagues, Jack was inherently warm, caring and unassuming, a strange combination in a man so determined, compulsive and hardworking. Beth, still convinced of her ability to judge men, was thrilled to go further.

  She loved the way he looked at her, and she especially appreciated his broad smile as their eyes engaged each time they met. She knew that smile, and what it meant.

  The doorbell rang, interrupting her tender fantasies.

  There they were again, those hazel eyes, and that smile.

  Chapter Forty-Three

  I handed Beth a single large red rose, feeling flushed, and then gave her an enthusiastic hug and a soft kiss on her cheek.

  The night looks promising, he thought.

  My day had been uneventful, and Beth had until about 10:30 p.m. before she had to return to work. We’d planned a quiet evening together and vowed no shoptalk. Beth had stopped for groceries at the local gourmet market and succumbed to the specialty cheeses, pâtés, and the still warm smell of a fresh sourdough round.

  She grabbed the ice bucket with the Chardonnay she’d purchased this afternoon, and handled me the corkscrew. I fussed with it a while and managed to remove the cork with only a few fragments floating in the wine.

  I smiled. “I’ll buy you one of those hi-tech bottle cork removers; even I can manage one of those.”

  Beth took the bottle in hand and, standing right next to me, began pouring. Her soft blonde hair hung down from her face and smelled faintly of some soft floral scent, as it brushed my cheek. I didn’t need much encouragement as I sought her hand, nearly knocking over my wine as I moved to bring us together. I felt self-conscious at my obvious arousal, but that lasted only seconds as we kissed gently, and then with increasing passion. She hesitated only a second, and then softly moaned. We fell back ungracefully onto her sofa, nearly upsetting the coffee table. She must have felt my full weight and my excitement as I stretched out over her, but she drew me closer. I had found my way to her breasts when the coarse ring of her phone startled us.

  “Shit, I forgot to unplug it,” she said.

  We looked at each other, sharing the same thought, hoping it would stop.

  Beth rose from the sofa, brushed back her hair, straightened her skirt and top, and pushed the speakerphone button. “Beth, Jack,” Warren shouted, “turn on the TV, to channel nine.”

  The local anchorman, Carl Williams, waited for his cue, then finally began, “I think we’re ready now at the accident scene on highway four. Salli, are you there?”

  “Yes, Carl we’re ready now,” she said.

  The perfectly coiffed Salli Pace, girl reporter extraordinaire, stared into their remote handheld camera. “True-to-life drama punctuated a ten car collision here on highway four. Through prompt and heroic action, one of our esteemed local physicians, Dr. Joseph Polk, saved a life. Dr. Polk, who had been making headlines of his own in his conflict with Brier Hospital and its medical staff, made news today in an altogether different way. At the tail end of this multi-car collision, Dr. Polk had the good fortune to be available to save the life of Sharon Clarke, wife of Reverend Titus Clarke. Mrs. Clarke nearly bled to death from a large tear of the femoral artery in her thigh. Using all his years of experience, and with confidence and skill, Dr. Polk stopped the bleeding from this large artery, which had put Mrs. Clarke at death’s door.”

  Beth and I looked at each other in utter amazement, surprised to hear each say in unison, “I don’t believe this.”

  Through the magic of television, the reporter suddenly appeared at Brier Hospital. She stood with Joe Polk, her eyes gazing upward into his face. She continued, “In your own words, Doctor, what happened?”

  “Whose damn words is he going to use?” I growled.

  Polk straightened his bow tie, confronted the camera, and began, “Well I’ve made it my business to be ready for any emergency, whether it occurr
ed in my office or anywhere else. When I came upon the accident, I grabbed my emergency bag and went to investigate the scene. Many victims suffered minor injuries, but when I came upon Mrs. Clarke, I saw immediately that she was in deep trouble.

  “Several bystanders were frantically pushing on her thigh in an attempt to control bleeding from the femoral artery, but I could see straight away I had to stop it. She was pale, sweaty and confused, early signs of impending shock. After I opened her wound, I placed a clamp on the actively bleeding branch of the femoral artery. Thank God, she stabilized. It’s amazing how a simple action can be lifesaving.”

  “Just the kind of false modesty you’d expect from one of our most respected physicians,” remarked Ms. Pace.

  The camera suddenly switched to Carl Williams. He was interviewing the town’s mayor, Fred (Fritz) Benson, not a man to miss a photo-op or leave any superlative unturned. “I’ve known Joe Polk for twenty-five years and he’s the best damn doc we’ve ever had in this community. His decisive and heroic action is what we’d expect from the man who has served this community unselfishly for thirty years. I’m going to ask the city council for the Outstanding Citizen Award for Dr. Polk.”

  “Outstanding Citizen Award,” Beth groaned. “Of all the damn things.”

  “Great timing.” I said. “I can see the headlines, LOCAL HERO DOC THROWN OFF MEDICAL STAFF and UNANSWERED QUESTIONS IN EXPULSION OF HEROIC PHYSICIAN.”

  “Warren, I’m sure you’re loving this.” I said.

  After a few thoughtful seconds, Beth suddenly began laughing uncontrollably.

  “It’s so exquisitely perverse,” she laughed, compelling me to laugh with her.

  “Black humor,” I said, “Warren, are you still there?”

  “I’m glad you guys are enjoying this. Of all the goddamn things. The next insult will be the commissioning of a Polk statue for the town square. Maybe Brier Hospital will become Polk Hospital.” Catching his breath he continued, “If we have any smarts left, we won’t go near this thing.”