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

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First, Do No Harm (Brier Hospital Series Book 1) Page 29

by Lawrence Gold


  I dialed Helen’s home number, but was disappointed to get the answering machine. I left the urgent message. When I called Chuck Martin at work, he was out to lunch. Finally, I got him by cell phone and was relieved to hear him say, “She’s here with me, we’re about to start lunch.”

  “Don’t let her take another bite. We have a liver for her.”

  “Are you sure she’s ready for this, Jack?” he asked with obvious concern.

  “She’s as ready as she’ll ever be. This appears to be a particularly good liver for her. Call the transplant coordinator right now. She will give you specific instructions. Beth and I will try to make it over for the surgery.”

  With obvious emotion in his voice, Chuck said, “I don’t know how Helen and I can thank you enough for all you’ve done, Jack. You have not only given her great care, but you’ve never relented in your optimism. It has sustained us all this time.”

  Chuck’s praise moved me. At one time, I had difficulty accepting patients’ gratitude, not knowing what to say. Now I simply replied, “Thanks Chuck, all I need now is for Helen to get through the transplant and come out with a functioning new liver.”

  Beth’s eyes were filling with tears. She grabbed my hand with both of hers, “I’m not letting go of this until Helen’s out of surgery and recovery.”

  I kissed her softly on the lips, held her close, and said, “I’m going to try to clear the decks so we can be there for her surgery. I’ll call you as soon as I know when they schedule the procedure and we’ll go over together.”

  We were anxious, excited.

  Chapter Forty-Sev en

  Before her illness, Laura Larsen paid little attention to her physical being, except when she suffered one of the predictable injuries of the active athlete, minor annoyances at most. After her heart problem, she was like the flight engineer during a NASA launch, focusing on the details; any twinge, any skipped heartbeat, and especially any change in her breathing. All it took to assess the details of her breathing, its depth or its ease, was to focus on this normally automatic process. Healthy people controlled their breathing only when they thought of it. In a minute or two, they’d get bored and relinquish control back to the nervous system, while Laura’s fears kept her obsessing on her breathing for hours at a time.

  She tried to explain it to Steve McIntyre, “Imagine completing a race or surfacing from a deep dive. Feel the discomfort of the shortness of breath. Then imagine the fear of unrelenting breathlessness and the true terror of its abrupt, unanticipated arrival, any time of the day or night.”

  “That sounds terrifying.”

  “I don’t know if it’s my heart acting up, or am I becoming a psychological invalid? All I know is, I hate it.” She began crying, “I hate what’s become of me.”

  At first, the changes were subtle. The first few minutes of exercise, the warm-up, was as anticipated, uncomfortable. Three to four minutes into it, however, Laura was in the groove and as long as she remained in the prescribed range of exercise, she remained comfortable. Lately the warm-up took much longer and she never completely reached her comfort zone. In addition, she found herself avoiding even a single flight of stairs, opting for the elevator instead.

  “Your heart’s a little more enlarged, Laura,” Rick Adams said, after her last examination.

  “What does that mean?”

  “It means that your heart is working harder to pump the blood through the circulation. It’s showing the strain.”

  “Do I need the surgery sooner? Will I be all right until then?”

  “I’ll adjust your meds. That should help. If not, I’ll talk to U.C.”

  Laura’s improvement was short lived. She suddenly awakened early this morning, sitting bolt upright, unable to breathe. Moments later, after a nitroglycerine tablet dissolved under her tongue, she regained her ability to speak. She began crying. “Mac, it’s so frightening. I can’t stand this!”

  Rick made further adjustments, but now Laura spent each night sitting upright in her Lazy Boy chair so she could breathe.

  I can make it. Surgery is only a week away.

  Chapter Forty-Eight

  The University of California San Francisco Hospital was difficult to approach due to late afternoon traffic. The ocean fog had again made its way through Parnassus Heights. Parking was difficult as the pay lots were full and street parking had become a spectator sport. After cuing up in line, Beth and I finally entered the garage and parked. We went directly to the thirteenth floor and the Liver Transplantation Unit.

  The unit consisted of thirty beds, doubles, and four-bed rooms. They’d decorated the faded and stained yellow walls with floral prints and many bulletin and blackboards detailing the day’s activities. The busiest day at Brier could not compare with the frenzy of activity on the transplant unit. Students of every variety, house officers, full-time staff, and the full range of support personnel milled through corridors looking like the Bart station platform at Montgomery Street each morning.

  After introducing myself and Beth at the nurse’s station, they directed us to Helen’s room where an intern and a resident were examining her. Chuck was waiting outside the room. He smiled as we approached and hugged both of us saying, “I’m so glad to see a familiar face here. I’m a little nervous, forgive me.”

  “We’re all anxious, Chuck,” I said, “but only in an anticipatory way. There’s no reason to doubt everything’s in place for a successful transplant. I don’t like to say this, since it’s not logical, but I feel that she’s going to do well.”

  “She’s getting her third physical examination,” Chuck said, “and has had so many visits by surgeons, anesthesiologists, medical students, nurses, unit administrators, social workers and business office clerks; we haven’t had a moment together in the last three hours. A teaching hospital, I guess?”

  “Receiving care at a teaching hospital is a mixed blessing,” I said. “The care is great and the docs are among the best, but there’s a price. You’re there to help medical students, physicians and nurse trainees, and it can get ugly; repeated examinations, the same questions over and over again and little or no privacy.”

  “Helen’s nearly exhausted,” Chuck said. “She’s not up to all this attention, but she’s been on a high, smiling, and chatting as she regurgitated the same information. She knows her history and physical by heart and could dictate it in ten minutes flat. She found the opportunity to talk with two other liver transplant patients nearing discharge. That perked her up.”

  Dan Cohen moved quickly through the ward in their direction. He smiled as he greeted us in front of Helen’s room. “Chuck, Jack, it’s great to see you again.”

  Dan Cohen paused taking a moment to check Beth out.

  I introduced her. “This is my very good friend Beth Arnold, an ICU nurse at Brier and a friend of Helen. We’re here for the procedure.”

  “Welcome Beth,” Dan said still looking, but not quite ogling her. “You all are welcome and Jack, if you want to, you can scrub in for the transplant.”

  “Sure,” I said, “That’s all you need today, a pair of internist hands in surgery. Thanks, but no thanks. I’ll keep Chuck and Beth company in the surgical waiting room. I’m sure you know most everything I know about her, but if anything comes up, I’ll be here.”

  After Dan entered Helen’s room, Beth bent over to whisper in my ear. With a malicious smile, she said, “Very good friend?”

  “Let’s see. I’m still paying for the last time, when I introduced you as my mistress. Anyway, girlfriend sounds too much like teenagers and lover is likely to generate the same unpleasantness as mistress.”

  “Don’t you worry a minute about it, Jack. I have a better introduction brewing,” she said still smiling.

  Dan exited, saying, “She’ll be going down to surgery in about ten minutes so say your goodbyes. The procedure should take about five hours. Next will be recovery, and then the Surgical ICU. I’ll be out to see you after the surgery and I’ll send out a
nurse with an update every so often.”

  Chuck grasped Dan by the hands. “We can’t thank you enough for what you’re doing for Helen.”

  Dan nodded then headed for the nursing station and his last minute orders.

  Helen smiled as we approached. She handed her watch and rings to Chuck saying wistfully, “That’s the first time I’ve removed my wedding ring since you placed it on my hand, sweetie.”

  “I’ll put it right back on when I see you in recovery.”

  Chuck sat on Helen’s bed at her side. “I won’t lie to you, baby, I’m scared. The docs and staff have been great, but I won’t relax until this is all over. I love you and don’t know what I’d do without you.”

  Moved to tears, Helen said, “I love you too, baby and you’re not getting rid of me so easily. I know somehow that I’ll be fine.” Smiling she continued, “But wait a minute, I’m having the surgery, shouldn’t you be reassuring me?”

  The loud thud of surgery’s stainless steel gurney stretcher, banging open the door, interrupted us. Four pairs of arms quickly whisked Helen onto the transporter and the team wheeled her down the corridor with Chuck still holding her hand. He reluctantly released it as the team pushed her into the elevator. He stared sadly into her eyes as the doors to the elevator closed.

  Chuck turned and shuffled back through the corridor, head down as if reliving the worst moments, the near death moments of the last few months. Reason flew out the window and he was alone, chilled by fear. He saw Beth and me waiting for him in the hallway. “Thanks for staying. It’s good to have friends around.”

  “I keep reliving the moment; watching Helen as those elevator doors closed,” Chuck said. “It’s more than I can bear.”

  “She’ll be fine,” Beth said as we moved to the surgical waiting room.

  The hospital had furnished the room with comfortable and well-worn lounge chairs and sofas. We tuned the television to the local news channel and were grateful to hear only the tail end of the anchor’s commentary on the Polk situation. The crowded room contained the members of two families and assorted individuals, struggling to act normal as they awaited the outcome of their loved one’s surgery.

  “It’s going to be a long night, Chuck,” I said. “Why don’t we run down to the hospital cafeteria for a bite? Amazingly, the food here is decent.”

  “No, you two go. I can’t think of eating right now.”

  “We’ll be back in thirty minutes or so.”

  We took the elevator to the first floor and found our way to the hospital cafeteria.

  The modern, stainless, sparkling clean facility had little resemblance to those of yore, especially in institutions dependent on community or charitable support. Feeding the public and contributors, elevated hospital food services to new levels of excellence. Besides the usual fast foods were the salad bars, the chef carving a variety of fresh meats and desert selections that rivaled the better local restaurants.

  Beth heaped her plate full with salad selections and I ordered a cheeseburger with fries. We were eating and drinking our coffee when Beth said, “That’s a heck of an example you’re setting there Doc,” pointing at my plate.

  I smiled at her comment. “I have a feeling I’m going to need more than rabbit food to see me through this night. Anyway, my cholesterol is low and my exercise program is going to start again next week.”

  Beth, locking eyes with mine. “You know I don’t often see relationships as good as Helen and Chuck’s. My own folks have what I previously considered a good marriage, though lacking in passion. I realize things might have appeared differently if I had been a witness to their early dating days, but no couple ought to lose the essence of what brought them together in the first place. Helen and Chuck are as crazy about each other as they ever were. Seeing them gives me hope.”

  Beth looked expectantly at me.

  I was elated. Beth’s admission put words to my feelings.

  I reached across the table and held her hands. “When you first asked me if I’d been in love, I said yes. Maybe so, but that was only a shadow of the feelings I have for you. When I get passed my lust for you...”

  “Don’t ever do that,” she said, smiling.

  “I won’t... I can’t. I just love being with you. I feel so lucky.”

  She bent over the table and placed a soft kiss on my lips, that I met softly at first, and then with growing intensity. “We better stop now or they won’t let us eat in here again,” she said, face reddening with the full bloom of her smile.

  We returned to the waiting room where Chuck sat alone, the big man now looking small and withdrawn. “Glad you’re back. I can use the company.”

  We chatted a while. Soon it became clear that we all were forcing the conversation, a sharp contrast to how we related before. Attempts to read or concentrate on the television were useless, and we rose as one, as a nurse in a green scrub suit entered the room 90 minutes later.

  “Things are going great. Helen’s liver was badly scarred and contracted, but is coming out easily. We’re getting the new organ ready for implantation. I’ll be back in an hour or so to update you.”

  The next three hours were tense, even as reports from surgery remained rosy. The last visit, forty minutes ago, predicted that the process of closure was nearly complete. Afterwards, they’d move her to surgical recovery where Chuck would have his first opportunity to see Helen again.

  The smell of iodine and dried blood hit us as we entered the surgical recovery room. The general aura of the place, a sterile tranquility, contrasted with the fragile circumstances of its occupants. It was alarming, eerie. Patients looking so ill yet the atmosphere radiating cool control.

  Chuck walked right past Helen’s recovery bed before he recognized her. She looked dreadful. Intravenous tubes galore, stomach tubes and surgical drains from multiple sites. Monitors beeped and oxygen bubbled, delivered through nasal prongs. She remained unconscious as he held her hand and slipped her wedding ring back into place.

  “I’m Cory,” said Helen’s recovery nurse, who looked every bit of sixteen years old. Chuck blinked with uncertainty until he remembered how, as he got older, young people seemed to get younger.

  Continuing, Cory said, “Her vital signs are stable and she should be back with us soon.”

  Dan Cohen’s arrival interrupted her. He smiled broadly. “The surgery went well. There were no technical problems and the liver looked great as we closed. When she wakes up, we’ll move her to the SICU where she’ll remain for the next few days.”

  Four hours later, and with increasing anxiety, Beth and I were sitting in the surgical waiting room when Chuck entered. A look of desperation contorted his face as he said, “Helen’s not recovering from anesthesia. She’s in a coma!”

  Chapter Forty-Nine

  I can’t sleep and worry at the same time. Finally, at three a.m., I yielded to the temptation I’d been fighting all night and called the university hospital’s surgical ICU. Helen Martin remained in a deep coma.

  When the phone rang at 6:30 a.m., jolting me awake, I fumbled with the receiver, fearing the worst.

  I was instantly relieved to hear Warren’s voice. “They’ve scheduled a strategy meeting this afternoon with administration, legal counsel, and medical staff leadership about the Polk situation. I want you there.”

  “What time is it, Warren?” I grunted. Absent a response, I continued, “I’ve heard as much as I care to about the good doctor. I have too much on my mind as it is, by the way, had you heard about Helen Martin?”

  “Yes I heard. What’s going on?”

  “She still hasn’t awakened after surgery. Nobody knows why.”

  “They have some great people there. They’ll figure it out.”

  Warren sounded uncomfortable discussing Helen Martin and Joe Polk in the same breath, so he paused for a respectful moment and then continued, “Getting back to our little problem, Jack, you are closest to Polk in recent times, and they may need your input. I expect to see
you in the boardroom at noon. Be a good boy and block off time after lunch, as this is not likely to be a short meeting.”

  “Whatever you do, Warren, don’t say I’m close to Polk, please. Say instead that I’m familiar with his recent behavior and practice.”

  “If that makes you feel any better.”

  “See you this afternoon—I can’t wait.”

  The phone rang immediately as the receiver fell back in place. It was Beth, who had also slept poorly.

  “Nothing’s changed,” I said, “and I can’t get there until late this afternoon or this evening. We’re having another big meeting on Polk starting at noon. Can I pick you up later so we can go over?”

  “Yes,” she said, “I need to be back at the hospital for my shift tonight. What’s going on with Helen?”

  “I sure wish I knew. The operative record didn’t help. She was stable throughout, nothing to suggest insufficient oxygen to the brain. They’re missing something. We hope it’s not brain damage. If it is, only time will tell. Meanwhile, they’re evaluating her for other possible reasons for the coma. When I get a chance this morning, I’m going to go back over Helen’s old chart from Polk’s office, this time with a fine tooth comb.”

  I promised to call her if there were any developments during the day. We planned to meet at 5:30 p.m.

  After rounds, I sat in my office working my way through the copious notes in Helen’s thick office chart. If you measured the quality of care by the volume of notes, Polk would be in the doctor’s Hall of Fame. Much of the verbiage served no useful purpose and made review of the chart painfully difficult.

  Thirty minutes later, I reached Helen’s appointment with Polk four to five months after Adriana’s delivery. During this routine office visit, Helen complained of a mild sore throat, yet Polk’s examination of her throat showed nothing. He did note thyroid enlargement and tenderness, but he failed to order diagnostic tests nor did he indicate plans for follow-up. I immediately recognized the likelihood that this represented postpartum thyroid inflammation, thyroiditis. It was a disorder that could lead to a low thyroid hormone state called hypothyroidism. I knew the university docs would be looking at thyroid function in the evaluation of her coma, but with this history, they needed to look a lot deeper.

 

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