Cookie's Case

by Andy Siegel

  She loads and ejects the CDs, one after another at a rapid-fire pace. Mixed in with Cookie’s MRIs are a number of plain X-rays. After reviewing each study—zooming in and out on the pertinent anatomy—she takes the CDs and begins placing them back in their respective sleeves. The review takes eight minutes.

  “I assume you don’t want to show me anything?”

  “Have you looked at them?”

  “Yes.”

  “Well, after all these years I’m sure I’ve trained you well. We both see the same thing, don’t we?”

  “I believe so.”

  “Well, what did you see?” she probes. She and Mick both love to do this to me.

  “The first post-op set showed the surgeon improperly screwed hardware into an unintended joint space. It also reveals collection of fluid at the C4 level. Subsequent study showed the fluid collection, whether it be blood or CSF, had spontaneously reabsorbed. The studies after her corrective surgeries show the removal of the offending screw and restabilization of the fusion that never took. Those images appear to be normal at the C4 level where there had been this fluid collection.”

  “That’s what I see, too. Not such a big case, if you ask me, despite the prolonged course of treatment and multiple surgeries. Bone-healing insufficiencies, such as delayed and nonunion, are a risk of the procedure. The most recent studies show acceptable alignment and bone union where the nonunion was. She must be close to healed by now.”

  “Yeah, she’s good enough to dance. But it’s what’s not imaged in the studies that’s giving me the problem.”

  “I’m listening. Tell me what isn’t imaged that you think should be.”

  “Okay. Here’s the deal. According to the defendant’s surgeon, the patient sustained an injury into the subarachnoid space at the level of C4, causing an intraoperative leak. Now he didn’t say this in his operative report, but he testified to such at his deposition.”

  Ray shakes her head. “That’s unheard of.”

  “Yes. I agree.” It’s unanimous.

  “But the first post-op MRI did image a fluid collection at that level, so maybe he knew he had to give that.”

  “I agree. Also, this nurse who’d been in the OR came forward and advised Cookie and her boyfriend while she was still in the hospital that Dr. McElroy had caused the injury. Anyway, about six months later, Cookie starts feeling pressure in her head, and Major, this retired doctor she lives with, starts tapping her on his own.”

  “Spinal tapping?” she questions in apparent disbelief.

  “Yes. Spinal tapping. Privately. He’s been doing it weekly, continuous to this day. It’s sick. I’ve seen it. I’ve even made a video of it. He performed the procedure in my office.”

  “So what are you saying here? That these subsequent MRIs should show some form of defect in the arachnoid layer at C4 that’s causing an obstruction of CSF flow and a backup of fluid to her brain?”

  “That’s exactly what I’m saying. Or at least an abnormal collection of fluid arising at that level if a defect is not visible.”

  “Well, other than the initial post-op MRIs from McElroy’s operation—the first series showing the fluid collection at C4 and the second documenting the expected reabsorption of the fluid, neither having strong evidence of an arachnoid membrane tissue defect—none of the subsequent studies show a fluid collection at C4 or strong evidence of an abnormal arachnoid either. However on some of them, where the base of the brain was incidentally imaged, I did see the presence of increased spinal fluid that might require tapping if clinically indicated. But there was no visible explanation for it or anything indicating that it arose from lower down at the C4 level. So you know better than to ask me to come to court on this case, right?”

  “Right,” I agree. “I know better.”

  “Good. That’s why it’s impossible to cross-examine me. I say what I see, and no one could ever make me change my mind.”

  “I’m with ya.” I put the CD sleeves together. While I’m doing that, a gray cat with yellow eyes and a patch of white on its throat jumps up on the table.

  “That’s Tinkerbell.” She scratches her ears. “I found her barely alive on Fifty-third and Eleventh. She was just lying there, and people were walking right on by. She’s my favorite. Bright, affectionate, and understanding. But sometimes she’ll scratch you for no good reason.”

  “That’s nice of you, Ray. Are all of these rescues?”

  “Every one.”

  As I’m at the door and she’s throwing back the locks to let me out, I think about all that we’ve just discussed. “You’ve helped a lot,” I tell her.

  “I don’t see how. I could talk about the screw extending into the joint and the initial fluid collection. Still, I understand there being no strong evidence of any defect at C4 impeding the circulation of the cerebral spinal fluid is against the interests of your client, if you’re claiming that as an item of damages.”

  “Correct. But it’s weird because, like I said, I actually saw him do it right in my office. ‘It’s time for tap,’ Major said when he saw her taking a downward course.”

  “That’s a dark expression, isn’t it?”

  “It sure is, and what followed was even darker.” After the memory of what I witnessed skates across my brain, I realize I have another question for her.

  “Several times you’ve used the phrase ‘no strong evidence’ with regard to whether there’s a tissue defect at C4. Is there any evidence of an arachnoid membrane abnormality at that level?”

  “There’s a hint of something there. I almost had to convince myself I was actually seeing it. I’m just not confident in saying what it is or what it isn’t with a reasonable degree of medical certainty. It could easily be a normal anatomical variant. But I am certain whatever it is, given its miniscule size, could not cause a back up of CSF into the skull. May I suggest something?”

  “Please.”

  “There are conditions other than a mechanical blockage from a tissue defect that can cause CSF to build up, requiring a spinal tap. These involve the overproduction of fluid and the failure of fluid to properly drain. You may want to explore such alternative explanations for the tapping.”

  “Sounds like a plan. Only thing is, I want the tapping to be related to the malpractice so she can collect for it. Can overproduction or the failure to drain be related to a surgical misadventure?”

  “Highly unlikely.”

  “Why’s that?” I ask.

  “Because it’s physiologic.”

  “Meaning?”

  “In simple terms, on a chemical level the body just produces too much cerebral spinal fluid. Or something’s going on that’s interfering with the reabsorption of fluid.”

  Chapter Fourteen

  I need to check in with Lily, make sure the office is still there. I’m also not too far from Cookie’s part of town. No time like the present to discuss Ray’s findings with them—or actually, with Major. As of this morning, by hand delivery, the tap video is in the hands of First Medical Liability, McElroy’s carrier. So, no doubt, they’re going to be reevaluating their two fifty offer while also mounting a defense based on what they see.

  Anyway, I want to hear what Major has to say about this—the lack of objective MRI evidence that could be responsible for the accumulation of cerebral spinal fluid. After all, he’s the tap-master. I’ll need to have something up my sleeve when First Medical claims it’s unrelated to the malpractice.

  On the fifth ring, Lily picks up. “Law office. We’re on the side of truth and justice. May I help you?”

  “That’s an interesting way to answer the phone.”

  “What can I tell you? I’m bored.”

  “I can think of a few things for you to be doing.”

  “Never mind that. What do you want?”

  “Pull up Cookie’s phone and address, will yo
u?”

  “Yeah, but I think there’s something you should know.”

  “On Cookie’s case?”

  “That’s who we’re talking about, right?”

  “Yes, Lily. But what should I know?”

  “It’s not good news. You got a letter from First Medical Liability today. They pulled the two hundred fifty thousand dollar offer off the table. It said the time period within which to accept the offer expired, so now you’ll have to litigate the case.”

  “You’re right, that’s not good news. When is the letter dated?”

  “Two days ago.”

  “No worries. You delivered the video this morning, right?”

  “I did, along with a copy of Major’s medical records, as instructed.”

  “Good. They’ll have a change in position. A big one.”

  “Okay. Listen, I’ll text you her contact information. I’m busy.” Click.

  Well, is she bored or busy? Whichever, Cookie’s contact information magically appears on my phone. I give her a call, letting it ring off the hook. No answer. I hop in a cab uptown, thinking I might as well head over there, imaging studies in hand, in the event Major wants to review them himself after I share Ray’s interpretation.

  Within a few minutes, I arrive at the impressive high-rise building. One white-gloved guy opens the door for me. Another one’s standing behind a black marble reception counter. Yet a third fellow, also white-gloved, is seeing a trio of women onto the elevator. “May I help you?”

  “Yes, you may. I’m here to see Cookie and Major.”

  “Really?” He’s clearly surprised.

  “Um, yes, really. If they’re here, that is. Why?”

  “Only because they don’t entertain visitors.”

  “I’m sure they’ve had guests occasionally.”

  “Actually,” he says, “no.” Then for emphasis: “Not ever.”

  He seems pretty confident about this. I could question how long he’s worked here, his hours, point out the fact that maybe one person may have visited when he was off, or ask some other lawyer-type question aimed at trying to prove that it could be possible that someone once came when he wasn’t on duty, but then I’d be just like the rest of the have-to-be-right lawyers I know. I take the high road. “Well, let’s give them a buzz and see what happens. Wouldn’t you be curious to know if they’ll accept a visitor?”

  “Now that you mention it,” he confesses, “I actually would.” He picks up the phone and rings their apartment. “I know Major’s out,” he says, as he waits for a response, “and I think you got a better shot at getting upstairs without him there, anyway. In fact,” he continues reflectively, “since Cookie moved in, not even Jimmy the super has been in their apartment. The truth is, Major even comes down to pick up any deliveries.”

  Remember what I said about doormen?

  He’s listening to the phone now. “Yes, Miss Cookie.” He nods at me. “There’s a gentleman here to see you.” He listens to her response. “No,” he says, “I forgot to ask him. We were talking about something. Hold on.”

  Taking my cue, I say, “Tell her it’s Wyler. Tug Wyler, her lawyer. I was in the neighborhood and have something I need to discuss with her.”

  “Miss Cookie,” he says, “Tug Wyler, your lawyer, wants to talk to you.”

  He waits for a response. I can tell he’s anxious. A few seconds pass. Time enough for her to have answered him. But nothing. A minute passes. Still nothing. The doorman’s just holding the phone to his ear, giving an occasional wave to the tenants coming and going. At the ninety-second mark, he shrugs. At a minute forty-two, he responds, “Okay, Miss Cookie, I will.”

  “This is a first,” he states, shaking his head. He seems shocked, even. “Go on up to thirty-four B. I can hardly believe it. What kind of lawyer are you, anyway?”

  “I’m an injury lawyer. You know, construction accidents, car accidents, slip-trip and falls, or strip-slip and falls as the case may be; people getting hurt when it’s someone else’s fault. But I specialize in brain damage injuries and medical malpractice.”

  “Oh, man, my auntie got messed up in the hospital just yesterday.”

  I hand him a card from my wallet. As he goes to tuck it away I say, “Hold on.” Taking out a pen, I hand it to Wilson (as his lapel tag reads). “Write your name, address, and phone number down on the back of the card,” I tell him. “Also write down the name, address, and phone number of the hospital your aunt’s in. Give me the name and number of her closest relative, too.”

  He complies and I take the card back from him. “I’ll call ya tomorrow,” I say, returning it to my wallet. Thirty-four B, here I come.

  “Thanks,” he says. He’s trying to figure out why I didn’t just give him a card. I leave him still wondering.

  The reason I didn’t simply give Wilson my card is because I’d never be certain what happened if no call ever came. By getting the information, if I don’t lock up the case, I’ll know the reason why. In the injury business, where you have to wait for an unfortunate mishap to occur, you never leave the signing to chance.

  I step out of the elevator on her floor and mosey down the hallway to Major and Cookie’s door. I press the buzzer and hear a faint yelp. The door opens a crack and Cookie looks out over the chain.

  “Are you all right?” I ask. “I thought I heard a scream.”

  She laughs.

  “Yeah,” she says, giggling, “that was me. I’m fine. I just never heard the buzzer before. It startled me. Come in.” She shuts the door, undoes the chain, and reopens it.

  I enter the apartment, which is gorgeous. “Let’s sit over here,” she says. I follow her into an open-plan living room with breathtaking city views all around. It’s wall-to-wall windows. Wow.

  “Nice view,” I say, playing it cool. But I’m impressed.

  “Thank you,” Cookie says. It’s clear from her tone that she’s a little embarrassed to be living in such an apartment. “Can I offer you anything to drink?”

  “No, but thanks. I’m okay.”

  She slowly moves closer and prepares to sit next to me on the oversized sofa. She bends at the knees, puts here rear down on the edge of the couch keeping her spine straight, then slowly shimmies back. She turns her stiff upper body toward me, scratches her head with a finger where one of the halo screws is penetrating her skull, and smiles encouragingly, prompting me to start.

  “I came here to update you on your case. I hope I’m not imposing or interrupting anything, but I was in the neighborhood.”

  She giggles again. “Um, I really don’t know how to respond to that.” A hint of confusion crosses her face.

  “Meaning?”

  “Well, it’s just that no one has ever come here before. Major’s a private man and, although he’s never said so, it’s always been understood visitors aren’t really welcome.”

  “Not even your friends?”

  “Not even my friends. When I first moved in, I’d ask about having people over, and Major would just tell me maybe another time. I kept trying until I realized another time was never going to come. I guess that’s why the buzzer scared me. And when it buzzed, the truth is, I felt sad because I realized I’ve never had a visitor.” She takes a deep breath, then lets it out in what I’d call a reflective sigh.

  “Anyway,” she continues, “I tried Major on his cell when Wilson said you were downstairs. When he didn’t pick up, which is unusual, I just told Wilson to let you up. I hope Major doesn’t get upset with me.”

  “I don’t know him that well,” I respond, “but I’m sure he’ll be okay with this. Besides, it’s in the interest of your case. So let me update you.”

  As I say this, though, I realize she’s uneasy. “What’s wrong?” I ask.

  “Could we wait ’til Major comes back before we go into my case? We shouldn’t have to wait too l
ong. He never leaves me alone for more than a little bit. That way you won’t have to do it twice.”

  “Sure. I’m good with that.”

  “Thank you,” she says, and then the conversation stops. What follows is an uncomfortable lull. It’s not that she’s uncomfortable with me, or that I’m uncomfortable with her. What’s obvious is that she can’t stop being worried about what Major’s reaction’s going to be when he finds me here.

  “Don’t worry,” I reassure her. “I’ll make him understand why I dropped in. It’ll be fine.”

  “No, I know, it’s just that … oh nothing, forget it.” She has something she wants to tell me. The incomplete and filtered stuff I sensed she was leaving out at my office is my guess. Should I make it easy? Or should I let her come out with it on her own, hoping she’ll be able to muster the strength to do so.

  I’m sensing she wants to spill her guts, but that’s my trial lawyer’s intuition. I could always be wrong. It might just be the fact that she’s never been alone with anyone long enough to share how she really feels about what’s happened to her.

  “It’s just,” she continues, “having a visitor here, even though it’s only you, no offense …” She pauses. I wait encouragingly.

  “Well, Wilson calling to say someone’s here, my own doorbell scaring me, having a real live person in my living room, and being nervous about Major’s reaction, well … I just have no life!” Cookie exclaims. The tears make a bursting arrival. Holy crap. I didn’t expect this.

  “Easy, Cookie,” I say, thinking under normal circumstances I’d move to comfort her, despite lacking skills in that department. But under these circumstances, such an act is definitely a bad move. I could just imagine Major entering, only to find his first-ever visitor in an embrace with his prized jewel. Better to keep her talking. She wants to vent, anyway.

  “Cookie,” I say, “what do you mean you have no life?”

  “Look at me!” she exclaims. Everything about her suddenly radiates an intensity I didn’t know she had in her.