by V.K. Sykes
“You ready to see me?” Lance Arnold asked in a bored voice.
Holly looked up from her desk at the man leaning against the frame of her office door. Tyler’s father, in his faded jeans and green Eagles football sweatshirt, looked even bigger and bulkier than she remembered from their ER encounter. His dark blond hair stood up in little gelled spikes, and his chin and jaw were covered with unkempt stubble. She could smell stale cigarette smoke, and had to work to keep from wrinkling her nose.
Arnold obviously wasn’t big on pleasantries. Holly couldn’t tell from his expression whether he was angry or not, but his deep-set eyes gave her a suspicious appraisal that ramped her nerves up again.
“Hello, Mr. Arnold.” She stood up from her desk and reached across it to shake his hand as he approached. “Thank you for coming. Please have a seat.”
Arnold sat down heavily in one of the chairs facing her. The man’s body radiated tension, and maybe even hostility. His shoulders were hiked up almost to his chin, and he’d clenched his hands, making fists that he now rested on the arms of his chair.
Holly took a mental cleansing breath as she sat back down. “Mr. Arnold,” she began in a friendly voice, “I’m sorry we didn’t get a chance to meet before Tyler’s emergency.”
Arnold’s lips quirked up in a sneer that was his only response.
She tried again. “I know Dr. McMillan told you I would be taking over Tyler’s case after he retired.”
“As if I had any goddamn choice,” Arnold said with a snort. “McMillan just told me that from now on, Tyler would be stuck with some rookie doctor.”
She held back a startled jerk. McMillan might have been out of line. Then again, more likely it was just Arnold being difficult.
“I’m sorry you feel that way,” she said calmly. “But I assure you that I’m hardly a rookie. I can discuss my qualifications with you if you’d like, or you can speak to our Chief of Surgery about my background. Dr. Rosen would not have brought me to this hospital if he had any doubts about my ability or my experience.”
The big man averted his eyes for a moment, craning his neck to look at her ego wall. Six framed certificates testified to her education and qualifications, and three more showcased professional awards she’d won. After a couple of seconds, he seemed to relax a little. He unclenched his fists and laid his palms flat on the chair arms.
“Okay,” he said. “Maybe I overreacted a bit. But the kid’s in trouble, right? It doesn’t seem right that he should get a rookie on his case.” He waved a hand dismissively, as if to ward off an objection from her. “Yeah, I know you’ve got lots of paper that says you’re qualified, but when somebody sticks a blade into Tyler’s chest, I want them to have some serious miles on their wheels.”
Holly wanted to wince at his terminology, but instead forced a sympathetic nod. “That’s understandable. I’d probably feel the same way if I were in your position. But the fact is that I’ve performed hundreds of surgeries, and assisted on several hundred more. Doctors don’t get through years of residency and fellowships in cardiac surgery without many, many miles on their wheels.” She gave him a smile as she threw his metaphor back at him.
“You’re damn right you’d feel the same way.”
She leaned back in her chair and met his belligerent stare. “If you wish, you can certainly speak to the chief about assigning another surgeon. I expect he would accommodate you, if you insist.”
He snorted again. “I doubt it. I know you people. You always stick together.”
Unease whispered through her, and her hand itched to pick up the phone and call Dr. Rosen to get a case transfer to another surgeon in motion. But she held back. If she started letting parents intimidate her, or gave up without a fight, she’d find herself heading down a slippery slope toward eroding self-confidence. Besides, nobody at PCH would do a better job for Tyler Arnold than she would.
“Mr. Arnold., you’ll do as you see fit. Let me just say that I am one hundred percent sure that I can take care of Tyler as well as any surgeon in this city. And, even more importantly, I care deeply about every single one of my patients, including your son. His welfare will always be my number one concern.”
Arnold stared at her for several seconds—long enough to make Holly uncomfortable, especially when his eyes drifted down to her chest. Though she wore a white lab coat, it hung open, as usual, and revealed a cashmere sweater that right now seemed to emphasize the swell of her breasts.
Finally, he nodded. “All right,” he said in a grudging voice. “Just don’t bullshit me, okay?”
She stifled her irritation. “Have no fear on that account. Now, I’d like to discuss Tyler, if you’re ready.”
“Yeah, let’s get on with it,” he replied.
“I’m afraid Tyler’s condition is serious,” Holly said. “Very serious. Endocarditis in a patient his age is life-threatening. We’ve got an array of antibiotics to choose from, though, and we think we’re making some progress. Still, I can’t sugar coat the situation. It’ll be several more days before we know whether we’re out of the woods.”
Arnold squinted, as if he had trouble seeing her. “He looked a little better to me today than he did on Saturday night.”
She forced a tight smile. “I can see why you might think that. We’re optimistic that the antibiotics will eventually deal with the endocarditis. But—”
“But his heart is a big goddamn mess. I get it,” he snapped. “It’s been that way forever, but you people always seem to manage to put it back together.”
She could have sworn he sounded almost unhappy about that. The man was starting to give her a weird feeling in the pit of her stomach. “Unfortunately, despite the earlier repair, it’s clear that his mitral valve is breaking down.”
“That sucks.” Arnold’s face revealed little.
Holly felt a stab of sympathy for him. “It’s certainly a significant setback. But we have some options. Good options. For one, we could replace the valve with an artificial one. After Tyler gets past this crisis and regains strength.”
“If” would be more truthful than “after”, but no parent needs to hear that.
Arnold slowly nodded.
“The surgery itself isn’t particularly difficult,” she continued, “but there are substantial risks and complications.”
“Like what?” Arnold sat up straighter.
“In a young child, the heart grows, but the valve doesn’t,” she explained.
“That could be a problem, all right,” he said in a sarcastic tone.
Holly’s hand clenched beneath her desk. “And there’s always a danger of…” she bit back the technical terminology that came to her lips, “…of a blood clot getting loose. Plus, we don’t know the extent of the further damage that the endocarditis and other complications will bring about. But there will be some, I’m afraid.”
Arnold turned his head to stare out the window. At least thirty seconds passed before he spoke, still not looking at her. “I guess it never crosses your mind, does it, that you might have put the poor kid through enough?”
Shocked, momentarily speechless, Holly stared at him. What the hell was he trying to say with that out-of-left-field comment?
“We don’t have to go over this in detail now,” she said, pulling herself together and ignoring his question. “The surgery couldn’t take place for some time, anyway—perhaps even weeks. We can discuss all this more in a few days once we get Tyler through this crisis.”
The man obviously had to be suffering major stress. There was no other explanation for his detached, almost cynical demeanor.
Arnold shook his head. “No, I want to do it now. I want to know where all this is going.”
Holly sighed inwardly. What could she do? Kick him out of her office?
“All right.” She pushed her chair back slightly, willing herself to relax. “As I said, a mitral valve replacement in a young child presents significant challenges. I’ll be completely honest with you, Mr. Arnold. Given Tyler’s param
eters and his current situation, his case gives me cause for concern.”
Holly, stop sounding so damn formal. But she couldn’t seem to relax an inch around Lance Arnold.
A muscle flexed along Arnold’s jaw. “Stop beating around the bush and give me the odds,” he demanded.
Hell, no. She always avoided that kind of guesswork. The blowback from a wrong guess could be very damaging for all concerned, especially Tyler. “Each case is unique, Mr. Arnold. Statistics are just statistics, not a prediction of an individual case.”
“Humor me,” he said in a cold voice.
She clenched her teeth for a moment, but Arnold was the parent. He had the right to ask, and she had the obligation to answer to the best of her ability if he insisted.
“Very well,” she said. “Studies have indicated that there’s a significant mortality rate within five years after surgery. The percentage of complications and resulting problems is even higher.”
“Keep going,” he said in that implacable but weirdly calm voice.
Both Holly’s hands were now fisted in her lap. Complicated surgeries didn’t faze her, but put her alone in a room with a parent like this and every muscle in her body threatened to go into spasm.
“The child has to be on a blood thinner for the rest of his life to prevent blood clots. Plus, the mechanical valve has a finite life. Even in the best case scenario, it will have to be replaced in a number of years as Tyler’s body outgrows it.”
Arnold nodded. “So, cutting to the chase, you’re saying Tyler is pretty much fucked?”
She flinched at his language, but managed to keep her face blank and her gaze steady. “Certainly not. It’s a difficult road ahead, for sure, though. Repairing the valve again would be my preference, but Tyler’s surgical history and current status makes that too risky. That’s why we need to go with the mechanical valve. It’s his best chance to have a relatively normal life. When Tyler is healthy enough for the surgery, I’d like to book it. I assure you, it’s the best option we have.”
Arnold muttered something she didn’t catch before he finally answered her directly. “Healthy enough for the surgery. And when the hell is that going to happen?”
Holly paused, her mind racing. She sensed Arnold was playing some kind of very screwed up game with her, but she couldn’t quite figure it out.
“Mr. Arnold,” she said, picking her words carefully, “all I know for sure is that we’re going to do everything we can to make sure he recovers as quickly as possible and regains sufficient strength to undergo the operation. I’m meeting with Dr. Morris this afternoon, and my recommendation will be that we start Tyler on a new medication protocol immediately. I’m sure we’ll be able to find the right combination, and it’s possible that we could do the operation within perhaps two or three weeks. Possibly even sooner.”
“He’ll be at least another month in this fucking place?” Arnold pushed himself out of his chair and leaned forward into her desk, the muscles in his shoulders flexing as he put his weight flat onto his hands. Every cell in Holly’s body revved into a fight or flight response as the big man loomed over her.
“Not necessarily,” she said, scrambling. “He may be able to be discharged and regain strength for a while at home.”
“Jesus!” Arnold shook his head sharply. “Do you have any goddamn idea what all this is going to cost? Hell, the insurance co-pays are already burying me. And I can’t rely on his grandmother anymore, so I have to pay somebody to stay with the kid all the time.” He jerked his head away. “I work in a bar—I’m not rich like you doctors.”
“I understand,” Holly said.
“Sure you do.” He pounded his fist into his palm. “Shit, I just don’t believe this.”
“I’m sorry.” Holly’s heart went out to him on that score. Inadequate insurance crippled so many parents. The hospital would probably reduce the unpaid bills and make installment payment arrangements, but it would still be a devastating financial blow to someone earning what Arnold did. Maybe an impossible one.
“What if I decide not to give you consent?” he said, refocusing on her. “What if I decide that Tyler’s had enough?”
Holly rolled her chair back as he raised his voice to a shout. She gaped up at him, speechless.
“Don’t look at me like that,” he growled. “You might be able to buy him a few more years, but you know damn well he’s never going to get to grow up. All you want to do is practice your high-tech crap on him. Treat like he’s some kind of goddamned experiment.”
Arnold slapped a meaty fist into his palm. The loud crack made Holly jump.
“He’s just a case number to you, isn’t he?” he ranted on. “So what if he gets all those complications you talked about? That’s just another challenge for you people to screw around with, but what about for him?”
He was nearing full-blown rage, and flecks of spit flew from his mouth onto the shiny surface of her desk. “The way I see it, he’s going to die soon enough, one way or the other. The difference between you and me is that I don’t want him to have to spend the little life he has left in this shithole hospital, all wired up and pumped full of drugs.”
Holly bolted up, her heart pounding a rapid, sickening beat. As they stared across the desk at each other, she searched Arnold’s eyes and found only fury and contempt.
Taking a deep breath, she forced down her shock. Life with a critically ill child could batter down even the best parents, provoking all kinds of emotional outbursts. Arnold might not be the best parent, but he was the only one Tyler had.
“I want only one thing, Mr. Arnold,” she said in a voice she hoped was a lot calmer and steadier than she felt. “I want Tyler to have the absolute best life he can have given the rotten hand he was dealt at birth. I know we share that goal, and we have to work together to make sure that happens. But, believe me, even though valve replacement surgery entails all the possible complications I’ve outlined, it’s by far Tyler’s best hope. And with a little luck and good care, he can have a good life.”
Arnold angrily shook his head. “I don’t believe you. You doctors are all fucking liars.”
Holly rubbed her forehead in exasperation, desperate to end the confrontation. “As I said, we don’t have to make any decisions today. You’re obviously under a lot of stress right now. I’m sure that once you’ve had a chance to think everything through and we talk some more—”
Arnold slammed his fist down on the desktop. Instinctively, Holly recoiled and pushed her chair back even more.
“Screw more talk,” he shouted in a thundering voice. “Just get Tyler through whatever shit he’s got now and send him home. You hear me, God damn it?”
His face had turned a deep shade of red. A thick vein bulged from his forehead. For a moment, Holly thought he might clamber over the desk to get to her.
She grabbed at her phone. “That’s enough! Your behavior is completely unacceptable. Please leave right now, or I’m calling security to escort you out.”
Arnold swept his thick forearm across her desk, scattering a stack of files across the floor. Her heart racing, Holly started to dial.
“You’re not playing hero with my boy.” Arnold’s voice had turned ice cold, sending a chill rushing along her spine. “You better not forget that if you know what’s good for you.”
He kicked his chair as he swept past it, and then slammed the door on his way out.
Holly stared after him as the phone slipped from her nerveless fingers.
Chapter Nine