As the doctor walked through the double doors back into the unit, the elevator opened and Jessie burst out. Dressed in brown slacks, a tan cashmere sweater and Nike running shoes, she wore a heavy gold necklace and diamond earrings that would have made Elizabeth Taylor proud. Jessie's wealth, combined with her headstrong personality, convinced her that there was no situation that she could not dominate and control by the sheer force of her will. She marched over to where Joanna and Bo were seated and almost physically lifted her sister out of her chair, hugged her and then turned to Bo for a kiss on the cheek.
"Lucy's better, right, Jo?" she said with confidence although one look at the two parents told her that it wasn't so.
"No, Jessie, the doctor just left here and there's been no real change since I talked to you."
"Joanna, are you sure you've got the right doctors involved? I know about doctors and hospitals. I'm going in there and talk to them."
She started toward the unit and before she reached the double doors, a nurse who stood as tall as Jessie and outweighed her by fifty pounds blocked her way.
"Excuse me, ma'am. Is there some way I can help you?" the nurse said.
"No thank you, nurse," Jessie countered sternly. "I'm just going in there to check on my niece and talk to the doctors."
The nurse had handled this situation too many times to count, and in a low but self assured voice, she said, "I'm sorry, ma'am. That won't be possible. You'll have to wait out here."
Not accustomed to being told "no," Jessie was momentarily taken aback. Recovering quickly, she commanded, "Then get one of those doctors out here. I want to talk to him or her right now."
"Ma'am, they have very sick patients in there. I'll try to get your niece's doctor out as quick as I can."
The nurse walked through the doors and Jessie returned to sit beside her sister.
"I'll give them five minutes," she warned.
Fortunately, it didn't take that long before Dr. McIntosh came out. Sizing up Jessie, she decided that deference was the best approach.
"Joanna, I understand that this is your sister."
Before Joanna could introduce them, Jessie interrupted, "I am Mrs. Warren Woolsey from Fort Worth. I sit on the board of the largest hospital system in the metroplex and my foundation is a heavy contributor to most of the hospitals in this medical center, including this one. I want to make sure that you have the best doctors in Texas taking care of Lucy. Do I need to get on the phone and call Dr. DeBakey or Dr. Cooley?"
The doctors in the Houston medical center were not surprised by Jessie's attitude. As a renowned center of medicine, they regularly operated on and cared for princes, potentates, presidents, celebrities and politicians from all over the world. Each of them demanded excellence and they got it. However, it wasn't because of their money or station in life. These doctors considered themselves the best in the world, and they were going to provide the same care for Lucy as they would for the president.
"Mrs. Woolsey, I'm sure that if I thought that Dr. Cooley or Dr. DeBakey could help, they would be here. Your niece doesn't have a cardiovascular problem and I am certain that they would defer to the team that we have assembled. Frankly, I don't think that all the money in Texas is going to buy her better care."
"Then tell me what in tarnation is going on with my niece."
"I'm a gynecologist and an infectious disease specialist. Lucy had to be life flighted here from Texas City. She'd had an abortion and had two complications, her uterus was perforated and there were some retained fetal parts. She lost a lot of blood and had developed sepsis, an infection in the blood. I operated, removed the fetal parts and then sutured the perforation."
"That means she's going to be just fine, right Dr. McIntosh?"
"I'm sorry, Mrs. Woolsey, but I'm afraid it's not that easy. She lost a lot of blood and I had to get Sam Hunt, a hematologist, involved. We've got her on antibiotics but I can't be sure they are the right ones until we get a culture back from the lab. Meantime, her temperature is still high. Trust me, Mrs. Woolsey. We're doing all we can do. If Lucy can be saved, I'll do it."
Jessie sized up Dr. McIntosh and recognized that Lucy was in good hands.
Smiling, she replied, "Thank you, Doctor. We'll be waiting."
Dr. McIntosh returned to the unit and Jessie turned to her sister who described what happened before she arrived. Shortly, a nurse let them know that Lucy had been moved to intensive care. They went one floor down and were permitted to see her briefly. She was being cared for by a short, stocky, black nurse who had an aura of proficiency about her.
"I'm Nurse Bancroft. I'll be responsible for your Lucy from three to eleven every evening. Which one of you is her mother?"
"I am," replied Joanna, dismayed to find that Lucy still had the same tubes and lines as she had upstairs. "This is Lucy's father, Bo, and this is my sister, Jessie, from Fort Worth."
"Well, I'm pleased to meet you all. My job is to take good care of Lucy and I'll do just that. This is the intensive care unit and until Lucy gets better, she'll have one nurse with her at all times. You're allowed to visit for about five minutes once an hour, family members only. That can include you, Jessie. The doctors are telling me that she is not going to change much during the night. If you all live close by, I suggest you go get some rest."
"Well, they don't live close by. We have rooms at the Marriott across the street," Jessie interrupted.
"Why don't you go over there to your rooms? We have that number and will call you if there is any change."
Although she was reluctant to do so, Joanna bowed to Nurse Bancroft's suggestion. She squeezed her daughter's hand, told her she loved her and followed Jessie and Bo to the hotel. Joanna slept a few fitful hours. At five a.m. she got up, dressed and went back to the hospital. This time a different nurse told her there was no change. To Joanna that was no solace. With a heavy heart, she returned to the waiting room.
Everyone was quiet. Some of the men had two day's growth of beard. Some slept. Many had haggard, worried looks, fearing the worst yet hoping for the best. The surroundings did nothing for her mood. As Joanna absentmindedly gazed at the television, the elevator opened. Bo and Jessie, carrying food and coffee from McDonald's, joined her. After eating two breakfast tacos, Bo left to go to their house to pack a suitcase. Clearly, the crisis would last several days.
Behind the closed doors, the doctors were making their morning rounds. Dr. Hunt, the hematologist, found that the blood drawn at seven-fifteen showed some slight improvement. He knew was only succeeding in stabilizing the patient and he could not hope for real improvement until Dr. McIntosh could find the right antibiotics. He had to keep her DIC in check until that time. At Lucy's bedside, Dr. McIntosh joined him, disappointed to find that her fever hovered around one hundred and three and had spiked a couple of times to one hundred and five. And, her white count was going up, not down. They did not have the right combination of antibiotics on board, but the lab had not reported on the culture. Her choices were to try something different, another shot in the dark, or to give the lab a few more hours. She regularly had to make such judgment calls and elected to give the lab more time. If she didn't have a report by early afternoon, she would reevaluate Lucy.
Returning to the professional building across the street, Dr. McIntosh saw patients until early afternoon when she called the lab again. They had nothing to report. Dr. McIntosh hung up the phone and weighed her options. She could wait no longer. Considering the various possibilities, especially the aggressiveness of the bacteria, she concluded that it was most likely a Group D strep, one of the most virulent and potent of bacteria assaulting patients in the modern era. Once it established a beachhead, the army of bacteria multiplied and moved with the swiftness and cunning of the Allies attacking Normandy on "D Day." Sometimes people had been known to die within seventy-two hours from their first symptoms. Dr. McIntosh had an uphill battle. At least the antibiotics were maintaining a holding action. Now, she would change the battle plan, substituti
ng massive doses of Vancomycin, one of the most potent of antibiotics and one that good infectious disease specialists saved for the worst of bacteria. She called the ICU and changed the order, discontinuing the previous antibiotics and ordering one gram of Vancomycin IV, every twelve hours. She also ordered a stat white count to allow her to measure the impact of the new drug. The nurse reported the change to Joanna, Bo and Jessie.
"Does this mean she is going to get better now?" asked Joanna.
"Mrs. Brady, I'm not the doctor. What I do know is this is a powerful drug and we can hope for the best," not adding that this patient was going downhill so fast that she might soon be classified as "a train wreck," a term used by the medical staff when talking among themselves about a potentially terminal patient. Very few people survived a train wreck.
Their hopes raised, Joanna, Bo and Jessie went downstairs to the cafeteria, confident that when they got back, Lucy would be awake and recognize them. Their hopes turned out to be no more than dreams. Nothing had changed. They called Dr. McIntosh who explained, "If we have the right antibiotic, as sick as Lucy is, it will be forty-eight to seventy-two hours before we will notice any improvement."
Jessie demanded to know what was going on. Did they need more doctors? Did they need to send her to Johns Hopkins or the Mayo Clinic? Should she charter a jet?
Two days after Dr. McIntosh had switched the antibiotics, she found the family in the waiting room after her morning rounds. "Are you guys holding up okay? Joanna, your eyes tell me that you're not getting enough sleep. We have a little good news. The antibiotic seems to be working. Lucy's white count is going down. While her temperature is high, it's moving down. I can't say that she has turned the corner. Nonetheless, there is room for a little optimism. Also, it looks like we are going to save her uterus. If she hadn't started improving on the antibiotics, we might have had to do a hysterectomy. Fortunately, I think that risk has passed. On the negative side, we still are unsure of the extent of the DIC since we have been keeping her packed with blood products. Also, we're calling in a nephrologist, a kidney specialist, because of some of the complications that can result from being on the blood products. That's not unexpected and I think that we can handle it."
Joanna had quietly absorbed all of this as she mentally counted all of the specialists, residents and interns involved in her daughter's care, then asked, "Doctor, I suppose I know the answer to this, but is she waking up at all?"
Dr. McIntosh's face clouded as she replied, "No, I promise, though, that I'll tell you the minute we see any signs of her coming out of it. Realistically, I think that we are looking at two or three days at the earliest."
Dr. McIntosh's prediction proved to be too optimistic. Two days later, Lucy's white count approached normal and her temperature hovered around one hundred degrees. The antibiotics were working. The hematologist started backing off on blood products as he became satisfied with Lucy's blood count. In spite of the improvement, Lucy didn't respond. Dr. McIntosh again discussed Lucy's status with her family.
"Joanna, Bo, Jessie, as you know, Dr. Gerald Rosenthal, a neurologist, has been monitoring Lucy with us. He and I have agreed that it's time for him to get more involved."
For several days Jessie had done a good job of keeping her mouth shut and her thoughts to herself. Now she erupted again. "Doctor McIntosh, what kind of games are you people playing? Your team of so-called experts chose the treatment plan. You pumped her full of antibiotics and blood products. You tell us that the antibiotics are working and her bleeding is under control, but you still have tubes running everywhere, have her breathing through a ventilator because she can't do it herself, and worst of all, you can't wake her up. Isn't it about time that you doctors quit practicing and get on with getting this girl well?"
"Jessie, calm down," Joanna interrupted. "These doctors are doing their best and your temper is not helping anything." She turned her attention back to Dr. McIntosh. "What's Dr. Rosenthal going to do now that you can't?"
"We think that we need to be looking for signs of central nervous system problems that could be resulting from the DIC or the infection."
"Now, I think that we have too goddamned many doctors involved," Jessie said. "What we need is one good country doctor like the one that I use in Fort Worth. He wouldn't need all these pedigreed specialists and professors."
Having her fill of her sister's comments, Joanna yelled, "Shut up, Jessie, or go back to the Marriott and watch soap operas."
"If you like, I'll just go back to Fort Worth," Jessie threatened but kept her seat as Dr. McIntosh excused herself.
Dr. Rosenthal was originally from the East Coast and still spoke with a slight Brooklyn accent. He had been trained in New York City and sought residencies at Johns Hopkins, Stanford and Baylor. Accepted at all three, he elected Baylor to enjoy the warm weather for a few years and never went back. As a doctor who took care of children with muscular dystrophy and adults with diseases like multiple sclerosis and Parkinson's along with victims of all ages who suffered from strokes and paralysis, he had to be good as well as compassionate. Now in his fifties, he combined the excellence of his training with close to thirty years experience in caring for such illnesses and injuries. With a grandfatherly appearance, most people he met took an immediate liking to him, including Joanna and even Jessie. Up until now, he had remained in the background since he and Dr. McIntosh had decided that it was better for Lucy's primary physician to interface with the family. This time, after he had examined her again, he introduced himself and made some slight small talk. Then, he told them his findings and what he proposed.
"The other doctors have done a good job. The infection and DIC are under control. My job is to figure out why Lucy is not waking up and what we can do about it. I don't find any clinical evidence of swelling in the brain. Her pupils are reactive and her reflexes seem to be intact. That's all good. DIC can cause hemorrhaging in a variety of places. I've done one CT scan of her brain, but it's time to do another. Hopefully, that will provide us with more information."
Joanna asked the same question once more, hoping to get a different answer from another doctor, "She is going to wake up and be all right, isn't she?"
"Mrs. Brady, we are going to continue to be optimistic, but there are no guarantees. I think the chances are good that she will wake up. Assuming she does, I need to warn you that she could have some brain damage and may require months of physical therapy. Even with therapy, she may still be left with some residual disability. Let's hope for the best."
Dr. Rosenthal excused himself and told them he would be back after the CT scan. Joanna lost herself in thoughts of her teenage daughter with long-term brain damage. Will she wake up? Will she be able to talk? To walk? To get back to her classes? To sing? To have babies? Those were questions that she would need to ask the doctors when Lucy woke. Once again she turned to prayer.
Late that afternoon, Dr. Rosenthal returned with the news. The DIC had caused some hemorrhaging on the left side of the brain that was causing her continuing problems. It had stopped but the blood
CHAPTER 21
Dr. Rosenthal did four more CT scans over the next two weeks, each showing less blood. In the intensive care unit, Joanna had just spent her five minutes talking to Lucy. As she got up to leave, she squeezed Lucy's hand and told her she loved her when she felt Lucy squeeze her hand in response. At first she thought that she imagined something until it occurred again. When she looked, Lucy's eyes were open.
"Nurse, nurse," she cried. "Come quick. Lucy's awake!"
The nurse came to the bedside, evaluated her patient and paged Dr. Rosenthal who was there within twenty minutes. While Lucy was in and out of consciousness, there was no doubt that she was awakening. Joanna was convinced that the nightmare was over. She was right, of course. She was also wrong. The nightmare of the hospital with her daughter teetering on the brink of death was about to end, but a new public nightmare was about to engulf the whole family.
Once she wo
ke, Lucy's otherwise healthy young body responded quickly. Within days the physicians were able to wean her from the ventilator, as she was able to breathe on her own. Her reflexes were generally intact. She tried to talk, but her words were slurred. Dr. Rosenthal was unsure of the cause. It could have been the result of being on the ventilator for so many weeks, or it could have been some continuing neurological involvement.
It was late in the afternoon when Dr. Rosenthal found Joanna and Bo in the waiting room. Lowering himself into an easy chair beside them, he grunted and then said, "I may never be able to get out of this chair again. You may have to start taking care of me." He shut his eyes for a few moments and then looked at the expectant faces. "Here's her status. She's made a lot of improvement. We need to give her two or three weeks of intensive physical and speech therapy. Hopefully, you'll be able to take her home after that. You'll need to work with the physical therapists to learn what to do because you'll have to continue the therapy for quite a few more weeks once she gets out of here."
The therapy started the next day with Joanna and Jessie observing at first. Two days later they started assisting. Even though Lucy cooperated, Joanna saw that she was merely going through the motions. When the physical therapist would try to push her a little farther, there were times that she would just shake her head, stop and refuse to go on. Speech therapists worked with her in the afternoon, and again there was only partial cooperation. No one was pleased with her progress. Soon everyone recognized that her recovery might drag on for months.
Joanna was convinced that Lucy was still experiencing severe emotional trauma. Even when she was in her room she generally ignored her family, staring at whatever sitcom was on the TV instead. Within a few weeks, the rehabilitation specialists told Joanna that there was nothing they could do for her that could not be done at home. They suggested a discharge if she could continue the therapy and care. Jessie rose to the occasion.
"Look, Joanna," Jessie argued, "you've been off work for nearly two months now. I've got a big house that is empty except for me and a housekeeper. And I've got nothing to do. Let me take Lucy to Fort Worth. I've been watching the therapy and I can do it as well as anyone. I'll also have therapists come to the house. As soon as she's ready, she'll come home."
So Help Me God Page 11