Doctors (77 page)

The obstetrician smiled. “All’s well that ends well,” he remarked, and then turned to his neonatologist and said, “You can take over from here, Laura. If you need any help, I’ll be in my office writing it up.”

He handed her the oxygen, nodded to the nurses, both of whom replied practically in unison, “Goodnight, Dr. Lemaistre,” and left the room.

The nurses were closing up shop when they heard Laura suddenly call out, “Shit! The tank’s empty. Get me the backup, stat!”

One of the nurses hurried to the wall, took the emergency oxygen tank from its fixture, and handed it to Laura. She took it and a second later shouted, “Goddammit, this thing’s empty, too. What the hell kind of hospital is this?”

She turned to the nearest nurse and commanded, “Try to ventilate him with an Ambu. I’ll be back as quickly as I can.”

Even as she was rushing frantically out of the O.R. she realized that she should have stayed and used the ventilation bag while someone else sought the oxygen. Yet at the same instant she reminded herself that only she was aware of how grave the situation was and would therefore move fastest.

The nurse at the station far down the corridor was startled to hear a frantic voice calling, “Oxygen—somebody get some goddamn oxygen!”

She looked up and saw Laura in her O.R. greens, sterile covers still on her shoes, racing toward her like a lunatic. She was reaching for her keys to the supply just as Laura arrived, out of breath and furious.

“I’ll get it for you right away, Doctor,” she said nervously, turning around and starting to open the supply room door. In her panic, she was fumbling for the correct key.

“Hurry, dammit,” Laura urged.

The harsh admonition only made the nurse more flustered. Laura finally snatched the keys from her hand, opened the door, grabbed a small oxygen tank, and lugged it with all her strength down the corridor as fast as she could.

At first the baby was obscured by the two nurses ministering to him.

“Let me at him,” Laura barked.

The nurses stepped to either side and Laura saw the baby. He was a very deep blue. And motionless.

No amount of oxygen could revive him now.

Laura stood in the middle of the room like a statue of ice, clutching the now-useless tank of oxygen. People seemed to be swirling around her. Her ears perceived fragments of words: “Call Dr. Lemaistre.… Tell the mother.… Take the child.… morgue …”

Then suddenly things came into focus again. For Lemaistre had called out to her in a manner that sounded like a captain upbraiding a sloppy private.

“Is this the first time you’ve gotten hysterical during a procedure, Dr. Castellano?”

She did not reply.

Then he added with ironic indulgence, “Perhaps you should arrange not to be on call when you’re having your period.”

Laura refused to let herself be provoked.

“That baby could have lived,” she stated calmly … and categorically.

“The result might have been more favorable,” Lemaistre conceded.

“Come on, Doctor,” Laura replied with annoyance. “You know damn well the baby
should
have lived. It was a screw-up. The hospital screwed up. Are you denying that, Dr. Lemaistre?”

“Perhaps you are perfect, Dr. Castellano. But in my somewhat greater experience I’ve found that even with the best of intentions, normal people can make mistakes.”

“Not this kind of stupid, totally avoidable mistake, dammit. This was negligence—inexcusable negligence.”

He was still unruffled. “I have also found, Dr. Castellano, that normal people do not enjoy being reprimanded by children. If you feel so strongly about what happened, why don’t you speak to the head of your department? Or, for that matter, my department? Now if you’ll excuse me, I’ve got another patient in prodromal labor.”

He turned and started to walk calmly away. At first Laura thought to herself, prodromal labor means she won’t be ready for at least five hours. Why didn’t you at least flatter my intelligence by giving me a more plausible excuse for chickening out? And then she called out, “Dr. Lemaistre.”

He stopped. “Yes, Dr. Castellano?”

“Have you told the parents?”

“Yes. I’m not the kind of doctor who is afraid to convey bad news. And I’ve already placed the mother under sedation.”

“May I ask how you put it to them?”

“I said that the baby was born in very poor condition and our very best efforts could not sustain him. Would you have put it any differently, Dr. Castellano?”

Before she could reply, he had turned again and was nearly out of the room.

Laura stood there, too worn by her efforts, the baby’s death, and the postmortem dialogue to be able to think clearly. One of the O.R. nurses came up to her.

“Laura, please don’t take offense if I tell you Dr. Lemaistre is a skilled man—and a good man. I’m sure deep down he was as upset as you are. But none of us can do this kind of job and mourn for every one we lose. We would go mad.”

Laura mutely nodded her thanks. And as the nurse departed, she thought to herself, you don’t understand either, Sister, I’m not mad—I’m angry.

Up till now, Laura had taken a kind of perverse pride in the fact that she did not know how to type. It was yet another part of her self-assertion that she would not fit into the cookie-cutter stereotype of the “typical woman.” She therefore had to impose upon the good graces of one of the day nurses, just now coming on duty, to sit with her in the ward nurse’s office and type up a letter—in quadruplicate. It was addressed not to her own chief of Pediatrics and the chairman of Ob/Gyn—they of course would receive carbons—but to Ivan Caldwell, M.D., director of the hospital.

After relating the night’s events as concisely as possible, she asked Dr. Caldwell if he would take some action to avoid a repetition of “this sort of stupid, tragic ineptitude.”

The young nurse typed furiously to keep up with the swift flow of Laura’s outrage. As the nurse was reading back the letter, she remarked pointedly, “I think you left something out, Dr. Castellano.”

“Oh?”

“You didn’t name your next of kin.”

“I don’t follow. I’m not about to die, nurse.”

She shook her head in disagreement. “That’s not how I see it. I’d call this a suicide note.”

Laura was late for rounds, and so, as soon as she had addressed envelopes for three of the letters, she picked them up,
rushed downstairs to hand them to the hospital receptionist, and hurried to the Pediatric wards. She sleepwalked through the rest of the day.

She finally got off duty at five-thirty and went to grab a quick sandwich in the cafeteria.

Then, en route to her room, she stopped by her mailbox to see if there was yet any reply from Washington about her application to the National Institutes of Health. But there was only some junk mail (mostly circulars from drug companies), a phone bill—and an envelope with “Dr. Laura Castellano” written by hand.

She suppressed a yawn as she opened it but was wide awake by the time she finished reading.

She glanced at her watch. It was six-fifteen; barely enough time to go up and take a shower—and perhaps two aspirin.

The director’s secretary knew Laura’s name without having to ask when she arrived just before seven.

“Good evening, Dr. Castellano. Go right in. I’ll buzz Dr. Caldwell.”

Even before she had fully opened the door to the director’s office, she realized that this was not going to be an intimate těte-à-těte. On the contrary, it looked like a committee of white coats—or perhaps more accurately, a posse—had been organized to confront her.

“Come in, Dr. Castellano,” said the director, the only one in civilian garb, as he stood up politely. “Is there anyone here you don’t know?”

Laura glanced around the room. She recognized her Chief of service, Lemaistre, and his boss, but was unfamiliar with the bony, bespectacled, gray-haired woman who quickly rose and introduced herself.

“I’m Muriel Conway, head of Nursing.” She smiled, offering her hand.

“Please sit down, Dr. Castellano,” the director said, pointing to a chair at what had to be the epicenter of the large room.

She sat obediently, too numbed by fatigue to be nervous.

“Well,” Caldwell began. “I suppose you know why I’ve asked you to come by.”

“I think so,” Laura allowed, “but I’m kind of surprised that it’s turned into such a … group affair.”

“I thought the reason would be evident, Doctor,” the director replied, “for your unfortunate letter tacitly implicates everyone present.”

“With due respect, sir, I would apply ‘unfortunate’ to the
situation
my letter describes.”

The director let her comment fly past him. He then gave what he deemed the correct version of the situation.

“Since receiving your note, I’ve made a thorough investigation into the events of this morning and it’s clear to me that you’ve behaved extremely unprofessionally.”

What the hell is he talking about?
she thought to herself. She struggled to retain her poise, for her intuition warned her that Caldwell was trying to provoke her into an angry outburst so he could fire her on the spot.

But she surprised him by conceding, “I’ve thought about it, too, Dr. Caldwell, and I know I was intemperate. I should not have been so emotional in the O.R. It didn’t help matters any, and it certainly couldn’t bring the baby back to life.”

She paused and then added pointedly, “Only oxygen could have done that.”

This remark elicited a few uneasy coughs.

“Anyway, I’m very sorry I flew off the handle.”

“That’s very mature of you, Dr. Castellano, and I thank you. But I’m afraid you’re missing the larger point.”

“Sir?”

“We are conscientious physicians. And we’ve also, as the young people say, ‘lost our cool’ at one time or another. One of the great and inevitable burdens of this profession is that we often get emotionally involved with our patients.”

Dr. Caldwell leaned across his desk and said, “But it is a cardinal rule that one doctor never impugns another.”

“With due respect, sir, I’ve never read that anywhere. I mean, it’s certainly not in the Hippocratic Oath.”

“Dr. Castellano, I will not dignify that remark with an answer. Let me just repeat that it is universally accepted that
doctors must take for granted that their colleagues have the best possible intentions.”

“And what if you see a mistake that’s so egregious that you can’t accept this ‘article of faith’? I mean, if someone, say, saw a drunken surgeon kill a healthy patient?”

“Don’t be absurd, Laura. Then of course you would report that to his superior.”

He paused till he could discern a look of relief on her face, then added, “But never in writing.”

Again there was a sound of people shifting in their seats. The director rose.

“I think I’ve made my point, Dr. Castellano. Thank you for dropping by.”

As Laura was walking down toward the elevators, she felt a hand on her shoulder. She stopped. It was Dr. Lemaistre.

“Laura,” he said, smiling, “you are a very beautiful woman.”

“And what is that supposed to mean, Doctor?”

“It means you will have no trouble whatsoever finding another job for next year.”

B
arney had finally convinced Bennett to let him be present when the surgery was performed.

“What the hell good are you gonna do me when I’m out cold?” Bennett asked.

“But you forget my specialty is the unconscious, Landsmann. I might do a little groping in your brain while they’re working on your spine. Anyway, you know that doctors are always on their toes when they’re being watched—and I actually remember some of my neurology.”

“I’m sorry, Livingston, you still haven’t given me a convincing reason.”

“Hey, Landsmann, this may come as a shock to you because you’ve never heard the word, but I’m your
friend.
”

Barney won the day.

*    *    *

Barney was there to joke with Bennett as they administered the pre-op injection, and his was the first face his friend saw when he regained consciousness.

“How did it go?” Bennett asked sleepily.

“It went, Landsmann,” Barney reassured him. “Kirk tells me the pictures are pretty. No one will ever accuse you of not having a strong backbone.”

Bennett was quiet for a moment and then asked, “Can I withhold laughing at that?”

“For how long?” Barney asked.

“Till the neurologist confirms I can cut more than a Christmas turkey.”

“Landsmann,” said Barney affectionately, “you
are
a turkey.”

Bennett smiled.

But in the days that followed, Bennett did not smile again. Anxiety had made a prisoner of his facial muscles. Because he knew his whole future depended on a few basic and painful tests he would undergo at the hands of Laszlo Farkas, Yale’s senior neurologist.

Barney once again insisted upon being present.

“I’ve heard of Farkas,” he said reassuringly. “He’s got a great rep as a diagnostician.”

To which Bennett commented, “Unlike his rep as a human being.”

“How’s that?” Barney asked.

“He isn’t one,” Bennett replied. “You’ve heard of doctors who have nerves of steel. They say this guy has a heart of cast iron.”

“Screw his personality, Bennett. At least he won’t sugar-coat the truth.”

“I’m not sure I want to know the truth,” Bennett said with a sense of foreboding.

At first, it seemed that the icy-mannered Professor Farkas could speak only one word—and even that was in an unknown language. He prepared Bennett for an EMG (electromyelogram) simply by using a series of gestures interspersed with exclamations of “Aha” in various tones of voice. This definitive test would measure the impairment, if any, in the normal transmission of impulses from Bennett’s brain to his precious hands.