Sisterhood (8 page)

Comfortable in the blanket of his own words, Huttner continued his presentation. “As always seems to happen when we work on nurses or doctors, everything that could have gone sour postoperatively seems to have done so. First, a pelvic abscess—I had to go back in and drain it. Next, a pneumonia. And then a nasty decubitus ulcer over her sacrum. Yesterday she developed signs of a bowel obstruction and I had to slip down a tube. That seems to be correcting the problem, and I have a feeling that she may have turned the corner.”

Huttner folded his hands on the table in front of him, indicating that his presentation was done. An almost imperceptible tic had developed at the corner of his right eye. He must be absolutely exhausted, David thought. Uncomfortable and anxious to do anything
other than stare, David returned to the chart. “If she needs to be operated on for the obstruction?” he asked, already praying it would not happen.

“Then you go ahead and do it if that’s your judgment. I’m leaving you in complete charge,” Huttner said somewhat testily.

No more questions, David resolved. Whatever you want to know, figure it out for yourself. Just get through this night.

But already another potential problem was becoming obvious. He tried to reason it through, but quickly realized that only Huttner could supply the answer. His resolve stretched, then snapped.

“If she should arrest?” he asked softly.

“Dammit, man, she’s not going to arrest,” Huttner snapped with startling vehemence. Then, sensing the inappropriateness of his outburst, he took a deep breath, exhaled slowly, and added, “At least, I hope she doesn’t arrest. If she should, I want a full Code Ninety-nine called on her, including tracheal intubation and a respirator if need be. Clear?”

“Clear,” David said. He looked down at the chart again. Whatever criticisms might be leveled at Wallace Huttner, undertreating Charlotte Thomas certainly could not be one of them. Thousands of dollars in laboratory work, hospital care, and radiologic studies had already been done. Still, at least on paper, the woman appeared far from “turning the corner.”

“Shall we go see the patient?” Huttner’s tone was more order than request.

David was about to comply when he noticed the report of Charlotte’s liver scan. The words burst from the page: “Multiple filling defects consistent with tumor.” Numbness crept over him as he stared at the reading. Rarely had he heard of a patient surviving long with the spread of rectal cancer to the liver. Certainly, with this kind of disseminated disease, there could be no way to
justify the aggressive therapy being given Charlotte Thomas. If, as in the Merchado case, this report had somehow been overlooked, whatever remained of his relationship with Huttner was about to disappear with the finality of a nuclear explosion.

“What is it this time, doctor?” Huttner asked acidly.

“Oh … probably nothing,” David said, wishing he were anyplace else. “I … ah … I was just reading this liver scan report.”

“Hah!” Huttner’s exclamation cut him short. “Multiple defects consistent with tumor, right?” He suddenly looked happier than he had all evening. “Look at the name of the radiologist who gave us that report. G. Rybicki, M.D., the living Polish joke of radiologic medicine. He read the same thing on a scan that we did preoperatively, so I checked her liver out carefully in the O.R. Even sent off a biopsy. They are cysts, David. Multiple, congenital, totally benign cysts.

“I even went to the trouble of sending Rybicki a copy of the pathology report,” Huttner continued. “He probably never even looked at it, as witnessed by this repetition of his initial misreading. Maybe we’d better just tear the report out of the chart.” He crumpled the sheet in a ball and tossed it into the wastebasket. “Now, if you have no further questions, shall we go in to see the woman?”

“No further questions, your honor.” David shook his head in amazement and smiled, grateful to be allowed off the hook. There was something about Huttner’s broad grin that went far toward dispelling the misgivings David had developed about the man.

Shoulder to shoulder, they walked down the corridor of Four South and into Room 412.

T
he only light in Room 412 came from a gooseneck treatment lamp directed at an area just above Charlotte Thomas’s exposed buttocks. Huttner strode to that side of the bed with David close behind and moved the lamp back a foot. He stiffened, then forced a more relaxed pose. Bewildered and somewhat amused, David stifled a smile at the man’s reaction; then he looked down at the reason for it. The bedsore Huttner had described as “nasty” was far worse than that. It was a gaping hole six inches wide. The walls of the cavity were raw muscle, stained white by a drying poultice. A quarter-sized eye of sacral bone stared sightlessly outward from the center.

Huttner gave the kind of shrug that said, “Nothing worse than other things we’ve dealt with, right?”

David tried to respond, but could manage only a shake of his head. He had seen sores and wounds countless times from every conceivable source. But this …

“It’s Dr. Huttner, Charlotte,” Huttner announced as he flicked off the lamp and turned on the dim fluorescent light set in a cornice over her bed. He drew the sheet up above her waist and stepped to the other side
of the bed. David followed, glancing at the I.V. bags and the restraints that held her on her side, at the urinary catheter snaking from beneath the sheet, at the oxygen and suction tubes. He understood the need for them and accepted their presence without a second thought. They were all as much tools of his trade as were the giant saucer lights and variegated steel instruments of the operating room.

However, in those first few seconds the one thing he noticed most about Mrs. Thomas was the emptiness in her face—a static soulless aura centering about her eyes, which were watching him through the dim light with a moist flatness. Even the sound of her breathing—soft, rhythmic cries—was empty.

Charlotte Thomas had The Look, as David had come to label it. She had lost the will to live, lost that extra bit of energy essential to surviving a life-threatening illness. The spark that was often the single difference between a medical miracle and a mortality statistic was gone.

David wondered if Huttner saw the same things he did, felt the same emptiness. Then, as if in answer to his question, the tall surgeon knelt by the bed, slipping his hand under Charlotte’s head and cradling it to one side so that she could look directly at his face. For nearly a minute they remained that way, doctor and patient frozen in a silent tableau. David stood several feet away, swallowing against the heaviness that was building in his throat. Huttner’s tenderness was as genuine as it was surprising—another facet had shown itself in this strange kaleidoscope of a man.

“Not exactly feeling on top of the world, huh?” Huttner said finally.

Charlotte forced her lips together—an unsuccessful attempt at a smile—and shook her head. Huttner smoothed the hair from her forehead and ran his hand over her cheek.

“Well, your temperature is down near normal today for the first time in a while. I think we might be getting on top of that infection in your chest.” He went on, carefully mixing encouraging news with questions that he knew would be answered negatively. “Is the pain in your back any less?” Another shake. “Well, if things settle down the way I expect them to, we should be able to get that tube out of your nose in a day or two. I know what an annoyance it is. While I have you rolled over like this, let me take a listen to your chest, then I’ll put you on your back and see if there ate any new noises in your belly.”

He examined her briefly, then glanced at the fluid levels in the intravenous bags and catheter drainage cylinder before kneeling beside her again. “You’re going to make it, Charlotte. You must believe that,” he said with gentle intensity.

This time Charlotte did manage a rueful smile to accompany her negative response.

“Please, just be patient, have faith and hang on a little longer,” Huttner implored. “I know the pain you’re going through. In many ways it’s as awful for me as it is for you. But I also know that bit by bit you’re turning the corner. Before you know it, you’ll be putting on lipstick and getting ready to see those beautiful grandchildren you’ve told me so much about.” He paused. In the silence David studied the man’s face. His brows were drawn inward, his jaw taut as a bow string. He seemed to be trying, through sheer will, to transfuse the energy of his words and hope. The woman showed no reaction. “My goodness, I almost forgot,” Huttner said at last. “Charlotte, you are in for a treat. I know how tired you must be getting of seeing my smiling mug every day. Well, you’re going to get a break from that.

“I’m going off to a conference on the Cape for a few days. This handsome young doctor will be covering for
me. He was the chief resident a few years ago at White Memorial. I couldn’t even get accepted for an internship there. His name’s David Shelton.” Huttner motioned David over to the head of the bed.

David took Huttner’s place, setting his arms on the sheet and resting his chin on them, six inches away from Charlotte’s face. It seemed to take several seconds for her to focus on him.

“I’m David, Mrs. Thomas. How do you do?” he said, realizing at the same instant that she had already answered his ill-conceived greeting several times. “Is there anything you need right now? Anything I can get for you?” He waited until he felt certain no response was forthcoming, then made a move to stand up. Suddenly Charlotte Thomas reached out a spongy, bruised hand and grasped his with surprising force.

“Dr. Shelton, please listen to me,” she said in a husky, halting voice that had its own unexpected strength. “Dr. Huttner is a wonderful man and a wonderful doctor. He wants so much to help me. You must make him understand. I do not want to be helped anymore. All I want is to have these tubes taken out and to be kept comfortable until I go to sleep. You must make him understand that. Please. This is torture for me. A nightmare. Make him understand.”

Her eyes flashed for an instant, then closed. She took several deep breaths and settled heavily back on the pillow. Her breathing slowed. It seemed to David that it might stop altogether, but within a minute a coarse, rhythmic stertor developed and held.

All David could manage was a whispered, “You’re going to be all right, Mrs. Thomas,” as Huttner took him by the arm and led him out of the room.

In the hallway the two men faced one another. Huttner was first to break the silence.

“Quite some night we’ve had for ourselves, yes?” he said, smiling his understanding.

“Yeah,” David answered. He pawed at the floor with one foot. He would have said more but for a persistent sliver of fear that he was about to come apart in front of the man.

Huttner scrutinized his face, then said, “David, never forget that many times patients with serious illness express the wish to die when they’re in a stage of weakness and pain. I’ve been around for a long time. I’ve seen many patients as sick or sicker than Charlotte Thomas recover. This woman is going to make it. She is to get total, aggressive treatment and, if necessary, a full-scale Code Ninety-nine resuscitation. Understand?”

“Yes, sir … I mean, yes, Wally,” David said mechanically, although he was searching his memory for the last time he had seen a sixty-year-old patient recover from the sort of severe, multisystem disease that beset Charlotte Thomas.

“We’re in agreement, then,” Huttner said, beaming with pleasure at having successfully made his point. “Let’s go write a few orders on this woman, then we can call it a day.”

As they approached the nurses’ station, David bet himself a guitar and six months of introductory lessons that the last critical moment of the hectic evening had passed.

An instant later, a portly man dressed in a turtleneck sweater and tweed sportcoat emerged from the visitors’ lounge at the far end of the hall and headed toward them. He was still thirty feet away when David knew with certainty that another wager had been lost. The anger in the man’s jaw-forward stride was mirrored in his reddened face and tight, bloodless lips. His fists were suspended several inches away from his body on rigid arms.

David glanced over at Huttner, who showed a flicker of recognition but no other emotion.

“Professor Thomas?” David whispered.

Huttner nodded his head a fraction, then moved forward. David slowed and watched as the two men closed on one another like combatants at a medieval joust. The grandstand for their confrontation was the nurses’ station, where several nurses, an aide, and the ward secretary fell silent, fascinated spectators.

“Dr. Huttner, what the hell is going on here?” Thomas lashed out. “You told me there would be no more tubes and I get here to find a red rubber hose coming out of my wife’s nose attached to some goddamn machine.”

“Now, Professor Thomas, just calm down for a minute,” Huttner said evenly. “I tried to call you last night to let you know what was going on, but there was no answer. Let’s go down to the visitors’ lounge, and I’ll be happy to go over the whole thing with you.”

Thomas was not a bit mollified. “No, we’ll have this whole business out here and now with these people as witnesses.” He gestured at the gallery. “I came to you with Charlotte because our family doctor told us you were the best. To me the best meant not only that you would be the best in the operating room, but that you would be the best at treating my wife—as a human being, not just as some unfeeling piece of … of
carrion
.”

The intensity and pain in Peter Thomas’s voice was startling. Behind the nurses’ station, Christine Beall cautiously turned her head toward Janet Poulos, the evening nursing supervisor. Poulos met her gaze impassively, then responded with an almost imperceptible nod. She was a slender woman, a decade older than Christine. Her coal-black hair was coiled in a tight bun, accentuating her narrow features and dark, feline eyes. A thin scar paralleling her nose gave even her warmest smile a slight sneer and undoubtedly contributed to her reputation among the nursing staff as being uncompromising and humorless.