Suzy's Case: A Novel (3 page)

“Me, doctor sir, mon?”

“Yes, you, nurse, thank you.”

“Ya, mon, doctor sir,” and she
click-click
s the machine into Suzy’s room.

Dr. Valenti turns back to June and, with a comforting look, continues. “Ms. Williams, everything is just fine right now. Suzy’s having some mild complications associated with her blood disorder, a little more serious than the ones that gave rise to her prior three admissions. There’s nothing to worry about. I promise. In a girl her age, this kind of thing will come and go. When she gets older, she’ll be at risk for more serious complications, but like I said, for now she’ll be fine. Would you mind waiting here a moment while I pull these residents to the side for some instruction?”

“You mean you’re going to talk about the bad stuff?”

“Now I see where Suzy gets it from, Ms. Williams. But no, like I said, at her age the complications from a crisis are relatively minor when treated. Suzy’s going to live a healthy and productive life. She’ll be giving you grandchildren whom you’ll be visiting one day at the White House during her presidency. I’m just going to do a little Q and A with my students. Okay?”

“Okay.”

Valenti and his residents shuffle a few steps to the left until they’re out of June’s earshot. “Okay, Gold,” Dr. Valenti queries, “can you tell us why I’m placing that wonderful little girl in there on a heart monitor?”

“To monitor her heart?”

“Very good, Gold. No doubt you’ll be discovering a cure for the common cold by the time you’ve completed our program.” Valenti turns to the next resident. “Dr. Guthrie, you’ve been quiet as usual. How are things this morning?”

“F-fine,” stutters Dr. Guthrie.

“Don’t be so nervous, Dr. Guthrie. Nobody likes a nervous doctor. Now, can you tell Dr. Gold and the rest of us why I just ordered a heart monitor? And please give us an answer incorporating the relevant information particular to Suzy’s condition.”

“Yes, sir,” Dr. Guthrie replies in a hesitant voice, not comfortable being the center of attention. “Suzy has sickle cell disease, which is an inherited blood disorder in which red blood cells are abnormally shaped. Instead of the RBCs being round, they’re distorted to the elongated shape of a sickle. A sickle is basically the shape of the letter
C
. Unlike round RBCs, which move easily through the body’s small blood vessels, the pointed and stiff sickle-shaped cells have a tendency to get stuck in these tiny capillaries. This can cause a sickle cell crisis which, technically speaking, is a vaso-occlusive crisis.
Vaso,
meaning vascular, and
occlusive,
meaning the inside of the vessel is blocked. So a sickle cell crisis is when the sickle-shaped cells obstruct the capillaries restricting blood flow to an organ. The lack of blood flow, known as ischemia, results in the deprivation of oxygen and can lead to organ damage. A sickle cell crisis can cause varying symptoms of pain to different parts of the body, depending upon where the vascular occlusion is.”

“Very good, Guthrie. Anything else you want to add?”

Dr. Guthrie nods. “The worst type of a sickle cell crisis is a sickle cell stroke to the brain. This is when the rigid sickle cells block the tiny brain vessels and the patient strokes out from the ischemia. Suzy doesn’t appear to be in this type of crisis, but, like all sickle cell patients, she’s at risk for developing a sickle cell stroke. The type of sickle cell crisis Suzy’s in is known as an acute chest crisis. This is caused by the trapping of the sickle-shaped red blood cells in her lungs, which obstruct the normal exchange of oxygen. The signs and symptoms of this are the exact ones Suzy is now exhibiting. She has difficulty breathing, is coughing, and has chest pains. When Suzy arrived here, she only had an elevated fever, which is generally the first indication that a child is going into crisis. So, Ms. Williams responsibly got her daughter here in a timely manner. Suzy’s constellation of symptoms,
however, evidences a worsening of her condition, putting her in a full-blown acute chest sickle cell crisis.”

“Dr. Guthrie,” Valenti interjects, “very good, but the question was why I ordered the monitor.”

“Yes, of course,” she responds, but before continuing she looks worriedly over to June, to the doorway of Suzy’s room, then slowly turns back to the group. “Without having listened to Suzy’s heart, I believe you ordered the heart monitor because her heart is beating faster than normal. Tachycardia can be an early sign of pulmonary congestion, when the sickle-shaped cells block the arteries that bring blood to the lungs. This causes the heart to beat more quickly as a compensatory measure in an effort to get more oxygen to the lungs. Like a heart attack, where the heart muscle is deprived of oxygen, the lungs can have a similar type of attack if they are deprived of oxygen, called a pulmonary infarction. A pulmonary infarction leads to a cardiopulmonary arrest, where both the heart and lungs stop functioning. An acute chest crisis that progresses into a cardiopulmonary arrest is the most common cause of death in sickle cell patients, so I believe you want to monitor Suzy’s heart to keep a watchful eye out for this.”

“Excellent, Dr. Guthrie. That was a textbook answer. I’m so pleased you switched your residency program from cardiology to hematology. You’re a born hematologist. Now let’s go back to Ms. Williams. It’s rude to keep her waiting there alone for too long.” The group shuffles back over.

Dr. Valenti faces June. “Ms. Williams, as I said, Suzy is going to be just fine. I’m going to put her on oxygen, which should help her breathe easier, and change her oral antibiotics to intravenous, upping her dose. I’m going to give her some fluids and medicine to dilate, or open, her lungs, which should also help with the breathing. I’m actually a little surprised Dr. Wise didn’t order these things earlier. It’s standard practice, but he’s the pediatric hematology expert, not I. I’ll make a note to discuss it with him.”

“Why isn’t my baby getting the standard care?” June asks testily.

“Dr. Wise is a good doctor, one of the best pediatric hematologists around. Maybe it’s because Suzy’s symptoms have only recently taken
a turn for the worse, but I don’t know. As I said, I’ll discuss it with him, but for now, no harm done. I can assure you of that. If things don’t improve, which I expect they will, then I’ll order a chest X-ray to look for a lung infiltrate.”

At that very moment, a loud shrieking scream blasts out from the room. It is Little Suzy. The echo of her cry can be heard throughout the entire floor and maybe the ones above and below. It’s followed by the accented screams of the nurse. “Help! Oh me God! Help me, doctor sir, mon! Help! Help me, God!”

June pops off the wall and barrels through the residents, knocking Dr. Gold to the floor. Dr. Valenti follows, high-stepping over Gold. All but one of the residents run around Gold into the room. The shy Dr. Guthrie freezes in place, incapable of meeting the demands of the evident medical emergency.

Upon entering the room, June and Dr. Valenti abruptly stop in their tracks at the horrid sight before them.

Suzy’s neck and upper back are freakishly arched off the bed. Her hair is standing on end and she’s shaking and convulsing uncontrollably, like the girl in
The Exorcist
. Her foaming mouth is wide open with no tongue in sight and her eyes have rolled back inside her head, with only the whites showing.

“Help me, mon!” the nurse screams, breaking the petrified silence from the corner a few feet away where she’s kneeling and using the heart monitor for cover. “Doctor sir, help me, mon!”

Valenti grabs a resident by his shoulders and speaks to him in a firm and controlled voice. “Call a code. Call a code. She’s in arrest. Get a code team here. Go now. Get a crash cart in here now!” The resident runs out.

Valenti swiftly moves to Suzy and presses her shoulders, forcing her jerking body down to the bed. He looks back and sees June standing there, her hands covering her mouth in shock and disbelief.

“Get her out of here! Get her out now!” Valenti demands as he struggles to keep Suzy’s jerking body pinned to the bed.

Dr. Gold, now up from the floor, rushes over to June Williams. “Come, come. You don’t need to see this,” he tells her. “Come outside
the room. Dr. Valenti will take care of it. You don’t need to see this. Come with me.” He guides June out with comfort and compassion as she instinctively resists.

Suzy is convulsing, her neck vaulted back unnaturally. Dr. Valenti rips the electrode patch with the lead wire off Suzy’s chest, tossing it backward. It slides along the tile floor toward the corner, underneath the cart, coming to rest between the thighs of the nurse, now kneeling in prayer.

Suzy abruptly stops her uncontrolled shaking, falling to the bed in apparent cessation of life. Valenti begins pounding the chest of her motionless body, attempting to jump-start the child’s heart so hard that ribs are surely being broken.

“Come on, come on, Suzy! Stay with us!” Valenti pleads, trying to beat the life back into her. He seals her mouth with his, gives a blow, causing Suzy’s chest to rise. This coincides with further “Help me, God, mons” coming from the corner behind the machine as the residents watch their mentor try to resuscitate the limp child.

The crude, barbaric-seeming chest pounding, alternating with mouth-to-mouth, continues for three more minutes until rushing footsteps are heard. A team of doctors hurries into the room wheeling a crash cart. Now it’s time for the advances of modern medicine to have a shot at saving the child.

The code team leader picks up the paddles. “Clear!” he yells, then presses them against Suzy’s chest, delivering a defibrillation shock that pops up her body. The nonlethal dose of therapeutic electrocution has no effect, so he again yells, “Clear!” and delivers a second charge. He steps back and looks at Suzy’s chest. “Ambu-bag her! Ambu-bag her!” Another code team responder secures a mechanical ventilation device over Suzy’s face and starts forcing air in her by squeezing the bulb.

The lead doctor puts his left arm under Suzy’s upper back and his right under her knees and lifts her limp body, cradling her in his arms. He quickly turns and dashes for the door with his second-in-command running alongside, bagging her.

They exit the room, heading past June. She’s sitting on the floor with her back against the wall and her head in her hands in the exact
place where Dr. Valenti had promised everything would be all right. June doesn’t notice as her near-lifeless daughter is whisked away by the dynamic duo of code team responders. She’s in shock and, by the looks of things, so is the motionless Dr. Guthrie, who is standing where she was when those double clicks were first heard coming down the hall. She watches the code doctors turn the corner, eyes hollow, in disbelief of what just happened.

I
’m standing near the corner of Twenty-Fifth and Madison on this bright sunny morning staring at the Beaux Arts–style courthouse just down the block, where it all started for me: the Appellate Division, First Department. The place where I was sworn in and admitted to the practice of law in the state of New York.

I never imagined it would also be the place where the practice of law could end for me, too.

As I wait for
my
attorney to arrive, so we can deal with certain allegations made against me, I see the street cart vendor who sold me a hot dog fifteen minutes after I took the lawyer’s oath. That was eighteen years ago. He’s stationed in the exact same place, at the curb in front of the courthouse steps. He looks exactly the same, too, just older with salt-and-pepper hair. Me, I’ve put on a few and now I buzz-cut close to my scalp what’s left of my hair, riding the cusp between fashionable and just another bald guy.

I take in the structure of that mighty courthouse, a New York City landmark. The front facade is dominated by an imposing triangular portico supported by six Corinthian columns. The message sent is
Don’t mess with the law
. But this particular building is more than just a courthouse that houses appeals, motions, and client complaints against their attorneys. It’s an elegant blending of art and architecture, and I count no fewer than twenty-five sculptured marble figures. They’re all over the place, on the steps, next to the columns, up on the
roof—allegorical figures such as Peace, Justice, Wisdom, and figures in legal history such as Confucius, Justinian, and Moses.

But one is missing. There should be a sculpture of a Herculean figure near the arched entry doors with a large marble erection in his masturbating hand because some of the lawyers forced to show up here by client complaint against them are just being jerked off because of a bad case result. A legal outcome that was inevitable the moment the client committed the act requiring him to seek counsel in the first place.

Me, I’m guilty of the charge. Unethical Conduct.

At least I admit it.

My lawyer arrives no time too soon, because you never want to be seen standing in the vicinity of this building on Friday mornings, the day when the Disciplinary Committee conducts hearings stemming from serious unethical conduct alleged by the client. The purpose of the committee is to protect the public by ensuring attorney adherence to the ethical standards codified in the Rules of Professional Conduct, “The Rules.” That’s why I insisted on meeting my attorney near the corner.