Twelve Patients: Life and Death at Bellevue Hospital (36 page)

“Yes,” he said, “I’ve done all the meds. But believe it or not, I’m feeling better. With Susanne. She has been the best treatment. I mean I was in emotional hibernation. She woke me up.”

I smiled and promised to come back with an update in a few hours. The cops were returning as I was leaving.

I went to see how Trauma Houston was doing. The decision to amputate Matta’s leg was not difficult. Everything below his knee was mangled, the vessels and nerves shredded by the steel bumper. I met him in the intensive care unit, heavily sedated, his mother by his side. Everyone understood he was a high-profile patient. She demanded every assurance that he would receive the finest treatment. Her children were just beginning to arrive from Brazil. She employed all of them and the in-laws in the family’s enterprises and kept a careful watch on everything and everybody. They were all exhausted. After I assured them that Diego would be well looked after, I promised to come back and left the room.

I called Marion from crime victims on my way down to my office. “Look, Marion, we got this trauma case overnight. Patient is in the OR and husband is a vet from the Middle East with a long history. Can you swing by soon and let me know your thoughts later. This is a really fragile situation.”

“Of course, I heard about the gunshot on 1010 WINS when I was checking for delays on the Long Island Expressway so I could plan my assault on Manhattan and how much coffee I would need, one gallon or two. I’ll check in and call you later.” Reed would need someone to talk to and sit with through this time when his wife’s life hung by a thread. Our therapists had seen just about everything that one human can do to another and helped to reconnect the pieces. They could help moderate the police interrogations and bring in additional help if and when it was needed. I couldn’t assess how vulnerable he might be, but there were people at Bellevue who could.

Patty knocked on the door of my office later that afternoon and ushered in Jon and the trauma surgeon, Elias. I shut the door. “Have a seat. Let’s go over Trauma Detroit from a couple of different points of view.”

Elias led off, “We think she’s doing pretty well at this point but things will be clearer by tonight and certainly by tomorrow. Transfusion reactions are usually pretty quick.”

“The surgical repairs? How are they going?” I asked.

“She’s back in the OR. Jamie is repairing the nerves now. It will also take time cleaning her out and looking for re-bleeding.” Our top surgeons were in on the case—that was a relief. Their experience came from the limb reimplantation program we had. Arms, fingers, limbs cut off by band saws, subway trains, machetes, knives, firecrackers, you name it. The limbs would arrive, packed on ice, in a cup, a bucket, wrapped in a towel, a lunch box; the team would spend the next twelve hours fitting the pieces together, vessels and nerves, bones and muscles, tendons and skin.

“Elias, for the record, what’s up with the other trauma case, Houston? I just saw him but I don’t have all the details. He was hit by a cab in Midtown, something like that. I have lost track.”

“Yeah, he stepped off the curb in front of the Parker Meridien just as a yellow cab screeched in to grab the spot. Bastard driver didn’t even get out of the front seat. He would have driven off except he was boxed in by a limo. One of the guys from the Meridien, the guys in the suits and top hats, pulled him out through the window and nearly took his head off. Ex-marine. Houston had his right leg de-gloved to the knee, all of the skin was flayed off, and crushed the vessels and bones below. We couldn’t repair it. It would have required twenty operations and even then it would probably still have to come off. Not worth it at the end of the day in my humble opinion. Houston opted for a guillotine, straightforward amputation.” His opinions were never humble, but they were dead-on accurate if you could discount the presentation style.

Jon jumped in before Elias finished. “Houston’s a young guy and will be playing tennis on a titanium prosthesis in a year or running in a marathon down in Rio. I heard he is a hotshot lawyer.” I’d figured from my glimpse of the family that he was a somebody. Besides, the Parker Meridien is not the local YMCA.

“Look, we need to talk about what you are going to say to the
Trauma Detroit family,” I said to Jon and Elias. “This is complicated and the husband needs an explanation. Not only is he dealing with the near death by exsanguination of his wife, but he’s also getting interrogated by the police like he’s some perp or part of a drug cabal.” I stopped at that point, and let them pick it up from here.

Jon jumped in. “Look, I fucked this up and will talk to him and explain what happened. I have been doing this for nearly twenty years and never, ever bypassed the sequence of checks before.” He was anxious, but I thought a little relieved to see that the goal of the meeting was not to hang him from the nearest lamppost. The old days of shame and blame in front of your peers had died a quiet death. There was nothing like public humiliation to burn a hole in your brain for a lifetime. It didn’t accomplish anything except make it even harder to find out what had
really
happened. It was the
Rashomon
effect, one event and ten different stories about what passed for reality.

“Guys, we saved Detroit’s life with rapid treatment, controlled the bleeding, brought in the best crew of über-specialists, and she will go home and have a normal life. I don’t know exactly why we have to beat ourselves up over this mistake.” Elias was out there on this one.

“Elias, we don’t mention anything about the transfusions and wheel her out of the door in a week and bask in the glow of another job well done? You have to be kidding.” I was getting tachycardic myself.

He jumped back at me. “Mistakes happen all the time, Eric. Do we apologize for giving a Tylenol instead of an aspirin? Do we flagellate ourselves over a chest X-ray done twice on the same patient because the order was picked up two times? Do we need psychotherapy for delays in getting patients to the operating room for their needed procedures because cases like this pop in and Jamie has been up for over thirty hours and can’t stand up anymore? Just tell me where you draw the line?” He was on a roll.

“I draw it at wrong blood for Detroit, for Christ’s sake, Elias. I know very well there is no black and white in the work that we do. Shades of gray, counterintuitive rules, lots of uncertainty, an over-reactive regulatory framework, complex systems of care, diffusion of responsibility, lack of clarity, a punishing legal system. I see the same
1-800 Sue Your Doctor signs on the subways that you do. I can also smell the trolling ambulance-chasing lawyers in their cheap baggy suits and shitty haircuts in the coffee shops hustling families for a piece of the action. Come on, I get all of that. But you cannot lump together mistakes of no consequence with this one. And by the way, every one of those mistakes of no consequence is an indicator. It sends a message. The next time it could be something a lot worse, a Detroit. Remember, we call them ‘near misses.’ Even the stupidest-appearing incident can send a message if you can hear it.” I was angry at Elias now. Jon got it, and was mortified.

“Her life was saved by outstanding medical care is my point.” Elias was retreating.

Jon joined us. “Look guys, Elias, we have to tell the patient what happened. In fact I have to tell her myself and not just for her but for myself as well. I’ve always considered myself a perfectionist. A lot of my colleagues call me a perfectionist asshole. Well, the asshole just got tighter. Let’s go.”

There was something to the personalities in the room that I deeply respected. Despite the bluster, it takes determination to get out of bed every day to do what they do with all the risks and at times terrible outcomes… then get up and do it again the next day. Decisions have to be made. Drugs have to be given. An electric cautery slices deep into a nearly blind space. When things go down it is in a split second. My job is easy.

Elias finished, “Jon and I will go and talk to the husband. We will go over the facts of the case from the surgery to the blood product errors. No apologies, just the facts and how she is doing. And we will keep him posted regularly and kept up to date.” I knew he got it all along. He had been furious—how to reconcile almost killing her when he’d been doing everything possible to save her life?

“Irony of ironies,” Elias continued sotto voce, “if she doesn’t have a substantial reaction it may very well be because she hardly had any of her own blood left in her vascular system.” I let it sink in as they left. She survived because she nearly died? That was the world we worked in.

I sat back in my chair and closed my eyes. It happened to be Tisha B’Av, the day of mourning, the Day of Lamentations for the loss of the Second Temple in Jerusalem over two millennia ago. I only knew that because my daughter, Marina, had been a religion major at college and had a project to educate me about my tribe’s history, rituals, and beliefs that began thousands of years ago. My mind traced a series of seemingly discordant dots. They left a contrail in my brain that I tried to stay with, to make some sense from the apparent randomness. Detroit’s veteran husband was being treated by being exposed to the trauma that had turned his legs into “armadillo” skin. The treatment was reimagining the event again and again, a little more each time, like turning up the sound, the brightness, until it lost its edge, its power, its force, its ability to dominate. This led me to the duty to “never forget.” The day, the loss of the Temple, the scattering of a people who lived cataclysms over and over again. But wasn’t this commemoration a form of transmitting trauma itself? A group psychopathy, passed from generation to generation. A vicarious type of PTSD visited upon the youth by the parents? How could re-exposure make you get better if continuous re-exposure could create the disease? It was confusing, and I was confused. Forgetting was a source of healthiness, or could be. Some treatments required remembering for trauma. Others required denial and forgetting for trauma. What about Detroit herself after this? Infusions of traumatic memories titrated to her heart rate? Or a pill that would obliterate her consciousness?

A few days after Diego’s admission, I went to the unit in the midafternoon. While still in the hall, I paused when I saw a willowy blonde sitting upright like a ballerina in front of a hospital adjustable bedside table covered with white linen, a bottle of red wine, bone china, and silver laid out like a four-star restaurant. She was eating slowly and methodically, as if this were the most natural thing in the world. A gourmet midafternoon lunch with views of the Empire State Building, Chrysler Building, and beyond all backlit with cumulus clouds lazily drifting to the east. Diego was prone in bed hooked to a morphine pump and intravenous fluids. His bed was covered with stacks of
newspapers in Portuguese, financial magazines and legal documents. His family was in absentia.

I hesitatingly slid the door open and entered.

The Mattas were from São Paulo; we communicated in Spanish since English was their third language. Diego looked up and said, “Hola, Eric, this is my girlfriend, Gabriela.”

I went over and shook the dyed blonde’s soft manicured hand. Her English was perfect, with a slight British accent. “Good afternoon, Doctor. I was expecting you. How is Diego doing? When will his wound be closed? When can we get on with therapy and a prosthesis?” She smiled. Too many questions, she acknowledged. We went through the basics and she continued to eat slowly and poured a glass of claret into a cut-crystal wineglass. On closer inspection, she was closer to the age of Diego’s mother. The visible effects of a fine plastic surgeon’s scalpel had removed age lines and the crow’s-feet around her made-up eyes. Without blinking, her vaguely expressionless face looked me over. The family’s absence was clear over the next couple of days. This was a family crisis, and the matriarch was not approving despite the blonde’s wealth from previous marriages and the bona fide beauty, certified by national pageants (thirty-plus years earlier). Half of the Brazilian government cabinet flew to New York to pay respects in the next few days. I figured if “wine and spirits” had been on the pharmacy list at St. Vincent’s hospital to prevent alcoholic church officials from going into withdrawal, then who was I to cork the bottle of deep purple Argentine Malbec Reserva and spoil the party for a family friend?

The next morning when I got to work, I met Susanne’s mother sitting in a chair just inside my office and shook her hand. She had arrived the night before. She was in her late fifties, wearing a designer knockoff, one of those non-wrinkle generic outfits adaptable enough to wear to shop, work, travel, or visit your daughter in a critical care unit in the oldest hospital in the country. The fatigue was leached from her face, which was carefully made up, everything in place. “My name is Margarita Ben-Habib Laurent. I want to talk to you about my daughter.” Her accent
was French. I nodded
of course
and arranged the chairs so we could talk comfortably. I offered her a coffee but she didn’t want anything, just my attention. I asked Patty to block all calls and visits. Patty didn’t say a word; she got it and quietly shut the door, leaving us in silence.

I decided to not say anything. This was her time, and I would go with her lead. “I saw Susanne this morning. She was awake. I only stayed two minutes. The nurses were in the middle of changing her sheets after the doctors had looked at the dressings. Just really poked my head in and we looked at each other. She needed to know that I am here.” I looked at her and listened closely.

“We’ve had a difficult time as a mother-daughter… team.” She got it out.

“I mean we have had a tough time. We communicate. We talk. We see each other. It has been so difficult. I got the call from Charles and all I could feel was guilt. A huge wall of guilt washed over me. Doctor, there were many times in the last few years when I didn’t care if I saw her again. Really, I know I must sound like a monster mother, not a human being really.” She looked up at me. Her muscles were tight, as if she were sitting in a vise. She was sitting at attention.