Could I Have This Dance? (44 page)

Tony huffed. “Right. Like I wasn’t really driving my car.”

Pinkerton held up his hand. “A rumor is circulating around the office about Roger Jones.”

“A rumor?”

“A well-substantiated fact, actually. Ramsey Plank’s paralegal told me that a tribunal has met and approved a malpractice suit on behalf of Sierra Jones.”

“What?” Tony sipped his beer and wiped his mouth with the back of his hand. “What’s that got to do with me?”

“If Ramsey can nail the university with malpractice, we’ll have another avenue to convince the jury that Sierra died because of faulty medical care, not because of the injury you caused her. It will go a long way toward getting a more reasonable charge. If they think that Sierra would still be alive unless some doctor screwed up, I’ll bet I can convince them that you can’t be held responsible for her death.”

Tony’s heart lifted. “Really?”

“It’s a hope.”

Tony smiled. Maybe old Pinkerton wasn’t so bad.

“Ramsey is the best. He specializes in nailing doctors’ hides to the wall. Malpractice insurance carriers have all heard of him.” Pinkerton straightened his shiny solid blue tie. “Ramsey can make a doctor’s life misery. He can make ‘em confess anything.”

Tony snickered. “Doctors make too much money.”

The attorney nodded. “Really.” He grasped Tony’s hand. “I’m going to do everything I can to get your trial delayed until after the malpractice trial. If they rule against the doctor, your jury will be much more likely to vindicate you.”

“Buy you a drink, Jeremy?”

Pinkerton frowned. “No!” He stood up and jostled Tony’s chair. “Come on, I’ll give you a lift home. We can’t have you getting another DUI now, can we?”

Tony stumbled out behind Pinkerton and laughed at the thought of a doctor being nailed, and how that might help his own cause. Tony hated doctors. He hated the way they dressed, the money they made, and the way they talked in big words which he didn’t understand.

Maybe slimy old Pinkerton wasn’t so bad after all.

Claire opened her eyes and squinted through the darkness at her bedroom ceiling. The night wasn’t over, but her mind wouldn’t let her return to sleep. The red numbers on the clock face seemed to mock her. Four-thirty. She would be on call the next night, and the knowledge that she might not get to sleep for another forty hours frustrated Claire even more. She rolled over and gripped her pillow. In another minute, she rolled back again and threw her pillow to the floor.

Sitting up, she rubbed her eyes and listened. All was silent outside, a fact that stood out in stark contrast to the lack of inner quiet in Claire’s soul.
Early awakening. Insomnia. It’s a classic sign of clinical depression.
She got up and walked across the cool, creaky oak floor.
It’s a curse to be an intern. You know just enough to torture yourself. Every time you have a common symptom, you’re sure you have some pathologic diagnosis.

She turned on the bathroom light and stared at herself in the mirror. She stuck out her tongue, then carefully ran her fingers over her neck and swallowed so she could feel for nodules in her lower thyroid. It was the week after her menses, so she proceeded with her monthly self-breast
check. She pulled off John’s jersey and watched carefully in the mirror so that she wouldn’t miss anything. She would repeat the exam a few minutes later in the shower, so a soapy lubricant could heighten the sensitivity of her exam.

It was a routine that Claire had followed since medical school. She was vigilant about her own health, wanting to practice appropriate self-examinations both as a part of proper health maintenance and as an example to her future patients. She’d started examining her own body parts as a way to learn what normal was supposed to feel like. She knew every inch of her well-built frame, and comforted herself in the even, firm texture of her own flesh beneath her fingers.

She checked her resting pulse rate. It was sixty-eight. She had been inconsistent with her running lately, but frequently avoided the elevator at work to raise her heart rate for a few minutes.

She looked at the dark circles beneath her eyes and yawned. The anxiety that had driven her from sleep was a cancer beyond her detection. A change in a mole could be detected by sight, prompting a biopsy. A colon cancer might cause a change in bowel habits or blood in the stool. A subtle change in a breast examination might hint at pathology lurking beneath the skin surface. But the thought that within every cell of her normal-appearing body, an abnormal sequence of DNA could be invisibly responsible for some horrible genetic illness seemed to be a deviation from the level playing field. It didn’t seem fair somehow, that something so horrible could lurk undetected for so long, only to raise its ugly head in midlife right when your life’s work was beginning.

Claire turned on the shower and waited for the steam to start clouding the mirror in front of her. She kicked John’s football jersey into the corner and stepped into the shower. There, she finished her monthly self-exam and tried to rinse away her obsession with her genetic future. She tried to concentrate on Dot’s advice.
“Use it as a springboard to walking in faith.”

As the water fell, she began to pray. “Please, God,” she whispered, “help me to trust. Help me to keep my mind on my work and be satisfied with not knowing.”

As Claire finished her preparations for the day, she thought back to all the other battles she’d waged in her young life. She’d slaved to get her GED, worked through college and medical school, and had matched into one of the most sought-after surgical residency programs in the world. In the past, she’d always tried to find a silver lining in every dark cloud. A stumbling block could be a stepping-stone, a sharpening tool to make her sharper, stronger. A lonely hilltop tree which meets the adversary of the
wind is always stronger than one in the forest. These were the attitudes that had helped her win. Now, she wanted to summon the same attitude to help her deal with the threat of HD.

But how could her risk for HD make her better, stronger? Claire dried her hair and decided to make a plan. If she wasn’t in control of the situation, at least making a plan would help satisfy the surgeon in her, and give her a feeling of power, even if it was an illusion. For starters, if anxiety about HD robbed her of sleep, she would use her waking hours efficiently. She could always study for her boards. And if her life was destined to be a short one, she would make the most of every day so she could accomplish everything she wanted to before it was too late.

She picked up John’s jersey and thought about her fiancé. He missed “the old Claire.” Claire the optimist. Claire wondered if she could recapture her optimism to fight her current trial. She folded the jersey and put it under her pillow before making her bed.

She made coffee and sat down at her desk, pushing aside her Bible and opening Sabiston. She did it with a twinge of discomfort, but thought about her commitment to being the very best resident she could be. Life may be short, so she couldn’t afford to slack off while she had her health.

Claire spent the next hour scribbling down facts about the dangerous skin cancer, melanoma. At five-thirty, she packed her call bag and headed for the hospital.

She met her chief resident, Drew Tripp, in the cafeteria. She approached his table. “Hi, Drew. You’re up early.”

Drew grunted and took a long swig of coffee. “Our liver resection decided to bleed at midnight.”

Claire looked at his unshaven chin and stared at the plate of eggs and bacon.
I hope you’ve got good cholesterol genes.
Claire knew the “liver resection” to be Lawrence Smith, a fifty-two-year-old asparagus farmer who had just returned from a cruise in the Caribbean, where he and his wife, Mary, had celebrated their thirtieth wedding anniversary. He didn’t recognize the jaundice right away. He thought he’d just gotten a good tan on the ship. By the time his wife’s tan had faded, he’d begun to itch from his deepening yellow color. He’d gone to his family doctor, who’d found cancer in his bile duct and referred him to the university for surgery. The chairman, Dr. Rogers, had resected the invasive cancer, along with a portion of Mr. Smith’s liver. Mr. Smith had endeared the house staff with his doctor jokes, and his constant complaining about the hospital food, and the green Jell-O that he called “cruel and unusual nourishment.”

She wrinkled her forehead and sat down with her breakfast, oatmeal and coffee. “Did you have to explore him?”

Drew shoved in a large bite of ketchup-laden scrambled eggs. “Yep. He bled from a portal vein branch. We stopped the bleeding, but not before he had a massive MI. He coded and died in the recovery room.” The chief resident shook his head. “Bummer.”

That delightful man dies after an operation you participated in and all you can say is “Bummer"? Will I ever get that callous?

Or is that what being objective is all about?

“That’s horrible.”

“Yep. And Rogers was already in a bear of a mood. He called a special meeting with all the senior residents later today to lecture us on legal risk management.

“Risk management?”

The solemn surgeon nodded. “He always gets this way when the university hospital gets sued.”

Claire felt a knot tighten in her stomach. “Sued?”

“Oh, I’m just guessing really. But I’ve been here long enough to recognize a trend. Every time the surgery department is threatened by a lawsuit, he briefs the house staff on damage control.”

“What do you mean?”

“The need for adequate chart documentation, confidentiality, never spilling any story about patients outside the hospital, etc.” He chuckled. “Mostly he’ll just want us to keep the interns from talking to the ambulance chasers.”

Claire stirred her oatmeal and replied quietly, “Oh.”

Drew tipped his head toward a man in a three-piece suit at a corner table. “See that guy?”

Claire nodded.

“He works for Ramsey Plank, attorney-at-law. He worms his way into the trauma patients’ rooms to convince them to file lawsuits because of their injuries.”

“What a leech.”

Drew sipped his coffee. “Really.”

“Why would an intern talk to him?”

“Medical malpractice suits in this state can result in huge profits for plaintiffs. And that means huge profits for their lawyers. The lawyers, in turn, don’t hesitate to pay handsomely for information that will result in big payoffs for their clients.”

“Hmm.” Claire’s oatmeal seemed too thick to swallow. She feigned nonchalance. “Any clue what a suit could be about?”

Drew seemed to be surveying Claire’s blouse. “Hmm?” He looked up. “Nadda. I don’t even know that there is one. I’m just making an educated guess, that’s all.”

“Oh.”

Drew rubbed his chin. “I need a shave.” He stood up. “I’ll see you in a few minutes for rounds.”

“Sure.” Claire looked down at her oatmeal.
Cruel and unusual nourishment.
She smiled to herself and shook her head.
Mary’s going to miss you, Lawrence. I know I will, and I only knew you for a week.

Claire pushed her oatmeal aside and looked over at an adjacent table of female medicine and pediatric residents. They were laughing and talking about men. She heard one of them complain about being on call every third night.

Good grief, girl. Try a surgical internship and we’ll show you what a real schedule is like, where the only thing wrong with every-other-night call is missing half the good cases.
She frowned and felt lonely. Only a few women from each medical school class decide to do general surgery.
It’s no wonder,
Claire mused.
It is almost impossible to pay attention to anything else during your training. Just look at me. I’m engaged, but I never see my man. And now that he knows my father has the dance, I’m not sure he’ll want to be my fiancé for much longer.

She stood and plodded toward the ICU so she could review a few charts before rounds.

A half hour later, Chris Bearss, the other intern on the service, arrived, looking as if he wore sleep as a cloak. His hair was combed, but his scrubs were wrinkled, and he carried a Dr. Pepper, his preferred breakfast beverage, in his left hand. He took a long swig of soda and stared blankly at Claire. He formed a word with the stomach gas which escaped as a belch. “Ralph,” he bellowed.

Claire rolled her eyes. “For a Harvard grad, you show remarkable talent.”

“My brother can recite the entire alphabet with one burp,” he responded, his voice showing hints of awe. “He’s one of the great ones.”

“You don’t get out much, do you, Pepper?” It was the name the Oman gave him when he rotated on the trauma service. It had stuck, and Chris didn’t seem to mind. In fact, nothing seemed to bother him. Once, during his first month of internship, on the neurosurgery service, he had eleven admissions in one day. He never even flinched. His resident just kept feeding him Dr. Pepper and pointing him toward the emergency room.

“None of us get out much. We’re terns. We’re not paid to get out.”

Claire nodded. “Rough night?”

“The usual.” He sighed. “Mr. Smith boned it.”

“I heard. I ran into Dr. Tripp at breakfast.”

“He had the gall to page me to the recovery room to dictate a stat death summary after the patient coded. Then, he stood over me, coaching me how to phrase everything, wanting everything documented, in case the chart is picked apart by an attorney someday.” He slurped his Dr. Pepper. “I’m not sure what’s going on at the top, but the sphincter tone is pretty tight in the chairman’s office right now, and that pressure is going to roll right down the pyramid.”

“So I hear.”

Claire thumbed through the bedside clipboards on the ICU patients while the rest of the team gathered. Claire and Pepper anchored the scut team with support from three medical students. There was one third-year resident and a chief resident over them, and four attending surgeons on the oncology service, including the chairman, Dr. Tom Rogers.

After a few minutes, Dr. Drew Tripp arrived to begin rounds. Lynn Nio, a third-year student, handed the chief resident a cup of coffee. He nodded. “Glad to see we’ve got at least one honors student among us.”