First Do No Harm (Benjamin Davis Book Series, Book 1) (3 page)

“Rosie Malone will be dead by Thursday.”

“Then Dr. Kelly won’t need to call an emergency meeting, and the transfer of Mrs. Malone will be a moot point.”

“I’ll bring my formal complaint to you by tomorrow morning.”

Laura was off all day Monday and could think of nothing but Mrs. Malone. She called the CCU nurses’ station twice, learning that the poor woman’s temperature was 105.1. Laura sat at her desk in her office and prepared the formal complaint against Drs. Herman and English for failing to transfer Rosie Malone to a better-equipped hospital. She kept her report simple, never questioning the surgery or its incompetent execution. She focused on the problem she could solve: getting the patient transferred. When she finished and reviewed it twice, she let Maggie read it. Both anticipated a huge backlash from the complaint.

First thing Tuesday morning Laura dropped off her formal complaint in Douglas’s office. She planned on visiting Mrs. Malone in the CCU but made a quick U-turn when she saw Dr. Herman at the bedside. At 10:30 a.m. Laura returned to the CCU; the coast was clear. She went to the nurses’ station and questioned the nurse on duty.

“How’s Miss Rosie doing?”

“Not good at all. Her systems are shutting down.”

Laura could barely keep from yelling. “Why in the world hasn’t she been transferred to Vanderbilt or Saint Thomas?”

The nurse shook her head. “That’s a question for Dr. Herman. He’s calling the shots.”

Laura looked in on the patient, now comatose. The more she thought about what was happening, the more pissed she got. Rosie Malone was about to die, and good medicine easily could have prevented her death. The system failed Rosie Malone. The system needed to be fixed.

The next evening, Laura learned that Rosie Malone, at the insistence of her daughter, Lorraine Burke, had finally been transferred to Saint Thomas by ambulance and had died on the table during emergency surgery. The Saint Thomas surgeon could not have done anything to save her at that point.

Dr. Lars Herman signed the death certificate on February 6th. He listed the cause of death as “cardiac arrest.”

Laura wondered how many other patients would meet the same unhappy ending within the walls of Plainview.

Dr. Herman pulled into his office parking lot just before 7:00 a.m. He loved everything German; he drove a German car and even looked Aryan. He had cropped blond hair and blue eyes. His skin was a pasty white. He was stockier and shorter than one would expect, at five feet seven inches, for a self-appointed German superman.

Getting out of the car, he removed a wrapped box from the backseat. When he entered the office reception area, three patients were already waiting. He smiled and said good morning to his first scheduled patient, Mrs. O’Malley. His receptionist, Sheila, was behind her desk drinking her second cup of coffee. Herman nodded to the other patients as Sheila gave him his morning charts.

He accepted the charts and handed Sheila the heart-shaped box of chocolates he had concealed behind his back. He then pulled a white envelope from his pocket and placed it on her desk.

In a deep voice that had a hint of a South American accent, he said, “Happy Valentine’s Day, my dear. Thank you for all your good work. Please take your husband out to dinner, on me.”

Sheila tore open the envelope to reveal a gift card
from Ruby Tuesday. She thanked him for the thoughtful gift and tucked the card in her purse before she ripped into the box of chocolates. Sheila was a large woman, weighing more than two hundred pounds. Herman doubted she would share the chocolates with waiting patients, let alone have leftovers to take home.

Herman grabbed a cup of coffee and entered his private office. He sat behind his mahogany desk and stared at the photos of his mother and his wife, Alice, before he got to work. He studied his appointment calendar and smiled. This would be a very busy and profitable day.

Sheila knocked on the door and waited for a response before leading Patricia O’Malley into the office. Dr. Herman oozed charm and confidence as his patient took a seat.

He reached into the glass candy canister on his desk, pulled out a pink heart candy with “Be Mine” written in faded red letters, and placed it in Mrs. O’Malley’s palm.

Mrs. O’Malley chuckled nervously but kept her eyes glued on the manila folder sitting on the desk. Herman’s lame attempt at humor had only marginally broken the ice.

“I have gone over your ultrasound results, and I’m afraid I have bad news.”

He moved from behind his desk and pulled a chair next to hers. He put his arm around her shoulder and held her ultrasound film up to the light.

“Can you see those dark spots?”

Mrs. O’Malley nodded her head as tears formed in the corners of her eyes. Her body began to shake under his arm.

“Those dark shadows are gallstones. I’m afraid your gall-bladder is diseased and has produced these calcified foreign bodies. These objects in your abdomen are the culprits of your pain and indigestion. We’re lucky we caught this in time. Left untreated, these could cause serious damage. One of these gallstones could get caught in your bile duct and your gallbladder could rupture. If we don’t intervene now, it could lead to a life-threatening situation. I recommend the immediate removal of the gallstones and your gallbladder.”

She wiped her eyes, and he could see the fear on her face.

“Am I going to die, Doctor? How can I live without my gallbladder? I thought my indigestion was getting better when I started drinking the pink stuff after every meal. The nerve medicine you gave me also seemed to help.”

He patted her hand reassuringly. “Don’t worry, Mrs. O’Malley. The gallbladder assists in digestion, but you can live a long and productive life without it. The Valium I prescribed will relax you, but that medicine can’t cure your gallstones. That will require surgery.”

“How much is this going to cost, Doctor? The county doesn’t pay me much to drive a school bus.”

“That’s not a problem, dear. Your insurance company will pay for everything except your deductible. Sheila checked, and since it’s still early in the year, you have $350 left of your $500 deductible. I’ll waive that portion of my fee as a courtesy to you.”

“Thank you, Doctor. That’s very generous. Bless you.”

“Here’s a renewal prescription for your Valium. Remember, I only want you taking them after work. The label specifically warns you not to take them and
operate heavy equipment. We don’t want you taking them and driving your school bus. You need to be alert, not relaxed, when you’re driving those kids around.”

She let out a deep breath and gave Dr. Herman a hug. She was glad he renewed her nerve medicine. It made her feel so much better.

“Will the surgery hurt? You know I don’t tolerate pain real good.”

“You won’t feel a thing. After the surgery, I’ll prescribe a powerful pain medicine that will keep you comfortable.”

He knew Mrs. O’Malley was sold. She would follow his advice unquestionably.

“I took the liberty of scheduling an appointment for you with Dr. Charles English. He’s the general surgeon upstairs and will confirm my diagnosis that surgery is your best option. Please take your ultrasound upstairs to him for review.”

“I don’t want another doctor. Why can’t you perform the surgery?”

“I’m not a general surgeon. But I’ll be there to oversee your recovery at the hospital. Don’t worry. Dr. English is an excellent surgeon. I send all my patients to him.”

“Can this wait until summer? I can’t afford to miss much work.”

“I wouldn’t recommend that. However, you won’t be off your feet very long. Dr. English is the only doctor in Plains County who can perform the surgery laparoscopically. Any other doctor would need to make an eight-inch incision across your belly to remove the gallbladder. Under those circumstances, you would be out of work for two, almost three, weeks. Dr. English will make only two small holes, each about the size of a
dime. In one hole, he will insert a small camera, which will let him see inside you. In the other hole, he’ll use a tiny laser to blast the stones and gallbladder into small pieces that your body will then absorb. With Dr. English’s method, you’ll be in the hospital one day, and you’ll be back to work within three.”

She was obviously relieved. Three weeks off work was more than she could financially handle. She thanked him and went upstairs to see Dr. English.

Herman owned the office building in which he practiced. He purchased the three-story building in 1990, when he first arrived in Plainview. Unlike most doctors, he was an exceptional businessman, capitalizing on all possible revenue sources. He knew it was smarter to own rather than to lease. His modest $20,000 down payment more than paid for itself. He borrowed the balance from the local bank, and the hospital guaranteed the loan. Herman was proud of the sharp deal he brokered.

His office occupied the first floor and operated virtually rent-free. His mortgage payment was covered by the rent generated from his tenants, Dr. Charles English, the general surgeon on the second floor, and an OB-GYN on the third floor. The hospital cosigned for those two doctors’ lease payments, minimizing Herman’s risk.

Putting a call in to Woody Douglas, Herman wanted to review the terms of the lease renewals for his tenants.

Woody himself answered the phone. “Lars, how are you doing? How’s business?”

“Couldn’t be better. This ultrasound machine is a cash cow. I’m thinking of getting another machine and hiring an operator, business is so good.” He only had
two hands, and he didn’t like leaving money on the table. “I just had a consult with a patient and diagnosed her with gallstones. I just sent her upstairs for a consult with Charlie. He’ll probably be scheduling her for surgery next week. It’s the perfect assembly line. I diagnose them, he cuts them, and we all make money.”

The conversation turned to the leases. Woody was unhappy about the terms, especially the rent increases. “I’m the one who set you up with both doctors. I know you’re getting a referral fee from them, Lars.”

My business relationships are none of your business. The hospital is benefiting financially from this arrangement, as are you personally
, thought Herman. He replied, “I’m the reason your income’s doubled. My ultrasound makes a lot of money for your hospital. It’s your job to make sure your pathology department keeps backing up my diagnoses of stones. Now just sign the goddamned leases, and let’s move on.”

Next he asked Douglas about Patel’s formal complaint concerning Herman’s care of Rosie Malone. The report had just come in, and the charges had been dismissed with no criticism of Dr. Herman or Dr. English. The findings concluded that during surgery, Dr. English had “inadvertently injured the patient’s bowel,” but that the “informed consent signed by Mrs. Malone had acknowledged that surgical problems, including puncture of the bowels and internal bleeding, were known risks of the procedure.” The Executive Committee report further stated that “the failure to transfer the patient to Saint Thomas until February 5th at 6:00 p.m. was within the standard of care because the patient was not stable and transport in an unstable condition had inherent risks.” The report concluded that
Dr. Herman, the treating physician, was “in the best position to evaluate whether to transfer the patient and that Dr. Herman used his best medical judgment.”

The rest of the day went like clockwork. Herman performed seven ultrasounds, at $1,500 a pop. He ended the day at six o’clock, earlier than usual, and hurried home to take his beautiful wife, Alice, out for a Valentine’s Day dinner.

Alice was waiting by the door when her tired husband walked in. She threw her arms around him before he could even take his coat off. She could feel the exhaustion in his body but knew his weariness was not the result of a long day at the office. Valentine’s Day was always a difficult holiday, but usually Lars masked the sadness.

Valentine’s Day was an annual reminder of Lars’s mother, Margot. It was the day she was horribly disfigured during the firebombing of Dresden in 1945. It was also the day of his father’s death. He was one of the many German soldiers killed in that horrific air raid. Valentine’s Day was never a celebration in the Herman household; it was a day of remembrance. Every year of his childhood, his mother took him to the beautiful Iguazu Falls near their home in Misiones, Argentina.

After a few minutes of chitchat about the day, Lars turned to Alice and asked, “Will you be my valentine?”

“Who else would be, Sheila?”

They laughed at the thought.

“Seriously, you’re the only woman who’s ever loved me, other than my mother,” Lars said.

“I wish I had met her. From what you’ve told me she was an incredible person and a great doctor. She would be very proud of you, Lars.”

“I wish she had seen me pass the FLEX exam and seen our dream came true. All she got to see was how hard I struggled.”

He started up the stairs and noticed a rectangular-shaped shipping crate on the landing. “What’s this?”

“It’s from Argentina. The return address is Uncle Wilhelm’s.”

Lars got a hammer and carefully opened the crate. As he suspected, it was a painting. He read the note out loud:

Lars began to cry. Although Alice made dinner reservations at their favorite Italian restaurant in Nashville, she went to the kitchen to take two steaks out of the refrigerator. There would be no restaurant visit tonight.