Living and Dying in Brick City (6 page)

I never learned for sure what happened in either suspicious death. At the time, I was shocked. But recent studies show that prescription drug abuse is the fastest growing drug problem in the United States, and deaths from overdoses of prescription painkillers are on the rise. In a November 2011 report that examined such deaths from 1999 to 2008, the Centers for Disease Control and Prevention called the problem an epidemic, saying that prescription drugs are behind the overall increase in drug overdose deaths. Even more startling, a greater number of people are dying from overdoses of prescription drugs, such as OxyContin and Vicodin, than from cocaine and heroin overdoses combined. The rise in prescription drug overdose deaths has been so steep that by 2008,
they were approaching the number of deaths from motor vehicle crashes, the leading cause of injury death in the United States.

A few weeks after Wayne died, I learned that another of our sickle-cell patients was his sister. Her name was Sarah, and she was in her mid-twenties, a few years older than Wayne. She had come to the emergency department for pain treatment that day and mentioned she had been struggling with depression since her brother’s death. Though Sarah and Wayne shared the same last name and had similar features—short and round with gold-colored skin—I’d never seen them together and hadn’t until that moment made the connection that they were siblings.

“I didn’t realize Wayne was your brother,” I told her. “I’m really sorry about what happened.”

Sarah, who always spoke in a soft, babyish voice, seemed distant and withdrawn. After that day, I noticed, she began careening downhill. I’d sometimes catch a glimpse of her, looking haggard and beaten down, a baseball cap or scarf pulled over her head, in a drug-induced sleep—or sitting in a daze on a hallway stretcher. This was doubly sad. Not only did both siblings have the same terrible, life-shortening disease, they both became addicted to painkillers … and perhaps more. I knew nothing about the siblings’ lives and struggles beyond the hospital, but I grappled with this question: Did we do more harm than good? We were supposed to help our patients, or at least do no harm. That’s what all doctors promise when we take the Hippocratic Oath.

A
s time went on, I grew more and more vocal among my colleagues with my complaints about the drug seekers and the anguish I felt prescribing narcotics when I had serious doubts about whether the patient needed it. One day, a fellow doctor blurted: “Just write the prescription. Why do you even care?”

I pondered that question the rest of the day: Why
did
I care?

The answer boiled down to this, I realized: When I was a naïve, impatient teenager, I’d walked away from drug dealing. I’d left behind the deceit and danger associated with that life and held on to hope that there was something better for me. I’d gripped every hand that reached down to pull me up and out. And no way had I come this far to end up in a fancy version of the hell I’d left behind.

At the moment, I wasn’t sure what, if anything, I could do. But I knew this: Remaining silent was no longer an option.

M
y exhausting twelve-hour shift at Beth was just a minute from ending one day in 2003 when I found myself in the center of a tragic reproductive mystery. The previous night had been a breeze—a few runny noses, a dog bite, and a couple of pediatric ear infections. As I glanced up at the clock one final time, the doors to my left swung open, and my replacement, Dr. Jones, strolled in, looking fresh and ready to take control. All I had left to do was sign out my two remaining patients, one of whom had an upset stomach that I was hydrating with saline and the other a heart patient with chest pains that we were monitoring closely.

In emergency medicine, the sooner you master the overnight shift, the better. But no matter how many times I worked it, I just never got used to staying up all night. This day was no exception. My brain had reached overdrive, and my red, bleary eyes gave away my exhaustion. I was just about to bid my colleagues good-bye when I heard a commotion brewing to my right. Looking past the tight circle of nurses, technicians, and residents, I managed to make out a woman slouched in a wheelchair being rushed into the department. Her head was flung backward, and her arms hung limply at her sides. She looked pregnant and appeared to be unconscious.
Instincts and adrenaline kicked in. Only a few feet separated me from Dr. Jones, who was moving toward us, but in matters of life and death, seconds are crucial. I was closer, so I sped to the patient’s side.

She appeared to be in her early-to-mid-thirties and about thirty to thirty-five weeks pregnant. As the staff lifted her from the wheelchair onto a stretcher in the resuscitation room, I started my rapid-fire battery of questions.

“What happened?” I yelled in the frenzy.

My colleagues chimed in what they’d been able to piece together quickly when they ran to the door after hearing her husband’s frantic pounding on the emergency room window: She’d suddenly started having trouble breathing at home, and as her husband was rushing her to the hospital, she lost consciousness. An emergency room respiratory technician delivered oxygen through a bag valve mask, a lifesaving device used to push air into the lungs. I instructed the junior resident to take over and the senior resident to prepare for intubation, the placement of a breathing tube into the patient’s windpipe or trachea. In search of a pulse, I placed my right hand on her femoral artery, one of the major blood vessels located in the upper thigh—but I felt nothing. I heard no heartbeat through my stethoscope either. There was no chest wall movement, no breathing. I started CPR and yelled for a nurse to page the obstetricians. An E.R. technician pulled a metal footstool to the side of the stretcher, jumped atop it, and started pushing on the patient’s chest, performing compressions as if his own life depended on it. This would help circulate the blood throughout the patient’s body and deliver it to her vital organs—the heart, brain, and kidneys—as well as to the unborn child. We had to get her blood moving; it was our only hope. The wait for the obstetricians seemed to take forever, but they arrived in only about two minutes, panting from their sprint to the emergency department. They
recognized the medical emergency right away. Seconds later, they were gloved, scalpels in hand.

The only chance of survival for both the child and mother was to deliver the baby immediately via C-section. Normally the surgery is performed with general anesthesia in a sterile operating room, but there was no time. It had to be done right then to allow the child a chance to breathe on its own. The obstetricians made a straight incision from the top of the patient’s abdomen down to her belly button. They cut the uterus in a similar fashion, pulled the baby from the womb, and cut the umbilical cord. It was a boy. His dusky purple skin was covered with blood and amniotic fluid. Miraculously, we managed to get a slight pulse and heartbeat, but even after we administered oxygen, the infant’s color remained dull. A nurse paged the neonatal doctor, who arrived shortly for a more thorough examination. I watched closely as the infant was placed onto warm sheets in an incubator and rolled away to the Neonatal Intensive Care Unit.

As the obstetricians did their part, tending to the baby, I did mine, caring for the mother. We tried epinephrine and atropine, squeezed a saline fluid through the central line, and kept up the chest compressions. Still, we got no response, no blood pressure, no spontaneous respirations, not even a flicker of life. There wasn’t a soul in the room who didn’t feel the weight of the situation, and no one was giving up. But unlike on television, the cardiac monitor didn’t suddenly start chirping after all the heroic medical measures. This wasn’t Hollywood. This was Newark. This was real life, and the flat line on the monitor wasn’t flinching. Sweat was now pouring from our foreheads, and all eyes remained fixed on the patient. But as the truth became evident, a few eyes began turning toward the floor. Our patient was dead. She had been dead when she’d arrived. I’d known it then but had been hopeful we could somehow trick death and snatch her back. I pronounced her dead at 7:45
A.M
.

Her husband was out in the waiting room, completely unaware. I asked a nurse to escort him to the family room, a more private place for relatives to receive news about their loved ones. The windowless room with its white walls and uninspiring canvas painting felt sterile and cold, but it was at least secluded. I stripped off my bloody gloves, scrubbed my hands, and took a deep breath, preparing for the most dreaded part of my job. The nurse soon returned with news that the husband was in the family room with two small children.

“What?” I blurted. “Two kids?”

As if her death were not tragic enough, she had two other children who had just lost their mother? What could I say to her husband? My head was pounding as I headed for the small room where they were waiting. I stepped inside and noticed two boys, who appeared to be about three and five years old, hugging the father’s legs. Both boys had to be the couple’s children; they were the spitting image of their mother. My presence made them uncomfortable, and they tried to hide their faces. I made eye contact with their father, Mr. Thomas, who looked up at me with an expression of fear mixed with hope that I’d never seen before. I stuck my right hand out to introduce myself.

Instead, he grabbed my shoulders and demanded, “Is she okay? Please, Doctor, tell me she’s all right.”

Before I could respond, he continued speaking, quickly, describing what had happened at the family’s home before he brought his wife to the hospital: “She said she couldn’t breathe, and I called the ambulance, but they never came. We waited and waited, but they never came. She looked like she was getting worse, so I took her to the car and drove her here as fast as I could. Tell me she’s all right! Tell me I did the right thing!”

I jumped in to assure him: “You did. You did do the right thing,” I said.

His words kept flowing. And the more I learned, the angrier I became that the city’s emergency medical system had failed this woman. She was a nurse, and she was in the final two weeks of her pregnancy, her husband said. The family lived in Newark, and he’d dialed 911 several times. Each time, a dispatcher informed him that an ambulance was on the way. Finally, he loaded his wife and children into the car, racing to the closest hospital. On the way, he could see his wife struggling to breathe, and just minutes before they made it to Beth Israel, she went limp. He kept calling her name, but she didn’t respond. He pulled up to the ambulance bay, jumped out of the car, and knocked on the window of the emergency department so hard that only the thickness of the glass had kept it from shattering.

Knowing how desperately Mr. Thomas had tried to save his wife only made the news I was about to deliver even more tragic. I’d needed to sit for this conversation, but Mr. Thomas had rushed over to me with the boys in tow.

“We did everything we possibly could,” I began, “and you have a new seven-pound baby boy. He was delivered by one of the fastest cesareans I’ve ever seen. Miraculously, we were able to get a pulse and blood pressure. He’s very sick, but he’s hanging on.”

I paused. “But your wife, she was unresponsive,” I said, continuing. “We did everything we could.”

The gravity of the situation seemed to wash over him. “What are you saying? My wife is dead?” He shook his head, looked at his sons, then to me again. “Are you sure?”

I nodded slightly. “Yes. Mr. Thomas, I’m very, very sorry.”

His expression, or lack thereof, is something I will never forget. An empty stare with depths beyond the ocean floor is the best way I can describe it. He looked at me with the saddest eyes.

“What am I to do?” he asked. “Tell me, what am I to do?”

“Mr. Thomas, you have a newborn son and two other little
boys who need you now more than ever. I know it is difficult, but you have to be strong.”

My words meant little. “You can take the baby,” he told me. “Without my wife, I can’t do it. I need my wife.” He looked around the room, and back to me once more, almost frantically. “Give me my wife! What am I supposed to do?”

I had no answers. All I could muster was a meager “one day at a time.” Mr. Thomas collapsed onto the striped beige sofa. Everything about his life had just changed with unbelievable abruptness. I knew he needed a moment alone with his children to grieve. I again expressed my sorrow, then left to call the medical examiner. Since Mrs. Thomas was a young woman with no known disease, her body would be held for an autopsy. Tests would have to be performed to determine the cause of death. I had absolutely no idea what they would reveal. Nothing made sense.

When I returned to the family room, Mr. Thomas was curled in a fetal position on the sofa; the children stood next to him. He opened his eyes and begged, “Please give me my wife’s body. Let me take her home.” He rose slowly and described a ritual that had been performed for generations in his native Haiti to loosen the seriously ill from the grip of death—prayers, a chant with a hymn, water and oils sprinkled over the loved one’s body. “I’ve never tried it, but I know it will work,” he pleaded. “Please give her body to me. I have to take her now if there’s any hope.

“I cannot take care of my children without my wife,” he continued. “I need my wife! How will the new baby survive without his mother?”

His words weighed on me. My shift was over, and so I just sat with him. I explained that the medical rules would not allow me to let him take his wife’s body home but that he would be allowed to see her and say good-bye. He was clearly on the edge emotionally, but I managed to get names and contact information for additional
family members. The staff kept their eyes on his children. The boys had just lost their mother and now watched in confusion as their father fell apart. Soon, other grief-stricken family members began to arrive. They were understandably in shock and repeatedly asked the same question that was on my mind: How did this happen? When I finally left the hospital, Mr. Thomas had been admitted for an overnight stay and was being sedated.