No Cure for Murder (11 page)
“It could be any number of things, most of them benign.”
“Well, let’s get to it.”
Three days later, Margaret Cohen came into Jacob’s office. “I have the radiologist on line two.”
Jacob’s hand hesitated over the handset.
“I’m so sorry, Jacob. Mr. Friedman has advanced carcinoma that involves a good part of the lower third of his esophagus.”
“There’s no possibility...?”
“None.”
I’m so sick of this, Jacob thought. Sixty years of small victories and big disappointments...swimming the currents of hope only to drown in a senseless sea of savagery...God’s negligence or nature’s cruelty...a distinction without a difference.
Josh and his wife Joanie sat across from Jacob’s desk. When Josh heard Jacob’s words, he paled and withdrew into silence. Joanie sobbed softly.
Joanie blew her nose. When she regained control, she stared at Jacob. “Today, with modern medicine, there must be something we can do.”
“I’m not saying that we won’t try to treat this. It’s just that our best falls terribly short. We’ll try chemotherapy and radiation and we have techniques to ameliorate problems caused by the tumor.”
Josh studied his old friend. “You’re omitting something, Jacob.”
“I know.”
“What is it?” asked Joanie.
“Cure...Jacob hasn’t used the word cure.”
Two months after completion and recovery from radiation and chemotherapy, Josh felt much better. “At least I’ve survived the treatment, Jacob. What’s next?”
“Watchful waiting. Enjoy your life, Josh. None of us really knows how long we have.”
“Right,” Josh responded. He paused and stared at Jacob. “I’ve signed an advanced directive for health care and a living will. I’ll sign or etch anything into my skull so that when the time comes, I can die in peace.”
“That should do it. It helps if you and Joanie are on the same page with this.”
“We made vows to each other, promises we intend to fulfill.” Josh reached over to his friend and physician. “We put our lives in your hands, Jacob. Now, I’m placing my death there, too. Don’t let me down.”
“Never.”
When Jacob entered Brier 515, Josh Friedman’s room, a sour-faced Marion Krupp followed. Joanie sat next to Josh’s bed, her head resting against his arm.
The once powerful man was skeletal. His weight had declined to 120 lbs. The tumor had recurred, completely blocking his esophagus, and forcing Jacob to place a tube above the mass, to remove Josh’s normal salivary secretions.
Jacob turned to Marion. “Why do you have his arms in restraints?”
“I was afraid he’d pull at his tube or his IV.”
“Take them off.”
“But, Doctor...”
“Damn it, I said, take them off.”
Marion sneered. “Yes, Doctor.”
When Jacob leaned over, Josh felt his presence and opened his eyes. His mouth formed a gentle smile. His lips were encrusted and dry, teeth stained with blood.
“When did he have his mouth care?”
“I was just about to do it,” said Marion.
Josh lifted his hand, making a come here gesture. When Jacob leaned over him, he whispered, “It’s time, Jacob. I can’t take any more of this...it’s time.”
“Is it the pain?”
Josh smiled. “It’s pain or coma. I can’t find anything between. Tubes, IV’s, restraints, spit running out of my mouth, and my own smell...I reek of death. I can’t stand it. Let me go, Jacob. I’m ready.”
Jacob turned to Joanie. “Joanie?”
She trembled. “Don’t ask me this, Jacob. I know what I want...what he wants...please don’t ask me.”
Jacob turned to Marion. “Let me have a word with you, outside.”
They stood in the corridor. Marion folded her arms firmly across her chest.
“I want you to replace the 50 fentanyl narcotic patch with the 100. How much morphine is he taking?”
“I’m giving him 50mg every three to four hours.”
“I’m amending the orders so that you can titrate his morphine dose up to 100mg every three to four hours. We have no reason to let him suffer.”
Marion reddened. “Absolutely not! I won’t be a party to your desire to kill Mr. Friedman.”
“I have no such intention. He’s suffering, don’t you think he’s entitled to relief?”
Marion placed her hands on her hips. “Don’t take me for a fool, Doctor. I’ve been around here long enough to recognize orders that will kill a patient. Those large doses of morphine will stop him from breathing...I won’t take part in that...it’s immoral.”
“If this disease isn’t frustrating enough, I have to deal with...” Jacob counted to ten. “Show me one study where a patient treated with high dose morphine for control of pain showed depression of respiration...you can’t...it doesn’t.”
Marion placed her hands on her hips. “I won’t do it. Get someone else.”
It’s later that evening when I arrive. I planned this timing with care, knowing that the night shift had just begun. They’ll be busy for at least fifteen minutes giving report. I walk down the hall looking over my shoulder then enter room 515.
How peaceful Josh looks.
He’s right on the edge.
Just a small step away.
This is too easy, I think, as I pull the syringe and insert the needle into Josh’s IV port.
Josh awakens. His eyes wander as if still dreaming then they fix on me.
He looks at the syringe then back at me.
“
What are you doing here?”
“
It’s okay,” I say. “It’ll be over in a moment.”
I watch his eyes widen as the syringe empties into his vein and he says, “No...no, it can’t be.”
As he closes his eyes, I lift his lids and watch as his pupils contract to the point of a pin and his breathing stops.
You’re free now!
When the night nurse entered Josh’s room, she knew. She touched his icy hand, listened to his chest, and shined her penlight into his dilated and fixed pupils. She dialed Dr. Weizman’s answering service. They told her that Dr. Spelling was on call.
Moments later, Zoe was on the phone. “Mr. Friedman’s gone. Do you want me to call the ER doctor to pronounce him?”
“No, it’s all right. I’m nearby. I’ll come up and do it.”
When Marion Krupp arrived for her shift the next morning, and heard of Josh Friedman’s death, she went at once to Gail Sergeant, the charge nurse. “I demand an investigation of Mr. Friedman’s death.”
“What are you talking about?”
“You may call it physician assisted suicide or euthanasia, or any damn thing you please, but I call it murder. You think that the staff doesn’t know what goes on at those ethics meetings. Somehow, the good Dr. Weizman always sides with death. I’ll see to it that your esteemed Jacob Weizman doesn’t get away with it this time.”
Chapter Nineteen
“Dr. Byrnes, Dr. Jack Byrnes, call ER stat,” blared the Brier Hospital speaker system.
Jack grabbed the nearest phone. “Dr. Byrnes, here. What’s up?”
“Dr. Hughes says it’s urgent. I’ll get him for you.”
Robert Hughes, director of the Emergency Department at Brier, trained in emergency medicine at UC with Jack and frequently referred patients to him.
“Sorry to do this to you, pal, but I have a Mrs. Mavis Smith down here that has overdosed.”
“What did she take and how bad is she?”
“She’s semicomatose. We have the empty prescription bottles, Valium, Theophylline, and a variety of antidepressants. I can’t tell yet whether her drug levels are rising or falling. You’d better come down.”
Jack turned to Ahmad Kadir. “Let’s go. We have an OD in the ER.”
When they arrived, the nurse pointed them to room two. Mrs. Smith was an obese female, age fifty-eight. She lay on the hospital gurney wearing a faded housedress. When they stimulated her to measure the depth of coma, all they got was a groan.
After a quick assessment, Jack observed as Ahmad inserted a tube into her stomach. Jack ordered charcoal instilled into her gastrointestinal tract to absorb whatever she swallowed then ordered IVs and diagnostic tests in preparation for her transfer to ICU.
Jack turned to the nurse. “Does she have any family?”
“A husband and two grown children.”
“Ask them to come in.”
Two minutes later, the door opened and her husband Horace entered with their adult children Randy and Lucille.
Horace wore dirty jeans, a plaid shirt, and a black leather jacket. He stared at Ahmad and pointed his finger. “What in hell is he doing here?”
“My name is Dr. Byrnes. I’m the medical director of the Intensive Care Unit. This is my assistant, Dr. Kadir. We’ll be taking care of Mrs. Smith.”
“Like hell he will,” said Randy. “We ain’t having no fuck’n A-Rab lay his murdering hands on my mother.”
Ahmad paled, but remained silent.
“I’m sorry you feel that way. Dr. Kadir is a skilled ICU physician, and I need his assistance in the care of your mother.”
“I don’t give a goddamn...” started Horace, stopped by Jack’s raised hand.
“Here are your choices,” said Jack. “As long as she’s under my care, I will treat her in any way I see fit and use the assistance of any physician I think helpful. You can fire me, find some other physician, or transfer to another hospital. You can choose to do that, but her condition is unstable. I don’t advise such an action.” Jack scanned the family’s faces and saw Lucille jerk her head diagonally. She wanted to talk. “If you’ll excuse me a moment.”
When Jack left the room with Ahmad, Lucille followed. “I’m so sorry, Dr. Byrnes. Just last week we received notification that Jesse, our baby brother, was killed in Iraq. It’s what set mother off. Of course I know that Dr. Kadir had nothing to do with this, but...”
“Dr. Kadir is a Palestinian, not from Iraq or Iran. You have no beef with him.”
“Please do what you can for mother. I’ll deal with Horace and Randy.”
When they wheeled Mavis away to the ICU, Lucille remained in heated conversation with her father and brother. The ICU nurses settled Mavis into bed five, right across from the nursing station.
Jack was completing his admission note when Ahmad approached. “Her blood levels are falling. If we can control any heart irregularities, I think she’ll do well.”
Jack nodded in agreement. “We’ll need to watch her closely. Check her mental status every thirty minutes.”
At 9 p.m., the family asked to see her.
“Only two at a time,” said the nurse.
Lucille and her tattoo-covered brother Randy stood by the bedside holding their mother’s hand.
Randy squeezed her hand. “Mom...mom...it’s me and Lucille. We’re here. You’ll be fine.”
Mavis groaned.
Ahmad approached the bed for his next thirty-minute check.
Randy tensed. “What are you doing to her?”
“Nothing,” said Ahmad, “I just need to check her pupils and her mental state.”
As Ahmad shined his penlight into her pupils, he felt himself jerked backwards by a strong arm and thrown against the wall, his head crashing with a blinding thump. He collapsed as the fist smashed into the pit of his stomach and felt the blinding pain as his nose exploded in agony.
Moments later, through blood-blurred eyes, Ahmad saw Brier security guards pulling Randy Smith away. Ahmad’s mind screamed with rage.
Mavis Smith recovered without incident.
Ahmad refused to press charges.
Chapter Twenty
Lola Weizman, after many years of rewarding but exhausting work as a psychotherapist, finally donated her tear-stained couch to The Salvation Army. She missed the best times and the closeness with her patients as well as the intellectual stimulation of the psychotherapeutic process. But being human after all, Lola found herself, on occasion, responding like the computer program Psyche: the ‘I sees’, the ‘what do you thinks’, and her all time favorite, the ‘tell me mores’.
“At least I still have the Berkeley Woman’s Mental Health Clinic to indulge myself and see patients,” she said to Jacob over breakfast.
“Don’t let this go to your head, but you were the smartest, most compassionate therapist I ever knew. They’re lucky to have you, even part-time.”
Lola met Elena, the clinic’s receptionist, with her favorite behaviorist greeting, “You’re fine; how am I?”
Elena smiled, not from the joke, she’d heard it a thousand times before, but from Lola’s warmth—her charisma.
“I’ve never heard that one before, Doctor. You’re getting to be like our Alzheimer’s patients, making new friends every day.”
“That’s an awful cruel thing to say to an old lady.”
Elena smiled. “Report me. She’s waiting for you.”
“Who’s waiting?”
“Sarah Hughes.”
“If I don’t come out in an hour, call the cops.”
