Oxygen (12 page)

Monday morning
we operate on a fifty-two-year-old grade school principal who came to our emergency room last night with cramping abdominal pain caused by a blockage in his intestine. When he wakes up his surgeon will have to tell him he has metastatic colon cancer. His plight should help me keep my own in perspective, but I have lain awake most of the night waiting for my lawyer’s office to open.

Mindy watches me like a mother cat with circling coyotes, smelling my distress. Bless her. I wonder if she would feel so protective if she knew what the autopsy report proved. Finally my pager goes off and flashes Donnelly’s number. At a quiet moment in the surgery, my patient gliding safely at cruising altitude on an infusion of drugs and gas, I punch his number into the telephone behind my anesthesia machine.

“You’ve read the report?” he says.

“Of course.”

There is a long pause, as if he’s waiting for me to volunteer something more. He must hear the high rhythmic beeping of my patient’s heart monitor in the background, the chatter of the operating room staff. Finally he clears his throat. “Well. This changes things. But don’t get too discouraged. I’m contacting a pediatric cardiologist to address the heart thing. We can mitigate the impact.”

“Mitigate?” The surgeon asks me to tilt the operating table and I put the phone down to make the adjustment. When I pick it up again Donnelly is already talking.

“…right expert can mitigate anything. Call Anne and set up an appointment for the end of the week. We’ll go over the report, talk about how we’ll be countering it.”

“I don’t have any time off this week. Could I meet with you on Saturday? It’s hard to keep dropping out of the operating room to come to your office.” My voice is tight. I feel like a child complaining about assigned chores or homework.

“Scoble knows how important this is. And not just to you. I’ll leave Friday open until I hear from you. Call Anne with whatever time you can work out.”

Am I imagining it, or is he sounding annoyed with me? I struggle to compose myself. “Fine then. I’ll see you on Friday.”

I’m about to hang up when he adds, “Marie, this isn’t going to be resolved quickly, and it isn’t going to be low stress. We’re here to help you, but I’d advise you to get used to the fact that a mediation process can be as rough as a trial.”

Mindy looks at me from her desk in the corner. I pull on new latex gloves and dive underneath the sterile drapes to adjust my patient’s breathing tube and IV lines, avoiding her eyes. I wish I worked in an office and could abruptly excuse myself to go to the bathroom. I hear her walk up behind me.

“I brought you another liter of fluid. Your IV’s running out. You OK?” She knows I don’t usually talk on the phone in the middle of surgery. She reaches above me to hang the clear plastic bag of saline from the pole above my patient’s outstretched arm, the loose skin above her elbow sagging in the way of a fit but elderly woman, a body losing pace with its own repair work.

“Thanks, Mindy. Maybe you could turn the music down some.” The forced rhymes of early eighties hits are grating on me.

“No problem.”

I hide my face over the anesthetic record on my table and start filling in the past few minutes’ worth of blood pressures and pulse rates, then realize I’ve messed the time lines up and have to correct each tiny mark. Ten minutes later Joe comes into the room and leans over my shoulder.

“Hey there. Why don’t you let me cover for you for a while.”

I jump back, startled, and realize how distracted I am by my conversation with Donnelly. My face flushes. “Mindy called you in, didn’t she? Thanks, Joe, I’m OK. I could use a favor, though. I have to go to Donnelly’s office sometime on Friday, and I’m scheduled for a late day. If you can get me out for a couple of hours, I’ll pay you back. I could take your late day next Tuesday.”

“Don’t worry about it.” He bends low over my desk so the others can’t overhear. “Look, there’s not much I can do to help right now. Someday it might be me who’s talking to lawyers and you can pay me back then.”

His sincerity makes me want to tell him about the autopsy, about this sense I’m getting that ultimately I will have to be my own defense—Donnelly’s goal will be to negotiate the lowest possible settlement, if he wants to stay on the hospital’s payroll. But all I can do is squeeze Joe’s hand.

I schedule another appointment with Phil Scoble, to talk about how to structure the time off I need for legal meetings. He sits on the corner of his desk dangling one leg over the side so his scrub suit pants scrunch up above his black socks and I can see the shiny, taut skin over his tibia. He rolls a crystal paperweight from palm to palm and every fourth or fifth pass it fractures the sunlight into a rainbow across the white walls.

“Why don’t you give more thought to taking a leave of absence? We could take it out of your sick leave—even hire someone temporary to fill in. Nobody would think less of you for it.”

“There’s no one out there to hire. Look how long it took you to fill the last vacancy. I love my work—I need my work. It may even look better to the mediator if I keep working. I just feel bad that my partners have to work harder when I’m away.”

Phil places the paperweight on his desk and folds his hands in his lap. He shifts and the sun silhouettes him so I can no longer read his expressions. “Donnelly tells me he doesn’t expect to go before the mediator for another few months. Marie, don’t underestimate the stress this might put on you. I want you to be considering all your options.”

“My options? What, like running away under an assumed name?” He doesn’t laugh—not that I’m sure I meant that as a joke.

“Do you want me to arrange for some counseling? Somebody from outside of the hospital?”

It’s certainly not the first time someone has suggested I talk to a counselor. I’ve thought of it myself. I
want
to talk about the academic facts of Jolene’s death. I want to discuss Turner syndrome and her cardiac abnormalities. I want to be adamantly, miraculously persuaded by another physician that in spite of those cloaked abnormalities my anesthetic management could never have killed her. Whatever collision of anatomy and medication occurred on the operating room table would have happened with any other anesthesiologist—Jolene was flawed, but I was not. I need to be told that the work I do sixty and seventy hours a week, the work I trained twelve years to master, is worthy. But I have no desire to probe the blurred boundaries that hinge my working life to my personal choices or my past.

“I want to keep taking care of patients, Phil. Just give me that chance, and let’s arrange some kind of payback for any time off I have to take.”

He stands up from the edge of his desk and walks to his chair on the other side. As he sits down and faces me again I can see all the features of his face, the deep-set creases of his professional, courteous smile, the parallel grooves above the bridge of his nose that reflect the gravity of his responsibilities. He answers me in a consoling tone. “Then you need to stay. You should stay. The hospital will stand behind you in whatever way we can.”

On Friday Joe comes
in to take over my case so I can make my appointment with Donnelly. He seems studiously nonchalant as he picks up my chart to look it over, protecting my privacy in the face of the surgeons and techs who wonder why I’m leaving in the middle of the day. But I notice a fine tremor across the papers he holds in his hand.

“Much blood loss so far?” he asks.

“Five hundred. But his starting hematocrit was forty-three and his heart rate’s stayed in the sixties. He’s typed and screened for two units if you need any. Thanks for covering for me, Joe.”

“No problem. Leave your pen, huh?” I’m almost out the door when he says, “Marie, let me know how it goes, OK?”

The women’s locker room is deserted between the eight-hour shift changes. I drop my scrubs into an overflowing laundry bin and put on a linen suit and high heels.

Donnelly’s office is only seven blocks down from First Lutheran. The plaza of his building is jammed with chattering coworkers headed out for lunch in the sun; I seem to be the only one going inside. I catch an elevator up to the twenty-second floor and step into the deep-carpeted, reverent hush of the reception area. Each of the firm’s eighteen partners has his name displayed in stainless steel relief against a cherry-paneled wall. The receptionist offers me coffee or tea or sparkling water, and then I wait, the two of us silent as churchgoers. She looks vaguely familiar to me and I wonder if I have ever anesthetized her. I open a
National Geographic
and begin an article about the space shuttle, but give up after reading the first paragraph three times. The cover photograph is of our cloud-enshrouded Earth drifting in a black universe. What speck am I, down there, on that spinning mass? What instant of my life passed as the camera shutter snapped closed? The instant of Jolene’s death?

Finally, on some hidden cue, the receptionist stands and leads me down the hall to Donnelly’s office. I hear the soft purr of an air purifier. The walls are lined with leather-bound legal books so densely packed and perfectly matched they could be hiding a secret panel, maybe a room from which other lawyers, other experts can observe our conversation. Donnelly folds his reading glasses on his desk and greets me pleasantly enough, closing the thick file folder in front of him and standing until I am seated in one of the silk-upholstered wing chairs facing his desk.

“Marie. Thank you for making the time. Can I get you anything to drink? You look well.”

I haven’t eaten or slept well in days, and I know my hair looks crushed and limp after being encased in a surgical cap all morning. But his voice has a reassuring resonance that recalls the invective prose of a Southern Baptist preacher.

“No. Thank you.” I scan the room and notice for the first time that nothing in here gives a clue about the personal life of John H. Donnelly, other than framed Ivy League degrees and original artwork. No pictures of wife or children, no golf trophies or gym bags, no photos of him shaking hands with mayors or sports figures. It’s as if he had been born and bred of law school and expensive, solicitous privacy. I wonder what the
H
stands for. He is looking at me, waiting for me to breach the polite chitchat and get to the point. I ask, “Have you talked to the pediatric cardiologist yet?”

“Extensively. He’ll be testifying for us.”

My mouth is suddenly dry. I find myself wanting to apologize for the missed diagnosis, as if he were a board examiner about to fail me. “John, I’ve spent every free minute since I read the report studying Turner syndrome and coarctation—Jolene’s heart defect. I feel terrible about missing it. It’s terrible every doctor who’s ever treated her has missed it. But I’m not convinced I would have changed my anesthetic. It made anesthesia riskier for her, and I would have gotten a cardiology consult and an echocardiogram. I concede that. But I might still have done everything the same way.”

I keep waiting for him to nod, or scowl, or smirk—give me some hint of his reaction to this. “Do you get what I’m saying? I don’t think Feinnes can prove it ultimately made a difference in her outcome.”

Donnelly leans over his desk and flips open a file folder. “The pediatric cardiologist agrees with that. But the real issue is that now the plaintiff, Darryl Feinnes, has something definitive to pin on you.”

“Wait. If an expert can testify that I still made all the right choices, even without knowing about her heart, how can I be any more liable than I was before we had the autopsy?”

“It goes to ‘breach of duty’ and ‘proximate cause.’ The autopsy gives Feinnes a much stronger case to argue that you failed to conform to the relevant standard of care by not recognizing the child had a heart defect, and that such breach of duty resulted in her death.” He cocks his head and watches me trying to process this. “Unfortunately, medical malpractice isn’t just about what is absolutely right or wrong. It’s about how successfully you can persuade a jury.”

“But there is no jury.”

“Not at this point. Hopefully never. But a mediator can be equally influenced. We’re in a betting game. It all comes down to who holds the strongest cards, and these autopsy results dealt Feinnes a royal flush.”

The absurdity and gut truth of it make me want to cry. They argue, all of them, as if any amount of money could repair Bobbie’s life or mine. What would all the lawyers do if I went directly to Bobbie, begged her to sit down with me, if she could bear being in my presence, and together we settled on the sum of money that would allow her at least a chance in life?

Donnelly says, “The plaintiff’s side, of course, has deposed their own expert. Do you want to see it?”

“See it?”

“The recording. Of his deposition. Then you can get an idea of what we’ll be rebutting.” He tucks his loosened tie back beneath a gold tie clip. The painting behind his desk rises to expose a flat-panel screen—he must have pressed something. A video begins playing with an initial jerk of the camera from a man’s folded and manicured hands up to his face, the focus moving in and out until it gels.

“Pediatric anesthesiologist from the East Coast,” says Donnelly. “Double-boarded in both specialties. Makes his living now traveling the country testifying in cases like this. Costs them a bundle, but he’s got an amazing track record.”

The witness starts talking, answering Feinnes’s questions in a rapid, certain voice that leaves no question of ambiguity or opinion. He has re-created the scenario from the operating room record, my anesthetic chart, pharmacy notes, and time estimates made by the multitude of extra hands who poured into the room when the code was announced—all composed after the tumult.

“I see no documentation that Dr. Heaton recognized this child’s preexisting cardiac abnormalities—a lapse in her responsibilities to her patient.”

“Dr. Heaton clearly misdiagnosed the earliest moments of pulmonary edema and impending cardiovascular collapse. Had she responded promptly enough, with more precision and familiarity with pediatric emergencies, Jolene Jansen would almost certainly be alive today.”

“Dr. Heaton has failed to recertify in pediatric advanced life support. While not required, it is a readily available course of instruction that could have saved this child’s life.”

He is as at ease with courtroom persuasion as I once believed myself to be with a difficult anesthetic. By the end of an hour of such unfaltering damnation I have lost any rational measure of my own competence or negligence. I cannot imagine facing these accusations before a jury or judge.

When the video ends I sit quietly, pulling at a loose thread on my blouse until the hem begins to unravel. The declining afternoon sun is making the room uncomfortably warm. Donnelly rubs an open palm over his face, then picks up a pen and begins turning it end over end against the polished desk; it clicks as rhythmically as a second hand.

“Well, you can see why he makes a profession of this.”

“Sure. He makes his career by ruining others’.” I recrease the blouse hem, unwilling to look up until I can compose myself.

After a pause Donnelly answers me with the first tinge of empathy I’ve heard today. “Look, Marie. I realize how vicious this feels. And I won’t minimize it—Feinnes will make this as painful as he can for you and the hospital. Your record has been clean until this. The nurses and Stevenson have said you handled yourself well in there. And of course we’ll be deposing our own expert. But a dead child. That carries so much emotional weight. We’re really scrambling for containment here.”

After a deep breath I meet his eyes. “Has Jolene’s mother seen the autopsy report, and this video?”

“She was at the deposition. Yes.”

I involuntarily cover my eyes with my hand, as if I could shut out the image of Bobbie hearing that her daughter died because of my mistake.

I can’t face the possibility of running into someone in the garage, of having to respond to anyone’s cheerful “How was your day?” I walk the ten blocks home. I’ll take a cab back to work tomorrow. The streets wind down past galleries and bookstores where hip young musicians and artists share sidewalks with unshaven men whose mongrel dogs wear signs asking for spare change or spare jobs, down to the piers where Seattle meets the sea. The deepening sky has lifted Mount Rainier right up off the horizon, a melting scoop of ice cream suspended in the city smog.

From the western-facing windows of my loft Elliott Bay casts the last blue reflection of sky, and the outer world is more visible than the interior. I don’t turn on any lights. I want to watch the glassy line between sky and reflected sky blacken and disappear. Tomorrow is Saturday, and I don’t have to work, I have no family responsibilities demanding my time or my money. I can stay home and sleep as late as I want, sit in my living room in pajamas until the sun is full up on the mountains, then walk down First Avenue to my favorite bookstore for espresso and the morning
Times,
or wander through Occidental Square to the antique stores—buy the Curtis photogravure I’ve been eyeing. I can drive my reasonably new and fully-paid-for car out to Whidbey Island or Port Townsend and go for a long run along the shore, then find a small inn where I can get a massage and have fresh oysters and a tiramisu brought to my room to be consumed with one of the unfinished novels stacked beside my bed.

I have worked and studied long enough and hard enough to have the luxury of options, sweet choices from a banquet of homes and vacations and cuisines. I have chosen my career, spiced with intellectual challenge and prestige and succor, conveniently garnished with a substantial salary. I have chosen the select friends I allow to become close, and packed the empty niches in between with framed professional degrees and purchasable clutter. If the mediation fails and we go to a juried trial, I could lose it all. And if all the money and possessions were stripped away, what, exactly, would be left?