Suzy's Case: A Novel (19 page)

“The what kind?” Bert asks.

“Nothing, Bert,” I respond, underestimating him again.

“I need to think about this shit. You’re supposed to be my lawyer and you’re fucking forcing me to take, like, nothing while Betty gets it all.”

“Listen, Bert. I’m new to this case and these entries have been in existence long before I ever got involved. Don’t shoot the messenger.”

“Shooting’s not my style,” he says, getting up in a huff.

I look up at him as he’s standing over me. “I’ll need you to sign these documents should you decide to take the five percent.” I slide the general release and spousal release agreements I had Lily prepare in front of him. “Here. Take them home with you and read them. I’ll answer any questions you have. What it all boils down to is you’ll take five percent in full satisfaction of your claim. No rush. Just think it over. I’m here.”

Bert grabs the documents and crumples them the way one does when taking anger out on paper. “Fucker, this shit ain’t over,” he grumbles, then stomps out.

I open my bird’s-eye-maple built-in and my TV/VCR combo unit awaits me. I thought I’d never use it again after the advent of the CD, but that just goes to show you. I hit the power button and slip in the tape of Suzy’s fifth birthday party. I think this is the first tape I’ve ever played in my office that wasn’t a video surveillance of one of my clients exchanged by defense counsel, showing the HIC performing some activity they testified under oath they could not do.

The tape begins to play. Suzy is standing in front of a tree in what looks like a public park. She’s an obviously delightful little girl. She has pigtails with yellow bows that match her yellow party dress. She’s still got all her tiny white perfectly aligned baby teeth. She’s standing there as if waiting for something fun to happen. All her expressions exhibit excitement, anticipation, and exuberance. It’s hard to believe I’m looking at the same disabled, deformed child I just left back at Dr. Harper’s office.

After ten seconds, Suzy speaks in an adorable voice. “Is it on, Mom?” She’s gazing straight at the camera.

June’s voice responds. “It’s running, honey. Take it away.”

“Thanks, Mom. Hi, y’all. I’m Suzy Williams and today is my birthday. I’m five years old and we’re having a party to celebrate. I made my mom have it right here in Prospect Park, the most beautiful park in all of Brooklyn. Everybody from my kindergarten class was invited so nobody got their feelings hurt. Not everybody showed up yet, but it’s time to get my party started. We’re gonna play duck, duck, goose, pin the tail on the donkey, and I made a piñata all by myself out of papier-mâché that I filled with the best stuff I just know everybody is gonna love. My mommy is the cameraman and I love her so much for making my party dreams come true. Say hello to everybody in partyland, Mom.”

The camera moves off Suzy and the image flips around like the camera almost fell. June’s face comes into focus on a superclose close-up as she holds the camera on herself. “I love you, too, baby.” June smiles and wipes away a big tear from underneath her giant-sized false eyelashes. Then the camera flips back around, but not before I’ve noted June and Suzy are wearing matching outfits again. June looks good in yellow.

“You’re the best mommy. Make sure you tape as much as you can. I want to show my friends that weren’t able to come.”

I spend the next sixty minutes watching the most incredible five-year-old I’ve ever seen. She’s a superstar. Not only is Suzy well-spoken, but she spends her whole party making sure everyone else is having a good time like a perfect little hostess.

The tape ends with Suzy standing in front of that big tree again. June’s voice is heard. “I love you, baby!” The tape cuts off.

I’m numb. The girl in the tape was bright and engaging, filled with a love for life. The Suzy I know is retarded, as crude as that word may sound. Not to mention politically incorrect and insensitive. She’s a severely compromised, brain-damaged, spastic quadriplegic capable of saying only three words.

After viewing that tape, I have the feeling that Suzy’s hip to her situation. She’s aware that what she is today is not what she once was. Somewhere in her consciousness she recognizes how her life has changed. There’s a condition doctors call locked-in syndrome, and this resembles it in some small degree.

Two lives were lost when Suzy suffered her “complication.” No amount of money will ever give her or her mother back their worlds, but their quality of life certainly can be improved. From my dealings with children like her who rely on Medicaid, I know they struggle daily just to get the necessaries. If I can make a difference here, I’m going to.

I hit the eject button and take the tape out while thinking how excited Suzy got when she saw it. She watches it every day. Yeah, she knows about her predicament.

It’s time to search the records. The entry I’m most concerned about in the Williams file is the one made right before Suzy’s cardiorespiratory arrest or stroke. Or whatever it was.

I take out the records, place them in front of me, then put the empty file folder on the floor. The top two pages are the Discharge Summary. This narrative typically gets dictated and signed by the attending doctor just after the patient goes home or to the morgue, whichever the case may be. At the time of dictation the doctor is meant to go over the record to incorporate and summarize all the
salient medical findings, treatments, and diagnoses. I know for sure that if a medical error has occurred, it is known at the time the Discharge Summary is created. However, by this point in time the doctor has had the opportunity to reflect upon the mistake and so dictates the Discharge Summary from hindsight rather than the initial reactive impulse to the event. Meaning, this lapse in time offers the possibility of creative medical thinking.

Before I actually begin to read Suzy’s Discharge Summary, I scan it, looking for that configuration of letters that to me is the equivalent of a large pink elephant sitting on the side of a highway. The letters spell “iatrogenic.”
Iatrogenic,
defined medically, means an injury sustained during the course of medical care.

Defined nonmedically, it means the doctor fucked up.

Complication,
then, is the word doctors use to explain why the iatrogenic injury occurred. If I ever see either of these words—
iatrogenic
or
complication
—I can be sure a defense of the medical error has been set in motion by the doctor and/or the hospital’s Risk Management office during the admission. Risk Management is that department of the hospital that is set up specifically to deal with medical mistakes in the appropriate manner, whatever that may be.

My scan of Suzy’s Discharge Summary reveals a circus so populated by pink elephants that a cover-up would just be laughable. Starring in the role of top complication is her sickle cell disease. How convenient, but under the circumstances possibly true. I read the summary from beginning to end, noting the many defenses in the case, most of which I’ve heard already from my expert Dr. Laura Smith and that confirm the medical affidavit in defendant’s motion to dismiss papers. Dr. Laura, I note, offers a complication not even referenced in the Discharge Summary—the blood infection.

The only good news, as far as the case is concerned, is the overall big picture: Suzy presented to the hospital in one condition and left in a vastly different one. She walked in with a fever and was wheeled out with massive brain damage. This is a major point, regardless of whatever complications may have occurred, because the injury claimed is seemingly unrelated to her presenting condition. Also, young people
of relatively normal health tend to get better with hospital treatment, not worse.

The Discharge Summary indicates Suzy’s condition deteriorated day to day, going into cardiopulmonary arrest on the morning of hospital day three. I finish reading it and place its two pages facedown. Then I begin going through the record page by page in a quick and methodical manner. The stack on the left begins to shrink as the pile on the right grows.

I get to a nurse’s entry recorded at seven o’clock in the morning, but before I read it I take the next page off the stack, just to tease myself. Is it the one that documents the event? Yep. I’m excited to see how the moment is going to play out, but I’m willing to wait. You could call it record-reading foreplay.

The seven o’clock entry is a nurse’s note with an illegible signature, the first letter of which is
B
. It reads in its entirety as follows:

Patient be restless. Temperature be up and down all night according to night nurse. Her blood pressure be high and she be breathing fast. See the girl’s vitals chart. Patient says she has headache and sweating. She was comforted by me and mother is at bedside. Doctors on way doing their rounds.

The event entry is timed at 10:45
A.M.
and is authored by the Dr. Valenti whom June spoke of. It was entered into the record by hand after Suzy met with her cardiopulmonary arrest at eight in the morning. It reads in perfectly clear and legible printed handwriting as follows:

Patient seen by myself (Dr. Gino Valenti) at eight o’clock this morning with hematology residents (Gold, Hassan, Guthrie, Peck, Lim) during rounds. I was the covering physician for Dr. Wise. After review of chart and physical examination continuous cardiac monitoring was ordered by me to monitor the patient’s cardiac condition and vitals, which were of
concern. At or about the time the patient was hooked up to the monitor she fell into cardiac arrest. The event was acute and unpredictable. Advanced cardiopulmonary resuscitation was initiated and a code 99 was called (see code sheet for further details). The patient’s heart was electrically stimulated by defibrillation but she was without pulse for eleven continuous minutes (see code vitals chart). After being revived the patient was transferred to the pediatric ICU for further acute care. This author and residents did not witness the onset of the arrest. Cardiac monitoring was being initiated by the on-duty nurse, Nurse M. Braithwait.

The note is clear, concise, and without the flavor that sometimes can accompany an entry that follows a malpractice event. Dr. Valenti writes a tight motherfucking note. He even used the word
acute,
which, translated into English from medicalese, means there wasn’t enough time to help this little girl. He should’ve ended his note by writing “defense verdict,” to discourage would-be malpractice attorneys like Henry Benson from initiating legal action. But since Henry didn’t have these records reviewed by a medical expert
before
he commenced a lawsuit, as the law requires, it wouldn’t have made a difference here.

The only thing Valenti actually did wrong, as far as defending the case is concerned, was identify the only witness to the event: Nurse Braithwait.

I send an email to Lily telling her to serve defense counsel with a Notice of Deposition for this woman. She’s the only one who can shed any light on the situation, as far as I’m concerned, and I want to hear what she has to say. The thing about nurses is they’ll document someone else’s mistakes but are skilled at covering up their own. It was pretty obviously Nurse Braithwait who made that seven o’clock entry with the
B
name, but there’s no entry for her time with Suzy at eight o’clock when the event occurred, according to the timing of the Code sheet. Taking Nurse Braithwait’s testimony is going to be a deep-sea expedition, but that’s okay. I like to fish.

T
he streets down here at the tip of lower Manhattan are filled with hustle and bustle. And the dichotomy between the people is unavoidably obvious. The men and women in business suits are mostly in the financial fields and have a determined quickstep in their gait. As though if they got to work a minute later it would cost them millions. The people in plain clothes with a lesser pop in their step work for them. If they arrive late, they’re out of a job. That’s the feel I always sense when I come downtown for depositions at the law offices of defense counsel. Technically, these law firms are not in the financial field, but the insurance companies paying their billables indeed are.

The Staten Island Ferry has just let out a group of passengers and they’re filing down the off-ramp. It’s amazing to me that most of the women in the herd of people spilling out still wear their hair big, eighties style. And it’s not like the airing of MTV’s
Jersey Shore
brought that look back. On the island known as Staten, that hairdo never left. I by chance happen to see Jimmy Broderick falling behind from the pack as he slowly comes off the ramp. I know he’s going to the same building as me on Whitehall Street, so I’m hoping to intercept him before he enters, purely for entertainment purposes.

Jimmy’s what I call an old-timer in the legal defense industry. He’s been at it so long and is so jaded, he no longer believes any plaintiff is actually really injured. He doesn’t do medical malpractice defense
work, though, because he’s not smart enough, so I see him mostly on my construction accident cases, which are generally less intellectually challenging. He’s in his early seventies, has scabs on his right cheek from treatment for sun overexposure, always smells like a bottle of whiskey, and is smoking as usual. He stops before going into the building, flicks his butt to the curb, and pulls out another cigarette. Excellent.