Trapped (14 page)

Chapter Twenty-Six

The first hint of potential problems with the Mayfields came with their suggestions. To everyone else, they were demands. The meals were unhealthy; could they bring in their own? Why didn’t they wait until Marla was awake before they took her vital signs? That orderly looked like a street person. Why didn’t the hospital provide more premium channels on TV
?

Soon, the staff counted the days, not toward her delivery, but to her discharge.

Harvey sat with Mike for their usual morning coffee in the doctor’s lounge.

“It’s amazing,” Harvey said, “that intelligent people like the Mayfields can be so blind about the effect they have on others.”

“They
’re not blind, Harvey, they just don’t give a damn. They don’t relate to others as fellow human beings, except to use them as objects for their own satisfaction. That makes them narcissists. I’ll bet you a dinner at Chez Panisse that if this delivery or this baby isn’t perfect in every way, we’ll be meeting the Mayfields in court. By the way, I’m taking the next month off.”

“Me too.”

They pointed fingers at each other, and laughed. Then Harvey said, “Then give them a perfect baby, Mike.”

“Okay, Harvey. I will
, if you get Marla to thirty-eight weeks, or more.”

Two weeks later, Harvey called. “Marla Mayfield is in labor.”

The problem
of trying too much becomes a double-edged sword. Practitioners saw it all the time when they took care of other physicians or their families. Every experienced physician said, “Treat them like everyone else and things will go well. Try too hard, and something will get screwed up.”

Mike came into the delivery room and greeted the Mayfields. Between contractions, he talked with them. “Twenty-six weeks is a lot better than twenty-four. The baby’s about three and a half pounds, and, so far, we see no signs of fetal distress. The baby’s small for his gestational age.”

“What’s the plan?” Donald Mayfield
asked.

“I’ll be right here during the delivery.” He turned and pointed to the door, “That’s Lisa Cooke, one of our NICU nurses
. She’ll be here with me. We’ll do a quick assessment, and then move the baby to the NICU.”

Marla’s labor progressed well, but soon the baby showed an ominous slowing of his pulse rate and the amniotic fluid showed the presence of dark green material, the contents of the baby’s intestine, called meconium.

Mike wanted to implore Harvey to get this baby out, but said nothing
—so much for treating the Mayfields like everyone else. Nevertheless, Harvey knew exactly what was on Mike’s mind.

Fetal distress and the presence of meconium in the amniotic fluid increased the risk. A baby so small
and in distress would likely need a tube placed in its windpipe.

With a last push, Marla finally delivered her son.

Mike looked at the tiny, green-stained, limp baby, and knew that the infant was in trouble. They suctioned vigorously, and then Mike said, “Get ready to intubate, Lisa.” Ten minutes later, with the tube in the baby’s the trachea, they prepared to move the baby to the NICU.

“How’s my baby?” Marla
asked.

“It’s too soon to know. He’s having breathing problems. We need to get him to NICU right away.”

Donald Mayfield’s cold stare startled Mike as he and Lisa rolled the baby out of the room. So much for that “open and friendly relationship”.

When they reached the NICU, Lisa settled in with the baby. They inserted IV lines, drew blood, ordered x-rays
, and attached an oximeter to the baby’s foot to monitor his oxygen saturation.

As Mike sat
before the monitor, looking at the baby’s x-ray and studying his lab data, Donald Mayfield entered the NICU. Mayfield stood behind the plate glass window, then raised his hand and flexed his index finger in a ‘come here’ gesture. Mike felt summoned, so he raised his own index finger in a ‘wait a minute’ gesture.

Two minutes later, Mike sat with Mayfield in the waiting room.

“What was his APGAR at birth, and at five minutes?” He demanded.

Here it comes
, Mike thought.

“His APGAR at birth was zero. At five minutes
, it increased to three, but we look at a broad spectrum of clinical indices to judge the baby’s risk. Remember, Don, that no index of any kind at this stage will interfere with all out maximal effort on our part.”

“That’s fine
, Doctor, but what about his neurological status?”

“Clinically, assessment is difficult, but I have the ultrasound tech on his way to look at your son’s brain.”

“What about an MRI?”

“I’ll order one when I think it’s needed.”

“When
you
think it’s needed?”

“Yes. I’m not moving your son to an MRI unit when he’s so unstable and I can get the information I need right at the bedside.”

“I see.”

“I hope so, Mr. Mayfield. You’re an intelligent and well-informed man, but sometimes a little knowledge can be dangerous.”

Mike looked for some type of reaction, but Mayfield’s face remained impassive.

“I’d like another neonatologist to consult on my son’s case, if that’s okay?”

“Of course. Whom do you have in mind?”

“I was thinking Ira Greenfield from UC Medical Center
, or Sharon Andrews from Stanford.”

“They’re both great choices. I trained with Ira, by the way.”

“I know.”

“I’ll call Ira first,
as he’s closer, and then I’ll call Sharon. These are busy people and I don’t know how available they might be to come over and see your son. If any consultant is to help with your son’s case, the earlier they see him, the better. You might consider some local neonatologist if these people are too busy.”

“Yes, I’ll do that. In the meanwhile, please keep me informed. As much as possible, I’d prefer
that the information about our son come directly to me. I want my wife to avoid this additional stress for as long as possible.”

Mike stood by the incubator for the next two hours. The ultrasound study of the baby’s brain showed no abnormalities. For the moment, baby boy Mayfield’s condition remained stable.

Lisa knew something was wrong when Mike returned from his discussion with Donald Mayfield. “What’s wrong?”

“Mr. Mayfield is a difficult
, demanding father, and a malpractice attorney, to boot. This is a high-risk baby, so we need to be especially careful.”

Lisa looked at him and felt his agitation. She smiled and said, “You want us to be especially careful
—not our usual level of carefulness?”

“Touché,” he responded, clutching his chest. “You’re right, of course. I promised myself that this would be just another case,
but it’s like trying to ignore that man with a gun at my head—impossible.”

He stood, preparing to leave the unit. “Anyway, our usual best is pretty damn good, don’t you think?”

“Yes, Doctor. I’ll call you if anything develops.”

Harvey called shortly after Mike returned to his office. “How’s the baby doing?”

“We deal with babies like this every day, but fortunately not with the likes of Donald Mayfield. The baby just got to the unit
, and he’s making suggestions and demanding consultants.”

“Stay focused, Mike. Don’t let him get to you.”

It’s a miracle, Mike thought as he returned to the NICU the next morning.

He felt a pang of apprehension when he approached Lisa. “Long time, no see,” he said as he kissed her on the cheek. “How’s baby Mayfield?”

“They named him Tanner, and he’s doing great.”

“Tanner?”

“Some kind of family name, I think.”

Mike studied the vital sign sheet, the lab data, and examined the baby carefully. “You’re right. He looks good.”

The ward clerk turned to Mike
, and said, “Dr. Russo on line two.”

“How’s it going Mike?”

“The baby’s doing better than expected. Maybe the fates are with us on this one.”

“The Mayfields are coming down to see their son.”

“Well, Harvey, this news should please them.”

“Don’t take anything for granted with them, Mike.”

Mike had completed examining his last preemie
, when the Mayfields entered the NICU. Marla smiled and waved. Donald looked at Mike and flexed his finger again.

There’s another digital gesture I’d like to employ in return
, Mike thought, but instead, he went to meet them.

“Your son is doing well. I examined him and reviewed all his tests, and I’m pleased.”

“Can we see him?” Marla asked.

“Of course.”

“Have either Dr. Greenfield or Andrews been in to see my son?” Donald asked.

“No. They’re both out of town at a research meeting. If you have other names, I’ll call and make arrangements.”

Mayfield said nothing.

Lisa made room for them at the side of the incubator.

“He’s so tiny,” Marla said. “I can barely see him through all the tubes and wires.”

“That’s normal for a baby born so early. He’s doing well.”

Donald moved beside Marla, looked at his son, and then stepped back. “What the hell’s going on here?” He yelled.

Mike and Lisa looked at each other in shock.

“What are you talking about?” Mike asked.

“What’s the matter with you people? Can’t you see that the baby’s having seizures?”

“What are you talking about? We’ve seen no seizure activity,” Mike said.

“I know convulsions when I see them,” Donald
said.

“What’s wrong with my baby? Do something, please
!” Marla begged.

“You’re getting your wife upset for nothing, Mr. Mayfield. The baby’s fine,” Mike
said.

“He’s shaking
—why aren’t you treating him? I want a neurologist, and another neonatologist, or there’s going to be hell to pay.”

“Please take this outside,” Lisa
said. “You’re disturbing the babies.”

“Like hell
, I will,” Donald said. “You people must be blind.”

Mike suddenly understood, and felt relieved. “Your son’s jittery, that’s all.”

“Jittery?” Marla asked.

“Lots of babies, especially preemies, have tremor
s, which we call jitteriness. It’s normal, and it’s nothing for you to be concerned about.”

“Jittery? Is that a technical term? What a load of crap that is,” Donald
said.

“First of all, keep your voice down. You’re disturbing the unit. If you don’t, I’ll call security and have you removed.”

“That would be the stupidest thing you could do, Dr. Cooper.”

Mik
e counted to twenty in silence. He took Marla by the arm and brought her to the side of the incubator.

“Watch what I’m doing,” he said as he turned the baby’s head toward them and lifted his eyelids. “Look at his eyes. If he was having seizures, you’d see the jerky motion there.” He then grasped the baby’s leg and moved it gently. Instantly, the tremors stopped.

Mike looked at Marla, then at Donald. “He’s jittery. That’s it. It’s normal. He’s fine.”

“I want a neurologist and an electroencephalogram, damn it
.” Donald screamed.

“Don, take it easy,” Marla
said. “Dr. Cooper knows what he’s doing.”

Donald shook his head and tried to approach the incubator. Mike put himself in Donald’s path, placed his huge hand against his chest
, and said, “Lisa, call security. Mr. Mayfield will be leaving.”

“You son-of-a-bitch,” Donald
cried. “When I get finished with you, you’ll wish you’d never been born.”

“That’s fine,” Mike
said. “I think we need to work on our people skills, Don. In the meanwhile, get out.”

Mike called Brier’s risk management department, explained what had happened, and told them to get ready for a lawsuit.

Later that day, Harvey called. “You had yourself a good day today, Doctor,” he said, laughing.

“It wasn’t funny, Harvey. That guy is obnoxious.”

“Marla wants to see you.”

“About what?”

“Don’t know. She asked to speak with you.”

When Mike entered Marla’s room, he felt relieved that she was alone.

“How’s Tanner?”

“He’s great.”

“I’d like to apologize for Donald’s behavior. He’s been under a lot of stress, but it was inexcusable.”