Twelve Patients: Life and Death at Bellevue Hospital (24 page)

A gypsy cab careening around Grand Army Plaza broadsided a twenty-two-year-old bicycle rider on a bright Wednesday morning. He was brain-dead immediately from massive brain injury. The organ donor team met with his family at the local hospital. They agreed that the best that could happen from this tragedy beyond imagination was to allow other people to live. His organs went to save many lives.

We all did not know what to say after such a long journey with Soraya. We had held her hand and listened to her stories. We had adjusted her medications and moved heaven and earth to get her a heart so she could have some years that were joyful and lived without fear and the threat of death, rape, or harm to her children. We had given her a heart for Rabinal. A partial payment for the chaos and suffering that didn’t have a voice. She had never thought she would have any time of enjoyment in her life. She never entertained a fantasy of happiness, satisfaction, or relationships; she never thought that anything was owed to her. Everything was God’s will.

When we found out from the transplant team that she had died, a bit of all of us died at the same time. We know we cannot predict who will survive and who will not after a heart transplant. There are too many moving parts, too many variables, from technical complications to rejection, blood clots, and infections. But the futility of what we’d done overwhelmed us. The vast emptiness laughed at us.

The morning was a dense haze. It was the fifth day of a warm-weather inversion that encased the city in a thick gunmetal-gray shield. The air did not move, keeping ozone and car exhaust gridlocked over the city. People were edgy; the hospital was packed and the emergency rooms, overflowing. Special shelters were opened around the city to protect the weak and the aged. I stopped by my office briefly to drop off my sweat-soaked sport coat and slip on a clean white lab coat. I had a visitor waiting in my office anteroom. She had thoughtfully bought me a coffee and a cream-filled Italian pastry spilling from the napkins.

“Hi, Yolanda.” A big smile appeared from under her signature large dark Dolce and Gabbana glasses, and then the invariable hug. She showed me a quick picture of her newborn son and her fifteen-year-old wannabe-doctor daughter on her BlackBerry to catch me up on family matters as she followed me into the inner office. I took a couple of bites and a sip of the coffee as she brought me up to date on half a dozen of our recent patients in common. Yolanda Valera was the NYC Organ Donor Network’s Bellevue representative. More part of the family than an “official,” her business was always fraught and bordered on the outer limit of emotional tolerances. Hearts breaking all the time was too heavy a load for me.

“Hey, you emailed me about coming to the labor floor. That’s not your usual hangout,” I intoned anxiously. I sensed this could be a disaster with repercussions that would spin endlessly. The smile and a hug were no indicators, no matter the circumstances, and the circumstances on labor and delivery were a worst-case starting point. “Give me two minutes and let’s head upstairs.”

“I got a call from the head nurse, Anne. She’ll be here any second. She is with the family now explaining about a C-section with Dr. Girardi.” She took over now. “Anne gave me a heads-up call. The first brain-death study has just been completed and they have the C-section team ready to go.”

“You got a call about what exactly?” I didn’t have the time or energy to let this drag on.

Yolanda heard the edge in my voice and got very professional and technical very quickly. “A young woman, twenty-nine years old, was pregnant with her second child, in her third trimester, due in a few days at most, at home working in the kitchen, watching TV, on the phone, the usual stuff when she had a sudden severe headache and vomited over everything and everybody. Her mother was with her and had her lie on the couch and put a cold wet towel around her forehead. She came back within minutes from cleaning up the mess and she couldn’t wake her daughter up. An ICH.”
Jesus
, I said to myself. Intracerebral or brain hemorrhage. In a twenty-nine-year-old woman. What was going on? We strode down the labor and delivery suite and parked ourselves in the head nurse’s empty office.

At that moment Anne opened the door to her office and saw me; we nodded at each other. A thin attractive middle-aged Filipina with a ready smile and a pageboy haircut, she eschewed melodrama and focused on the business of taking care of patients. We had been colleagues for years and gone through many challenging battles over everything from late-term abortions to midwife-obstetrical-nursing turf wars that reminded me of the Thirty Years’ War. Not all hospital politics was benign and ended with a handshake. The thing that bound Anne and me together, more than anything, was only known to five other people and our respective spouses. We were members of the Platinum Club.

For several years we met with three to seven other staff members over a monthly lunch at the Greek diner across First Avenue at a corner table away from the crowds and noise. All of us had been diagnosed with cancer within a year of one another, and all of us had platinum chemotherapy. We christened ourselves the Platinum Club. Lifetime
memberships were all that were offered. There were no dues and no elections, no mailings, and none of the annoying mealtime fund-raising phone calls.

“Anne, what is happening now?” She was agitated; her face was always a dead giveaway to her feelings. It was one of the things I liked about her. She was professional but not an automaton.

“The family is devastated. They are crying and inconsolable at this point. It turns out the Sahagún family matriarch, the grandmother, is in our rehab unit now recovering from another round of surgery. She has been here on and off for over six months.” She paused for a couple of seconds to let it sink in.

“We got consent from the mother, Marta Sahagún, legally the next of kin, for the C-section to try to save the baby. No husband in the picture or significant other. That was our first priority. The baby’s life is giving them a focus and Dr. Roman is with them as my nurses are setting up the room for an elective C-section. Peds is already here to assist. Should be under way in ten minutes, no more.” The mother was like an incubator for the baby at this point. Her blood pressure and blood tests were normal. The fetus was getting what it needed from the placenta to stay alive for the time being. Anne was efficient and ran a tight unit, but she was stressed and I knew she was working on autopilot now. The radiation had taken its toll on her. The exhaustion was impossible to describe and it went on and on, month after month.

“Hey, Anne, you said Sahagún?” I said. This was not a common Spanish name.

“Yes, you know them, Eric. They asked about you already. I thought you had seen them by now when Yolanda told me you were texted. Marta and her crew are all in the doctors’ lounge. We gave it over to them. She may be a single mother who just lost her daughter, but she has worked at Bellevue for over twenty-five years. We had to set up limits on which staff could stop by. Everyone loves her. She is like the queen here. It is too much.” She was pretty depleted herself emotionally.

Marta was a
limpiadora
or housekeeper for the hospital way before I arrived. I had gotten to know her when she would sneak out the parking lot entrance for a Lucky Strike in the Sobriety Garden, the
space created by recovering drug and alcohol abusers in treatment at Bellevue. The handmade garden paths and artwork, Gaudiesque in their strangeness and munificence, were wedged between an exit ramp and the medical examiner’s new glass sarcophagus. I recognized her one day as I waited for a ride to take me to the city council. She had a lovely way of greeting everyone with the Caribbean “
mi amor
.” “Have a great day,
mi amor
…” How could anyone resist? So we started to talk and gradually got to know each other over several years with bits and pieces of conversations stitched together from waits for elevators, in line for coffee, in the medical library when she came to clean and I was holed up writing a paper, the errant cigarette in the Alice in Wonderland garden, and two years ago about her own health concerns.

Dr. Roman, the attending obstetrician, poked her head in the room. “C-section in five minutes.” We looked at each other and had nothing to say. She shook her head slightly and that was it. Many years of working together had given us an ability to communicate telepathically when necessary. This was one of those times. Anne reached into her desk and without asking handed me some fresh green scrubs. While she and Yolanda went out to sit with the family, I changed in her office and walked the fifteen yards down the main corridor of labor and delivery to the entrance to the operating rooms.

Perry was the senior OB anesthesiologist. He wore wire-rimmed glasses and was tall and lean; he never aged. He was already checking the lines and numbers on his brand-new Dräger anesthesia machine with a young female resident in scrubs and a heavy teal sweatshirt he was supervising. On the operating room table covered with several blue paper sheets was an enormous mound of a person. A quick guess put Irene Sahagún at close to 250 pounds. A huge round ball of a human being with an enormous panniculus (belly) that moved with the force of gravity, sliding and hanging from her small frame. It was impossible for the surgeons to lean over the patient and proceed safely. This was not going to be a three-minute slash-and-burn emergency C-section with an infant’s heart decelerating and the time ticking mercilessly.

Dr. Roman asked one of the general surgeons who specialized in bariatric surgery to join her. Manish Parikh came in the room gowned
and ready to operate. “Let’s try this bariatric-style,” he said after a quick glance at the patient and the room. He organized everyone to slide the leg pieces on the table apart and cushioned Irene’s legs in extra sheets and soft blankets.

During the procedure “time-out,” all of the patient’s identifiers are read out and signed off by the treating team. Parikh started, “Holy… Sahagún. I operated on her mother a year and a half ago. I know this woman.” He backed out for a few minutes, went outside, rescrubbed, and came back in. “Okay, sorry about that, ready now. Let’s do the time-out again.” His voice was controlled, but the humor and banter with the staff were gone. It was going to be all by the book. You could only hear the circulating nurse’s booties scuff the linoleum floor as she walked around the room and some rustling and muffled single-word comments from anesthesia.

Parikh knew they had time. The baby was well oxygenated. Its heartbeat could be heard and seen on another monitor looking at the fetal heart strip. They divided up the tasks quietly and efficiently. After a careful dissection through a foot of white and pink fat tissue with tiny red pinpoint bleeders cauterized on the way down, they reached the dusky red-blue uterus. Dr. Roman took over and quickly had a little girl by her feet and then in her arms. Brenda swooped in from peds and took over with suctioning the mouth and handling the baby. She was pink and breathing and squawking.

It was time for me to go and see Marta and her friends. The baby would be fine, in the neonatal intensive care unit (NICU) for a couple of days and then to the nursery. Who would be looking after the baby was another matter. Marta had a million issues to deal with. Now a million and one.

I pushed open the door to the doctors’ lounge across from the nursing station. Marta was seated near the window overlooking FDR Drive snaking southward toward the Brooklyn Bridge. Techs, supervisors, hospital police, messengers, transport, nurses, translators, social workers were all in their uniforms filling the rest of the large conference room. I recognized most of them, and the room fell silent. My eyes locked on Marta, and I went over and hugged her tight. Her tears said it all.

“Marta, your new grandchild is fine. A little girl. Does she have a name? She is with the pediatricians and on her way to the NICU, we can go there a little later and you can hold her.”

“Dr. Eric, I don’t know what to say.
Mi amorcita
was fine. She had a headache, I mean a really bad headache, she was pale and cold. I put her down to rest and three minutes later she was lifeless.
Mi amor
…” I held her hand and rubbed her back. The friends stood back a little and let us be together while they talked in the background.

“Isabela. Isabela is what Irene wanted to call her. Her great-grandmother’s name, a
partera
, a midwife from another time completely.” She dried her tears and looked around the room for a moment. “
Yolanda, por favor
.”

Yolanda and Anne slid their chairs closer. “Marta has agreed to donate her daughter’s organs, Eric. We talked about what Irene would have wanted.” Yolanda had Marta’s other hand in hers, and her arm was around her shoulders. The two came from similar impoverished backgrounds in the
campo
, the countryside, in two different countries. They had both struggled to make it through hard work. One had an extended social network through hundreds of daily encounters over the years at a big public hospital. The other through hundreds of visits with complete strangers at the most difficult times of their lives in the same big public hospital. In the end it was all about “
mi amor
” one way or the other.

Six months earlier, I had found an envelope in my inbox with my name written in block letters: “Doctor Eric.” Inside there was a note on paper ripped from a grade school notebook in Spanglish.
Por favor, Doctor, mi mama is in hospital, Cuarto 1024. Can you see her. Olimpia Gutierrez.
Signed
Marta Sahagún, the cleaning lady
.

I took it into my office and tried to remember Marta Sahagún. And then an image came back of a smiling, very large woman with a big laugh and husky voice and a cigarette cough who pushed her heavy yellow-and-black plastic cleaning cart quietly through the halls. Though invisible to most people, Marta had enormous dignity and
goodwill that added a comforting feeling to the medicine floors. She was middle-aged with jet-black short hair and bright red lipstick on her lips permanently in a half smile. She felt proud to have a job at Bellevue Hospital. “
Dios mío
,” she would say, “with all of the great doctors and patients from around the world.” I hadn’t seen her in some years.