Cook,Robin - Mortal Fear.txt Read online

  pain was still there, and the anger, too.

  "Excuse me, Dr. Howard?"

  Jason looked up into the broad face of Kay Ramn, the unit secretary.

  "Mrs. Harring is in the waiting. room," Kay said. "I told her you'd be

  out to talk with her."

  "Oh, God," Jason said, rubbing his eyes. Speaking to the relatives after

  a patient died was difficult for any doctor, but since Danielle's death,

  Jason felt the families' pain as if it were his own.

  Across from the coronary care unit was a small sitting room with

  outdated magazines, vinyl chairs and plastic plants. Mrs. Harring was

  staring out the window that faced north toward Fenway Park and the

  Charles River. She was a slight woman with hair that had been allowed to

  go naturally gray.

  When Jason entered, she turned and looked at him with red-rimmed,

  terrified eyes.

  "I'm Dr. Howard," Jason said, motioning for her to sit. She did, but on

  the very edge of the chair.

  "So it is bad ..." she began. Her voice trailed off.

  "I'm afraid it is very bad," Jason said. "Mr. Harring has passed away.

  We did all we could. At least he didn't suffer." Jason hated himself for

  voicing those expected lies. He knew Cedric had suffered. He'd seen the

  mortal fear in his face. Death was always a struggle, rarely the

  peaceful ebbing of life portrayed in film.

  The color drained from Mrs. Harring's face, and for a moment Jason

  thought she would faint. Finally, she said, "I can't believe it."

  Jason, nodded. "I know." And know he did.

  "It's not right," she said. She looked at Jason defiantly, her face

  reddening. "I mean, you just gave him a clean bill of health. You gave

  him all those tests and they were normal! Why didn't you find something?

  You might have prevented this."

  Jason recognized the anger, the familiar precursor to grief. He felt

  great compassion for her. "I didn't exactly give him a clean bill of

  health," he said gently. "His lab studies were satisfactory, but I

  warned him as I always did about his smoking and diet. And I reminded

  him that his father had died of a heart attack. All these factors put

  him in a highrisk category despite his lab values."

  "But his father was seventy-four when he died. Cedric is only fifty-six!

  What's the point of a physical if my husband dies just three weeks

  later?"

  "I'm sorry," Jason said softly. "Our predictive abilities are limited.

  We know that. We can only do the best we can."

  Mrs. Harring sighed, letting her breath out. Her narrow shoulders sagged

  forward. Jason could see the anger fading. In its place came the

  crushing sadness. When she spoke, her voice was shaking. "I know you- do

  the best you can. I'm sorry."

  Jason leaned forward and put his hand on her shoulder. She felt delicate

  under her thin silk dress. "I know how hard this is for you."

  "Can I see him?" she asked through her tears.

  "Of course." Jason got to his feet and offered her a hand.

  "Did you know Cedric had made an appointment to see you?" Mrs. Harring

  said as they walked into the corridor. She wiped her eyes with a tissue

  she'd taken from her purse.

  "No, I didn't," Jason admitted.

  "Next week. It was the first available appointment. He wasn't feeling

  well."

  Jason felt the uncomfortable stirring of defensive concern. Although he

  was certain no malpractice had been committed, that was no guarantee

  against a suit.

  "Did he complain of chest pain when he called?" Jason asked. He stopped

  Mrs. Harring in front of the CCU door.

  "No, no. Just a lot of unrelated symptoms. Mostly exhaustion."

  Jason breathed a sigh of relief.

  "His joints ached," Mrs. Harring continued. "And his eyes were bothering

  him. He was having trouble driving at night."

  Trouble driving at night? Although such a symptom did not relate to a

  heart attack, it rang some kind of a bell in Jason's mind.

  "And his skin got very dry. And he had lost a great deal of hair-"

  "Hair naturally replaces itself," Jason said mechanically. It was

  obvious that this litany of nonspecific complaints had nothing to do

  with the man's massive heart attack. He pushed open the heavy door to

  the unit and motioned Mrs. Harring to follow him. He guided her into the

  appropriate cubicle.

  Cedric had been covered with a clean white sheet. Mrs. Harring put her

  thin, bony hand on her husband's head.

  "would you like to see his face?" Jason asked.

  Mrs. Harring nodded, tears reappearing and streaming down her face.

  Jason folded back the sheet and stepped back.

  "Oh, God!" she cried. "He looks like his father did before he died!" She

  turned away and murmured, "I didn't realize how death aged a person."

  It doesn't usually, Jason thought. Now that he wasn't concentrating on

  Cedric's heart, he noticed the changes in his face. His hair had

  thinned.

  And his eyes appeared to have receded deep into their orbits, giving the

  dead man's face a hollow, gaunt look, a far cry from the appearance

  Jason remembered..when he'd done Cedric's physical three weeks earlier.

  Jason replaced the sheet and led Mrs. Harring back to the small sitting

  room. He sat her back down and took a seat across from her.

  "I know it's not a good time to bring this up," he said, "but we would

  like permission to examine your husband's body. Maybe we can learn

  something that will help someone in the future."

  "I suppose if it could help others Mrs. Harring bit her lip. It was hard

  for her to think, much less make a decision.

  "It will. And we really appreciate your generosity. If you'd just wait

  here, I'll have someone bring out the forms."

  "All right," Mrs. Harring said, with resignation.

  "I'm sorry," Jason told her again. "Please call me if there is anything

  I can do."

  Jason found Judith and told her that Mrs. Harring had agreed to an

  autopsy.

  "We called the medical examiner's office and spoke to a Dr. Danforth.

  She said they want the case," Judith told him.

  "Well, make sure they send us all the results." Jason hesitated. "Did

  you notice anything odd about Mr. Harring? I mean, did he appear

  unusually old for a man of fifty-six?"

  "I didn't notice," Judith said, hurrying away. In a unit with eleven

  patients, she was already involved in another crisis.

  Jason knew that Cedric's emergency was putting him behind schedule, but

  Cedric's unexpected death continued to disturb him. Making up his mind,

  he called Dr. Danforth, who had a deep resonant voice, and convinced her

  to let the postmortem be done in house, saying death was due to a long

  family history of heart disease and that he wanted to compare the heart

  pathology with the stress EKGs that had been done. The medical examiner

  graciously released the case.

  Before leaving the unit, Jason used the opportunity to check another of

  his patients who was not doing well.

  Sixty-one-year-old Brian Lennox was another heart attack victim. He had

  been admitted three days previously, and although -he'd done well initially, his
course had taken a sudden turn for the worse. That morning

  when Jason had made rounds he had planned to move Lennox from CCU, but

  the man was in the early throes of congestive heart failure. It was an

  acute disappointment for Jason, since Brian Lennox had to be added to

  the list of Jason's inpatients who had recently gone sour. Instead of

  transferring the patient, Jason had instituted aggressive treatment for

  the heart failure.

  Any hope of a rapid return by Mr. Lennox to his previous state was

  dashed when Jason saw him. He was sitting up, breathing rapidly and

  shallowly in an oxygen mask. His face had an evil grayness that Jason

  had learned to fear. A nurse attending him straightened up fi-om

  adjusting the IV.

  "How are things going?" Jason asked, forcing a smile. But he didn't have

  to ask. Lennox lifted a limp hand. He couldn't talk. All his attention

  was directed toward his breathing efforts.

  The nurse pulled Jason from the cubicle into the center of the room. Her

  name tag said Miss. Levay, RN. "Nothing seems to be working," she said,

  concernedly. "The pulmonary wedge pressure has gone up despite

  everything.

  He's had the diuretic, the hydralaizine and the nitroprusside. I don't

  know what to do."

  Jason glanced over Miss. Levay's shoulder into the room. Mr. Lennox was

  breathing like a miniature locomotive. Jason didn't have any ideas save

  for a transplant, and of course, that was out of the question. The man

  was a heavy smoker and undoubtedly had emphysema as well as heart

  trouble. But Mr. Lennox should have responded to the medication. The

  only thing Jason could imagine was the area of the heart involved with

  the heart attack was extending.

  "Let's get a cardiology consult stat," Jason said. "Maybe~ they'll be

  able to see if the coronary vessels are more involved. It's the only

  thing I can think of. Maybe he's a candidate for bypass."

  "Well at least it's something," said Miss. Levay. Without hesitation,

  she went to the central desk to call.

  Jason returned to the cubicle to dispense some compassion to Brian

  Lennox.

  He wished he had more to give but the diuretic was supposed to reduce

  fluid while the hydralazine and nitroprusside were supposed to reduce

  pre-load and after-load on the heart. All of this was geared to lower

  the effort the heart had to expend to pump the blood. This would allow

  the heart to heal after the insult of the heart attack. But it wasn't

  working. Lennox was slipping downhill despite all the efforts and all

  the technology. His eyes now had a sunken, glazed appearance.

  Jason put his hand on Brian's forehead and pushed the hair back from his

  perspiring brow. To Jason's surprise, some of the hair came out in his

  hand. Momentarily confused, Jason stared at it, then he carefully pulled

  on a few other strands. They came out as well with almost no resistance.

  Checking the pillow behind Brian's head, Jason noticed more hair. Not

  anenormous amount but more than he would suspect. It made him wonder if

  any of the medications he'd ordered had hair loss as a potential side

  effect.

  He made a mental note to look that up in the evening. Obviously hair

  loss was not a major concern at the time. But it reminded him of Mrs.

  Harring's comment. Curious!

  After leaving word that he should be called after the cardiology consult

  on Brian Lennox and after one more masochistic glance at the

  sheet-wrapped corpse of Cedric Harring, Jason left the coronary care

  unit and took the elevator down to the second floor, which connected the

  hospital with the outpatient building. The GHP Medical Center was the

  impressive central facility, of the large prepaid health plan. It

  incorporated a four-hundred-bed hospital with an ambulatory surgery

  center, separate outpatient department, a small research wing, and a

  floor of administrative offices. The main building, originally designed

  as a Sears office building, had an art deco flair. It had been gutted

  and totally renovated to incorporate the hospital and the administrative

  offices. The outpatient and research building was new, but it had been

  built to match the old structure, with the same careful details. It

  was built on pillars over a parking lot. Jason's office was on the third

  floor, along with the rest of the department of internal medicine.

  There were sixteen internists at the GHP Center. Most were specialists,

  though a few like Jason maintained a generalized practice. Jason had

  always felt that the whole panoply of human illness interested him, not

  just specific organs or systems.

  The doctors' offices were spread around the perimeter, with a central

  desk surrounded by a waiting area with comfortable seating. Examining

  rooms were clustered between the offices. At one end were small

  treatment rooms. There was a pool of support personnel who were supposed

  to rotate positions, but in actual fact the nurses and secretaries

  tended to work for one or another of the doctors. Such a situation

  promoted efficiency since there could be some adaptation to each

  doctor's eccentricities. A nurse by the name of Sally Batman and a

  secretary by the name of Claudia Mockelberg had aligned themselves with

  Jason. He got along well with both women, but particularly Claudia, who

  took an almost motherly interest in Jason's well-being. She had lost her

  only son in Vietnam and contended that Jason looked just like him

  despite the age difference.

  Both women saw Jason coming and followed him to his office. Sally had an

  armload of charts of waiting patients. She was the compulsive one, and

  Jason's absence had disturbed her carefully planned routine. She was

  eager to "get the show on the road," but Claudia restrained her and sent

  her out of the room.

  "Was it as bad as you look?" Claudia asked.

  "Is it that obvious?" Jason said as he washed his hands at the sink in

  the comer of the room.

  She nodded. "You look like you've been run over by an emotional train."

  "Cedric Harring died," he said. "Do you remember him?"

  "Vaguely," Claudia admitted. "After you got called to the emergency

  room, I pulled his chart. It's on your desk."

  Jason glanced down and saw it. Claudia's efficiency was sometimes

  unnerving.

  "Why don't you sit down for a few moments," Claudia suggested. More than

  anyone else at GHP, Claudia knew Jason's reaction to death. She was one

  of only two people at the Center in whom Jason had confided about his

  wife's fatal accident.

  "We must be really behind schedule," Jason said. "Sally will get her

  nose bent out of shape."

  "Oh, screw Sally." Claudia came around Jason's desk and pushed him

  gently into the seat. "Sally can hold her water for a few minutes."

  Jason smiled in spite of himself. Leaning forward, he fingered Cedric

  Harring's chart. "Do you remember last month the two others who died

  just after their physicals?"

  "Briggs and Connoly," Claudia said without hesitation.

  "How about pulling their charts? I don't like this trend."

  "Only if
you promise me you're not going to let yourself "-Claudia

  paused, struggling for a word$4 get into a dither over this. People die.

  Unfortunately it happens. It's the nature of the business. You

  understand? Why don't you just have a cup of coffee."

  "The charts," Jason repeated.

  "Okay, okay," Claudia said, going out.

  Jason opened Cedric Harring's chart, glancing through the history and

  physical. Except for his unhealthy living habits, there was nothing

  remarkable. Turning to the EKG and the stress EKG, Jason scanned the

  tracing, looking for some sign of the impending disaster. Even armed as

  he was with hindsight, he could find nothing.

  Claudia came back and opened the door without knocking. Jason could hear

  Sally whine, "Claudia ..." but Claudia shut the door on her and came

  over to Jason's desk. She plopped down Briggs's and Connoly's charts in

  front of him.

  "The natives are getting restless," she said, then left.

  Jason opened the two charts. Briggs had died of a massive heart attack

  probably similar to Harring's. Autopsy had shown extensive occlusion of

  all of the coronary vessels despite the EKG done during his physical

  four weeks prior to his death being as normal-looking as Harring's.