Mercy

CHAPTER 2

There was no “normal” to Dr. Julie Devereux’s workday. Life as a critical care doc at White Memorial, a five-hundred-bed hospital in the heart of Boston, was suited to people who could roll with it when the emergency department interrupted morning rounds for an immediate consultation, or when a patient who had been stable moments ago was suddenly and inexplicably teetering on the edge of death.

Having Trevor, her twelve-year-old son, tag along for the day was not on Julie’s schedule. But go with the flow, right? In no way did that mean Julie was pleased. If this were some official take-your-kid-to-work day, she would have had a different attitude. But this was a take-your-kid-to-work-because-he-got-suspended-from-school-for-fighting day. Not endearing. Not by a long shot.

Trevor, a lanky, sweet-faced boy with thick, shoulder-length brown hair just like his father’s, brooded behind Julie as she headed for her office down the hall.

“Wish I didn’t have to be here,” Trevor grumbled.

Julie stopped walking, turned around, and gave her son a hard-edged stare. “Well, I’m sorry, Trevor, but people do have to work for a living.”

Two nurses strode past and said a warm hello to Julie. She was beloved here-a lot more than at home, it seemed.

Julie reminded herself to be patient with her son. Change was not easy, and Trevor, her only child, had to adjust to the fact that his mother would soon be remarried. She wondered if this acting out was Trevor’s way of processing a slew of conflicted emotions. He liked Sam, or maybe tolerated was the better word, but resented the idea of a man other than his father living with them. He had said as much to Julie. Maybe the kid held out hope that Julie and Paul would reconcile one day. That was not going to happen.

Perhaps once she and Sam were married and living together, Trevor’s recent string of bad behavior would come to an end.

“I still don’t see why you couldn’t have left me at home like I wanted. I would have been fine on my own. Better than being stuck in your office all day.”

Julie shook her head in frustration. “Getting suspended two days for fighting isn’t exactly how to earn trust,” she said in a matter-of-fact tone.

“Well, he started it,” Trevor shot back.

Julie sighed. Trevor always had an answer for everything.

“How come I can’t just stay with Dad?”

“Because your father isn’t home. Believe me. I called.”

“Where is he?”

“In New Hampshire, collecting scrap metal for his next sculpture.”

Trevor seemed to think this was cool. His dad was cool. Of course he would think that. His dad thought homework was a waste of time and sugared cereal was a four-course meal.

“Dad let me weld the last time I was there.” Trevor made this seem like an off-the-cuff remark when he knew he had tossed a barb that would sting.

“He did what?” Julie arched one of her delicate eyebrows and tried to block all sorts of horrible images from her mind. She had seen enough third-degree burns in her career to have some stern words with her ex-husband before this day was over. Paul had good intentions, but when it came to good judgment, he could be worse than Trevor.

“If it sells, I’m going to get a cut,” Trevor announced with pride.

“Well, before you pick out a new iPad with your earnings, ask your father how many sculptures he’s sold in the last few years.”

Trevor looked away because he knew the answer was zero. Paul was quite talented, and his art fairly inventive, but he was not particularly ambitious or motivated. He did not make much money from his sculptures. Julie accepted that, as long as he paid the court-ordered child support. Paul could do this because of a substantial inheritance from a grandmother, one that allowed him to lead an artist’s life. Paul paid his share of the child support on time and with no grumblings, but still Julie wished he’d be a stronger role model for his son.

Sam Talbot would never replace Paul as a father-nor would he ever try-but with his kindness, maturity, and stability, Sam was sure to be important in Trevor’s life. As a high school history teacher, Sam was not exactly rolling in the dough, but the way he loved her and the way she loved him made Julie feel like the richest woman in the world.

Julie set a hand on Trevor’s delicate shoulder. Her son might have been obstinate, disrespectful at times, a little mouthy, but he was still her pride and joy.

“Look, kiddo, you’re here for the day,” Julie said, “so do your homework and try to make the best of it. And I hope you brought a good book, because you’re not going to be glued to your electronics all day.”

Julie tugged on her white lab coat so it fit better over her beige blouse. Everything fit better since she’d lost the weight gained during the divorce. She told people it was diet and exercise, but really the weight came off after she jettisoned the stress. For that, Julie had motorcycles to thank-a Honda Rebel 250, to be precise, which Sam, an avid rider, had bought for her as an engagement gift. Julie was looking forward to their upcoming ride to the Berkshires, and showing Sam the new hip-hugging leather pants she’d bought online from Cycle Gear. But the weekend was several days away, which meant plenty of time for Julie to work, look after Trevor, and feel like she was shortchanging both.

Since her separation from Paul, Julie had come to know a lot of single, career-oriented mothers who tried to be all and do all. Her advice to them, whenever asked: go ride a motorcycle. The moms might not lose the worry and doubt, she explained, but they’d have a blast forgetting some of their troubles for a while.

Julie’s first patient of the day was Shirley Mitchell, a seventy-seven-year-old woman with a nasty case of pneumonia to go along with the initial stages of peripheral artery disease. Despite her illness, Shirley had a fairly decent quality of life. This could not be said for many of Julie’s critically ill patients in the thirty-three-bed unit, who sometimes endured debilitating and costly treatments in order to squeeze out only a few more months of life.

Julie was an advocate for death with dignity. She wrote papers and frequently spoke at conferences with the goal of bringing about policy change. Self-determination was a fundamental right, and the courts were beginning to agree. It was coming to health care whether the providers liked it or not. High-profile cases like that of Brittany Maynard, the twenty-nine-year-old woman dying of brain cancer who ended her suffering on her own terms, would continue to be a force for change. Death with dignity laws did not, as some critics said, kill people who did not wish to die. Julie could produce thirty years of data as proof.

She, and others who thought like her, wanted to take government out of the equation and let the patient and the patient’s doctor come to a decision on what was best. The option to have an option was what Julie fought for, not some death mandate, as her opponents feared.

Her activism, of course, was controversial among her colleagues who viewed her stance as anathema to their profession. It violates the Hippocratic oath to do no harm. It demeans the value of human life. It will lead to abuse or reduce palliative care options. All valid arguments, but Julie believed that even those most vocal in their opposition had at some point wrestled with doubt while helping to keep alive a supremely sick patient who wished only to die.

Sometimes dead is better.

Shirley’s nurse was Amber, a petite twenty-six-year-old blonde who one day-not quite yet-might turn Trevor’s head. For now, Trevor seemed oblivious to Amber’s beauty and was content to wave hello from the doorway after Julie made introductions.

“Trevor, you know where my office is. Why don’t you go there now and wait. I’ll come get you for lunch.”

Trevor gave a nearly imperceptible head nod, and away he went.

Somehow Amber had managed to turn Shirley onto her side, not a simple feat given this particular patient’s size, and was applying moisturizer to the backside of her body. ICU nurses were some of the most compassionate Julie had ever worked with. They did an incredible amount of work, almost always with a smile regardless of the unpleasantness of the task.

Shirley was not aware of Amber. She was sleeping soundly, thanks to the propofol, and breathing normally through the endotracheal tube inserted down her throat.

“How was her night?” Julie asked. Since this was the morning shift, Julie would get Amber’s take on what the night nurse had relayed.

“I heard it went pretty well,” Amber said in a cheery voice. “Fever is down to a hundred and one. WBC is fifteen thousand.”

“Fifteen thousand for the white blood count,” Julie repeated, sounding pleased. “That’s approaching normal.”

“And there’s less secretion in her endotracheal tube,” Amber added.

“Less secretions, eh?”

Another bit of good news. When Shirley arrived at the ICU, her chest x-ray showed substantial infiltrate clogging her lungs.

Amber said, “The respiratory therapist titrated down her oxygen and now she’s only on forty-five percent. When I left yesterday she was on sixty.”

Julie went to the Medi-Vac unit mounted on the wall and inserted a catheter down the tube. She engaged the suction, producing a whirring sound, and up came a soupy, yellowish, highly viscous, putrid-smelling liquid. It was less than Julie had expected.

“Looks like Shirley really is getting better,” Julie said. “Maybe today you can give her a wake-up and lighten the propofol.”

Amber acted disappointed. “Shirley can be a handful. I’m really going to miss the milk of amnesia,” she said.

Julie smiled at the long-running ICU joke; the milky white drug had the same color and consistency as the popular over-the-counter laxative. A sleeping patient makes no trouble, said the adage on the floor. But staying on the ventilator long term increased the likelihood of going from sleeping to dead. The breathing tube keeping Shirley alive was also a gateway for getting bacteria into the lungs. Ventilator-associated pneumonia was a real risk. For people already seriously ill, it could be a death sentence.

“Let me know how Shirley is doing when she’s awake. Maybe we can reduce the ventilator further, and if that goes well, we’ll move on with a spontaneous breathing trial.”

If Shirley were able to breathe for two hours under her own power, Julie would consider taking her off the ventilator.

“I’ll get her awake right away,” Amber said.

“Good,” Julie answered.

So far the day was off to a banner start.

A raven-haired nurse named Lisa, dressed in floral scrubs, poked her head into Shirley’s cubicle.

“Dr. Devereux, I need some help. It’s the quarterback. I’m worried. We’re cranking vasopressors, but his BP is unstable and trending down.”

Julie darted out of the room and Lisa fell into step behind her. ICU nurses were not only compassionate, but were some of the best trained in the field. They seldom worried over nothing.