Critical Conditions

Three

Adrienne had a peds patient she wanted to check on before she left the hospital. I said good-bye to her at the elevator, told her I’d be available all day, and headed home. Before I leashed Emily up for a walk I put a fresh battery in my pager. I had a patient in my outpatient practice who had a newfound love for single-edge razor blades and another patient who had been paging me to pay phone numbers on weekends just to check on me and reassure himself that I was a responsive and caring human being. Although he never said a word when I returned the calls, I could tell from our sessions that he knew I knew who he was.

And now I also had Merritt Doe lying unconscious at Community Hospital awaiting whatever magic I could provide that would help her view the world as a place in which she might wish to continue to maintain residence.

All in all, more than enough reasons for a fresh battery in my pager.

Emily and I were only ten minutes from the house when the call came in to my beeper. I had Lauren’s cell phone with me. I punched in the number from my pager screen and the call was answered by the distinctive lilting voice of the ward clerk from the ICU. As instructed, he was alerting me that although Merritt wasn’t awake, her parents had been located. They were with their other child, another daughter, who was hospitalized in Denver at The Children’s Hospital. One of them would come to Boulder immediately.

I thanked him.

The ward clerk wasn’t done. In a breathless rush, he said, “You know who I bet this is, don’t you? I think it’s that little Chaney Trent, that little girl from the news. That’s who Merritt’s sister is. I bet that’s why she tried to kill herself. She must be soooo distraught about her little sister.”

I looked at my watch, silently added an hour for Merritt’s mother or father to get to Boulder from Denver, and told the ward clerk when to expect me at the ICU. “Make sure whichever parent shows up waits for me, okay? No matter what, I need to speak with one of them.”

“Absolutely,” he said, still energized by his suspicion that he was on the very periphery of notoriety.

Since the shootings that Lauren and I had been involved in the previous October, I had stopped watching the local news. Too many people I knew and cared about were on too often those days, almost always presented in ways that made me sad or angry. Usually angry. Sometimes I would watch Headline News or wait and tune in to the local network affiliates at twenty minutes after the hour just in time to catch the weather and sports, but mostly I relied on out-of-town newspapers to fulfill my anemic craving for current events. With the newspaper, it was easy to skip articles I didn’t want to read, and the editors of the Denver dailies and USA Today didn’t seem to give a crap what happened in Boulder, Colorado.

I hadn’t exactly missed the whole to-do that had been going on about the little girl, Chaney, and her illness, but I hadn’t focused on the names. To me, it was just another public tragedy. Lately they seemed to be falling like raindrops, and I had my fill in my own life and my friends’ lives and my patients’ lives and all I wanted was an umbrella to shelter me until the storm passed. I wanted, first, to pull Lauren in out of the rain with me.

What I knew, all I knew, from glancing over a few stories in the local paper was that there was a TV reporter mommy from the Boulder area who had a sick little girl who was being denied treatment with some experimental protocol that had a low double-digit chance to save her life. The denial was coming from her cost-conscious insurance company. The mom/reporter’s name hadn’t stuck in my head, nor had the little girl’s last name. The child’s first name had stuck, though, like a yellow sticky note.

Chaney.

I figured she had been named Chaney in order that she be memorable, and now she was. For all the ink the father received, I would have guessed that the sick child was a member of a single-parent family.

I didn’t recall Merritt’s name ever being mentioned in anything I had read about the sick little girl. But then again, I admit that I hadn’t paid a whole lot of attention.

It would have been better if I had.

I had some time before I needed to return to the hospital to meet up with Merritt’s mom or dad. I preferred to be armed with information rather than saddled with ignorance, so I called Diane Estevez, who does gossip as effectively as CNN does news.

“Diane, hi, it’s Alan. Can you fill me in some more on this sick little girl in Denver, the one who’s been in the news all the time lately? It looks like I may be getting peripherally involved.”

“Wow, no kidding. Hold on, let me get comfortable. God, you’re so out of touch sometimes. You really don’t know the story? Really?”

“Really. But I want to know more about the situation you alluded to at lunch. John Trent’s kid.”

“Of course. But first, dear, you have to dish. How are you involved?”

I considered how much I could share with Diane. “Adrienne called me from the ER at Community this morning to see a patient. The two cases, the ER and the sick little girl, may be related; that’s all I can tell you.”

“What do you mean, ‘may be’? You don’t know who your patient is?”

“My patient is unconscious. Let’s just leave it that there’s reason to believe that the case may be linked to the kid on the news. Come on-”

“Do you know your patient’s name? Is it Trent?”

“Please. Let’s not play twenty questions.”

She made an unpleasant noise before she said, “This is John’s first marriage. I’m pretty sure of that. I can check with someone if you need me to. But maybe his wife brought a kid along with her. Remember, she’s that reporter for Channel 7, Brenda, a, um, Strait. Yeah, Brenda Strait, that’s her name. She calls her news reports The Strait Edge.” Diane mounted her best on-air voice imitation and said, “This is Brenda Strait at Woeful Recycling in Arapahoe County, and this is The Strait Edge.”

Strait. “Tell me about the sick kid, Diane.”

“She’s a cutie, Alan. Breaks your heart to see her. Like I told you at lunch, she has some rare cardiac condition. I think it’s called, don’t quote me on this, viral myocarditis. It’s an awful thing. I mean, she has a runny nose and, poof, a month later she has a terrible heart disease that may kill her. The news reports say there’s a program in Vancouver that’s doing some experimental things with some drugs from Japan to try and arrest the virus, but the chances of success are still pretty low. The kid’s docs believe the only real hope for her is a team in Seattle that has been using the same drugs as the Vancouver people, but for kids with problems as critical as Chaney’s, they follow the drugs with a heart transplant. But the kid’s insurance company won’t approve the funds for it.”

“This is all from the news?”

“You expect me to rely on single sources for my information? I’m insulted, Alan. This is from Dani Wu. Confirmed by the news. But my sources are reliable.”

“You said it’s an insurance company? Which one?”

“Excuse my vernacular-it’s actually a managed care company. I think it’s-”

“MedExcel.”

“Right. How did you know?”

“Lucky guess. Usual suspects. Is MedExcel on solid ground in refusing to pay for the procedure?”

“Sounds like it. Everybody agrees it’s an experimental approach the Washington hospital is doing. The drugs they use to kill the virus aren’t approved by the FDA for anything but investigative use.”

“How critical is Chaney’s condition right now?”

“The news reports make it sound grim. Dani-she works with John Trent a lot, she should know-says it’s bad, the baby’s heart muscle is mush, that John’s in Denver whenever he’s not working, day and night. Mom is carrying the ball publicly, trying to raise sympathy to keep pressure on MedExcel, without further alienating them. Tough act, huh? I think the parents are still hoping for a last minute change of heart, so to speak. Me, I think the strategy is naive.”

“Sounds naive to me. I think I’d just call Jon Younger and take my chances with MedExcel at the courthouse.” Jon Younger is a lawyer friend of mine.

“Me, too.”

“How much does it cost? The procedure that they won’t approve?”

“I think I heard the Seattle hospital wants almost four hundred thousand dollars in cash to walk in the door.”

“And what kind of success have they had?”

“Remember, it’s rare and experimental. Even the Seattle center says so. They’ve only done a handful of cases and they’ve saved a couple, three maybe.”

“That’s hopeful, given the prognosis otherwise, right?”

“It definitely beats the alternative.”

“What’s Brenda Strait like?”

“I only know her from the news. She’s pretty in a hard way. Acts like one of those eighties women who thought they had to be way too serious to get along in a man’s world. Remember them? But her hair’s a little too big and she wears clothes that are a half-size too small for her, you know, like Oprah does. And if you ask me, she should wear a little less makeup and a lot more sunscreen.”

Diane was never far from an opinion. “And her work? How is it?”

“I admire her work. She pisses people off. Uncovers graft. Makes politicians look silly. Exposes consumer fraud. That’s her beat.” The media voice came back. “She is Brenda Strait and she gives us The Strait Edge.”

I did recognize her. I think I’d seen Brenda Strait on a billboard or the side of a bus.

I arrived back at the hospital before she did. When I walked in, the same ICU ward clerk I’d met earlier was having a whispered conversation with, I’m guessing, his boyfriend. It was something about someone getting home too late last night. I dug for Merritt’s chart and flipped through Merritt’s spartan record to discover that her last name had been changed from “Doe” to “Strait,” that she was just shy of fifteen and a half years old, and, as of twelve minutes before, she was still unconscious. It was absurd of me to read the chart to find out her level of responsiveness; it was akin to tuning in the Weather Channel instead of glancing out a window to discover that it was raining. I knew it was absurd, but it allowed me a transition to the clinical tenor of intensive care, a distance I needed.

I replaced the chart and started toward Merritt. From ten steps away I could hear her ventilator. My ears told me it was the only one operating in the unit. The puffing sound it made was much too mundane to be so essential to life.

The red-haired nurse stood at the next bed. Her arms were above her head as she hung some fresh IV fluids on a person so bandaged up I could determine neither age nor gender. She looked at me, mouthed a silent, “Hi. Motorcycle.”

I nodded and pulled a chair up beside Merritt. Without thinking, I reached for her hand. She was warm. I was a little startled, unconsciously expecting Merritt’s body temperature to have taken on the chill of the circumstances.

Merritt’s hand was large, as large as my own, and her fingers were thin and beautifully proportioned. The nails were painted carefully with a bright red polish, though the nail on her ring finger was broken badly, exposing some of the tender skin below. The break must have hurt.

Her hand wasn’t limp; she had tone. But her fingers didn’t respond with any pressure to my touch. I said, “Hello, Merritt, I’m Alan Gregory, Dr. Gregory, and I sure hope that I can help you.”

Behind me, across the room, I heard a loud, “I’m her mother, that’s who I am. Where? Where? Over there? Is that her? Is that my baby?” and saw the face from the side of the bus rushing across the ICU. I released Merritt’s hand and stood.

The nurse stepped between Brenda Strait and her daughter, Merritt.

“Excuse me, please, ma’am, you are…?”

“I’m her mother, damn it, get out of my way.” Brenda stepped sideways to maneuver around the nurse, who anticipated the deke and managed to outflank her.

“Hello, I’m Susan, I’m Merritt’s nurse. Have you talked with the doctor yet?”

“No, we played phone tag the whole way over here.” Brenda’s voice broke. “Please get out of my way. May I see my daughter? Oh, God, Merritt. Oh, my baby.”

Susan, the nurse, grabbed Brenda Strait’s hand and led her to the bedside opposite me. Although Brenda was incapable of hearing anything but the puffing and exhaling of the machine that was breathing to keep her daughter alive, Susan adopted a compassionate tone and began to patiently explain Merritt’s condition.

“Ma’am, as you can see, your daughter is on a ventilator to help her breathe. She is still unconscious from her ingestion but her vital signs have begun to…”

“Is she okay? She’s not okay, is she? Where’s her doctor?” She noticed me standing across the bed as she leaned close to her daughter. Her arms were hovering but not touching, the machinery of survival an effective barrier to a mother’s touch. She didn’t look at me as she said in a voice that was half-demanding, half-pleading, “Are you her doctor? She’s going to be fine, right? I can’t lose two girls. Please tell me she’ll be fine. Please, please.”

“I’m Dr. Alan Gregory, I’m a clinical psychologist. I was called in by her-”

“Oh, God, where’s her doctor? What did she do? Oh, Merritt, what the hell did you do? Oh, God.” She took a deep breath. “I promised myself I’d be calm. I need to be calm.” Another deep breath. “Can she hear me? Merritt, darling, can you hear me? It’s your mom. I’m here, oh, sweetie, I’m here.”

“Mrs. Strait, I’m Dr. Klein. Marty Klein.” I turned and saw Marty holding out his hand. “Why don’t you take a few minutes to be with your daughter and then we’ll talk. Alan, you’ll join us, please?”

I guided Brenda Strait into a small conference room off the ICU and listened to Marty while I observed his defeated audience of one.

Brenda Strait’s frantic entrance had deteriorated into a semicatatonic hand-wringing that was as full of pathos as anything I had recently observed. Occasionally Brenda interrupted Marty’s recitation to ask a question, as often as not confusing her younger daughter’s symptoms with her older daughter’s symptoms, the lines of despair having blurred and blended in mother’s horror.

Twice, after requesting a clarification about something Marty was explaining, she said, “Excuse me, I haven’t slept much. Did I already ask that?”

Her eyes were red and the tissues wadded in her hands would have needed to be sea sponges to manage to contain all her tears and sniffles.

Marty was patient, twice ignoring beckons from his beeper, but he was not able to ignore the urgency of a STAT overhead page. He took Brenda Strait’s hand in both of his and excused himself reluctantly, promising to answer all her questions another time, before rushing back to the ER.

Brenda, hollow-eyed, watched Marty’s hustled exit and then turned back in my direction, viewing me as disdainfully as she would have scanned the leftovers at a buffet.

“You’re a psychologist, right? Right? Well, why did she do this?” she demanded. Her tone was mocking and condescending. I wasn’t sure whether it was intended to belittle me and my profession-and by implication, her husband and his-or her daughter, and the inconsiderateness of her suicide attempt.

Maybe she wanted me to bite on the hook of her anger. I couldn’t be sure. But I didn’t bite. I said, “I’m at more of a loss than you are, I’m afraid. I was hoping you and I could begin to puzzle that out together.”

She fidgeted. I think she would have preferred being provoked.

From the aroma building in the enclosed room, I hazarded a guess about her agitation. “Would you like to walk outside, Ms. Strait, for a cigarette maybe?”

“I quit three weeks ago. Chaney, you know? I could never get away from the hospital room for a smoke. You can still smell it on me, can’t you? I chewed half a pack of gum on the drive over here. I need to get to the dry cleaners. Maybe buy a new wardrobe.”

I said, “I know. It’s hard to quit.”

“My husband’s a psychologist. Did you know that?”

“No, I didn’t.” Until verified, I still considered Diane’s information to be gossip.

“His name is John Trent. You know him?”

“We may have met once. I’ve heard of him. He hasn’t been in town very long, has he?”

“Maybe it’s better that you don’t know him.”

“Better how?”

“Better for Merritt. It’ll be easier for her to trust you. I’m guessing.”

“Is trust an issue between Merritt and her father?”

“Stepfather. Oh, God, please don’t do this shrink-wrap shit with me. I get enough of this from John.” Her intensity accelerated; she was almost spitting words now. “What do you want to know? What could you possibly need to know that isn’t already apparent? This is obviously about Chaney, right? And about me ignoring Merritt. Right? What else could it be about? Well? What else am I going to be punished for? Tell me that. Go ahead, what else have I done wrong?”

I learned a few things.

Take away the burden of the stresses caused by the fact that her younger daughter was at death’s door, and that her older daughter had just joined her there, I suspected that Brenda Strait was a decent woman. Smart and incisive, and with a reservoir of wit that could carry her through the onslaught of most stresses.

Not these two stresses. But most.

The family move to Colorado had been accomplished despite Merritt’s objections. “My God, I understand that,” Brenda said. “She was fourteen years old. When we moved, we took her away from her friends, her school, her security. I would’ve hated my parents for that, too. I understand her being angry, okay. I thought I did, anyway. But at some point she has to get over it, right?” She sighed, swallowed. “I’m not being fair to Merritt, I should be fair. The truth is that Merritt was doing better before Chaney got sick. She was starting to adjust. She was being a trooper. That’s what John said.

“But Chaney, that, God, that’s done us all in. All except John. He’s been a rock for that baby, for all of us. Maybe except for Merritt. Before Chaney got sick, John was Merritt’s buddy at home. They’d be out on the driveway shooting baskets at all hours. The neighbors used to complain. Police even came by once and suggested that eleven was a little late for playing horse.” She smiled meekly at the memory. “I work a lot, odd hours, and John filled in with Merritt, with both girls. He’s good with them. But now he’s been in Denver so much, too. Maybe Merritt’s angry about that-about John being gone. Maybe she feels deserted, left alone. Like we don’t care about her. I’ve thought about that, I’m not insensitive.

“When we moved, we left Merritt’s dad, my ex, back in Wichita, too. She misses him. Who could possibly be a more receptive audience to bitch about your mother to than her ex-husband? So there’s that, too, not seeing her dad. It’s a lot, huh…?

“School? You probably want to know about school. She does well. She did better in Wichita. John says to give her time to adjust. So we don’t pressure her about grades. She’s an A and B student getting B’s and a few C’s. She plays on the basketball team. She’s tall and thin like her dad. Gosh, you’ve never seen her standing up, have you? Basketball’s been good for her…

“Friends? Boyfriends? Kids don’t really date these days like we used to. They go out in packs, don’t have to deal as much with the pairing-off pressure. Not a bad adaptation-do you remember high school?” Brenda’s shoulders shuddered in response to some distasteful memory. “Awful. She hasn’t had to be part of all that. Merritt’s popular, she’s funny, she’s pretty. She has two best friends. One in Wichita, Toni, and another girl who’s here in town, named Madison. They hang out together…”

I asked, “Have you and John talked about this…this suicide attempt?”

Brenda exhaled as though she were intent on deflating. “I’m not ready to call it that. So far, I can barely say ‘overdose.’ But, yes, we talked before I left Denver.”

“I’d like to call him.”

“Fine, I’m sure he wants to talk with you, too. Chaney’s in Room 406. He spends nights there, too. One of us always tries to be with her.”

“You looked like you were about to say something else?”

Her shoulders sagged. “I thought things were going to get better. For all of us. I’d been getting death threats for a while. I did a story that resulted in somebody dying. Maybe you heard about it. Afterwards, I got some nasty phone calls and then some threats. They stopped a few weeks ago. The threats. I told myself everything was going to get better.”

“Do you know who the threats were from?”

“No. I did a recycling story that had some major, I don’t know, ramifications. A mayor tried to kill himself. His wife had a heart attack. It’s about that. Someone slashed my tires at work. Broke my car window and threw a dead cat on my seat. The police don’t know.”

“But the harassment stopped?”

“Yes. It stopped.”

I moved on. “Your first husband, Merritt’s father? Where is he? Wichita?”

“Right now, he’s in the Persian Gulf on an oil platform; when he goes abroad, he’s over there for weeks, months even, at a time. You know-the Middle East? I’ll call him. If you need to talk with him, I’ll have him call you.”

“Please.”

“He’s more of an uncle to her than a father. Do you know how it started?”

How what started? I shook my head. “No.”

“Sniffles. Chaney had a runny nose, just like a hundred other little colds. That’s how it started. Sniffles. And now this.”

Brenda was a talker. All in all, I didn’t do much more than provide a few prompts. Still, before Brenda Strait returned to her daughter’s bedside, she had dumped a lot of her anger at my feet. She had made a transition from feeling victimized by fate to feeling able to once again be a mother. The anger wasn’t over, but the pressure was off for a few minutes, or a few hours. I felt confident that for some brief time, Brenda would be able to view her daughter’s struggle to survive with love, not just with fury.

I also learned a few things that I hoped I might be able to use to help Merritt when she recovered consciousness.