Do No Harm

Chapter 11

Shifting the stack of files in his lap, David lay back on the exam table he'd adjusted like a chaise longue, propping his feet on one of the gynecologic stirrups. He continued with his paperwork, enjoying the quiet serenity of Exam One.

Diane barged in, startling him. "Oh sorry. Didn't realize you were

… What are you still doing here?"

David checked his watch: 21:25. He hadn't realized he'd been there for an hour and a half after his shift ended. He was accustomed to working late, preferring the excitement of the ER to the solitude of his too-large house, but it alarmed him how quickly the habit had grown. Arriving a few hours early, leaving later and later, shouldering extra days on call-anything to avoid reconstructing a personal life without Elisabeth. His house was quickly becoming a million-dollar stopping place between shifts.

He looked at the paperwork before him. Nothing important, nothing pressing. Exhaustion pooled through him all at once, jumbling his thoughts. He squeezed the bridge of his nose. When he released it, he was touched by the concern in Diane's eyes.

"I don't know," he said. His stomach grumbled so loudly both he and Diane glanced at it.

"Come on," Diane said. "Let me buy you dinner."

A hospital cafeteria is a depressing place at night. Spouses with vacant, grief-haunted eyes, children pulling IV poles, parents slurping inconsolably on tepid coffee, the sleepless hours gathering in half-moons beneath their eyes. Their lethargy draws a sharp contrast with the bustle of the interns and nurses in scrubs. But even the grieving and the dying have to eat.

David stared at the food on his tray-a Milky Way, a half-eaten chicken sandwich, a small container of apple juice. Diane bit into an apple and shrugged. "What did you expect on a resident's salary?"

"This is perfect," David said. "I wouldn't have made it any farther afield without falling on my face." He studied his reflection in the back of a spoon. "Jesus, maybe I should check myself in."

"You don't look that bad. Mrs. Peters still swooned when you checked her eyes this afternoon."

"She's ninety years old. With glaucoma."

"She told me she thinks you look like George Clooney."

David pursed his lips to keep from smiling. "And what did you say?"

Diane twirled her straw in her Coke. "I told her no one looks like George Clooney."

"True," David said. "True."

Diane cocked her head slightly, amused. "I'd bet you were a great womanizer before you got married."

He shook his head.

"No? Why not?"

He shrugged. "I guess I liked women too much." He fished a crumb of some sort from his apple juice and wiped it on the tray. "And I married young."

"What did your wife look like?"

A web of images entangled him. A white snowball smudge on her winter sweater. The first movement of her face in the morning, sleep-heavy and gentle. His hands lifting her wedding veil. He imagined her the night of their fifteenth anniversary. The twin strokes of her hips beneath a sleek black dress. They'd gone to a gallery opening in Venice where Elisabeth, as the LA Times art critic, had been fawned over by dealers and struggling artists alike. After a few hours, David had snuck her off to Shutters in Santa Monica, where they'd sat out on the balcony of their hotel room, holding hands, listening to the waves rush the shore in the darkness.

"Her smile made me weak," he said.

"David… " — Diane looked away- "… am I delusional in thinking there's something going on between us?"

"Positively schizophrenic. It must be your Yale education."

"It's a tough question to ask. Why don't you answer it seriously?"

"You're right," he said. "I'm sorry." He pried at the hard bun of his chicken sandwich as if he'd developed a sudden intense interest in baked goods.

"The few times we've been out… " Diane squeezed one hand with the other. "For the life of me, I can't figure out if they're dates or just an attending and a resident talking shop outside work. I mean, we're alone… we're at dinner… but we're talking about lesions and contusion fractures."

"An attending and a resident," he repeated.

"Well?"

"We've worked side by side, hands in the mud, for-what?"

"Almost three years."

"Three years now. You're one of the best residents I've ever had the pleasure to train. I consider you a colleague. Not a resident."

The glimmer of a smile cut through the discomfort on Diane's face, just for a moment. "I didn't know that," she said. "But it still doesn't answer my question."

"Look… " David realized his voice was shaking ever so slightly. "I've definitely thought about… but we can't… I can't… "

"Why not?"

He leaned back in his chair, trying to find what he wanted to say. "Diane, I'm almost twice your age."

"I'm thirty-one and you're forty-three. That's nothing. Elizabeth Taylor has married men twenty years younger."

"She doesn't have the same performance anxieties, I'd imagine."

Diane played with her straw some more, poking at ice cubes. "All right," she finally said, with a slight hint of humor. "Why don't we make a deal? I won't call you on your lame-ass excuses, but when we do overlap socially, no more talk of lesions and contusion fractures."

She extended her hand across the table and he shook it, mock formally, before settling back in his chair. He crossed his arms and fought off a grin. "So what's your middle name?" he asked.

"Allison."

"You like dogs or cats?"

"Dogs."

"What's your favorite kind of lesion?" She scowled at him, and he held up his hands defensively. "Just kidding. What do your folks do? Are they doctors?"

"We don't all come from high-powered medical families. Not all our fathers have grand rounds auditoriums named after them."

"It was named for my mother, actually," David said.

Diane whistled. "What was it like growing up in that house?"

"A lot of pimping at the dinner table. Name the eight bones of the wrist. The twelve cranial nerves. The five components of the Apgar score." He tilted his head. "My mother was chief of staff here at the NPI from '60 to '71, and she recruited a lot of the world's preeminent physicians-in all fields-to come lecture and teach at the Med Center. It wasn't uncommon for a few Nobel Prize-winning physicians to show up for dinner. The instructors and department heads that came through… it was truly amazing."

"Who was the better doctor, your mother or your father?"

"It's tough to say. They were in pretty divergent fields. My mother was a psychiatrist, my father a neurologist. My father passed away when I was young. Prostate cancer."

"That's why you asked Pinkerton about a prostate checkup today even though he was only thirty-nine?"

"We all have our pet illnesses, I suppose." David's mind followed some flight of reason, and he found himself saying, "My mother just went in '99."

Diane nodded, and he was grateful she didn't offer any platitudes. He'd wanted to share the information with her, not elicit sympathy.

A man in a wheelchair rolled slowly past, tray cradled on his atrophied knees.

"My mother was a tough woman. All fire and ambition. I never saw her crack. Not once." David drew his hand down across his face, like a window blind. "When she was in her late sixties, she headed up the Disciplinary Review Board here. She had to call a young male nephrologist into her office to confront him about a claim made against him by a young woman. When she reprimanded him, he rose, locked the door, and beat the shit out of her. Broke two ribs." He watched Diane's slender eyebrows rise and spread. "The only thing my mother was upset about afterward was her lack of medical judgment in not being able to predict she was dealing with an unstable man." He set both hands on his tray and pushed it slightly away. "That was my mother."

"A lot to live up to?"

"A lot of people spend their lives trying to overcome their upbringing. I spent mine trying to fulfill it."

"And have you?"

"My mother was pretty disappointed when I decided to enter Emergency Medicine."

"Why's that?"

"If a surgeon is a glorified carpenter, an ER doc is a glorified carpenter with an inferiority complex." He laughed. "As you know, it's generally not considered the most cerebral field."

"Your mother might have thought different if she'd seen you in action," she said. Her eyes quickly lowered. "Pardon my schoolgirlish fervor."

"Medicine was a different thing back then. As has often been said-doctors of my parents' generation were the first for whom medicine was a science and the last for whom it was an art." Pulling a napkin from the dispenser, he wiped all the crumbs on the table into a neat line. "My mother never really forgave me for entering ER. As if it were a slight against her. My father wouldn't have minded, I don't think-he and I were always quite close. He was a charming, handsome man. Tall and broad. When I was a kid, he used to tell me I was the kind of person he wanted to be when he grew up." David smiled at the memory. Suddenly self-conscious, he looked up at Diane. Her blond hair was down across her eyes in front, and she brushed it aside.

"Jesus, I'm sorry," he said. "Talking about myself all night. I guess it's been awhile since I've talked. Openly."

His hands were folding the napkin in neat squares, and she reached out and stilled them.

Leaving the cafeteria, David averted his eyes from the large bas-relief letters over the double doors to the right, as was his habit. He did not have to look to know what they read: SPIER AUDITORIUM. The name hovered overhead, as it did everywhere throughout the hospital.

Speaking into a walkie-talkie, one of the new security guards breezed by with a female nurse, presumably escorting her to her car. David was glad to see that more precautions were indeed being taken after the assault on Nancy.

A Mexican woman quietly worked a mop across the lobby floor, bringing the tile to a polished shine. Behind her, a chemotherapy-bald boy ran out of the hospital gift shop, stuffing a stolen Snickers in his pocket. The hefty register lady thundered after him, all but shaking her fist.

Good for you, kid, David thought. Run, Forrest, run.

He trudged down to his car, passing a few security guards on the way, and headed lethargically for home. He was glad to see the news vans had finally cleared out. On to the next tragedy, the next big story. Just past San Vicente, David pulled into a corner Shell station, swiped his credit card through the slot, and started to fill up his tank.

While the gas pumped, he sat in the car, his mind playing through the cases of the day, picking at them from all angles to see if he'd made any mistakes. His mind kept returning to Diane, and from there, to Elisabeth.

There is no way to predict an embolus. A perfectly healthy thirty-five-year-old, not even into middle age, no family history of disease, no hypertension, no diabetes, no vascular disease. One day she throws a clot, it lodges in her basilar artery, and for seventeen crucial minutes the brain is denied blood. Seventeen crucial minutes are enough to suck a loving, intelligent woman dry of thought and emotion, to leave her a living husk. Sometimes it takes less time than that.

David had been the chief attending the night Elisabeth had been wheeled in-sick call on his birthday-so, knowing his medical judgment would be impaired, he'd let Don Lambert take lead. Of the first few hours in the ER, he remembered only scurrying bodies and the thick numbness of his tongue. Awhile later, his wife had lain in a limp recline upstairs in the MICU, the sheets humped over her inert body.

The pattern of her gown had been repetitious and infantile, pale blue snowflakes on a white background. David recalled certain images vividly-the drops of urine inching dumbly along her Foley catheter like items on an assembly line; the hum of the ventilator pushing air down the endotracheal tube and through the snarl of plastic into her throat; her thin gown wrinkling slightly as her chest rose and fell, rose and fell.

They'd EEG'd her promptly at David's request, his legs trembling beneath his scrubs. It had shown no activity at all, no wave forms. A still sea.

She'd been tracheotomied and G-tubed, the monitor showing sound vitals. Her body was stable. A perfect life-support system for a dead brain.

Elisabeth had signed a living will. David had maintained his composure, perhaps due to the fact that he was a physician practiced in high-intensity, emotional decision-making, but more likely because he'd seen too many times the other roads that lay ahead. They'd given him some time alone with her body before removing her from life support.

He'd sat in a typical bedside post-leaning forward in the padded chair, chin resting on the union of his fists. He remembered being struck anew by how different the MICU was from the sunken B Level of the ER, in which nurses and doctors scurried among the wounded like industrious ants. The unit exuded a calm, almost peaceful air. Here it was easy to forget that one moved among the sick and dying. The scents were better contained, the nurses more personable, the floors and walls better scrubbed.

Elisabeth's skin had been pale and smooth, like porcelain. Her arm had protruded from the papery cuff of her gown, her skin gray against the white sheets. Her simple wedding band provided the only stroke of color against her flesh.

David had flattened his hand across her forehead and studied her eyes, but he'd seen nothing in them but the faintest flicker of his own reflection. It had taken him only a few moments to determine that Elisabeth's presence did not reside in her body any more than it did in the hospital room.

He had not been moved to tears. He had not been sure what he'd been expecting, but it hadn't been the cold nothingness in his wife's eyes.

The neurologist had been waiting outside the door. He'd rested a hand on David's shoulder. "Are you ready?" he'd asked.

"I'm not going to stay," David had said.

The nurses and doctors on the floor had seemed surprised by how briskly he'd left.

As David had driven home, the first edge of morning had leaked over the horizon, imbuing the air with a dreamlike quality. He'd pulled into the garage, removed his shoes, and stood motionless in the foyer for a full minute.

It hadn't been until he'd walked down the long hallway and sat on their large empty bed that he'd broken down. His hands had started shaking first, then his arms, and then he'd wept softly and erratically, his wife's pillow pressed between his hands.

A blaring horn on Wilshire brought David back from his thoughts. He put the car in drive and pulled away, but slammed on the brakes when he heard an awful metallic clunk. He got back out and picked up the broken gas handle from the ground; he'd pulled away with the handle still in the tank and torn it cleanly off.

He walked slowly back to the well-lit booth.

"I'll bill the usual account," the attendant said.

David managed a weak nod. "That'll be fine."