Do No Harm

Chapter 22

"To say I'm pissed off would be an understatement." By the time David entered the doctors' lounge his rage had turned to disgust. He had pulled most of the staff who had been on the floor during the incident into an impromptu meeting, leaving Carson and a few nurses to oversee the floor. Pat had apparently followed his orders and left. Nurses and interns crammed onto the cheap vinyl couch, leaned against the coffee-stained sink, and sat cross-legged on the floor.

He looked blankly from face to face. Almost all of them lowered their eyes from his stare. "A patient comes into our division in acute pain, requiring emergency treatment, and we withhold care. A top-notch medical facility withholds care. I can't… " The words were jumbling in his mouth, so he paused and took a breath. "I'm meeting with Dr. Evans today, but I can't even begin to figure out how I'm going to present this."

A few of the interns stiffened at the mention of the hard-nosed chief of staff.

He couldn't recall ever seeing the staff so uncomfortable. Nervous shuffling, regretful expressions. One of the nurses looked up to stop her moist eyes from leaking. A medicine intern raised a fist to stifle a cough.

"Outside these doors, the world can be as vicious and cold as it wants. People don't help each other. People don't have to help each other. In here, we take care of them, trite as that may sound."

"That man is a vicious mutilator of women who got a taste of his own medicine." The anger in Don's voice surprised him.

"That man is a suspect" — David emphasized the nouns with jabs of his open hand- "but that's the cops' concern. To us, he's a person with a serious injury, like any other."

"Just doing our job, huh? That's the philosophy you want to rely on?"

David's stomach was awash with acid and rage. "The Hippocratic Oath, Dr. Lambert, is the philosophy I rely on. We took an oath, every one of us, that we would work by our medical ethics and hold them above everything else. What does it mean if that oath ends beyond the point that someone is appealing, or mentally sound? Or likable?"

"It's not that black and white."

"It is precisely that black and white. If we can reduce the pain of another human being, we do it."

"How can you want to show that man compassion?"

"Compassion? It has nothing to do with compassion. This is our job. If you don't like it, go be a goddamn accountant. But you can't stay here and think you can call your own shots."

The others watched the exchange with stunned expressions.

David took another moment to gather his composure. "It is not our place to question our patients' morality. Do you really think you can keep your footing on that slippery slope? What next? We stop treating criminals? How about people who cheat on their income taxes? Do we let them lie in pain? The mentally ill? Do we deny them medical care? Do we?" David's arms were tensed before him. "That man in Fourteen could very well be mentally incapacitated. Leave judgment to the courts, and do the jobs you swore under oath to do."

"I never abandon my own instincts," Don said. "Not for any code of ethics."

"Fine," David snapped. "If that code of ethics doesn't work, try this one. I'm the division chief, and you will listen to me. So do your fucking job. All of you. Now."

He walked out and left the door standing open, the murmurs following him a few yards up the hall. Whether the confrontation had done any good or not, he felt considerably better.

He returned to the CWA and checked in with Carson, noting the emptiness of the ER's main axis. Aware that he had just acted like the kind of manager he'd sworn he would never be, he focused on the board as the other staff members trickled back to work.

Preoccupation stayed with him for the next few hours. His concentration wandered; his movements were mechanical. He forgot a patient's name during an examination for the first time since June of 1987.

The rest of the staff gleaned the fact that he didn't want to interact with them. Except for essential exchanges, the nurses left him alone. The interns went to Don to present cases and have their orders signed. Don spent his time alternating between gloating over his newfound popularity and sulking like a scorned girl.

When David stopped by the CWA later, the room quieted as he entered. He glanced at the board. Aside from an MI and a severed finger, things appeared to be quiet, so most of the staff were hanging out on the stools or leaning on the counters, catching up on paperwork.

Don's hand rasped over the stubble he kept Miami Vice length. His eyes, beneath his perfect brow, were intensely angry. Jill touched David's arm, a gesture he thought was apologetic. The others ignored him.

He nodded at Jill, a bit awkwardly, and walked from the room. Before heading to his lunch meeting, he went to check on Clyde. He was just about to turn the corner when he overheard Jenkins talking to the two LAPD cops stationed outside the closed door to Clyde's room. They looked tall and hard in their uniforms, their black belts laden with tools and weapons. Yale stood by also, silent and seemingly uninvolved in the conversation.

"— business end of my nine-millimeter," Jenkins was saying. David peered around the corner and saw him remove his pistol and aim it at an imaginary victim, execution-style. The hall was momentarily deserted; David had decided to direct new patients to the rooms off Hallway Two until Clyde was moved.

One of the uniformed cops muttered something, though David picked up only snatches. "… doc releases him… get your hands on.. "

"That's right," Jenkins said. "We'll file it under DSAF: Did Society a Favor."

David was unsure how to gauge the severity of Jenkins's grandstanding, but he felt his face tingling with the panic mixture of anger and sudden dread. Yale leaned against the door but didn't comment. Was he complicit in Jenkins's scheming, or did he believe Jenkins was simply venting?

David pulled silently back from the corner and headed to his meeting. It took him nearly ten minutes to negotiate the cafeteria lines and locate two opposing seats at a table, and he found himself fondly recalling the days of the separate physicians' dining room. He had already finished eating when he spotted Sandy Evans crossing the cafeteria toward him, juggling a soft leather briefcase and a forest-green tray covered with a mound of food. She wore a well-tailored charcoal suit, and wore it well for a sixty-five-year-old. Her hair, chestnut with auburn highlights, was shag-styled down around her neck.

He was glad to have pinned her down for lunch; the last time he'd needed to speak to her on short notice, he'd had to scrub in and catch up to her in the OR. Speaking through surgical masks tended to blur the words, and though surgeons never seemed to mind, David had always found a certain stark irreverence in discussing unrelated issues over an opened patient. To accent her points, Sandy had pointed at him with a Kelly-clamped segment of resected bowel.

David rose slightly in the black cafeteria chair, and he and Sandy touched cheeks in a semblance of a kiss. Aside from her husband, David was the only person she permitted closer than a handshake, an indulgence granted him only because she'd had an exceedingly close relationship with his mother. She was much like David's mother in many regards-the stern attractive looks, the insatiable ambition, the aggressive set of the shoulders. Even their faces sometimes blended in David's memory; both had a hard-shelled, resilient cast, the result of weathering myriad broadsides early in their careers from male colleagues and superiors. But David felt Sandy's similarity to his mother most keenly in something unexpected and unsettling-his desire to please her.

Sandy dropped her briefcase on an empty chair and lowered the tray to the table, a bottle of Gatorade rolling toward the edge until David grabbed it. Her voice was deep and throaty, a smoker's voice, though she'd never smoked a single cigarette. "The Board of Directors wants a complete media blackout, and rightly so. One suture untied, and we'll have a scandal on our hands. ABC, CNN, MSNBC, and Fox News are all pressing my office for comment, and they're expecting me to roll over. Little do they know." Her vivid green eyes gleamed. "They'd better gear up for one hell of a dogfight, 'cause this old bitch don't roll over unless she's in the mood." Her eyebrows, lightly penciled, rose beneath her bangs. "Oh, it's true. You can ask Stephen."

David absentmindedly bent a plastic fork in half. "I'll take your word."

Sandy opened two containers of yogurt, unwrapped a burrito, and lifted the lid of a cardboard box from the grill. Sandy still jogged five miles every morning, and ate like an NFL linebacker. "Sounds like you've had your hands full today," she said around a mouthful of chickwich.

"More than you know," he muttered.

"What?"

"Nothing." David shook his head. "What happened this morning-the entire division not stepping in to provide care-I've never seen anything like it."

"People react violently when friends and colleagues have been injured."

David looked up, shocked. "You're condoning this?"

"Hey!" She pointed at him with the end of a banana. "Direct that righteous Spier anger elsewhere, David. I'm on your side here. If I condoned your staff's behavior this morning, I'd be perfectly capable of expressing that sentiment, so don't get pissy with me over implications."

"All right. I'm sorry. I apologize."

"If you'll pardon the equestrian metaphor, David, you're one of my Thoroughbreds. You were the youngest division chief in the history of this hospital, and I leaned like hell to get you that post, not because your mother was my mentor and dear friend but because you are that good. You're one of maybe three department heads here whom I trust implicitly, across the board, without question." Her voice was hard and driving, as if she were still being challenged.

"Would you like me to apologize again?"

Her lips pursed and pulled to one side in her distinctive smile. "No. Once was sufficient. Now, I agree that your staff's behavior was egregious. I'm merely pointing out that, however misguided and asinine, there are extenuating circumstances here. Now let's talk about this. First of all, what's this man's name? The patient."

"Clyde."

"Clyde? Who the hell's named Clyde?" She looked at David, miffed, as if he were somehow responsible for naming him.

"That's all he'll give up," David said. "No last name either."

"All right. How many staff members refused to help you?"

"Everyone."

"David, if the radiology tech or a desk clerk didn't pitch in, that's not relevant to this discussion. I'm interested in how many members of ER staff who receive and treat new patients refused to help you."

David thought for a moment. "Seven. Four nurses, two interns, and Don Lambert."

"All right. So legally, we're concerned with seven people here."

"My concerns are ethical, Sandy. Not legal."

She finished chewing a bite of burrito. "Hurrah, David. However, what I'm concerned with, in running this facility, is the area where your ethical concerns cross the boundary into legal concerns."

"Or PR concerns."

Her penciled eyebrows pulled up as she appraised him. "You inherited your mother's moral sense, but it's a shame you didn't inherit her overriding grasp of politics. It's the only thing that stands between you and a future post as chief of staff."

David ignored the dig. "How do you intend to handle this issue, Sandy?"

"Well, we've long known that Dr. Lambert is a lazy SOB, but when he's focused he's actually quite competent, and he is very popular among the staff. Do you really want to push this? It'll be a big stink. Do you feel your patient's care was compromised?"

"Well, I couldn't get to him as quickly-"

"Truly compromised?"

He bit his lower lip. "Probably not."

"All right. Now let's bear in mind that we are dealing with a very specific situation. This man was attacking ER workers. While the behavior of your staff is inexcusable, I'm not concerned that they'd withhold care from other patients. And the likelihood of someone else attacking ER workers and then needing medical care at the hands of that same staff… well, we know how remote a possibility that is. You have to pick your battles. Now let me ask you again. Do you really want to push this?"

David suddenly felt quite nauseous. "I want them to be formally reprimanded, yes."

A woman trudging slowly past glanced over at him, and he realized the intensity in his voice was making it carry.

"Don't get me wrong, David. I'm as pissed about this as you are. In fact, I'm planning on personally meeting with all seven employees and tearing them each a new orifice. What I'm asking is, do you want to involve the Ethics Committee? Risk Management? The California Medical Board?"

He rolled the soft lining skin of his bottom lip between his teeth. "No."

"All right." She smiled curtly. "I'm quite good at being furious. By the time I'm through with those seven, they'll have the Hippocratic Oath tattooed on their foreheads."

He nodded, somewhat formally, and she returned the gesture, amused.

"Now I've got another tangentially related headache," Sandy said. "As I mentioned before, the media's been crawling all over the hospital, jamming the phone lines. It's not the kind of press we like, but, even worse, it's interfering with the hospital's effectiveness. When can you get this… Clyde on his way to the Sheriff's station?"

"It's complicated."

"No, David, it's not. Get him stable and get him moved."

Sandy leaned back and crossed her arms, an amused, attractive little smile playing across her face. "One of the rules when dealing with Thoroughbreds is that you don't rein them in too much. They lose some of their fire, their passion. So I'm making a suggestion, not a directive, and you can throw it out if you'd like."

He knew what was coming, and he knew he deserved it.

"More people look up to you here than you're aware," Sandy said. "You're part of the bedrock of this hospital. I heard you lost your cool pretty badly this morning. That unsettles people. Whether we like it or not, your division is under intense scrutiny because of this case-both internal and external scrutiny."

David took this in, trying to strip away his anger and defensiveness, and find some utility in the information. "Your suggestion?" he asked.

Sandy rose, picked up her tray, which was littered with gutted food containers and fruit rinds, and winked at him. "Keep your clay feet covered."