Natural Causes

TAKE IT OR LEAVE IT

by Axel Devlin

July 2

… And finally, I give you Axel's Axe, absent from this column for a few days, but always poised to take a good chop at the tires of those who would try to take us all for a ride.

Today, the ol' blade swishes through the air and once again thwacks into your favorite hospital and mine, Crunchy Granola General, otherwise known as the Medical Center of Boston. Hospital president Glenn Paris, a.k.a. California Glenn, presented his state-of-the-hospital message yesterday at the annual residents' change day assembly. That's when the new residents start their training and the old ones move up a notch.

And although the hospital shogun didn't come up with any innovations as spectacular (or embarrassing) as his breast implant raffle or his free crystallography clinic, he did pledge that nothing was going to stop the resurgence of his hospital back to the topmost ranks of academia. "And," he blustered, "you can take that to the bank!"

Well, at that moment, at that very moment, the power-and all the lights-went out in the entire hospital. Get the message, Glenn? Your approach might have worked in San Diego. But here in Boston we like our doctors to do it by the book, not by the alignment of the planets.

"I don't believe it."

"Don't believe what?" Andrew Truscott slid a plate of watery scrambled eggs and suspect hash browns onto the table and took a seat catty-cornered from Sarah.

"This-this vicious, unprincipled… crap."

"I gather that's a copy of the Herald there before you."

"Why's Devlin got it in for this place so badly?"

"You don't know?"

"I guess not."

"Five years ago-I know because it was right after I started here-his wife needed gallbladder surgery. Devlin wanted her to go to White Memorial, but she liked Bill Gardner and the newly ordained, touchy-feely atmosphere here. Two days after Gardner did the operation, she had a massive pulmonary embolism and croaked on the spot."

"That's terrible, but it could happen to anyone at any hospital."

"Apparently that's what the malpractice lawyers told Devlin. So he set about getting retribution his own way."

"How sad."

"Maybe not. For some people vendettas of one kind or another are therapeutic. Don't get mad-get even. Lashing out at MCB like he does probably helps to keep him going."

"And how do you think he gets his information? This article sounds almost as if he was sitting in that amphitheater when the lights went out."

"Sarah, I hope this doesn't come as too much of a shock, but not everybody is as gung ho about this place as you are. But enough about Devlin. I thirst for knowledge."

"Knowledge about what?"

"Don't be coy now. You are currently the doc of the hour around here, and I want to know exactly what you did in there yesterday."

Sarah smiled.

"Just what you saw," she said. "The only way I could think of to stop her bleeding was to slow Lisa's heart rate and circulatory speed while she was mentally doing what she could to seal off the bleeding points in her body."

"Excuse me for saying so, but Lisa Summer mentally stopping an arterial pumper is a bit hard for this swag-man to swallow."

"Except that you saw her do it, Andrew. Listen, a good hypnotist can tell a hypnotized subject that he is going to be touched on the arm by a hot poker. When the subject is touched with a pencil eraser instead, he raises a welt, then a blister on that spot. How do you explain that? You know, the real problem is that western physicians are taught about the autonomic nervous system by physiologists and anatomists. If we were taught by yogis or acupuncturists as well, our concepts of what humans can and cannot control in their bodies would be quite different."

"Believe in your limitations and they are yours, huh? Well, I for one am certainly impressed. Maybe you can ask young Miss Summer to look inside her body and tell us exactly what in the hell happened-how she got into this pickle to begin with. Does she know she's not the first?"

"I don't think so."

"Well, she ought to. Maybe if she knew how lucky she was to survive this at all, she'd perk up a bit."

"There's plenty of time for her to perk up. She just lost her baby and her arm. Andrew, do you have any idea what might be going on? Did you ever see that other girl as a patient?"

"No. Et tu?"

"I haven't a clue as to what's going on, and I was on vacation when the other woman came in and died. But I did see her in the clinic."

"And?"

"And she was a healthy young woman with an uncomplicated pregnancy. Just like Lisa. I put her on the herbal supplement I like to use and wished her well with her delivery. That was the only time I saw her."

"Herbal supplement?"

"Yes. Almost all pregnant women are given some kind of prenatal vitamins by their doctors. In our OB clinic, it's standard fare. Well, in the mountain villages where I worked in Thailand, the women all took prenatal supplements as well-a combination of roots and herbs, crushed and taken as a tea twice a week. The only study done of these women showed higher birthweights and better infant survival than in women who delivered in the teaching hospital in Chiang Mai. And believe me, the nutrition in the Meo villages was not very good, and the hygiene even worse. I helped conduct that study with an M.D. from the public health service and the herbalist who taught me most of what I know."

"Remarkable."

"It was, actually."

Sarah was excited to have the chance to talk about the Thai study and her work with the Meo and Akha tribes. It had been a wondrously happy and peaceful time in her life. She might still be working and studying there had it not been for the sudden death of Louis Han and the subsequent entry into her life of Peter Ettinger.

"So you use this herbal mix instead of prenatal vitamins?"

"Ever since I found a herbalist in town who could put it together, I have. I give every woman I see in the OB clinic the choice of taking whatever vitamin samples we happen to have on hand or the tea. Some pick one, some pick the other. I've been keeping some notes on birthweights and infant health, but the numbers are still too small to see any difference."

"Fascinating. What sort of herbs and roots are we talking about here?"

"Do you know about herbal medicine?"

"Not unless you consider having an assortment of Celestial Seasonings teas as being knowledgeable. I am interested in being enlightened, though."

"In that case, here's the handout I give to all the women I see in the clinic. It lists the nine ingredients in the supplement, and what each does."

"Angelica, dong quai, comfrey," Andrew said, scanning the list. "This is exotic-sounding stuff."

"Not really. If we were in Beijing, folic acid, beta-carotene, cupric oxide, and many of the other components of our standard prenatal vitamins would be considered just as far out."

"Point taken. This hospital is certainly tailor-made for you, isn't it."

"I know you have some misgivings, but I think we deliver the best patient care of any hospital in the city."

"Maybe so. We're certainly becoming the leading hospital for treating active labor complicated by DIC, I'll say that much for us."

Sarah's beeper sounded, ordering her to call extension 2350.

"That's the birthing room," she said. "I've got to go."

"Don't worry about your trash. I'll take care of it."

"Thanks. Andrew, do you think we should form some sort of committee to begin investigating these cases?"

"I think that's a splendid idea. If there's one thing this hospital could use more of, it's committees."

"I'm serious. I mean, it's not like an epidemic or anything. But two such similar and unusual cases. It certainly makes you wonder. Well, as they say in the postal service, I've got a delivery to make. We'll talk about all this more later, won't we?"

"You bet," Andrew said.

He watched until Sarah had left the cafeteria. Then he took an envelope from his lab coat pocket and tapped it thoughtfully against his palm.

"Not two cases, m'dear," he muttered. "Make that three."