Well, lately things weren't making muchsense at all. The big answers were just as elusive as ever. More so. Hismarriage was shaky. The kids he had always wanted just never happened. Thefinancial security that he had expected would gradually develop over the yearswas tied to a brand of medicine he was not willing to practice. He neverallowed his office to become a medical mill. He never sent a collection agencyafter anyone. He never refused anyone care because the patient couldn't pay. Henever moved to the suburbs. He never went back for the training that would havemade him a sub-specialist. The result was a car that was seven years old and aretirement fund that would last indefinitely — as long as he didn't try toretire.
Now, his professional stature was beinghauled up on the block, his wife was facing a neurosurgeon's scalpel, and justfour weeks from the first of September, his fifty-first year, he hadexperienced pain in his chest.
The hastily called family medicinedepartmental meeting accomplished little. Each physician who spoke during theemotional forty-five-minute session seemed to have different information aboutwhat the findings of the Sidonis committee were going to be. In the end, nomotions were passed, no actions of protest approved. Aside from presenting aunified front at the amphitheater, there was nothing to do until the specificsof the task force's recommendations were known.
'Harry, you didn't say a word in there,'Steve Josephson said as they left.
'There was nothing to say.'
'Sidonis and his vigilantes are on a witchhunt, and you know it. Everyone's scared. You could have calmed them down.You're. . you're sort of the leader of the pack. The unofficial kahuna.'
'A kind way of saying I'm older than mostof the others.'
'That's hardly what I mean. I deliverbabies. Sandy Porter strips veins and does other stuff in the OR. The Kornetskybrothers are better in the CCU than most of the cardiologists. Almost every oneof us does some procedure or activity that might be taken away today. You'reabout the only one who does all of them.'
'So? Steve, what are we going to do?Challenge the specialists to a medical Olympics?'
'Oh, this is crazy. Harry, I don't knowwhat's come over you lately. I just hope it's not permanent.'
Harry started to respond that he didn'tknow what Josephson was talking about. Instead, he mumbled an apology. He hadnever been a fiery orator, but over the years his directness and commonsenseapproach to resolving conflicts had earned him respect in the hospital. And hecertainly had never backed away from a fight. He could have —
The crisis at MMC was the direct result ofthe hospital being named as codefendant in three successive malpractice suitsover a period of a few months. All three suits involved GPs. Harry felt theepidemic of litigation was nothing more than coincidence. In the new medicalorder of sue first, ask questions later, similar numbers could probably beproduced to show that specialists were equally vulnerable. But the medicalstaff had panicked and the Committee on Non-Specialty Practice had beencreated. Caspar Sidonis, a charismatic, widely known cardiac surgeon, had beenmade its chairman.
Sidonis and Harry had never hit it off,although Harry never really understood why. Now they were on opposite sides ofthe table, playing a high-stakes game for a pot that was of value only to theGPs. And Sidonis held all the cards.
'Steve, I'm sorry,' Harry said again asthey turned down the passageway that cut through the emergency room, 'I guess I
The corridor, a shortcut from the roomwhere their meeting was held to the amphitheater, was closed to the public butnot to hospital staff. Today, the ER was humming. The rooms to either side ofthem were all occupied. Major surgery, minor surgery, orthopedics, ENT,pediatrics, minor medical, major medical, cardiac.
'Each one a story,' Harry said as theywalked through.
'Yeah,' Steve mumbled. 'Well, after todaywe better get used to having to read the Cliffs Notes.'
A nurse rushed past them from behind andinto one of the two cardiac rooms.
'Give him another three of morphine,' theyheard a resident say as they neared the room.
'How much Lasix has he gotten?'
'Eighty, Doctor
'This is V. tach. I'm almost certain ofit.'
'His pressure's dropping, Doctor.'
'Dammit! Someone was supposed to havecalled cardiology.'
'I put a page in for them. They haven'tanswered.'
The two GPs stopped at the doorway. Thepatient, a husky black man, probably in his early seventies, was in extremis,sitting nearly upright on the litter, gasping for breath. Loud gurgling wellingup from within his chest accompanied each inhalation. His heart rate was nearlyone hundred and seventy. The young resident managing the case was a decentenough doctor, but he had developed a reputation for losing his cool indifficult situations.
'What is his pressure?' he asked.
'Maybe seventy, Doctor. It's quite hard tohear.'
There was undisguised urgency in thenurse's voice.
Her repeated use of the resident's titlewas a demand that
he do something.
'We can't wait for cardiology,' he said.'Get ready to shock him. Someone please page cardiology again. Janice, I wantthree hundred joules.'
Steve Josephson, his eyes wide, lookedover at Harry.
'Pulmonary edema,' Josephson said.
'Right you are,' Harry replied.
'But that's not V. tach on the monitor.'
'I agree. Plain old garden variety sinustachycardia, I would say. Due to the stress of the situation.'
'We can't let him shock that.'
Harry hesitated for just a moment, thennodded. The two of them moved to the bedside.
'Sam, that's sinus tach.' Harry whispered softlyenough so that no one but the resident could hear. 'Try to shock that and youmight kill him.'
The resident looked first at the monitorand then at the nurses and technicians surrounding his patient. In seconds hisexpression went from confusion to anger to embarrassment, and finally torelief.
'You want to take over?' he askedsuddenly. 'Please, go ahead.'
Without answering. Harry picked up a toweland dried the perspiration that was pouring off the patient's brow. He glancedat the plastic identification bracelet.
'Mr. Miller, I'm Dr. Corbett. Squeeze myhand if you understand. Good. You're going to be okay, but you've got to tryand breathe slower. I know it's hard and I know you're frightened right now,but you can do it. We're going to help you. EKG, Steve?'
'Maybe a small anterior MI,' Josephsonsaid. 'He's beating too fast to tell for sure.'
'Hematocrit?'
'Fifty percent. If he's not a smoker, hisblood is concentrated big time.'
They looked over at the resident, whoshook his head. 'Lifetime nonsmoker,' he said. 'But what's his red blood cellconcentration got to do with all this?'
Harry's exam disclosed no ankle swellingand no other signs of excessive fluid. Heart failure, from whatever cause, wasproducing back pressure throughout the pulmonary circulation. Serum, thenoncellular part of blood, was being forced through the blood vessel walls andinto the man's lungs. As a result of the serum shift, the red blood cells, toolarge to pass through the vessel walls, were becoming sludge. Harry checked theman's pupils for the constriction that would signal marked narcotic effect. Thepupils were small, but not yet pinpoint.
'Three more of morphine,' he said. 'Pleaseget me a phlebotomy bag. We're going to take some blood off him. Get ready tointubate him if we have to.' He toweled the man off again. 'Mr. Miller, you'redoing great. Try to slow it down just a little bit more.'
'Excuse me,' the resident whispered,astonished, 'but you're going to take
'We are.'
'But. . but nobody does that anymore.'
