Michael Palmer: Natural Causes

Lisa's life had been saved. Her womb, her senses, and her nervous system were intact, and she could walk. In time, she would learn to use her left hand better and to control whatever prosthesis was placed on her right. She might even find a way to continue expressing herself as an artist. She would begin to deal with her grief, and someday, perhaps, she would once again bear a child. In a purely clinical way, Sarah knew all these things were true. Still, she could not shake the reality that Lisa was her patient, and that not twenty-four hours before, she had excitedly been preparing to give birth.

"You all right?"

Sarah was sifting through a printout of the already substantial number of lab tests run on Lisa, searching for a clue-any clue-as to what might have caused the catastrophe. Startled, she looked up to see Alma Young, a seasoned SICU nurse, standing at the foot of the bed.

"Oh, yeah, I'm okay, thanks. Just a little tired is all."

"That's understandable. Well, your girl'll be up in a few minutes. Recovery just called. Apparently she's doing reasonably well, all things considered."

"That's great," Sarah said, with little enthusiasm. "I keep staring at these numbers, hoping that something I missed will suddenly leap off the page and explain what's going on."

"Maybe you should just close your eyes and nap for a few minutes."

"I'm afraid that if I do that, my body will figure out it doesn't have to feel the way it does right now, and I'll be finished for the day."

"You know, the whole hospital's talking about what you did yesterday. The ER nurses are saying that girl would have died for sure if you hadn't stepped in and then held your ground against that hematologist."

"Then why don't I feel better than I do about all that, Alma?"

The older woman sat down on the end of the bed.

"Because you're a good doctor," she said. "That's why. You're sensitive. You care about people's suffering and pain-I mean really care."

"Thank you."

"But may I say something?"

"Sure."

"Sometimes I think you care too much. You take it all too personally. Sitting here poring through those lab reports when you could be resting is a perfect example. That's taking sensitivity one step too far. I've seen all kinds of residents-and nurses, too-come through here. One thing I've noticed that the really good ones all have in common is this little switch they can throw that lets them become totally objective when they need to be that way. You have everything it takes to be one of the really good ones, but I think sometimes you let all this get you down too much."

"You see that in me?"

"I do. So do some of the other nurses. Our favorite sport is dissecting the residents, you know. We all really like you, Sarah; and we love working with you. But we worry about you, too. It's as if you always think there's something more you should be doing instead of just accepting that you can only do what you can do."

The nurse's observations triggered a rush of images and emotions, most of them unpleasant, and all of them centering on Peter Ettinger.

"Alma," Sarah said, "I've never been much good at accepting my limitations. In fact, if I didn't always think there was more I could do for a patient, there's a good chance I'd never have ended up as an M.D."

"What do you mean?"

Sarah laughed uncomfortably. "Do you have a few hours?"

There was concern in Alma Young's eyes.

"Actually," she said, "I'm completely caught up until our friend Lisa arrives."

Sarah thought for a time before responding. She had always been a private person. And the compartmentalization of her life-high school in upstate New York, college in a Boston suburb, the Peace Corps in Thailand, Peter and the Ettinger Institute, medical school in Italy, and now this residency-had made it easy for her to stay private. In each place she had begun to develop friendships, but none of those relationships, except with her mentor, Dr. Louis Han, was strong enough to survive the next move. And gradually she began to find that when asked to talk about herself-even when she felt inclined to do so-she simply didn't. Or couldn't.

Now, a woman with whom she had worked for more than two years seemed genuinely interested in who she was and how she was reacting to this most difficult case. Perhaps it was time to open up a bit.

"A number of years ago," she said finally, "-ten, actually-I was living in the mountains in northern Thailand, building a clinic while I was teaching and studying acupuncture and herbal medicine. An older man became my friend and my mentor. It was-you know-the father-I-never-had sort of thing. Well, he died rather suddenly. And soon after, a man quite like him, although much younger, passed through our village. He was brilliant and dashing, and interested in the same things I was. At the time, he was already world renowned in many areas of alternative healing.

"Well, within a month, I was back in the States, living with him and his daughter, and working at his institute…"

Sarah debated sharing Peter's name, but decided there was no reason to do so. "For almost three years I lived with him and the teenage daughter he had brought back from Africa when she was a baby and adopted. For those three years I was the closest thing she had to a mother. Although, as I said, this man and I worked together at his institute, as far as he was concerned, I always worked for him, not with him. When the event I'll tell you about happened, he had actually asked me to marry him. But this dark side of him-an enormous, insatiable ego, and an inflexibility that frightened me-had begun to surface more and more in our life."

"Go on, please," Alma said.

"He had a patient, a sculptor, whom he had quite literally cured of a case of rheumatoid arthritis that the man's doctors had labeled incurable."

"How did he do it?"

"Oh, dietary changes and herbs, plus some of the same sort of techniques I used yesterday with Lisa. The man went from being a cripple to playing racquetball every day."

"Amazing."

"Not to us it wasn't. Alternative healing cures many, many patients that western physicians have given up on. We M.D.s still don't have much of a handle on the mechanism of disease, you know. Our microscopes get bigger and bigger, and the things we can look at get smaller and smaller. We prescribe penicillin without giving it much thought. But we still don't know why Person A got the strep throat we're treating, or why Person B didn't.

"Anyhow, my friend went away for a month and left me in charge of his patients. He was treating the sculptor for headaches with herbs, acupuncture, and chiropractic adjustments. I saw the man several times and felt more concerned about him each time. He said his headaches were better, or at least no worse, but he seemed to me to be walking funny. And believe it or not, his smile seemed off center as well."

"That sounds like trouble."

"That's what I thought. I called White Memorial and spoke to a neurologist who wanted to see him at eleven the next morning. My friend was due home from Nepal that night, but I decided his patient needed to be seen no matter what. So I made the arrangements. That may sound like an easy decision, Alma, but it wasn't. There was still the matter of explaining why I would go against everything my friend believed in-"

Sarah could not remember the last time she had shared with anyone that final, horrid day with Peter. But Alma Young was such a wonderful listener that the story came with surprising ease. And although Sarah told it rather quickly, the pieces she actually voiced were only snippets of what she was remembering…

The night that resulted in so much torment had actually felt magical. Peter listened quietly and attentively to her account of the referral of the sculptor, Henry McAllister. Peter's response-the response she had so dreaded-was, in essence: Hey, listen. I left you responsible for the institute because you are a responsible person. You saw what you saw, made a decision, and went with it. What could possibly be wrong with doing that?