Michael Palmer - Flashback

Donald Norman cursed under his breath. "Morning, Doreen, " he said, tugging at the small bulge that had materialized behind Annie Doucette's chart. "How goes it?"

"Oh, Dr. Norman, hi."

"Hey, I told you, " he whispered, with a conspiratorial wink, "when no one's around you can call me Don. Listen, I'd like you to make rounds with me, if that's okay. Mr. Rolfe has some interesting findings in his chest, and that… that harpy, Mrs. Doucette, should still have her murmur."

The nurse glanced about. "Well, I'm a little behind in my work, and-"

"Oh, come on, " he urged. "I just have these two on this floor. It shouldn't take long."

"I… well, okay. As long as it's just two. And Dr. Norman, Annie's a nice lady. Really she is. Just give her a chance."

"It's Don, remember? " Norman said. "And as far as Annie Doucette goes, she may be a sweet old lady to you, but she's been a harpy to me." He checked the three by five file card he carried on her. "Besides, " he added, "It's all academic. To all intents and purposes, she'g out of here."

"You're sending her home? " Doreen asked with disbelief. Norman shook his head* "Not home, " he said. "To the Sterling Nursing Home, provided they can clear out a bed. Remember, under the Diagnostically Related Group system-you know, the DRGS-medicare pays by the diagnosis, not the length of the hospital stay. Our job is to get patients out as quickly as possible."

What Norman did not mention, although they were certainly on his mind at that moment, were the Ultramed incentive points awarded for discharging patients before the end of their DRG period, and the even greater number offered for a transfer to a Leeward-owned nursing facility. "I don't think Annie's going to like that idea, " the nurse said. "She's very independent."

"Well, then, " Norman said, tucking her chart under his arm and adjusting his tie, "we'll just have to reason with her, won't we? Bring your order book along just in case. By the way, " he added as they started off, "I'm giving an in-service on hepatitis next Thursday evening. I hope you'll be there."

"Well, actually, I-"

"I think Flo Bergman, the Ultramed nursing director, will be up from Boston. I'd like her to meet you. With the Ultramed director of nursing and the Davis chief of staff on your side, there's no telling what opportunities might open up for you…"

Annie Doucette flipped off the quiz show she had been trying to watch, settled back on her pillow and stared up at the ceiling. The pains in her chest, little more than twinges throughout the previous day, had begun to intensify, and for the first time since the horrible night of her admission, she was frightened. There were gaping holes in her recollection of that night, but not gaping enough to erase the agony and the humiliation she felt, to say nothing of the disruption she had caused Cinnie Iverson, the Judge, and their family. She should never have accepted their invitation to dinner, she told herself. Never. After twenty-odd years of doing her work proudly and well, of being the glue that held the Iverson household together, she had become nothing but a burden-an imposition and source of worry for everyone. If only she could have just gone as her husband had, quickly and painlessly in his sleep.

She chewed two Rolaids from the pack her son had bought for her and tried to focus her thoughts on the sweaters for her grandchildren and the afghan for the church bazaar-unfinished projects waiting for her at home in her flat. All she needed was a few more days-a week, maybe-in the hospital, and everything would be okay. She had not given in to the aches and pains and the passing years yet, and she would not this time.

The rumblings in her chest were probably nothing more than indigestion, anyhow. Annie closed her eyes as bit by bit the discomfort yielded to a gentle sleep… A week… That was all she needed… A week to get her strength back… Then everything would be okay… everything would be back to nonnal again… It felt so good to nap… So good to drift off… so good… "So, Mrs. Doucette, how are we doing this morning?

" Donald Norman boomed. Startled, Annie felt another, slightly more urgent twinge in her chest. "We have felt better, Dr. Norman, " Annie said, opening her eyes only after the last vapor of sleep had drifted away. "Oh, hello, Doreen, dear."

"Hi, Annie."

"And what seems to be the trouble? " Norman asked. Annie debated whether or not to repeat what she had already told the nurses about the pains.

Donald Norman had never paid much attention to her complaints, anyway.

"I'm getting some pains," she said finally. Norman thumbed through her chart. "Doreen, look. Here's the description I wrote of that murmur.

Right here. A grade-two systolic. Let's listen and see if it's changed."

He slipped his stethoscope down Annie's nightgown, listened for a few moments, and then guided the nurse to the bedside with his arm around her waist and gave her a turn. "Hear it?"

The young woman looked at Annie uncomfortably and nodded. "Dr. Norman," she said, "Annie's been having chest pain on and off since yesterday morning."

"Of course she has, " Norman said, as if he and the nurse were the only two in the room. "I would bet dollars to doughnuts that they started right after I mentioned her discharge from the hospital. It happens all the time. People get anxious. Did you order an EKGT' "It's right there in the front of her chart."

"Good, " he said. "Good work." He scanned the tracing. "Well, it shows nothing to be alarmed at. Just the same T-wave changes in the anterior leads. Here. See? Right here. I'll explain how they're different from other T-wave changes after we finish seeing these two patients." He turned back to Annie. "So, if everything else is okay, I think we should begin to plan for your discharge."

"I'm not feeling well enough to leave yet, Dr. Norman."

"I know, dear. I know."

Norman took her hand to pat it, but Annie pulled away. "You're bound to be nervous at the prospect. That's why I've arranged for you to-"

"I wish to stay in the hospital for another week or so, " she said.

"Then I should be ready to go home."

"Mrs. Doucette, you didn't let me finish. I was saying that I'm in the process of arranging a bed for you at the Sterling Nur-uh, convalescent facility. A couple of weeks there, and you should be ready to go home."

"I won't go, " Annie said flatly, sitting up in bed to confront the man.

"You are not going to stick me in any nursing home. I shall stay here for one more week, and then I shall go to my own home."

"I'm afraid that's not possible, Mrs. Doucette."

"Well, " she said, "I'll just speak with Mr. Frank Iverson, and we'll see what is possible and what is not."

"Feel free to do that if you wish, Mrs. Doucette. But Frank Iverson is not taking care of you. I am. And I am telling you that your hospitalization is about to run out and you will not be able to remain here for another week. That is the rule. In fact, it is one of the rules Frank Iverson is paid to uphold. Now, please calm down and try to realize that what I'm doing is in your best interests." Before she could respond, Annie felt another stab beneath her breastbone. Under the sheet, her fists clenched. "You're not a very good doctor, you know," she managed finally. "You not only don't take very good care of yourself, you don't take very good care of your patients, either."

Donald Norman glanced back at Doreen Lavalley, his face flushed with anger and embarrassment. The old woman was a goddamn harpy, there were no two ways about it. Not only was she jeopardizing a hefty set of bonus points for him, but she was making him look like a goddamn asshole in front of Doreen, as well. "Mrs. Doucette, " he said sternly, "we'll discuss this later. Meanwhile, lie back and get some rest. Doreen, come with me, please."