Richard Mabry: Diagnosis Death

After Elena turned the patient over to the anesthesiologist, she lingered in the hallway, praying the surgery would save the life of this man whose name she didn't even know. That he wouldn't be kept alive to simply survive in a coma. Not like Mark.

The patient's name was Chester Pulliam. Elena sat in a corner of the waiting room with his wife, Erma, and explained the situation. "A blood vessel in your husband's brain burst. Usually it's because of a weak place, sort of like a bulging spot on a balloon. This is more likely to happen when there's high blood pressure and hardening of the arteries, and your husband has both these conditions."

The woman looked down at the handkerchief she was twisting. "Can they save him?"

"Dr. Clark is an excellent neurosurgeon. He'll do his very best."

"Oh, I hope so. I couldn't bear to lose Chester. We've been married for forty-eight years. If he died… I'd die too."

Elena patted Mrs. Pulliam's hand. "Is there anything I can do for you? Are there any other questions?"

The woman shook her head. "I'm sure there are, but I can't think of them right now." She looked into Elena's eyes. "Thank you for what you've done."

"I'm glad I could be here to help." Elena felt a familiar lump in her throat. She turned and strode away before the woman could see the tears forming in her eyes. Would this happen every time she had a patient with an intracranial hemorrhage? Where was the dispassionate approach she'd been told she had to adopt if she were to survive as a family doctor? Her department chair had put it to her this way, "Elena, Mark's situation wasn't uncommon. You did the best you could. Everyone else did too. The timing was just bad. You can't let that carry over to every patient you see for the next forty years."

In less than a month, she'd complete her training and be out in the world of private practice. She had to get past this. Medicine was all she knew, all she'd ever wanted to do. Surely God wouldn't take that from her after He'd already taken her husband.

Elena's mind was on everything and nothing, churning fruitlessly as she shuffled through the lunch line in the hospital cafeteria. She'd eat, but only because she knew she had to. Her life was coming apart, and she didn't know how to mend it.

"Hey, come join me."

She saw David at a table for two in the far corner of the cafeteria. He stood and waved, as though he was afraid she might miss him. That would be hard to do. He stood a shade over six feet, with a shock of reddish-blond hair above a tan that reminded Elena of a California surfer. He might be quiet, but David was hard to overlook.

She wove her way through the tables and began to unload her tray. She jerked her mind away from the worries that were her constant companion, and struggled for an opening conversational gambit. "Good to see you. I didn't think OB residents ever took time to eat lunch."

"Eat when you can. Isn't that what they teach us as medical students?" David held the chair for her, another of the small things that made her admire him. His bright blue scrub suit and the ring around his forehead from the pressure of his surgical cap told Elena he'd been in the operating room already.

She tried to focus on the man at the table with her, not on the shambles her life had become. "How are things going for you?" she asked.

"Pretty good. I'm on Dr. Cobb's service, and he's letting me do quite a bit. Just finished a case with him." He took a healthy bite of sandwich, chewed, and swallowed. "How about you?"

Elena paused with her fork halfway to her mouth, careful not to drip ranch dressing from the chef's salad she'd chosen. "Right now I mainly divide my time between the FP Clinic and the ER. Sometimes I round with one of the specialists. Good preparation for going out on my own-if I only had a place to practice."

"What's that mean?"

"Are you ready for the next chapter of the Elena Gardner tragedy?" She related the gist of her conversation with Helen Bennett and watched deep concern overshadow David's normally placid countenance.

"I'll add that to my prayers for you," he said. "Be sure to let me know if anything develops."

She nodded before filling her mouth with salad. Doctors learned to eat fast, never knowing when the meal might be interrupted. She noticed David doing the same.

"And did you get a call last night?" David asked.

Elena nodded. "Midnight. A woman sobbing. But I think I recognized the voice."

"You did?"

"I'm pretty sure-but I don't know what to do about it. And until I do, I don't want to say anything-even to you."

"Fair enough. But I'm here for you when you're ready to talk."

Elena dabbed at the corner of her mouth with her napkin. She was opening her mouth to reply when a staccato electronic bleat split the air. Both doctors reached for their belts and extracted their pagers.

"Mine," Elena said. She thumbed the button and read the display. "Dr. Gross's office." She pushed back her chair. "Guess I'd better see what the department chair wants."

The chairwoman's secretary was noncommittal in delivering the message. Dr. Gross would like to see Dr. Gardner this afternoon at five. Could she make it?

Elena mentally reviewed her schedule. "No problem. Can you tell me what this is about?"

"Sorry, I'm simply relaying the message."

Elena tried to put the matter out of her mind until time for the meeting, but with little success. It was all she could do to concentrate on her duties for the afternoon. She gave silent thanks that her patients presented straightforward problems: congestive heart failure, early peptic ulcer, migraine headache. She ordered the appropriate diagnostic tests, wrote prescriptions for the proper medications, arranged for referrals to staff specialists when necessary. Somehow she got through the afternoon.

Next she had to finish her clinic charts, go over some X-rays and lab reports, return about a half-dozen phone calls, and change into a fresh white coat before her meeting. She managed to do all this, even run a brush through her hair and redo her ponytail, before she tapped on the open door of Amy Gross's office at precisely five o'clock.

"You wanted to see me?" Elena waited for Dr. Gross to look up from the papers she was signing.

"Oh, Elena. Come in. Have a seat." The woman motioned toward the couch on the far side of her office. "Let's sit down over there so we can talk without the desk between us."

Elena took this as a good sign. If Dr. Gross planned to deliver bad news, she'd do it from behind her desk, putting a barrier between them.

Elena sat at the end of the couch. Dr. Gross took a seat beside her and half-turned to face her.

"I'm sure you're curious about this 'summons.' " She made quote marks with her fingers to set off the word. "But it's good news, I assure you."

Elena felt the pounding headache she'd experienced all afternoon ease a bit. "Well, I could use some good news."

"I understand you talked with Dr. Bennett this morning."

Elena nodded. She didn't think she could have said a word even if she wanted to. Her throat was in a knot at the reminder of the bombshell Helen dropped on her this morning.

Dr. Gross continued. "Helen called me at home Sunday afternoon, right after she decided to take the job offer from Lincoln Clinic."

Elena remained silent.

"You may not believe it, but it caused her a great deal of pain to go back on her offer to you. Both she and I have made lots of calls trying to find something for you. I even looked into the possibility of your working in an emergency room somewhere."

Elena knew that was a possibility, but not one she wanted to consider. In that situation, there'd be no continuity of care. No way to establish a rapport, a long-term relationship with her patients. That wasn't the way she wanted to practice medicine. She hoped that wasn't what this was about.