Robin Cook - Fever

“It’s about Michelle,” said Dr. Keitzman finally.

“I assumed as much,” said Charles. The vise on his stomach turned another notch tighter.

“She’s not doing as we would have hoped,” said Dr. Keitzman with a sigh, looking up into Charles’s face for the first time. “Doctors’ families are always the most difficult. I think I’ll call it Keitzman’s law.”

Charles was in no mood for humor. He stared at the oncologist, watching the man’s face twist into one of its characteristic spasms. “What’s this about a double dose of Daunorubicin?”

Dr. Keitzman swallowed. “We gave her the first dose yesterday but she did not respond. We gave her another today. We’ve got to knock down her circulatory leukemic cells.”

“That’s not the usual protocol, is it?” snapped Charles.

“No,” Dr. Keitzman replied hesitantly, “but Michelle is not a usual case. I wanted to try…”

“Try!” shouted Charles. “Listen, Dr. Keitzman,” Charles snapped, pointing a finger in Dr. Keitzman’s face. “My daughter isn’t here for you to try things on. What you’re really saying is that her chances of remission are so poor that you’re ready to experiment.”

“Charles!” said Cathryn. “That’s not fair.”

Charles ignored Cathryn. “The fact of the matter, Dr. Keitzman, is that you are so certain she’s terminal you abandoned orthodox chemotherapy. Well, I’m not sure your experimentation isn’t lessening her chances. What about this cardiac problem. She’s never had any trouble with her heart. Doesn’t Daunorubicin cause cardiac problems?”

“Yes,” agreed Dr. Keitzman, “but not usually this fast. I don’t know what to think about this complication and that’s why I asked for a cardiac consult.”

“Well, I think it’s the medicine,” said Charles. “I agreed to chemotherapy, but I assumed you would be using the standard doses. I’m not sure I agree with doubling the usual treatment.”

“If that’s the case, then perhaps you should retain another oncologist,” said Dr. Keitzman wearily, standing up and gathering his things. “Or just handle the case yourself.”

“No! Please!” said Cathryn, letting go of Charles and clutching Dr. Keitzman’s arm. “Please. Charles is just upset. Please don’t leave us.” Cathryn turned frantically to Charles. “Charles, the medicine is Michelle’s only chance.” She turned back to Dr. Keitzman, “Isn’t that right?”

“That is true,” said Dr. Keitzman. “Increasing the chemotherapy, even if it is an unusual approach, is the only hope for a remission, and a remission has to be obtained quickly if Michelle is going to survive this acute episode.”

“What are you proposing, Charles?” said Dr. Wiley. “To do nothing?”

“She’s not going to go into remission,” said Charles angrily.

“You can’t say that,” said Dr. Wiley.

Charles backed up, watching the others in the room as if they were going to force him into submission.

“How do you think she should be treated?” asked Dr. Wiley.

“We can’t do nothing, Charles,” pleaded Cathryn.

Charles’s mind screamed for him to get away. Within the hospital, close to Michelle, he could not think rationally. The idea of causing Michelle additional suffering was a torture, yet the concept of just allowing her to die without a fight was equally abhorrent. There were no alternatives open to him. Dr. Keitzman was making sense if there was a chance they could get a remission. But if a remission was impossible, then they were merely torturing the dying child. God!

Abruptly Charles turned and strode from the room. Cathryn ran after him. “Charles. Where are you going? Charles, don’t go! Please. Don’t leave me.”

At the stair he finally turned, gripping Cathryn’s shoulders. “I can’t think here. I don’t know what’s right. Each alternative is as bad as another. I’ve been through this before. Familiarity doesn’t make it easier. I’ve got to pull myself together. I’m sorry.”

With a feeling of helplessness Cathryn watched him go through the door and disappear. She was alone in the busy corridor. She knew that if she had to, she could handle the situation even if Charles couldn’t. She had to, for Michelle’s sake. She walked back to the chart room.

“The strange thing,” said Cathryn with a tremulous voice, “is that you two anticipated all this.”

“Unfortunately we’ve had some experience with families of physicians,” said Dr. Keitzman. “It’s always difficult.”

“But it’s usually not this difficult,” added Dr. Wiley.

“We were talking while you were gone,” said Dr. Keitzman. “We feel that something must be done to ensure continuity of Michelle’s care.”

“Some kind of guarantee,” said Dr. Wiley.

“It’s mostly because time is so important,” said Dr. Keitzman. “Even if the treatment were stopped for a day or two, it could mean the difference between success and failure.”

“We’re not suggesting that Charles’s concerns are unfounded,” assured Dr. Wiley.

“Absolutely not,” agreed Dr. Keitzman. “In Michelle’s case, with circulating leukemic cells unresponsive to the Daunorubicin, the outlook is not the best. But I think she deserves a chance no matter what the odds. Don’t you agree, Mrs. Martel?”

Cathryn looked at the two doctors. They were trying to suggest something but she had no idea what it was. “Of course,” said Cathryn. How could she disagree? Of course Michelle deserved every chance.

“There are ways of making sure that Charles cannot arbitrarily stop Michelle’s treatment,” said Dr. Wiley.

“The powers need only be evoked if they are needed,” said Dr. Keitzman. “But it’s good to have them just in case.”

There was a pause.

Cathryn had the distinct impression that the doctors expected her to respond, but she had no idea what they were talking about.

“Let me give you an example,” said Dr. Wiley, leaning forward in his chair. “Suppose a child desperately needs a transfusion. If the transfusion is not given, then the child will die. And further, suppose that one of the parents is a Jehovah’s Witness. Then there is a conflict between the parents as to the proper treatment of the child. The doctors, of course, recognize the need for the transfusion to save the child. What do they do? They have the court award guardianship to the consenting parent. The court is willing to do this to guarantee the rights of the child. It’s not that they disrespect the beliefs of the nonconsenting parent. It’s just that they feel it’s unfair for one individual to deprive another of lifesaving treatment.”

Cathryn stared at Dr. Wiley in consternation. “You want me to assume guardianship of Michelle behind Charles’s back?”

“Only for the specific purpose of maintaining treatment,” said Dr. Keitzman. “It might save the child’s life. Please understand, Mrs. Martel, we could do it without your help. We would ask the court to appoint a guardian, which is what we do when both parents resist established medical treatment. But it would be much simpler if you participate.”

“But you’re not giving Michelle standard treatment anymore,” said Cathryn, remembering Charles’s words.

“Well, it’s not that unusual,” said Keitzman. “In fact I’ve been working on a paper about increased chemotherapeutic doses in cases as recalcitrant as your daughter’s.”

“And you must admit that Charles has been acting bizarrely,” added Dr. Wiley. “The strain of this may be too great. He may be incapable of making sensible decisions. In fact, I’d feel much better if we could also get Charles to seek some professional help.”

“You mean see a psychiatrist?” asked Cathryn.