Robin Cook - Crisis

"I do not."

"Perhaps you could tell us why since, to use your words, it 'flies in the face' of rationality."

"As a well-informed internist, Dr. Bowman knows that the symptoms women experience with myocardial infarction do not follow the classic symptoms experienced by men. As soon as an internist thinks about a heart attack in a female, particularly a postmenopausal female, he should act as if it were a heart attack until proven otherwise. There's a parallel in pediatrics: If the thought of meningitis occurs to a physician with a pediatric patient, the physician is obligated to proceed as if it is and do a spinal tap. Same with a female and a possible heart attack. Dr. Bowman suspected a heart attack, and he should have acted accordingly."

"Dr. Brown," Randolph said. "It is often said that medicine is more of an art than a science. Can you tell us what that means?"

"It means that factual information is not enough. A doctor must use his judgment as well, and since this is not an objective arena that can be studied, it is labeled an art."

"So scientific medical knowledge has its limits."

"Exactly. No two humans are exactly the same, even identical twins."

"Would you say that the situation Dr. Bowman faced on the evening of September eighth, 2005, when he was called to see for the second time in the same day a woman whom he knew was hypochondriacal called for a large measure of judgment?"

"All medical situations call for judgment."

"I'm asking specifically about the evening in question."

"Yes. It would have called for a large measure of judgment."

"Thank you, doctor," Randolph said, gathering up his notes. "No more questions."

"The witness may be excused," Judge Davidson said. Then, turning to the jurors, he added, "It is nearing the noon hour, and it looks to me as if you could all use some sustenance. I know I could. Remember not to discuss the case with anyone or among yourselves." He cracked the gavel. "Court's adjourned until one thirty."

"All rise," the court officer called out as the judge stepped down from the bench and disappeared into his chambers.

Alexis, Craig, and Jack had found a small, noisy sandwich shop that looked out onto the broad Government Center esplanade. Randolph had been invited, but he'd begged off, claiming he had preparation to do. It was a beautiful late-spring day, and the esplanade was full of people escaping from their confining offices for a bit of sunshine and fresh air. Boston struck Jack as an outdoor city much more so than New York.

Craig had been his usual brooding self at first, but had begun to relax and join the conversation.

"You haven't mentioned the autopsy," Craig said suddenly. "What's the status?"

"It's in the hands of a funeral director at the moment," Jack said. "He's got to take the paperwork to the health department and arrange for opening the grave and transporting the coffin."

"So it's still a go?"

"We are trying," Jack said. "Earlier I was hoping it might happen this afternoon, but since there's been no word, I guess we'll have to aim for tomorrow."

"The judge wants the case to go to the jury on Friday," Craig said discouragingly. "Tomorrow might be too late. I hate to put you through all this effort for nothing."

"Maybe it is futile," Alexis agreed dejectedly. "Maybe it is all for nothing."

Jack looked from one to the other. "Hey, come on, you guys. I don't see it for nothing. It gives me the sense I'm doing something. And besides, I'm interested the more I think about the cyanosis issue."

"Why exactly?" Alexis questioned. "Explain it to me again."

"Don't get him started!" Craig said. "I don't want to raise any false hopes. Let's analyze this morning's proceedings."

"I didn't think you wanted to talk about it," Alexis said with some surprise.

"Actually I'd rather forget about it, but unfortunately, I don't have that luxury if we're going to make any changes."

Both Craig and Alexis eyed Jack expectantly.

"What is this?" Jack questioned with a wry smile, looking from one to the other. "An interrogation? Why me?"

"You can be the most objective of all of us," Alexis said. "That's obvious."

"How do you feel Randolph is doing, now that you've seen more of him in action?" Craig asked. "I'm worried. I don't want to lose this case, and not just because there was no negligence involved. My reputation will be in the gutter. That last witness had been my preceptor in medical school, as he said, and my attending as a resident. I worshipped that guy, and still do professionally."

"I can understand how devastating and humiliating this has to be," Jack replied. "With that said, I think Randolph is doing a good job. He neutralized most of what Tony established with Dr. Brown. So I suppose I have to say from what I saw this morning it was a wash. The problem is that Tony is more entertaining, but that's not enough to switch attorneys in midstream."

"What Randolph didn't neutralize was Dr. Brown's powerful analogy about a pediatric patient and meningitis. He's right, because that is the way you have to respond to a postmenopausal female when you even think she might be having a heart attack. Women don't have the same symptoms as men in a surprising number of cases. Maybe I screwed up, because a heart attack did pass through my mind."

"Second-guessing oneself is a rampant tendency in physicians in every case of adverse outcome," Jack reminded Craig. "It's especially so when there's alleged malpractice. The reality is you bent over backward with this woman, who was actually taking advantage of you. I know it's not politically correct to say that, but it is true. With all her false alarms, calling you out in the middle of the night, there's no wonder your index of suspicion of real illness would have been down in the lower basement."

"Thank you," Craig said with his shoulders sagging. "It means a lot to me to hear you say that."

"The trouble is, Randolph must make the jury understand that. That's it in a nutshell. And keep in mind Randolph hasn't presented his case. You have your own experts who are willing to testify to exactly what I outlined."

Craig took a deep breath and let it out noisily. He nodded a few times. "You're right. I can't give up, but tomorrow I'll have to testify."

"I would think you would be looking forward to it," Jack said. "You are the one more than anyone else who knows exactly what happened and when."

"I understand that perfectly well," Craig said. "The problem is I despise Tony Fasano so much, I have trouble keeping my cool. You've read the deposition. He got to me. Randolph advised me not to appear arrogant; I appeared arrogant. Randolph advised me not to get into an argument; I got into an argument. Randolph advised me not to get angry; I got angry. Randolph advised me only to answer each question; I flew off on a tangent, trying to justify honest mistakes. I was terrible, and I'm afraid it might happen all over again. I'm not good at this."

"Consider your deposition a learning experience," Jack said. "And remember: The deposition lasted two days. The judge will not allow that. He's the one who wants this trial brought to an end by Friday."

"I suppose it boils down to the fact that I don't trust myself," Craig said. "The one good aspect of this whole damn affair is that it has forced me to look at myself in the proverbial mirror. The reason Tony Fasano got me to appear arrogant is because I am arrogant. I know it's not politically correct to say so, but I am the best doctor I know. I've had confirmation in so many different ways. I've always been one of the best students, if not the best, throughout my training, and I've become addicted to acclaim. I want to hear it, which is why the reverse, like what I'm hearing throughout this malpractice ordeal, is so goddamn distressing and humiliating."