Robin Cook: Harmful Intent

"Any complications I should know about?" Jeffrey asked, almost afraid to hear. Things hadn't been going well for him on this particular day.

"Looks routine," the nurse said. "Primipara. Twenty-four. Healthy."

"Who's the attending?"

"Simarian," the nurse replied.

Jeffrey said he'd be over shortly and hung up the phone. Simarian, Jeffrey pondered, thinking it a wash. The guy was technically fine but Jeffrey found his patronizing manner toward patients a bit trying. Thank God it wasn't Braxton or Hicks. He wanted the case to go smoothly and hopefully quickly; if it had been either of the others, that wouldn't have been the case.

Leaving the anesthesia office, he headed down the main OR corridor, passing the scheduling desk and its attendant bustle of activity. The evening shift was due in a few minutes; the changing of the guard inevitably spelled momentary chaos.

Jeffrey pushed through the double swing doors of the surgical lounge and yanked off the mask which hung limply on his chest, dangling by its elastic. He tossed it into the waste receptacle with relief, he'd been breathing through the blasted thing for the last six hours.

The lounge was abuzz with staff members coming on shift. Jeffrey ignored them and passed through to the locker room, which was just as crowded. He paused in front of the mirror, curious to see if he looked as bad as he felt. He did. His eyes seemed to have receded, they appeared so sunken.

Below each was a dark indelible crescent-shaped smudge. Even Jeffrey's mustache seemed the worse for wear and tear, though what could he expect after having kept it under the wraps of the surgi-. cal mask for six solid hours.

Like most doctors resisting the chronic'hypochondriasis induced by medical school, Jeffrey often erred at the other ex-

treme: he denied or ignored every symptom of illness or sign of fatigue, until it threatened to overwhelm him. Today was no exception. From the moment he'd awakened that morning at six, he'd felt terrible. Although he'd been feeling run down for days, he first ascribed the light-headedness and chills to something he'd eaten the night before. When the waves of nausea came midmorning, Jeffrey was quick to attribute it to too much coffee. And when the headache and the diarrhea started in the early afternoon, he pinned it on the soup he'd had for lunch in the hospital cafeteria.

Only as he confronted his haggard reflection in the miffor of the surgical locker room did Jeffrey finally admit he was ill. He was probably coming down with the flu that had been going around the hospital for the last month. He put the flat of his wrist to his forehead for a rough check of his temperature. There was no doubt about it: it was hot.

Leaving the sink, Jeffrey went to his locker, grateful that the day was almost over. The idea of bed was the most appealing vision he could conjure.

Jeffrey sat on the bench, oblivious to the chatting crowd, and began to twirl his combination lock. He felt worse than ever. His stomach gurgled unpleasantly; his intestines were in agony. A passing cramp brought beads of perspiration to his brow. Unless someone could relieve him, he'd'still be on duty for another few hours.

Stopping at the final number, Jeffrey opened his locker. Reaching within the neatly arranged interior, he retrieved a bottle of paregoric, an old remedy his mother used to force on him when he was a child. His mother had consistently diagnosed him as suffering from either constipation or diarrhea. It wasn't until he got to high school that Jeffrey realized these diagnoses were just excuses to get him to take his mother's cherished cure-all. Over the years, Jeffrey had developed a confidence in paregoric, if not in his mother's diagnostic skills. He always kept a bottle on hand.

Unscrewing the cap, he tilted his head back and took a healthy swig. Wiping his mouth, he noticed an orderly sitting next to him watching his every move.

.'Want a swig?" Jeffrey asked, grinning, extending the bottle toward the man. "Great stuff."

The man gave him a disgusted look and got up and left.

Jeffrey shook his head at the man's lack of a sense of humor. From his reaction you'd have thought he'd offered him poison.

With uncharacteristic slowness, Jeffrey took off his scrubs. Briefly massaging his temples, he then pushed himself to his feet and went in to shower. After sudsing and rinsing, he stood under the rushing water five minutes before stepping out and drying himself briskly. Brushing his wavy, sandy-brown hair, Jeffrey dressed in clean scrubs, donned a new mask and a new hat. He felt considerably better now. Except for an occasional gurgle, even his colon seemed to be cooperating-at least for the moment.

Jeffrey retraced his steps through the surgical lounge and down the OR corridor and pushed through the connecting door that led to the delivery area. The decor there was a welcome antidote to the stark utilitarian tile of the OR. The individual delivery rooms may have been as sterile, but the delivery area and labor rooms were painted in pastels, with framed

Impressionist prints on the walls. The windows even had curtains. The feeling was more like a hotel than a major urban hospital.

Jeffrey went to the main desk and inquired about his patient.

"Patty Owen is in fifteen," a tall, handsome black woman said. Her name was

Monica Carver, and she was the nursing supervisor for the evening shift.

Jeffrey leaned over the desk, thankful for the momentary rest. "How's she doing?" he asked.

"Just fine," Monica said. "But it's going to be awhile. Her contractions aren't strong or frequent, and she's only dilated four centimeters."

Jeffrey nodded. He would have preferred to have things further along. It was standard practice to wait until the patient had dilated six centimeters to put in an epidural. Monica handed Jeffrey Patty's chart. He went through it quickly. There wasn't much there. The woman was obviously healthy. At least that was good.

"I'll have a chat with her," Jeffrey said, "then I'll be back in the OR. If something changes, give me a page."

"Sure thing," Monica said cheerfully.

Jeffrey started down toward room fifteen. About halfway down the hall he got another intestinal cramp. He had to stop and lean against the wall until it passed. What a nuisance, he thought. When he felt well enough, he continued to room fifteen and knocked. A pleasant voice told him to come in.

"I'm Dr. Jeffrey Rhodes," Jeffrey said, extending his hand. "I'll be your anesthesiologist."

Patty Owen grasped his outstretched hand. Her palm was

damp, her fingers cold. She appeared considerably younger than twenty-four.

Her hair was blond and her wide eyes looked like those of a vulnerable child. Jeffrey could tell the woman was frightened.

"Am I glad to see you!" Patty said, not willing to let go of Jeffrey's hand immediately. "I want to tell you straight off that I'm a coward. I'm really not very good with pain."

"I'm sure we can help you," Jeffrey said reassuringly.

"I want an epidural," Patty said. "My doctor said I could have it."

"I understand," Jeffrey said, "and have it you will. Everything is going to be fine. We have a lot of deliveries here at the Boston Memorial. We'll take good care of you and after all is said and done, you'll wonder why you were so apprehensive in the first place."

"Really?" Patty asked.

"If we didn't have so many happy customers, do you think so many women would be coming back a second, a third, or even fourth time?"

Patty smiled wanly.

Jeffrey spent another quarter hour with her, questioning her about her health and allergies. He sympathized with her when she told him her husband was out of town on a business trip. Her familiarity with epidural anesthesia surprised him. She confided that not only had she read about it, her sister had had it for her two deliveries. Jeffrey explained why he wouldn't be giving her the epidural immediately. When he told her that she could get some Demerol in the meantime if she wanted it, Patty relaxed.