Doing Harm (16 page)

And as for operating, well … it’s bad. Bad in a way that I never could have imagined.

Because the joy is gone.

Part of it is that I don’t think the professors trust me anymore. Since the word has gotten out about what I did to Mrs. Samuelson, some professors who previously let me do their most complex operations will now barely let me touch their patients. When they do let me operate, they second-guess, scrutinize, and criticize every single move I make.

But it’s more than that. Something worse—much worse—has robbed me of my love of the operating room.

I’m afraid.

Afraid of operating.

Afraid of doing something bad to another patient, of inadvertently ripping apart another organ, of having to face another family like Mrs. Samuelson’s. The fear paralyzes me in the OR. I can’t pull the trigger anymore. Even during the simplest, most straightforward operations, I keep freezing up. Before, I never hesitated, never doubted myself. Ever. This fear is completely unfamiliar and makes me feel … emasculated. Angry.

Intensifying my misery is that fact that, through all of this, I don’t really have anyone I can talk to. I would normally go to Larry, but he’s too pissed at me. There’s Luis, I suppose, who remains cordial and respectful; he moves through our daily routines as if nothing ever happened. But I’m much too embarrassed to talk about it with him, especially because, in both cases, he tried to stop me from being so stupid: first, by trying to talk me out of giving Mr. Bernard potassium; and second, by urging me to wait for Larry to come back to the OR before forging ahead with Mrs. Samuelson’s surgery. So Luis is out.

Sally means well but just doesn’t understand. When I first tell her about what’s happened with Mr. Bernard and Mrs. Samuelson, she’s sympathetic and deeply concerned. But she’s not a surgeon, so how can she truly empathize with what it feels like to make the kinds of mistakes I’ve made? Besides, she didn’t know Mr. Bernard the way that I did. She wasn’t there for our final conversation, in his hospital room; doesn’t realize what I robbed him of, doesn’t know that, because of me, he’ll never again spend time with his lady friend, or see an alligator farm in Florida. And she’s never seen the pale, drawn faces of Mrs. Samuelson’s husband and daughters; never heard them sobbing, or watched them pray over her bedside.

Besides, I feel incredibly ashamed that I might have completely blown my chances at staying at University Hospital, and guilty about having let her down. So I withdraw, both emotionally and physically. I keep the guilt and the fear and the frustration corked up and I start spending less time at home.

Instead, I pass hours at night sitting alone at my computer in my cramped cubicle in my office, wishing I had done things differently, burning a hole through my stomach worrying that the Safety Committee is going to recommend that the hospital fire me. Meanwhile, as Mrs. Samuelson hangs on by her fingernails, I pore over her vital signs, studying every minor change in her lab results, praying for her to get better. I obsess about her operation, replaying the series of events in my head again and again and again, thinking about what went wrong.

Because of my self-imposed exile in the hospital, I end up spending a lot more time with the only other person who’s in the hospital as much as I am.

GG.

GG—ever eager, admiring, and calm—is always there at my side.

She never mentions Mr. Bernard, or what happened with Mrs. Samuelson; never stops complimenting me on my skills or medical decision making, never once throttles back from her relentless work schedule or apparent determination to prove to the rest of us that she is the greatest medical student in the history of medical students. We work together, eat our meals together, and, when I’m not hiding in my office feeling sorry for myself, hang out together in the residents’ lounge, talking for hours.

Soon I’m seeing more of her than I am of Sally, Katie, and Annabelle. I tell her about my life, and she, in turn, confides in me about hers: her childhood in Southern California, the daughter of two Cal Tech professors who nurtured a passion for all things scientific; the pressure to achieve in such an academically high-powered family; her first place in the Westinghouse National Science Fair competition in high school; her years at MIT; her recent research in a heart laboratory at University Medical School.

So, in a weird way, as I sort through the emotional debris left in the aftermath of Mr. Bernard and Mrs. Samuelson, GG quickly becomes more my friend and confidante than any of the most important people in my life.

CHAPTER 8

Saturday, August 8

In the morning, I round on the patients with GG. It’s just the two of us because Luis has the weekend off. I occasionally have to round like this on weekends, when Luis isn’t working, and I like to strike out early in order to get done as quickly as possible. Patients are less likely to ask you annoying questions (and hence slow you down) when you’ve just roused them from sleep at some god-awful hour of the morning.

So it’s still dark outside when we start. Things are quiet. All of the patients are doing well. GG and I flit from one room to the next, examining abdomens, checking bandages, removing bladder catheters, and reassuring groggy patients blinking the sleep from their eyes that they’re doing just fine. We move smoothly and efficiently.

Toward the end of rounds, however, one of our more verbose patients traps me in her room with an endless series of questions. Luis and GG have dubbed her “Chatty Kathy.” She’s an immense, flatulent mother of two with orange-brown, tanning-booth-toasted skin, curly, bright red hair, and a high, childish voice. She likes to keep a rust-colored, red-haired teddy bear with her in the bed. The bear looks disturbingly like her.

The most exasperating thing about her is that I don’t even understand why she’s in the hospital. She has a bladder infection, but as far as I can tell, we’re not doing anything for her that couldn’t be done at home. I think she just likes it here in the hospital, and her attending, an affable and absentminded older professor, is too nice a guy to kick her out.

Anyway, this morning, Chatty Kathy keeps repeating the same questions over and over, clutching her teddy bear while absently brushing out its red hair. There’s no end in sight, and I’m finding it increasingly difficult to stifle my exasperation or suppress a growing desire to reach across the bed, bury my fingers in the flabby flesh of her neck, and throttle her.

I’m just starting to wonder if I’m ever going to be able to get myself out of her room when the piercing tone of my pager interrupts Chatty Kathy’s discourse midsentence. I read the text message: U R NEEDED IN HALLWAY STAT. I glance around and realize that GG is no longer there—she must have slipped out of the room, unnoticed by either Chatty Kathy or myself, and paged me from out in the hallway.

Brilliant.
It’s exactly the cue I need to escape.

I frown with appropriate doctorly concern, gesture toward the pager screen, and tell Chatty Kathy that I’m very,
very
sorry, but there’s an emergency with one of my other patients, and I have to leave right away. She thrusts out her lower lip like a pouting child as I flee the room.

GG is waiting for me at a discreet distance down the hall, leaning against the wall, smirking, with her arms folded.

“Thanks,” I say once Chatty Kathy’s door swings shut behind me.

“No problem.” Her smirk widens into a broad smile. She looks really good this morning. Her hair is pulled back in a ponytail, away from her face, which accentuates her dark, placid eyes; and instead of a scrub top, she’s wearing a formfitting, white, short-sleeve shirt. “Let’s keep moving. We just need to see Mrs. Samuelson, then we’re done.”

We make our way to the SICU, taking care to use the back door so that we don’t run into Mrs. Samuelson’s family out in the waiting room. She looks a little better this morning; a few of her medications have been discontinued, a few of the plastic tubes connecting her to the machines have been taken out. I hold out a small measure of hope that she still might survive. After seeing Mrs. Samuelson, we head downstairs to the cafeteria.

Sally, the girls, and her parents drove down to Sally’s sister’s place in Providence this morning, and won’t be back until tonight. Without a reason to go home, I linger over breakfast with GG, trying not to think about the fact that part of me is glad to have an excuse to spend more time with her; and to ignore the way her T-shirt lingers over the curves of her body; and to not notice the very pleasant feminine smell (some kind of shampoo?) wafting across the table.

Eventually, the conversation peters out, and we each become lost in our own thoughts. I stare at my empty plate, pondering Mrs. Samuelson’s latest vital signs.

“Steve, do you mind if I ask you something about Mr. Bernard?” She looks pained. Neither she nor Luis has ever spoken to me directly about what happened to Mr. Bernard.

Surprised, I take a stab at feigned indifference by shrugging and shaking my head.

“I heard that you’ve been meeting with the hospital Safety Committee investigating his … you know.”

“His death. Yeah.”

“How’s it going?”

“Working with the Committee? Okay, I guess.”

Working with
the Safety Committee isn’t an entirely accurate way of describing the way I feel about the whole experience.
Interrogated by
is more like it. I’ve met with the Committee three times now, a glum panel of senior medical-school professors, hospital administrators, chief nurses, and hospital lawyers. Both times I felt as if a German guy wearing a brown trench coat and a fedora was questioning me under hot lights.

What made you decide to order the potassium? Did you think it was indicated in this clinical situation? Did you ever suspect that hyperkalemia might have been a problem? Talk! What do you know? Where are the plans? Your papers are not in order!

The only friendly face on the Committee is an orthopedic-surgery resident named Jason Kobayashi. Jason has been a good friend of mine for years, since we were students at University Medical School together. We met in gross anatomy class, and subsequently bonded together for hours at a time over a dead body. Although we haven’t hung out much lately, we used to go out regularly for beers, until both of us started having kids at roughly the same time.

During the meetings, Jason looks as serious and somber as the rest of them but somehow manages to also come off as marginally sympathetic. And he never asks me tough questions.

But he’s also been extremely careful to keep his distance. I sense that he doesn’t want the other members of the Committee to know that we’re friends. I play along during the meetings, pretending I don’t know him; and I haven’t tried to contact him otherwise. I guess I just have to trust that he’ll help me as best he can.

At any rate, the Committee itself seems to be moving with unusual speed. Dr. Collier originally told me that this kind of investigation can drag on for months; but as I was leaving my last interrogation, I overheard the chairman say to another member that he wanted to get a formal report on the hospital CEO’s desk within a few weeks. I don’t know if the Committee’s fast pace is a good thing or a bad thing. I suspect that it’s a bad thing: After all, aren’t the speediest trials the ones that invariably end with the defendants lined up against a wall or dangling from a rope?

So, all in all, I’d have to say that my experience with the Safety Committee has, like the rest of my life lately, totally sucked.

I don’t tell GG any of this. I simply shrug, and say, “It’s okay, I guess. They’re waiting right now on the final autopsy results. The Committee doesn’t tell me much; they just ask me a lot of questions about what happened.” My suspicion is that the Committee is keeping me in the dark because my actions—my
mistakes
—are an integral part of their investigation.

“Can I help you somehow? After all, I was there for the code, right? I’m really interested in improving patient safety: preventing medication errors, medical mistakes, that kind of thing.”

“That’s great. But I don’t think you can help.” I watch over her shoulder as an older man and woman push a younger, gaunt woman past our table in a wheelchair. The woman is tethered to an IV pole on wheels. She has a scarf tied around her head. A cancer patient.

“Mr. Bernard was the first patient I saw die. I was … the first one to find him.”

“Uh-huh.”

“I guess you’ve probably seen a lot of people die by now.”

“Some.”

“It wasn’t … it wasn’t what I expected.”

“What did you expect?”

“I guess I, well … I’m not sure. It was like he was alive and then … not alive. That was it. There was nothing more to it. I expected something else.”

“Like what?”

“Like, umm … I don’t know. Something more dramatic.”

“Like a signal, or a sign? Something poetic? Watching the soul shuffle loose the mortal coil? Glimpsing the ghost as it escaped the machine?”

“Maybe. You know, people always talk about the light going out of someone’s eyes when they die. I’m not sure what that means. What do you think, Steve?”

“I usually don’t. Not about this stuff.”

“Yeah, well, there wasn’t anything poetic or mystical about Mr. Bernard’s death. He just … died. It was stupid. I don’t know how I missed that potassium.”

“You know, you really shouldn’t feel badly about what happened, GG. It’s not your fault. It’s mine. I’m the one who gave the order. Besides, you shouldn’t have to worry about stuff like that—don’t take this personally, but you’re just a med student.”

“It’s just … I mean, for Mr. Bernard to make it through major surgery, only to die from a preventable mistake. It’s just so … I’m sorry you have to go through this.”

She reaches over and gently touches my bare forearm. The brief contact is enough to send the hairs on the back of my neck standing on end and my heart racing. Underneath the table, she shifts her legs and moves one up against mine, lightly at first, so that it could almost be an accident, but then more firmly and with definite purpose, stroking my calf with her foot. She leans forward, her immense brown eyes—so serene, so assured—fixed on my face. Involuntarily, my own eyes flicker a beat too long over the revealing neckline of her T-shirt.