No Cure for Murder (20 page)
“I’m referring the Nathan Seigel case to the Medical Examiner,” said Ira. “Shelly will continue her investigation, and Mr. Bryant, I’m requesting that Brier Hospital conduct its own review of all hospital deaths in the last 18 months. God help us, if our suspicions prove accurate.”
The next day, when Jacob looked at Kate Planchette, she reddened and looked away.
“I want to talk with you a moment, Kate.”
“I have to give some meds.” She started to walk away.
“Kate...”
She stopped and looked at her feet.
“I’ll wait for you in the dictation room.”
When Kate finally arrived, she stood across from Jacob with the expression of a prisoner awaiting execution.
“Sit, please. Put it out of your mind.”
“Put what?”
“You didn’t do anything wrong. It’s not your fault.”
“Are you sure, Dr. Weizman?”
“The Lidocaine levels were through the roof. An accidental overdose is impossible. Someone murdered Nathan.”
“I kept thinking that it was my fault...that maybe the MS allowed me to make a mistake.”
“How is your MS?”
“Dr. Roth says I’m still in remission, although I guess I really can’t ever leave it behind.”
“You’re doing great. In my experience, when you’ve had a benign course for as long as you have, the odds are overwhelming that you’ll be fine.”
Kate walked up to Jacob, kissed him on his cheek, and gave him a hug.
She took her first deep breath in a while. “They’re right,”
“Who’s right?”
“Whatever it is that makes people trust you, derive comfort from you, Jacob, you have it.”
Chapter Thirty-Five
“Shit,” Byron said when the phone rang for the fifth time that evening.
“You know I’m on call tonight,” said Zoe. “Grow up!”
“We have Sunshine Manor on the line, Dr. Spelling. They say it’s an emergency.”
“Put them through.”
“It’s Mildred Kaysen, Doctor. She’s in severe respiratory distress, turning blue, and sitting upright. It looks like heart failure to us, Doctor.”
“What happened?”
“Nothing. She just awakened and couldn’t breathe. We put an oxygen mask on her, but that didn’t do much.”
“Give her a shot of morphine sulfate and call 911. I’m on my way into Brier Emergency.”
Zoe arrived just as the ambulance pulled up to the ER entrance. She followed Mildred into Treatment Room One and began her assessment. Mildred was still sitting upright and struggling to breathe. She had a bluish tinge around her mouth and in her nail beds. Her respirations were 40/minute.
The EMT looked up from his clipboard. “She’s much better since getting the morphine, Doctor.”
Zoe turned to Mildred. “I’m Doctor Spelling, Dr. Weizman’s partner. We’re going to get this thing under control.”
Mildred looked up at Zoe. “You’re a very beautiful woman.”
Zoe smiled, and when she placed her stethoscope on Mildred’s back, she jumped.
“Oh...that’s cold,” she gasped.
Zoe smiled. “It’s not easy to keep it that cold.”
Mildred took Zoe’s hand and gave it a firm squeeze.
Zoe moved the head of her stethoscope over Mildred’s back and front of her chest, hearing the coarse bubbling sounds of fluid in her lungs. When she listened to Mildred’s heart, she heard the telltale sounds of the struggling, overburdened, and failing heart.
The portable x-ray machine banged against the door to enter the room. Paige Sims, Mildred’s daughter, followed behind.
“What going on here?” she yelled. She stared at Zoe. “And who the hell are you?”
“I’m Dr. Spelling, Dr. Weizman’s associate.”
“I told mother not to listen to that old man...now see what’s happened.”
“I’m sorry, Mrs. or is it Ms. Sims...”
“It’s Mrs.”
“I’m afraid I don’t know what you’re talking about...listen about what?”
“Mother...Mother,” Paige cried. She hugged Mildred. “It’s Paige...are you all right?”
“I’m just a little winded, sweetheart,” Mildred gasped. “I’ll be fine. I don’t know what the whole fuss is about.”
Paige formed her mouth into a tight sneer, and then turned to Zoe. “I told her it was a mistake...now see what you’ve done.”
“I still don’t know what you’re talking about, Mrs. Sims.”
“Twenty years on digoxin and never a problem. Then Weizman stops it. Why? Look what happened.”
“If Dr. Weizman stopped digoxin, he had a good reason.”
“Stop making excuses for that old man. I don’t want him touching my mother ever again. I demand that you call a heart specialist.”
Zoe lowered her voice. “Please. You’re upsetting yourself and your mother for nothing. It’s not necessary to demand anything. All you need do is ask that we get a cardiologist to evaluate your mother.”
“Don’t play word games with me, Doctor.” Paige burst into tears. “I want to file a formal complaint against Weizman...I’ll make sure he doesn’t hurt another patient.”
What have you done, Jacob? Zoe thought.
“Oh, by the way,” said Paige. “I love your dress.”
Zoe gave Mildred a powerful diuretic and within two hours, she was breathing easily. Sharon Brickman consulted and they agreed to place Mildred in the cardiac step-down unit for observation.
“What do you think?” asked Zoe.
“The cardiogram doesn’t show any acute changes, Zoe. I’m getting an echocardiogram . . . maybe that will help pin down the cause of her heart failure.”
“Her daughter Paige...she’s got it in for Jacob for some reason,” said Zoe. “What do you think about Jacob stopping the digoxin?”
“Medically, he made the right decision. Knowing this patient and especially her demanding daughter, I might have kept it up just not to rock the boat. After all those years, I doubt that the digoxin would have hurt her.”
“You know Jacob, and how he feels about the risks of medication. He’s always looking for an excuse to stop useless or potentially dangerous meds. He calls himself a therapeutic nihilist, skeptical about all medications. Maybe, as a purist, he’s right, but this case and several others have caused people to question his judgment.”
“Can you talk with him, Zoe? Will he listen to you?”
“I’ll try, but I don’t think it’s an argument I can win.”
Sharon nodded. “He’s headed for a fall, Zoe. It’s cases like this, his therapeutic bias, and his outspoken position on right-to-die issues that’s undercutting a lifetime of excellence and achievement. I’ll do anything to make sure that doesn’t happen.”
When Zoe entered the office the next morning, she walked into Jacob’s office. “I had to admit Mildred Kaysen last night.”
“What happened?”
“Don’t know for sure, but when I arrived, she was in heart failure.”
“I should get up to see her.”
“That’s a problem, Jacob,” Zoe said as she sat next to his desk.
“Problem?”
“It’s Mildred’s daughter Paige. She blames you for her mother’s condition. She doesn’t want you on her mother’s case.”
“What about Mildred? What does she want?”
“I don’t know, but perhaps it would be best if I took care of her with Sharon Brickman as a consultant.”
“Best for whom?”
“Please, Jacob, don’t make an issue out of this now. Paige is an angry woman. She has a problem with you. Let it go.”
“She can’t dismiss me like that, Zoe. Mildred’s my patient...if she refuses to see me...”
“It’s no reflection on you. You must have dealt with angry patients and relatives.”
“Listen for a minute, would you. In sixty years of practice, patients have rejected me for all sorts of reasons...many completely irrational. Do I like it? Hell no.
“If I screwed up, it wouldn’t be the first time, and it won’t be the last. “
“Did I do something wrong with Mildred? I doubt it. I’m going to let this go for a while or at least until Sharon completes her evaluation, but I’m not going to abandon Mildred to the ministrations of a controlling and misguided daughter...count on it.”
“Why in hell is the hospital administration sticking their noses into the QA process?” asked Warren Davidson, the chief of medicine as he sat with Arnie Roth in the QA office the next morning.
“You know why, Warren,” said Arnie, Chairman of the QA Committee. “They don’t want a repeat of the situation we had with that psychopath, Joe Polk, or with several other physicians who we discovered, too late, I might add, to have psychiatric illness or Alzheimer’s. We all share a degree of responsibility when patients are injured under those circumstances.”
“So specifically, what do they want?”
“Physical examinations on all physicians over age fifty.”
“That’s window dressing. They want to cover their asses by saying that they have a physician surveillance program. That kind of assessment won’t show a damn thing.”
“Look, Warren, we have only two choices: Just go along with the farce or decide to make physician evaluation meaningful like looking at the nuts and bolts of how docs practice.”
“I don’t like patting ourselves on the back too much, Arnie, but we have a pretty good QA program as it is. We see the reports every week and when we have a doc whose work is beginning to slide, we know it. Everything we do at Brier is under the scrutiny of someone, especially nurses and other docs. That’s the best way to pick up problems from dementia, to psychiatric, and to my all-time favorite, staff who just don’t give a damn.”
“That’s doing nothing, Warren. It’s the status quo.”
“If you tell me that we’re going to do psychiatric evaluations, cognitive function tests, tests of physical skills, especially fine motor skills and dexterity, and if you’re going to do them on everyone, fifty and over, who works at Brier Hospital, professional, administrative, and all others, I’ll go along.”
“That’s not going to happen.”
“Then, I’ll pass,” said Warren.
“We still have to talk about Jacob Weizman.”
“I don’t want to hear it,” said Warren.
“You think I like this? Jacob, just like the rest of us, is answerable for his actions. We have too many complaints. If we don’t deal with them, someone else will. I’m calling a special meeting of QA to discuss our options in dealing with Jacob Weizman.”
Chapter Thirty-Six
Monday morning. They hadn’t seen their first patient when Betty Kaufman, the receptionist at Jacob’s, office turned to Margaret. “ Lydia Barns want a word with you.”
“Send her in.”
Lydia was one of their newest patients, and a professor of economics at UC Berkeley. “Margaret, thank you for speaking with me.”
“Of course, Lydia. What is it?”
“Can you find someplace private?”
“Sure. Come into Jacob’s office. He’s still on rounds.”
“The main reason I moved my care to this practice was Dr. Weizman. I guess I’m a little old-fashioned, but I really like the hands-on, and if you’ll excuse the term, old-fashioned type of medicine.”
“You sure picked the right place.”
“It disturbed me a little when instead of seeing Dr. Weizman, you assigned me to Dr. Spelling, but I assumed, wrongly I’m sad to say, that she practiced like he did.”
“Jacob is so busy, and he’s not a kid anymore. That’s why we brought Dr. Spelling on board.”
“Believe me, I understand perfectly. I not saying that I’m prepared to leave the practice, but Dr. Spelling, while she has all the moves, the charisma, and the intelligence, doesn’t have it.”
“It?”
“The patients who sent me here said that Dr. Weizman is smart, compassionate, and when he works with his patients, they have his full attention. Moreover, they know that he cares about them. Dr. Spelling’s mind is all over the place. She feigns caring, but she can’t sell it to me. I think someone should talk with her, perhaps Dr. Weizman.”
“I will. Thank you for being so forthright. Too often we discover we’ve screwed up when a patient sends us a nasty letter or transfers to another physician.”
“One thing more. Please don’t use my name. I hope to work this out.”
When Lola arrived at the clinic Monday morning, Elena pulled her aside. “She was waiting at the front door when I arrived.”
“Who?”
“Sarah Hughes. It looks like you have your work cut out for you today.”
As Lola approached her office, Sarah stood and stared at her through reddened eyes. She looked at the floor and began chewing on her fingernails. “I’m real upset, Lola, I...”