No Cure for Murder (8 page)

“My God, Marion. How can you be so cruel?”

“Well, I’m sorry, but Jacob Weizman just can’t make up his mind. First, he pushes his patients toward an early grave and here, where he can do nothing, he wastes our time and the hospital’s resources. I’m tired of Weizman’s shit.”

Ginny had heard it all before.

How can they keep such a woman on staff? We can’t need nurses that badly, she thought, shaking her head.

Marion paused a moment, then grabbed Ginny by her upper arm and whispered, “If you take him, I’ll take two of your patients...that’s a good deal.”

Ginny wondered why Marion wanted to be off P.J.’s case so badly.

It must be Weizman she’s avoiding.

Ginny hated having Marion care for any of her patients, but how could she force her to care for a patient she couldn’t or wouldn’t help? It was about time the administration did something about her.

“Okay, Marion. Just this once.”

P.J. heard the door open. He struggled to move his eyes that saw two shadows approaching his bed. “I’m seeing double again.”

I shake my head in sorrow over this once powerful man.

The DNR sign says it all.

Your sojourn is almost over, I think and smile...no illusions remain.

I bend over and whisper, “So good to see you, P.J...Paul Joseph.”

He turns his eyes to see me but the soft light at the entrance to the room leaves me in black silhouette.

“It’s time,” I say holding the clear fluid-filled syringe before his eyes. His pupils widen. “Oh, excuse me,” I say. “I’m sure you want to know the instrument of your death...it’s insulin; life to most; a quick peaceful death for you, P.J. My gift.”

P.J. tried to speak, but the weakened and uncoordinated musculature of his mouth and tongue kept him silent. I want to say goodbye. My last vision of Julie and my girls. Don’t rob me of that.

I bend over P.J.’s body and whisper again into his ear, “Don’t be afraid. You’ll be with Him soon. You’ll be what you were...healthy...intact, an eternal journey of peace.”

No! No, P.J.’s mind screamed.

“Don’t fight it,” I say as I insert the sharp needle into the rubber stopper of the intravenous line placed into P.J.’s vein for IV fluids and medication. I flush the contents of the syringe, a lethal dose of Insulin into P.J., and smile.

P.J. felt suddenly hungry. His body began to tremble, then all turned black as his body began to convulse.

When I reach the staff parking section, the lot’s lamp casts dim lights over my car’s shiny trunk. I stare at the back bumper’s faded sticker: No Jesus, No Peace; Know Jesus; Know Peace, and smile. It’s a good sticker, and it’s been a good day.

Thirty minutes later, beginning routine afternoon rounds, the nurse entered P.J.’s room. She knew at once.

Tears streaked down Julie’s cheeks. “Thanks for everything, Jacob. I don’t think we could have made it without you and Zoe. You two are the best of what medicine has to offer. Please thank Zoe for me. You got it right when you chose her for your practice.”

Chapter Thirteen

When the phone rang during dinner, Lola turned to Jacob. “Don’t pick it up, it’s probably a damned telemarketer.”

“Sorry to bother you at home, Doctor, but Dr. Vincent is convening an emergency ethics committee meeting tonight. It’s at seven-thirty, can you make it, Doctor?”

“It’s still that way, but lately it only serves to rubber stamp decisions made by patients, families or physicians themselves. We’re in a position to help, to explore important issues, not to justify actions which belong to physicians and their patients. It’s just another example of physician domestication.”

The committee met in Brier’s boardroom, with its long, highly polished oak table. Stern-faced portraits of the hospital’s historic figures, former CEO’s, Presidents of the Medical Staff, and Chairmen of the Board of Trustees decorated the walls. Even the more recent pictures followed the tradition that a small grin would somehow offend convention. The kitchen placed carafes of coffee, tea, and ice water on the table with plates of cookies. In spite of the interruption of their evening, members were relaxed and in good humor.

Jaime Vincent, an internist and social activist, chaired the meeting. His lanky physique was that of the long distance runner. He pushed his salt and pepper hair back and began. “Sorry for dragging you out tonight, but neither time nor ethics waits for man.”

Warren Davidson, the chief of medicine stared at Jaime. “This better be good. If I could find my assistant chief to take my place, I’d be at the Warrior game.”

Jaime smiled. “Thanks, Warren. We appreciate your sacrifice.”

The medical staff bylaws designed the ethics committee with a majority of non-physicians. It had representatives from nursing, social services, pastoral care, hospital administration, and several community representatives who were not hospital employees. The hospital attorney, Alan David, sat as an ex-officio member.

“Arnie Roth, a family practitioner, has asked for our assistance tonight,” said Jaime. He turned to Arnie. “Let’s have it.”

Arnie placed a thick hospital chart before him. “Don’t worry, I won’t read it all.”

“Helen Ashley, of the Piedmont Ashleys, has been my patient for fifteen years. At the age of eighty-two and with the presumptive diagnosis of early Alzheimer’s disease, her tests showed that she had advanced kidney failure and needed dialysis.”

Jacob shook his head. “She doesn’t sound like the best candidate for dialysis.”

“You’re right and that prospect led to much discussion involving her husband and daughters. Helen, though a little slow, was competent and her decision, dialysis rather than death, was unequivocal.

“Initially, she did well, though the treatments were exhausting. She required about twenty-four hours to reconstitute her energy level. After six months, things deteriorated. First, it was the failure of her vascular access needed to perform dialysis. She had three procedures in two months, each one taking a toll on her cognitive function and her mood.”

Warren raised his hand. “Had she signed an advanced directive for health care or a living will specifying her wishes under these circumstances?”

“She did, and that’s where the plot thickens for two reasons: First, we know from experience that decisions made in the abstract about terminal care can be different when death arrives on your doorstep. Then, we have the family. Her husband and two daughters living in the Bay Area, all agree with some limitation on how far we should continue treatment. Her estranged daughter Patricia just flew in from Tulsa and entered the picture. As you might expect, she has a completely different perspective.”

Carleton Dix, the chaplain, raised his hand. “These are all chronic problems, Jaime. Why the emergency meeting?”

“Helen’s vascular access clotted again, and she hasn’t had a dialysis treatment for three days. She needs one tonight or it’s unlikely she’ll make it to morning.”

“What’s her mental status right now?” asked Sharon Brickman, Chief of Cardiology.

Arnie looked around the room. “You guys like complex ethical issues, here’s a big one.” He paused, and then continued, “She’s semicomatose, probably in part from a lack of dialysis treatments, and therefore she can’t assist in this decision.”

“Let me get this straight,” said Jacob. “The woman’s condition has deteriorated over time. She’s previously expressed a desire that her physicians not prolong her life, and allow her to die with dignity. Her family, who knows her best, agrees with stopping treatment, and finally, even if we do everything, what will be left? I don’t see the issue. Let the woman die in peace.”

“Any way you cut it, it’s suicide or worse!” Carleton Dix spit out each word. “And this comes with the tacit support of family, physicians, and Brier Hospital. Suicide is a violation of divine law, and in a Christian nation like America, it’s fundamentally immoral.”

Jacob boiled. “That’s the typical response from a cleric who can’t accept that in this country, so far, we have a separation between church and state. Why is it that some religions are all too happy to impose their moral values on others?”

Carleton leered at Jacob and shook his head in disgust. “Your life is not your own, but a gift from God. Nobody has the right to take her life before its natural time, and to take someone else’s life...well you’ve heard the phrase, Thou shalt not kill.”

“Excuse me, but the phrase is Thou shalt not murder...a chaplain should know that. In any case, aren’t you the same cleric who justifies violence against abortion providers? Haven’t you publically glorified Eric Rudolph, the so-called Olympic Park Bomber, who killed three and injured one hundred fifty in his campaign against abortion?”

“It saddens me that the deaths of the innocent push the faithful to those extremes.”

Jacob reddened. “Your anguish is misplaced, chaplain. Another thing, only an ignorant ideologue like you has the chutzpah to talk with me about life and death. I know it in a way, if you lived ten lifetimes, you’ll never understand.”

Jaime interrupted. “We’re getting off track here, gentlemen. I have reason to believe that both sides are showing good faith on these sensitive ethical issues.”

“Let me lay out the facts on which we can agree,” said Warren Davidson. “Mrs. Ashley will die if she doesn’t receive a dialysis treatment; she’s expressed her desire verbally and has executed documents that she wants no heroic end of life treatments. Those family members close to her concur in her decision. An estranged daughter, new to the situation, wants her treated. Her physicians think that intervention will only prolong her suffering on the pathway to her death.”

“For God’s sake,” said Jacob, “let the woman die in peace.”

The discussion moved around the room. The consensus followed the theme that a person has the right to decide whether she wants to live or die.

“How can you be absolutely sure you know, right now, that’s what she wants?” Carleton asked. “She’s semicomatose. If we are to make a mistake, it must always be on the side of life.”

“You mean,” Jacob asked, “that if you knew with moral certainty that she wanted no further treatment, you’d be okay with her choice?”

“Well...” Carleton hesitated, “that decision is contrary to my belief.”

Jacob shook his head in dismay. “So, you’d have all of us live and die by your set of beliefs?”

Alan David, the hospital’s attorney, raised his hand. “I don’t have a vote on this committee, but you need to understand that your decision and the action of Mrs. Ashley’s physicians could leave us liable for wrongful death charges. Clearly, we’re interested in avoiding such involvement.”

Warren Davidson stared at the attorney. “Are you saying that Brier Hospital administration will superimpose its will on physicians’ decisions just to avoid litigation?”

“Hold onto your shorts, Warren,” said David. “We live and die by the medical staff’s policies and decisions. I wouldn’t have it any other way...I may be a patient here some day.”

“I call the question,” said Jaime. “All those supporting Mrs. Ashley and her family’s decision to terminate care, vote yes, those opposed, vote no.”

When Jaime counted hands, one abstention and two no’s. “Thank you, ladies and gentlemen.”

Carleton Dix, stone faced, rose, and then stretched his hand, pointing around the room. “Physicians who took the Hippocratic Oath promised to do no harm, that’s plain and simple. Killing Mrs. Ashley is doing harm any way you phrase it. I’m ashamed to be part of this institution.”