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Authors: Carol Cassella

BOOK: Oxygen
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He holds his palm up for a high five and I meet it with a light slap, but then clasp it tight. “Thanks for being in there, Will. It sure helped to look up and see your face.”

He shoves his hands into his pockets—now I’ve embarrassed him. “Jenny’s picking me up for dinner at Chez Chez. Why don’t you come?”

“I can’t. I’ve got a hair appointment.”

He weighs an invisible scale of pleasures. “Dinner out? Haircut? It’d be our treat!”

I laugh. “Believe it or not, this is a great sign—that I’m relaxing enough to even think about my hair. Maybe next week, though. You and Jenny can come over to my place.”

 

James combs my hair back from my face, presses his palms against my temples and turns my head from side to side. “How about some more layering, around the front?”

He tips my head back into the sink and begins a deep scalp massage that puts me into a near trance. Over the sound of spraying water I listen to the continuing story of his tattoos: an evolving work of animal art that crawls, swims and flies over his arms and torso. “I interviewed an artist from Taos for the dragon scales.”

“What happened to the guy from Laguna Beach? I thought he was finishing the dragon.” Even my words are slowed down; I wonder if James can read my future through the bumps on my head.

“We ran into some artistic differences. This guy’s got a better sense of color, anyway. New Mexico sunsets.”

“Just make sure he uses clean needles.”

“Of course,
doctor
!” He exaggerates the title humorously and starts rinsing out the soap. “So what happened to that kid at your hospital?”

The muscles in my abdomen go rigid. “What kid?”

“One of the surgical techs is a client and he told me some kid died on the operating table a couple of weeks ago. Makes me glad I don’t have to cut anything that bleeds. I guess you have to get used to that kind of thing in your business.”

The water is so warm over my face I can’t be sure if I’m crying when I answer him. “Nobody with a heart could get used to that.”

 

Driving home, I go over and over the questions I answered for the committees, replaying their supportive comments and reassurances, waiting for them to sink in and make me believe in myself again. In all the medical minutiae I recited, nobody asked me about the hour I’ve never had to document—the hour I spent trying to help Bobbie understand what had happened to her daughter in the operating room. I can close my eyes and see Bobbie’s face going white, watch her slide onto her knees as if something solid inside her were dissolving.

I never had a chance to tell her I was sorry. The chaplain interrupted us.
Sorry
feels like such an insignificant word in the irrevocable context of death; such an obvious sentiment—Bobbie may have heard me say it even though I didn’t. But now, absurdly, it feels like some vital conclusion we both needed. As if, if I could only go back in time and tell her how sorry I am, the outcome could change.

8

A certified letter
from Feinnes, Reames and Peynor, Personal Injury Legal Specialists, arrives at the end of the second week. We are all named: Don, Brad, Mindy, Alicia, the pharmacist, Matt Corchoran, even Joe—everyone who was anywhere near that room during Jolene’s surgery, whether because they’d been randomly assigned to her case or because they’d been compassionate and dedicated enough to come running when I called the code. Caroline Meyers-Yeager assures me this shotgun approach is common. After the first scattered blast Bobbie’s attorneys will quickly focus on the most exposed and lucrative targets—the hospital, the surgeon and me.

Lawyers seem to rain out of Seattle’s skyscrapers, clustering around First Lutheran’s mahogany conference table so every named soul can be pulled out of the operating rooms in shifts. Boxes of Krispy Kreme doughnuts and vats of coffee are passed around while they interview all of us. Mindy sits next to me, and she keeps squeezing my hand under the table in a maternal way. She answers every question with an emphatically optimistic note, like a mother defending her child before the school board. They hammer Brad for more than two hours about his twenty minutes in that room. He sifts through pages of typewritten notes he made right after the death, blushing and stammering every time he answers a question about my choice of anesthetic technique, drugs or equipment, or the way I managed her resuscitation.

If self-confidence could win a legal case, it’s hard to believe John Donnelly’s ever lost one. He is not an overtly handsome man, but his height, his tan, his graying hair, even the hook of his nose, evoke all the principals and college deans and medical board examiners who have ever unnerved me, and I’m thankful he’s on my side. He conducts my interview in a resonant, assured voice. He guides me through hundreds of questions in practice for my deposition—reiterations of my degrees, my medical experience, my certifications—guides me with the skill of a slalom racer, avoiding the red flags of litigation. I relive those hours of my life a dozen times in a single day, while charts and records are checked and rechecked, notes are scribbled and passed between hospital administrators and insurance executives, and attorneys rhythmically tap their pens through the silence that follows each of my answers.

I keep wanting to blurt out my own questions: Do any of
you
see the mistake I’m blind to? Would you trust me to take care of your own child? And, reverberating always, below words, is the germinating concept that the more we lose, the more Bobbie Jansen, who has already lost everything, could gain.

Phil walks me to my car at the end of the day, filling up silence with complaints about our litigious age. Just before I open my door he becomes more serious. “You look like you haven’t slept all week.”

I sort through my keys so I don’t have to see his expression, unsure what to say. “It’s hard. I’ll get through it.”

“Look. Some tragedies are just unavoidable in this job. It’s normal, almost expected, that you’ll begin to doubt yourself, even though you did everything you could to save this kid’s life—absolutely by the book. You can’t let this interrupt your career. You’re one of the best doctors in this department, and I don’t want to lose you.” His jacket is slung over his shoulder and faint rings of perspiration darken the blue fabric under his arm.

I try to answer him but my throat closes up. The garage is empty, lit by spotlights that pock the vast space in cold white cones. I clutch my sweater tighter, shivering. “Thanks.” It comes out barely audible until I swallow and repeat the word.

“We can give you some time off if you want. Anything you need.”

I shake my head vigorously, terrified of idle hours at home. “Oh God. That’s the worst thing you could do right now. Work is the only place I feel sane.”

“You’re able to concentrate?” he asks, the crease between his brows a black gash.

“Of course,” I say, holding my breath while I look straight into his eyes. “I wouldn’t be in the OR if I couldn’t.” But I see on his face that he hears my own doubt.

 

Four days later I’m coming home after a night on call, fragile with exhaustion after twenty-four hours of labor epidurals and emergency cesarean sections. A gaunt woman with stringy blond hair and chapped skin rushes at me from the curb beside my building, her cigarette still burning on the pavement. “Are you Dr. Marie Heaton?”

“Yes, I’m Dr. Heaton, what can I…”

“I’ve got a subpoena here for you.” She pushes a long white envelope into my hand, jabbing a finger at the black letters of my name, a relieved look on her face, knowing she has earned her pay. She runs back to her car before I can open it, her cigarette still disintegrating on the sidewalk in a graceful twist of smoke. I’ve been expecting this for weeks, but I still feel the affront—like running into a piece of familiar furniture in a dark bedroom.

 

In the weeks leading up to my first actual deposition I start coming to work earlier, often arriving before the night cleaning crew has finished—an institutional odor of disinfectant rising like morning fog off stainless steel, the hallways so dim and still they have the aura of a morgue. It becomes the only peaceful part of my day, opening the heavy swinging doors into the dark operating room, the ventilator and pumps and monitors looming in the shadows like mechanical mannequins. I almost hear their robotic voices interrupted by my living presence.

At home, in the sleepless single digits of the night, I scour textbooks in search of answers. I read about anaphylaxis, an unchecked death spiral of the immune system. I study biochemistry, evolution’s masterwork of elements shot from the first exploding star, cohered into a living being. I rememorize pharmacology, the molecules we manufacture to stall nature’s culling of the ill and aged. I read as much as I can of the ocean of knowledge we have accumulated about our physical bodies since the days of leeches and humors, the ocean of knowledge that encompasses only a fragment of all there is to know about what holds physique and soul in union for the flicker of a lifetime. Knowledge will be my magic wand; knowledge will reclaim my control over the anesthetized patient spread like a crucifix on the operating table.

My answering machine gradually fills up with messages I barely listen to, invitations I won’t accept. Anyone who knows about the suit wants to ask if I feel prepared, if I’m completely confident in my lawyer, if I’m sleeping all right. Anyone who doesn’t know can’t tolerate my silences, the puzzled stare I give to their jokes, the full plate of food I push away at the end of dinner. Lori coaxes me through sheer persistence. She threatens to get on a plane within the hour if I don’t pick up, then fills our short conversations with stories about her children instead of questions.

And Elsa. I always answer Elsa. I recognize her calls by their late or early hour, only when her parents are sleeping. Her adolescent self-centeredness is a gift, a secret room where time rolls back and I am me again. Sometimes I huddle on my own closet floor when we talk, a long-distance comaraderie of solitariness. “Why don’t you think she believes you?” I ask her, my knees folded against my chest, curtained between my wool coat and flannel bathrobe.

“I can just tell. With both of them. They tell me how great I am and then they watch every little thing I do, like they think I’m a juvie. It’s driving me crazy.”

“They watch you because they love you, Elsa. You know that. In your heart. Don’t you? Learn to trust that voice inside yourself.”

I wonder if she knows that the lifeline I’ve been holding out to her has become my own.

 

My first official deposition falls one month to the day after Jolene died. I arrive so early the janitor has to unlock the conference room door for me. The room has one tall, thick-paned window looking out over Puget Sound where an early spring fog floats the Olympic mountain peaks like a grand ship. My palms are so damp I wish women still wore the short white gloves my mother used to put on my sister and me for Easter.

Men arrive lugging scuffed briefcases weighted with papers. The room takes on a jovial atmosphere, a breakfast outing away from the office routine. Everyone seems to know one another, regardless of which side of this suit they represent. Donnelly shakes my hand and pulls out a chair in the middle of the polished table. As people take their seats along either side, the divisions of loyalty split: defense team over here, plaintiff’s over there.

After I am sworn in, Bobbie Jansen’s lawyer, Darryl Feinnes, smiles at me cheerfully and waves at a video recorder set up in the corner, pushing the bridge of his glasses higher on his nose with a stubby index finger. “You don’t mind the video, do you, Dr. Heaton? It just helps us all be sure we get the information right.” An assistant punches the silver button on the recorder down with a sharp snap that abruptly shifts the convivial mood.

I answer and reanswer the questions Donnelly has prepared me for, but now my answers feel false and overrehearsed.

“How long have you been an anesthesiologist, Dr. Heaton?”

“Have you ever completed a fellowship in the specialty of pediatric anesthesia, Dr. Heaton?”

“How many children have you anesthetized? Fifty? Two hundred?”

“When did you last study pediatric resuscitation?”

“What were your board scores, Dr. Heaton?”

He keeps rocking back in his armchair and sucking his lips in between his teeth, as if he is tasting my vulnerability. The video camera’s steady red light reminds me that every hesitation in my voice, every stutter over my career statistics, is being seared onto a permanent record.

After a few hours Feinnes suggests we all break for coffee, and there is a general scraping of chairs and loosening of ties. He is a short, puffy man with back-combed hair and blushed cheeks better suited to an English schoolboy. Feinnes leans forward over his Styrofoam cup and makes a chuckling remark to Donnelly, who throws his head back and laughs. I use the moment to go to the bathroom, where I sit silently in the stall, holding my forehead against tight fists.

After the break another lawyer, some junior partner, repeats all the same questions. Every time I answer I look at his face to see if I have missed a date, a number, given some inconsistent answer that will damn me. The court reporter, a shrunken, osteoporotic woman, hunches over the muffled keys of her steno machine like a muted pianist.

During the final three hours of the deposition the lawyers dissect every moment of the day Jolene died.

“Which drug did you give first?”

“Why did you choose that drug?”

“How much did you give?”

“Are you sure you gave that amount?”

“Was that the correct dose?”

“How many patients have you anesthetized in the prone position?”

“How much sleep did you have the night before?”

“Did you have anything to drink the night before?”

“Do you tend to drink very much? How much is not much?”

Donnelly objects to this and I shrink as if I’d been scolded. He tells me that I’m still required to answer the question, but at least his objection will be on record. I shift my clasped palms into my lap and see a damp outline of their shape on the tabletop.

Near the end of the deposition Donnelly does his best to piece me back together. He reassures me that I’m doing fine, turns me by the shoulders to face his groomed graying hair, his creased, authoritative face. “Try to keep to the facts, tell the truth, stay calm. Just tell them exactly what steps you took in the operating room that day, to the best of your knowledge.”

To the best of my knowledge I let a healthy eight-year-old girl entrusted to my care, my medical expertise, die. But until we have a pathologist’s report and a final settlement, who could tell me this was not my fault? Forgiveness can only come from myself.

Donnelly reassures me that once we have the autopsy results Feinnes’s case for negligence will be even weaker. Still, he warns, the discovery phase of the mediation will probably take months. He walks down the hall with me after my deposition listing the records he’ll need to pull from my medical school and residency and years of work at First Lutheran, discussing the expert witnesses he plans to hire, explaining the tedious seesaw of haggling and bartering between legal teams that will finally affix a price tag to Jolene’s life.

We wait for the elevators opposite another plush room, nearly identical to the one in which I’ve just been deposed. The door swings farther back and a young woman carries out a tray of dirty coffee cups and crushed sandwich boxes, leaving me a clear view of the gleaming conference table, the walls hung with paintings of flowers and fruit and English hunting parties. Bobbie is sitting at the table. If she looked up now we would be facing each other for the first time since Jolene’s surgery.

Darryl Feinnes pushes a stack of papers in front of her marked with red stickers. I can hear snatches of their conversation—accounts and fees, funeral costs, pain and suffering, lost companionship—as he calculates the final tally of her tragedy. He twirls a pen in his fingers with a pinched mouth that suggests he finds her exasperatingly slow to comprehend. She watches him curiously, as if she’s hearing a foreign language dribble out of his mouth, the concrete details and dollars irrelevant. The bones of her face seem more angular than I remember, disproportionately prominent, her eyes and cheeks hollowed in purple shadows as if she’d forgotten to eat. The top buttons and holes of her blouse are misaligned. The fluorescent panel lights wash the flesh tones from her face and highlight gray strands seeded through her brown hair as her hand mechanically fills in the signature lines. I feel like I’m spying on her own private wound. We are coupled, she and I, through this lost child who has skewed the orbits of our lives.

The elevator door buzzes and I turn to see Donnelly holding it open, patiently waiting for me to follow.

 

It is almost dark by the time I get home. I should have left a lamp on—something, if not someone, to wait up for me. I call Lori but she doesn’t answer and I don’t have the heart to talk to a machine. I pick up the phone again intending to call my father, then put the receiver down before I dial.

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