Do No Harm (2002) Page 14

  The others watched the exchange with stunned expressions.

  David took another moment to gather his composure. "It is not our place to question our patients' morality. Do you really think you can keep your footing on that slippery slope? What next? We stop treating criminals? How about people who cheat on their income taxes? Do we let them lie in pain? The mentally ill? Do we deny them medical care? Do we?" David's arms were tensed before him. "That man in Fourteen could very well be mentally incapacitated. Leave judgment to the courts, and do the jobs you swore under oath to do."

  "I never abandon my own instincts," Don said. "Not for any code of ethics."

  "Fine," David snapped. "If that code of ethics doesn't work, try this one. I'm the division chief, and you will listen to me. So do your fucking job. All of you. Now."

  He walked out and left the door standing open, the murmurs following him a few yards up the hall. Whether the confrontation had done any good or not, he felt considerably better.

  He returned to the CWA and checked in with Carson, noting the emptiness of the ER's main axis. Aware that he had just acted like the kind of manager he'd sworn he would never be, he focused on the board as the other staff members trickled back to work.

  Preoccupation stayed with him for the next few hours. His concentration wandered; his movements were mechanical. He forgot a patient's name during an examination for the first time since June of 1987.

  The rest of the staff gleaned the fact that he didn't want to interact with them. Except for essential exchanges, the nurses left him alone. The interns went to Don to present cases and have their orders signed. Don spent his time alternating between gloating over his newfound popularity and sulking like a scorned girl.

  When David stopped by the CWA later, the room quieted as he entered. He glanced at the board. Aside from an MI and a severed finger, things appeared to be quiet, so most of the staff were hanging out on the stools or leaning on the counters, catching up on paperwork.

  Don's hand rasped over the stubble he kept Miami Vice length. His eyes, beneath his perfect brow, were intensely angry. Jill touched David's arm, a gesture he thought was apologetic. The others ignored him.

  He nodded at Jill, a bit awkwardly, and walked from the room. Before heading to his lunch meeting, he went to check on Clyde. He was just about to turn the corner when he overheard Jenkins talking to the two LAPD cops stationed outside the closed door to Clyde's room. They looked tall and hard in their uniforms, their black belts laden with tools and weapons. Yale stood by also, silent and seemingly uninvolved in the conversation.

  "--business end of my nine-millimeter," Jenkins was saying. David peered around the corner and saw him remove his pistol and aim it at an imaginary victim, execution-style. The hall was momentarily deserted; David had decided to direct new patients to the rooms off Hallway Two until Clyde was moved.

  One of the uniformed cops muttered something, though David picked up only snatches. ". . . doc releases him . . . get your hands on . . . "

  "That's right," Jenkins said. "We'll file it under DSAF: Did Society a Favor."

  David was unsure how to gauge the severity of Jenkins's grandstanding, but he felt his face tingling with the panic mixture of anger and sudden dread. Yale leaned against the door but didn't comment. Was he complicit in Jenkins's scheming, or did he believe Jenkins was simply venting?

  David pulled silently back from the corner and headed to his meeting. It took him nearly ten minutes to negotiate the cafeteria lines and locate two opposing seats at a table, and he found himself fondly recalling the days of the separate physicians' dining room. He had already finished eating when he spotted Sandy Evans crossing the cafeteria toward him, juggling a soft leather briefcase and a forest-green tray covered with a mound of food. She wore a well-tailored charcoal suit, and wore it well for a sixty-five-year-old. Her hair, chestnut with auburn highlights, was shag-styled down around her neck.

  He was glad to have pinned her down for lunch; the last time he'd needed to speak to her on short notice, he'd had to scrub in and catch up to her in the OR. Speaking through surgical masks tended to blur the words, and though surgeons never seemed to mind, David had always found a certain stark irreverence in discussing unrelated issues over an opened patient. To accent her points, Sandy had pointed at him with a Kelly-clamped segment of resected bowel.

  David rose slightly in the black cafeteria chair, and he and Sandy touched cheeks in a semblance of a kiss. Aside from her husband, David was the only person she permitted closer than a handshake, an indulgence granted him only because she'd had an exceedingly close relationship with his mother. She was much like David's mother in many regards--the stern attractive looks, the insatiable ambition, the aggressive set of the shoulders. Even their faces sometimes blended in David's memory; both had a hard-shelled, resilient cast, the result of weathering myriad broadsides early in their careers from male colleagues and superiors. But David felt Sandy's similarity to his mother most keenly in something unexpected and unsettling--his desire to please her.

  Sandy dropped her briefcase on an empty chair and lowered the tray to the table, a bottle of Gatorade rolling toward the edge until David grabbed it. Her voice was deep and throaty, a smoker's voice, though she'd never smoked a single cigarette. "The Board of Directors wants a complete media blackout, and rightly so. One suture untied, and we'll have a scandal on our hands. ABC, CNN, MSNBC, and Fox News are all pressing my office for comment, and they're expecting me to roll over. Little do they know." Her vivid green eyes gleamed. "They'd better gear up for one hell of a dogfight, 'cause this old bitch don't roll over unless she's in the mood." Her eyebrows, lightly penciled, rose beneath her bangs. "Oh, it's true. You can ask Stephen."

  David absentmindedly bent a plastic fork in half. "I'll take your word."

  Sandy opened two containers of yogurt, unwrapped a burrito, and lifted the lid of a cardboard box from the grill. Sandy still jogged five miles every morning, and ate like an NFL linebacker. "Sounds like you've had your hands full today," she said around a mouthful of chickwich.

  "More than you know," he muttered.

  "What?"

  "Nothing." David shook his head. "What happened this morning--the entire division not stepping in to provide care--I've never seen anything like it."

  "People react violently when friends and colleagues have been injured."

  David looked up, shocked. "You're condoning this?"

  "Hey!" She pointed at him with the end of a banana. "Direct that righteous Spier anger elsewhere, David. I'm on your side here. If I condoned your staff's behavior this morning, I'd be perfectly capable of expressing that sentiment, so don't get pissy with me over implications."

  "All right. I'm sorry. I apologize."

  "If you'll pardon the equestrian metaphor, David, you're one of my Thoroughbreds. You were the youngest division chief in the history of this hospital, and I leaned like hell to get you that post, not because your mother was my mentor and dear friend but because you are that good. You're one of maybe three department heads here whom I trust implicitly, across the board, without question." Her voice was hard and driving, as if she were still being challenged.

  "Would you like me to apologize again?"

  Her lips pursed and pulled to one side in her distinctive smile. "No. Once was sufficient. Now, I agree that your staff's behavior was egregious. I'm merely pointing out that, however misguided and asinine, there are extenuating circumstances here. Now let's talk about this. First of all, what's this man's name? The patient."

  "Clyde."

  "Clyde? Who the hell's named Clyde?" She looked at David, miffed, as if he were somehow responsible for naming him.

  "That's all he'll give up," David said. "No last name either."

  "All right. How many staff members refused to help you?"

  "Everyone."

  "David, if the radiology tech or a desk clerk didn't pitch in, that's not relevant to this discussion. I'm interested in how many members of ER
staff who receive and treat new patients refused to help you."

  David thought for a moment. "Seven. Four nurses, two interns, and Don Lambert."

  "All right. So legally, we're concerned with seven people here."

  "My concerns are ethical, Sandy. Not legal."

  She finished chewing a bite of burrito. "Hurrah, David. However, what I'm concerned with, in running this facility, is the area where your ethical concerns cross the boundary into legal concerns."

  "Or PR concerns."

  Her penciled eyebrows pulled up as she appraised him. "You inherited your mother's moral sense, but it's a shame you didn't inherit her overriding grasp of politics. It's the only thing that stands between you and a future post as chief of staff."

  David ignored the dig. "How do you intend to handle this issue, Sandy?"

  "Well, we've long known that Dr. Lambert is a lazy SOB, but when he's focused he's actually quite competent, and he is very popular among the staff. Do you really want to push this? It'll be a big stink. Do you feel your patient's care was compromised?"

  "Well, I couldn't get to him as quickly--"

  "Truly compromised?"

  He bit his lower lip. "Probably not."

  "All right. Now let's bear in mind that we are dealing with a very specific situation. This man was attacking ER workers. While the behavior of your staff is inexcusable, I'm not concerned that they'd withhold care from other patients. And the likelihood of someone else attacking ER workers and then needing medical care at the hands of that same staff . . . well, we know how remote a possibility that is. You have to pick your battles. Now let me ask you again. Do you really want to push this?"

  David suddenly felt quite nauseous. "I want them to be formally reprimanded, yes."

  A woman trudging slowly past glanced over at him, and he realized the intensity in his voice was making it carry.

  "Don't get me wrong, David. I'm as pissed about this as you are. In fact, I'm planning on personally meeting with all seven employees and tearing them each a new orifice. What I'm asking is, do you want to involve the Ethics Committee? Risk Management? The California Medical Board?"

  He rolled the soft lining skin of his bottom lip between his teeth. "No."

  "All right." She smiled curtly. "I'm quite good at being furious. By the time I'm through with those seven, they'll have the Hippocratic Oath tattooed on their foreheads."

  He nodded, somewhat formally, and she returned the gesture, amused.

  "Now I've got another tangentially related headache," Sandy said. "As I mentioned before, the media's been crawling all over the hospital, jamming the phone lines. It's not the kind of press we like, but, even worse, it's interfering with the hospital's effectiveness. When can you get this . . . Clyde on his way to the Sheriff's station?"

  "It's complicated."

  "No, David, it's not. Get him stable and get him moved."

  Sandy leaned back and crossed her arms, an amused, attractive little smile playing across her face. "One of the rules when dealing with Thoroughbreds is that you don't rein them in too much. They lose some of their fire, their passion. So I'm making a suggestion, not a directive, and you can throw it out if you'd like."

  He knew what was coming, and he knew he deserved it.

  "More people look up to you here than you're aware," Sandy said. "You're part of the bedrock of this hospital. I heard you lost your cool pretty badly this morning. That unsettles people. Whether we like it or not, your division is under intense scrutiny because of this case--both internal and external scrutiny."

  David took this in, trying to strip away his anger and defensiveness, and find some utility in the information. "Your suggestion?" he asked.

  Sandy rose, picked up her tray, which was littered with gutted food containers and fruit rinds, and winked at him. "Keep your clay feet covered."

  Chapter 23

  YALE emerged from Exam Room Fourteen, jotting something in a worn black leather notepad. A rubber band held several yellow sheets to the top cover, marking his place. As David approached from the cafeteria, Yale flipped the pad shut and slid it into his sport-coat pocket. The two LAPD officers had been replaced by UCLA PD cops, who now stood guard at the door.

  "Dr. Spier," Yale said. He took a few steps toward David, perhaps so the officers wouldn't overhear the conversation to come. "We'd like to get the suspect moved to the jail ward at Harbor. As I'm sure you're aware, the ward there is a high-security treatment zone, and we think it will be safer for everyone involved when we get him moved there. Is he stable?"

  "I'd like to continue irrigation for a few hours. Alkali continues to burn deep within the skin, even when it looks like it's been cleaned off."

  "Yes," Yale said. "We've learned that the hard way."

  "I also need to get him stitched up."

  "Can't that wait and be handled at Harbor?"

  The last time David had checked, Clyde was still reporting pain. David had his hesitations about releasing a patient in a fragile state into the hands of officers who were less than concerned about his health and safety. He thought about how slowly they'd sauntered into the ER with Clyde screaming and burning in their hands. Jenkins's execution pose with his pistol. "I need to keep an eye on him for a few more hours, see how things settle. I don't want him moved in this condition."

  "I'd really prefer--"

  "Maybe tonight."

  "What time?"

  "We'll see how he's doing at eight, nine o'clock."

  That would give David more time to observe the burn's course and make sure the gashes were stitched and cleaned up. Plus, Jenkins's shift should be over by then. David would be less concerned about turning Clyde over to a more impartial officer.

  Yale glanced over his shoulder, and the two officers at the door looked away quickly, pretending they hadn't been eavesdropping. "I'm gonna be honest with you," Yale said. "It's not going well in there. He won't talk to me."

  "Maybe you alienated him too much during the arrest."

  "Perhaps."

  "What took you so long getting him to the ER?"

  "We were busy subduing and frisking him. Minor considerations like that." Yale tapped his pen, a cheap Bic ballpoint, against his lips. "I'm thinking maybe you could try to loosen him up for me."

  "That's really not my job, Detective Yale. The psych consult will be along shortly, and I'm sure--"

  "Dr. Nwankwa. I'm familiar with him and not optimistic he'll be looking to advance our cause."

  "Advancing your cause is not his job. Or mine. Our job is to treat patients."

  "In any event, I'm not permitting Dr. Nwankwa to see the suspect. This is not the time for a psychiatric assessment."

  "Fine. I need Dr. Nwankwa to assess the patient's need for antipsychotic medication. If we can keep Clyde calmed down, that benefits both our agendas." David crossed his arms. "My treatment of this patient will be unimpeded."

  Yale studied David with clever, shiny eyes. "You know, Dr. Spier, our jobs share certain similarities. We're both exposed to elements of society few people deal with. We both see people at their worst--in pain, terrified, furious, suicidal, dead. Just like you think I don't know my ass from . . . Just like you think I don't know much about what goes on in the ER, I can tell you, you don't know much about how things work on the street. Your code of ethics holds up just fine in here, between the scrubbed white walls, but there are different kinds of choices, different kinds of pressures and stresses and concerns out there. This man is a predator--"

  "A suspected predator."

  "Please keep your voice down, Dr. Spier. I'm saying that this man is a suspected predator, and when you deal with predators at large, free from restraints and backup, you might find your politics sliding slowly to the right."

  "My politics are irrelevant to my ethics. I'm sorry you don't understand that."

  "I learned my ethics wading through dismembered bodies, drug labs, and homemade torture chambers."

  "So tell me, then," David said. "Ho
w do you think a suspect should be treated?"

  "Is this the issue at stake? You wouldn't be holding this patient for reasons other than to provide critical medical care? As you're well aware, that would be overstepping your bounds, Dr. Spier."

  "The patient is still in need of critical treatment."

  "I see." Yale took a step back.

  David cleared his throat. "Will Jenkins be involved in the transfer?"

  Yale studied him closely. His pupils were dark and smooth; in the sterile overhead light, they resembled obsidian. "Jenkins will be involved as long as he wants to be involved." His little smile was cold and efficient. "He's got a first-class crush on the suspect. Won't leave him alone, even for a minute. He's sitting out in his patrol car on Le Conte right now, just in case we need him for anything."

  "In medicine, physicians don't treat their family members." He did his best not to picture Elisabeth's face. "There's too much emotion there. Might make a bad decision."

  "Dalton and I are running the show, not Jenkins. But I'm not going to take away his involvement. This is his way of dealing. So we let him drive behind the transport vehicle, let him twirl his lights and run his siren. He needs this."

  "He's under a great deal of stress, and he's highly unstable. What are you going to do if he comes undone? Acts rashly?"

  "There are any number of things about me that are questionable, Dr. Spier. My competence is not one of them."

  David pointed to the closed door of Exam Fourteen. "That is a sick individual in there. Sick and violent, but also confused and scared. He needs your protection."

  "And why do you trust me and not the others?" Yale said. Through all David's dealings with Yale, this was the first hint of anger he'd heard in his voice. "Because I can afford the same suits as you?"

  "You wear better suits than I do, and no. I trust you more because you're the only one not acting like you want to treat my patient like Rodney King."

  "Let me tell you something," Yale said, stabbing a finger at David. "You can take your classist disdain and shove it. You think you understand what goes on in our lives? Do you think you even understand what went down in the Rodney King fiasco? There were twelve officers on the scene for a reason. Why don't you look into it?"