Diagnosis Death (8 page)

Elena licked her lips but remained silent.

Matney frowned. "If it were not for the similarities between this case and that of your late husband, this might have gone unnoticed, or at least been ignored. As it was, because of your involvement in the case, Dr. Clark brought this to my attention. We thought it best to deal with the matter in this setting, rather than mounting any kind of official inquiry."

Amy leaned forward. "Elena, you're about to finish your residency. I don't want you to go out under a cloud of suspicion. It's possible that what you say in this room can stay in this room, but the three of us need assurance this sort of action won't be repeated."

Elena cleared her throat. "Could . . . could I have some water, please?"

Matney swiveled in his chair and plucked a bottle of water from a mini-fridge behind him. Elena took it and drank deeply. "Thank you."

Matney came right back on point. "Can you give us the assurances your chairman has asked for?"

"I can give you assurances, but not the ones you want," Elena said. "I can assure you that I neither wrote that DNR order nor disconnected Chester Pulliam's respirator."

E
lena's words hung in the silent room like the last notes of a grand symphony dying away in a concert hall.

Clark pinched his lip and furrowed his brow. Matney leaned forward and opened his mouth, but Amy Gross spoke first. "Elena, I recognize how difficult it must have been for you to be involved with a patient whose situation so closely mirrored Mark's. Are you sure you're not simply denying—even repressing—an action you regret?"

Elena scanned the tribunal before her. She realized that's exactly what they represented: a tribunal. As surely as Caesar and his buddies decided the fate of a gladiator, these people held her professional life in their hands. Thumbs up or thumbs down. Well, she wouldn't go without a fight.

"I've admitted that I wrote the 'do not resuscitate' order on Mark's chart. After I made up my mind, I decided to write the order before I backed out." She fixed her gaze on Dr. Matney. "I didn't think it would matter whether I told you or the resident about it or wrote it myself. Obviously, that was a bad decision, a breach of protocol, but I wasn't exactly at my best after practically living in the ICU for two weeks waiting for Mark to show some sign of recovery."

Matney raised a hand like a sixth-grader trying to get the teacher's attention, but Elena plunged ahead. "I don't think I was the one who disconnected Mark's respirator. I have no memory of doing so, but it's possible that I did and repressed it. I've told you—at least, two of you—all that before." She picked up the water bottle and finished it in two greedy gulps.

"But—" Amy said.

"But in this circumstance, I'm absolutely clear about my actions."

"You don't deny you were alone in Pulliam's room," Matney said.

"Why deny it? It's true. There was even a witness. A nurse—Ann was her name—came in after Mrs. Pulliam left. We talked briefly before she left the room to help with another patient."

Matney bored in for the kill. "Turning off the ventilator would only take a few seconds. How long were you alone in the room?"

"I don't know. Maybe five minutes." She read the doubt in their eyes. "Yes, long enough to do any number of things to end Pulliam's life. And I thought about every one of them. But I didn't."

Amy pushed Pulliam's chart across the desk and pointed to a line on the order sheet. "This is the order not to resuscitate Pulliam. There's your signature. Do you deny writing it?"

Elena didn't even look at the chart. Instead, she pulled a blank sheet from the notepad on Matney's desk and scribbled on it. "
This
is my signature. Does it match?"

Amy took the sheet of paper and the chart. Her gaze ran back and forth a couple of times before she passed them to Matney. He scrutinized them and handed them to Clark, who spent almost no time comparing the signatures before he dropped the chart on the desk, saying, "They're not the same."

Elena scanned the group. "Get a handwriting expert to compare them if you want to."

"That won't be necessary," Amy said. "It's pretty obvious that someone else wrote this."

Matney tapped his fingers absently on the chart cover. "If you didn't write that order, who did?"

"I think there's a more important question," Elena said.

Amy was the first to voice it. "Who took Chester Pulliam off his respirator? And why did they want the blame to fall on you?"

David waved to Elena and motioned her to the corner of the hospital cafeteria where he sat with the remains of his breakfast. She shuffled over and slumped into the chair opposite him.

"Bad night?" he asked.

"Bad week. Bad month. Bad year." She drank deeply from the coffee cup she held. "Bad life, I guess."

"Do you want something to eat? I'll get it for you?"

Elena shook her head and emptied her cup. "Just coffee for me this morning. If I ate anything, I'm afraid it would come right back up."

David rose and took her empty cup, returning in a moment with two full ones. "Here. If you're going to be caffeinated, you might as well go all the way."

That brought the faintest trace of a smile to her lips. She nodded her thanks.

"What's the problem? Want to tell me about it?"

She launched into a retelling of the circumstances of Chester Pulliam's death and her meeting with the neurosurgeons and Dr. Gross. Elena's voice was flat, her face showed no emotion, but it was obvious to David that her composure hung by the merest thread.

He waited until he was sure she was finished. "So how did they leave things?"

"Matney is going to talk with the ICU nurses. Maybe one of them knows who had the opportunity to write that note and discontinue Pulliam's life support. Personally, I don't hold out much hope there. And I sure don't see someone coming forward to say, 'Oh, I did it.' In the meantime, I'm to finish my residency and keep my nose clean."

"So you're not in trouble over this."

"I don't know why I should be! I did nothing wrong." She lifted her cup, but put it down without drinking. "I want to leave here with a clear record instead of going out with a cloud hanging over me, labeled as a doctor who practiced euthanasia."

David had never felt so helpless. "If there's anything I can do—"

She shook her head. "Thanks. I'll let you know if you can help. Right now, I don't know what anyone can do to make this better." She brushed away a tear.

"Hey, you'll get through this. You've handled worse."

"That's not it. With everything else that's happened, I forgot—this is Tuesday. Tonight is my night to get another call."

"Do you think this business with Pulliam is connected to your mystery caller?"

"I don't see how it could be," Elena said. "I still think the calls are coming from Mark's mother. And there's no way she could get anything done inside the hospital."

"I guess that's good."

"No, it's terrible. It means that there are at least two people out to get me. And I have no idea how to fight back."

Elena brushed a strand of hair from her eyes. "Mary, please tell me I'm about finished."

The clinic nurse held up a chart. "One more patient. After that, I promise you can go home and forget about this place."

If only I could.
"Thanks. Put him in room two. I'll be right there."

Elena walked to the workroom and took a Diet Coke from the refrigerator. She held the cool can to her forehead until she heard, "Ready, Dr. Gardner." She popped the top and took several long swallows before heading for the exam room.

"Mr. . . ." She looked down at the chart. "Mr. Emerson, how can I help you?"

"My wife's been after me to get a physical. I keep telling her it's old age, but she insisted."

How many times had she heard that excuse? She hoped the man was right, but her intuition told her different.

"Let me get a bit of history. Then I'll have a look at you." She eased onto the rolling stool and propped the chart on her knee. "What's the main thing that's bothering you?"

"It's really nothing. I just get out of breath real easy."

"How far can you walk without getting tired?" Elena asked.

"Maybe from here to the front of the waiting room out there."

The distance he indicated was less than a hundred feet. "Do you ever wake up short of breath?"

"Sometimes. But it helps if I prop up on two or three pillows."

Thirty minutes later, Elena sat in the exam room with the patient and his wife. "Mr. Emerson, you have what we call congestive heart failure." She saw the look of shock that the words "heart failure" always produced, so she hurried on. "There's no need to panic. This is fairly common, and we can treat it. I need to start you on a medicine to improve the efficiency of your heart. It's called digitalis, and doctors have been using it in one form or another for over two hundred years, so you know it must work."

"I've heard of digitalis," Mrs. Emerson said. "Is that all that's needed?"

"No. In this condition, the body accumulates fluid." Elena looked at Mr. Emerson. "This is why your feet and ankles are swollen. We treat that with medicines called diuretics. You've probably heard them called 'water pills.' "

"Anything else?" To Mrs. Emerson's credit, she hadn't berated her husband for putting off this visit so long. But Elena got the distinct impression that Emerson's wife would definitely make sure he followed orders from now on.

"There's salt restriction," Elena said. "That means you cook without added salt. And hide the salt shaker so your husband doesn't use it."

While Mary phoned to set up an appointment with a cardiologist, Elena answered a few more questions. She rose and handed Emerson the appointment slip. "If you have problems before then, call us. We're here to help."

On his way out the door, Emerson offered Elena his hand. "Thanks, doctor. I'm glad she bullied me into coming." The loving look he gave his wife took any sting out of the words.

Elena decided that Emerson was lucky on two counts. He'd sought medical help before his disease became irreversible. And he had a partner, someone who'd help him through the days ahead. She wished she could say the same for herself.

Elena must have eaten something that evening, but she couldn't remember what it was. Anyway, she wasn't hungry. She'd flipped on the TV when she got home, just as she did every night, but there was no comfort in the noise, and the flickering images made no sense.

She slumped in a chair in her living room and tried to sort out the tangled mess that was her life. Mark was gone. She'd almost come to grips with that, although there were still times when she couldn't quite believe she'd never see him again. The thought brought a few tears to her eyes, but she counted that an improvement over the floods that came without warning right after his death.

The harassment from her mother-in-law apparently wasn't going to stop, but maybe she could outrun it when she moved. In the meantime, she still had those Tuesday night calls and threatening letters to contend with.

Her finances were in ruins. Mark's insurance—he'd been so stubborn about having his own coverage through work instead of being included with hers—had only paid a part of the expenses of his illness. There were still unpaid obligations for ambulance services, lab and X-rays, even the cost of his funeral. She'd been able to stave off her creditors, but eventually she had to pay those debts. And that meant hanging on to the position Cathy Sewell offered.

Which brought her to her next quandary. The tribunal—she'd come to think of Matney, Gross, and Clark in that fashion—had promised they'd conduct their investigation discreetly, but would Amy Gross think it best to warn Cathy of this latest hiccup in Elena's professional career? Had they talked already? Would the practice offer, the lifeline to which she clung so desperately, be yanked out of her reach?

No, it was better to face it head-on. She'd call Cathy and tell her the truth. At least, as much of the truth as Elena was prepared to offer. Maybe that would be enough.

The first time Elena dialed Cathy's home number, the line was busy. Was Amy talking with Cathy even now? Elena cradled the phone, looked at her watch, and decided to give it fifteen minutes before she called again. She made a cup of tea. It sat untouched on the table beside her chair when she roused herself from thoughts that went round and round like horses on a carousel, ending where they started with no progress.