Harmful Intent (4 page)

The male nurse continued the chest compressions and the ventilator kept Patty's lungs filled with pure oxygen. Her pupils remained miotic, suggesting her brain was getting enough oxygen, but her heart stayed electrically and mechanically still. Jeffrey repeated all the textbook procedures but to no avail. He even had Patty shocked again with the defibrillator set at 400 joules.

Once the pediatrician had the newborn stabilized, he had the entire infant care unit vacate the OR along with its attendant clutch of residents and nurses. Little Mark was on his way to the neonatal intensive care unit. Jeffrey watched them go. He felt heartsick. Shaking his head in sorrow, he turned back to Patty. What to do?

Jeffrey looked up at Ted, who was still standing next to him. He asked Ted what he thought they should do. Jeffrey was desperate.

“Like I said, I think we should open her up and work on the heart directly. There's not much to lose at this point.”

Jeffrey watched the flat EKG for another moment. Then he sighed. “Okay. Let's try it,” he said reluctantly. He had no other ideas, and he didn't want to give up. As Ted pointed out, they had nothing to lose. It was worth a try.

Ted gowned and gloved in less than ten minutes. Once he was prepared, he had the nurse stop compressing the chest so that he could rapidly drape and slice into it. Within seconds he was holding Patty's naked heart.

Ted massaged the heart with his gloved hand and even injected epinephrine directly into the left ventricle. When that failed to have an effect, he tried to pace the heart by attaching internal leads to the cardiac wall. That resulted in a complex on the EKG, but the heart itself did not respond.

Ted recommenced the internal cardiac massage. “No pun
intended,” he said after a couple of minutes, “but my heart is no longer in this. I'm afraid the ballgame is over unless you guys have a heart transplant waiting around here. This one is long gone.”

Jeffrey knew that Ted didn't mean to sound callous and that his apparently flip attitude was more of a defense mechanism than a true lack of compassion, yet it cut Jeffrey to the quick. He had to restrain himself from lashing out verbally.

For as much as he'd given up, Ted continued the internal cardiac massage. The only sound in the OR came from the monitor recording the pacemaker's discharge and the low hum of the pulse oximeter as it responded to Ted's internal massage.

Simarian was the one who broke the silence. “I agree,” he said simply. He snapped off his gloves.

Ted looked across the rapidly erected ether screen at Jeffrey. Jeffrey nodded. Ted stopped massaging the heart and pulled his hand from within Patty's chest. “Sorry,” he said.

Jeffrey nodded again. He took a deep breath, then turned the ventilator off. He looked back at the sorry sight of Patty Owen with her abdomen and chest rudely sliced open. It was a terrible sight, one that would stay with Jeffrey for the rest of his life. The floor was littered with drug containers and wrappers.

Jeffrey felt crushed and numb. This was the nadir of his professional career. He'd witnessed other tragedies, but this was the worst, and most unexpected. His eyes drifted to his anesthesia machine. It too was covered with debris. Beneath the debris was the incomplete anesthesia record. He'd have to bring it up to date. In the fevered attempt to save Patty he'd had no time to do so. He looked for the half-empty vial of Marcaine, feeling an irrational antipathy toward it. Although it seemed unreasonable in light of the test dose results, he couldn't help but feel an allergic reaction to the drug was the root of this tragedy. He wanted to dash the vial against the wall, just to vent his frustration. Of course he knew he wouldn't actually throw the vial; he was too controlled for that. But he couldn't find it among the mess.

“Sheila,” Jeffrey called to the circulating nurse who was starting the clean-up process, “what happened to the Marcaine vial?”

Sheila stopped what she was doing to glare at Jeffrey. “If you don't know where you put it, I certainly don't,” she said angrily.

Jeffrey nodded and then turned his attention to unhooking
Patty from the monitors. He could understand Sheila's anger. He was angry too. Patty didn't deserve this kind of fate. What Jeffrey didn't realize was that Sheila wasn't angry at fate. She was angry at Jeffrey. In fact, she was furious.

A shaft of golden morning sunlight filtered through a window high on the wall to Jeffrey's left and knifed down through the courtroom, hitting the paneled wall behind the judge's bench like a spotlight. Millions of tiny motes of dust sparkled and swirled in the intense beam of light. Ever since the beginning of this trial, Jeffrey had been struck by the theatric quality of the justice system. But this was no TV daytime drama. Jeffrey's career—his whole life—was on the line.

Jeffrey closed his eyes and leaned forward at the defendant's table, cradling his head in his hands. With his elbows splayed on the table, he roughly rubbed his eyes. The tension was about to drive him crazy.

Taking a deep breath, he opened his eyes, half hoping the scene before him would have magically disappeared and he would wake up from the worst nightmare of his life. But of course it wasn't a bad dream he was suffering. Jeffrey was involved in his second trial for Patty Owen's untimely death eight months previously. Just then he was sitting in a courtroom in the center of Boston, waiting to hear the jury deliver his fate on criminal charges.

Jeffrey glanced over his lawyer's head to scan the crowd. There was an excited, low-pitched babble of voices, a murmur of expectancy. Jeffrey averted his gaze, knowing that all the talk centered on him. He wished he could hide. He felt utterly humiliated by the public spectacle so rapidly unfolding. His entire life had unraveled and disintegrated. His career was going down the drain. He felt overwhelmed, yet oddly numb.

Jeffrey sighed. Randolph Bingham, his lawyer, had urged him to appear calm and controlled. Easier said than done, especially now. After all the heartache, anxiety, and sleepless nights, it was
now down to the wire. The jury had reached its decision. The verdict was on its way.

Jeffrey studied Randolph's aristocratic profile. The man had become a father to him through these last eight harrowing months, even though he was only five years Jeffrey's senior. Sometimes Jeffrey had felt almost love for the man, other times something more akin to rage and hatred. But he'd always had confidence in his lawyer's skills, at least until this point.

Glancing at the prosecuting team, Jeffrey studied the district attorney. He had particular antipathy for this man, who seemed to have seized on the case as a vehicle for advancing his political career. Jeffrey could appreciate the man's native intelligence though he'd grown to despise him during the course of the four-day trial. But now, watching as the D.A. conversed animatedly with an assistant, Jeffrey realized he felt oddly devoid of emotion toward the man. For him, the whole business had been a job, no more, no less.

Jeffrey's eyes strayed beyond the district attorney toward the empty jury box. During the trial the realization that these twelve strangers held his fate in their hands had paralyzed Jeffrey. Never before had he experienced such vulnerability. Up until this episode, Jeffrey had been living under the delusion that his fate was largely in his own hands. This trial showed him just how mistaken he was.

The jury had been deliberating for two anxious days and—for Jeffrey—two sleepless nights. Now they were waiting for the jury to return to the courtroom. Jeffrey again wondered if two days of deliberation was a good sign or a bad. Randolph, in his irritatingly conservative manner, would not speculate. Jeffrey felt the man could have lied just to give him a few hours of relative peace.

Despite his good intentions to refrain from fidgeting, Jeffrey began to stroke his mustache. When he realized what he was doing, he folded his hands and set them on the table in front of him.

He glanced over his left shoulder and caught sight of Carol, his soon to be ex-wife. Her head was down. She was reading. Jeffrey turned his gaze back to the judge's empty bench. He could have been irritated that she was relaxed enough to be able to read at this moment, but he wasn't. Instead, Jeffrey felt thankful that she was there and that she'd shown as much support as she had. After all, even before this legal nightmare had
started, the two of them had come to the mutual conclusion that they had grown apart.

When they had first married eight years ago, it hadn't seemed important that Carol was extremely social and outgoing while he tended toward the opposite. It also hadn't bothered Jeffrey that Carol wanted to put off having a family while she advanced her career in banking, at least until Jeffrey found out that her idea of postponement meant never. And now she wanted to head west, to Los Angeles. Jeffrey could have lived with the idea of moving to California, but he had trouble with the family issue. Over the years he'd come to want a child more and more. To see Carol's hopes and aspirations move in an entirely different direction saddened him, but he found he didn't hold it against her. Jeffrey had fought the idea of divorce at first, but had finally given in. Somehow, they just weren't meant to be. But then, when Jeffrey's legal problems materialized, Carol had graciously offered to hold off on the domestic issue until Jeffrey's legal difficulties were resolved.

Jeffrey sighed again, more loudly than before. Randolph shot him a disapproving glare, but Jeffrey couldn't see that appearances mattered at this point. Whenever Jeffrey thought about the sequence of events, it had a dizzying effect on him. It had all happened so quickly. After the disastrous death of Patty Owen, the malpractice summons had arrived in short order. Under the current litigious climate, Jeffrey had not been surprised by the lawsuit, except perhaps by the speed.

From the start, Randolph had warned Jeffrey that it would be a tough case. Jeffrey had had no idea how tough. That was right before Boston Memorial suspended him. At the time, such a move had seemed capricious and unreasonably vicious. It certainly wasn't the kind of support or vote of confidence Jeffrey had hoped for. Neither Jeffrey nor Randolph had had any inkling of the rationale for the suspension. Jeffrey had wanted to take action against Boston Memorial for this unwarranted act, but Randolph had advised him to sit tight. He thought that issue would be better resolved after the conclusion of the malpractice litigation.

But the suspension was only the harbinger of worse trouble to come. The malpractice plaintiff attorney was a young, aggressive fellow named Matthew Davidson from a firm in St. Louis specializing in malpractice litigation. He was also associated with a small general law firm in Massachusetts. He'd filed suit against Jeffrey, Simarian, Overstreet, the hospital, and even
Arolen Pharmaceuticals, who'd manufactured the Marcaine. Jeffrey had never been the subject of a malpractice action before. Randolph had to explain that this was the “shotgun” approach. Litigators sued everybody with “deep pockets” whether or not there was any evidence of direct involvement in the alleged incident of malpractice.

Being one among many had initially provided some solace to Jeffrey, but not for long. It quickly became clear that Jeffrey would stand alone. He could remember the turning point as if it were yesterday. It had happened through the course of his own testimony in the early stages of the initial civil malpractice trial. He had been the first defendant to take the stand. Davidson had been asking cursory background questions, when he suddenly became harder hitting.

“Doctor,” Davidson said, turning his thin, handsome face toward Jeffrey and putting a pejorative cast to the title. He walked directly to the witness stand and placed his face within inches of Jeffrey's. He was dressed in an impeccably tailored, dark pinstriped suit with a light lavender shirt and a dark purple paisley tie. He smelled of expensive cologne. “Have you ever been addicted to any drug?”

“Objection!” Randolph called out, rising to his feet.

Jeffrey had felt as if he were watching a scene in some drama, not a chapter in his life. Randolph elaborated on his objection: “This question is immaterial to the issues at hand. The plaintiff attorney is trying to impugn my client.”

“Not so,” Davidson countered. “This issue is extremely germane to the current circumstances as will be brought out with the testimony of subsequent witnesses.”

For a few moments silence reigned in the crowded courtroom. Publicity had brought notoriety to the case. People were standing along the back wall.

The judge was a heavyset black man named Wilson. He pushed his thick black-rimmed glasses higher on the bridge of his nose. Finally he cleared his throat. “If you're fooling with me, Mr. Davidson, there's going to be hell to pay.”

“I certainly wouldn't choose to fool with you, Your Honor.”

“Objection overruled,” Judge Wilson said. He nodded toward Davidson. “You may proceed, Counselor.”

“Thank you,” Davidson said as he turned his attention back to Jeffrey. “Would you like me to repeat the question, Doctor?” he asked.

“No,” Jeffrey said. He remembered the question well enough.
He glanced at Randolph, but Randolph was busy writing on a yellow legal tablet. Jeffrey returned Davidson's steady glare. He had a premonition that trouble was ahead. “Yes, I had a mild drug problem once,” he said in a subdued voice. This was an old secret that he'd never imagined would surface, especially not in a court of law. He had been reminded of it recently when he had to fill out the required form to renew his Massachusetts medical license. Yet he thought that information was confidential.

“Would you tell the jury what drug you were addicted to,” Davidson asked, stepping away from Jeffrey as if he was too revolted to remain too close to him for any longer than necessary.

“Morphine,” Jeffrey said with almost a defiant tone. “It was five years ago. I had trouble with back pain after a bad bicycle accident.”

Out of the corner of his eye, Jeffrey saw Randolph scratching his right eyebrow. That was a previously arranged gesture to signal that he wanted Jeffrey to confine himself to the question at hand and not offer any information. But Jeffrey ignored him. Jeffrey was angry that this irrelevant piece of his past was being dredged up. He felt the urge to explain and defend himself. He certainly wasn't a drug addict by any stretch of the imagination.

“How long were you addicted?” Davidson asked.

“Less than a month,” Jeffrey snapped. “It was a situation where need and desire had imperceptibly merged.”

“I see,” Davidson said, lifting his eyebrows in a dramatic gesture of understanding. “That's how you explained it to yourself?”

“It was how my treatment counselor explained it to me,” Jeffrey shot back. He could see Randolph frantically scratching again, but Jeffrey continued to ignore him. “The bicycle accident occurred at a time of deepening domestic strain. I was prescribed the morphine by an orthopedic surgeon. I convinced myself that I needed it longer than I actually did. But I realized what was happening in a few weeks' time and I took sick leave from the hospital and volunteered for treatment. And also marriage counseling, I might add.”

“During those weeks, did you ever administer anesthesia while . . .” Davidson paused as if he were trying to think how to word his question. “ . . . while you were under the influence?”

“Objection!” Randolph called. “This line of questioning is absurd! It's nothing short of calumny.”

The judge bent his head down to look over the top of his
glasses, which had slid down his nose. “Mr. Davidson,” he said patronizingly, “we're back to the same issue. I trust that you have some cogent reason for this apparent excursion.”

“Absolutely, Your Honor,” Davidson said. “We intend to show that this testimony has a direct bearing on the case at hand.”

“Objection overruled,” the judge said. “Proceed.”

Davidson turned back to Jeffrey and repeated the question. He seemed to relish the phrase “under the influence.”

Jeffrey glared back at the plaintiff attorney. The one thing in his life that he was absolutely sure of was his sense of professional responsibility, competence, and performance. The fact that this man was suggesting something else infuriated him. “I have never compromised a patient,” Jeffrey snapped.

“That is not my question,” Davidson said.

Randolph got to his feet and said, “Your Honor, I would like to approach the bench.”

“As you wish,” the judge said.

Both Randolph and Davidson went up to the judge. Randolph was obviously incensed. He began talking in a hoarse whisper. Even though Jeffrey was only ten feet away, he could not hear the conversation clearly although he did hear the word “recess” mentioned several times. Eventually, the judge leaned back and looked at him.

“Dr. Rhodes,” he said, “your counsel seems to think you need a rest. Is that true?”

“I don't need any rest,” Jeffrey said angrily.

Randolph threw up his hands in frustration.

“Good,” the judge said. “Then let's get on with this examination, Mr. Davidson, so we can all get out for some lunch.”

“All right, Doctor,” Davidson said. “Have you ever administered anesthesia under the influence of morphine?”

“There may have been one or two times . . .” Jeffrey began, “but—”

“Yes or no, Doctor!” Davidson cut in. “A simple yes or no is all I want.”

“Objection!” Randolph called. “The counselor is not letting the witness answer the question.”

“Quite the contrary,” Davidson said. “It's a simple question and I'm looking for a simple answer. Either yes or no.”

“Overruled,” the judge said. “The witness will have a chance to elaborate on cross-examination. Please answer the question, Dr. Rhodes.”

“Yes,” Jeffrey said. He could feel his blood boil. He wanted to reach out and strangle the plaintiff attorney.

“Since your treatment for your addiction to morphine . . .” Davidson began, walking away from Jeffrey. He emphasized the words “addiction” and “morphine,” then paused. He stopped near the jury box, turned, then added: “ . . . have you ever taken morphine again?”