Comfort Zone

Chapter 13

"Dr. Gotlin, I need to talk to you about Lisa Phillips." Dr. Engels had come up silently behind her and startled her during hospital rounds later that day, looking even paler than usual. Miriam couldn't help noticing that he looked unhealthy. Ghost-like, she thought.

"You want me to discharge her," Miriam said, attempting a weak joke.

"No, of course not, although it's true she's using up all her hospital days, and you certainly want to avoid a hospital-acquired infection that would prolong her stay. Hospitals can be dangerous places, Dr. Gotlin.

"I've reviewed her prior admissions over the past year. She seems to be deteriorating rapidly. Have you spoken to her about signing a DNR, or a hospice consult? Some of the staff is questioning whether it's wise to treat her with medicines like filgrastim if she's failed to have any response to it. one of the nurses is considering an ethics consult."

"I'm the consultant this month, Dr. Engels."

"I see," he said.

Miriam started to get angry as the face of the patient and her family swam in front of her, but her anger quickly dissipated. Her patient's health had been eroded by years of not taking medicines as prescribed, for whatever reasons. Dr. Engels was a pain in the butt for sure, but he was absolutely right to point out her failure to discuss end of life issues with her patient. Even her hematologist had mentioned it. With the ethics committee meeting fresh in her mind, there was no excuse except her own cowardice. As for the rest, it was a matter of insurance and hospital policies; it wasn't personal. Why blame the messenger? No one likes to have their medical judgment questioned, to start to doubt themselves, or to have other doctors and administrators micromanaging their cases. But the truth was that Lisa Phillips' body was failing, she was probably dying, and no expensive medicine Miriam could order was likely to change that fact.

She walked away soberly, practicing the speech she would give the patient and family. She could delay no longer, she would do it today. No backing off. End of life care is as important as the other kind, and she couldn't let her patient down with false hope and promises.

Infectious disease had ordered the appropriate antibiotic for the unpronounceable bacteria growing in her patient's blood. The antibiotic itself was a tongue twister. Various tests were on the agenda including an echocardiogram, to check out her patient's heart, and a CT scan of the chest. Miriam slowly walked to the bedside and was surprised to see Ms. Phillips with a blissful look on her face.

Her friend Katy Byron, also a patient of Miriam's, was brushing Lisa's sparse brown hair with a pale pink baby brush, its bristles looking soft as fur. The two women looked up at her greeting, and Lisa gave a wide smile.

"My son just won an award for a composition he wrote!"

"That's wonderful, Ms. Phillips, I can only imagine how proud you must be."

"He's the one who has a learning disability and we gave him extra tutoring."

"Looks like it's paying off."

"Sure is! Dr. Gotlin, I didn't get my filgrastim today. The nurse said pharmacy didn't have it ready when he went down there, and then he was too busy to go again. Could you talk to him? I need it. It always works when I take it at home. I just want to get better and go home and be with my kids." Her friend kept brushing. Does she have any idea? I really have failed her. "Even if it's just for a short time, Dr. Gotlin," she said. She knows. They always know.

Miriam put off her intended discussion with relief. She'd have to come back when her patient was alone. Instead, she conferred with the nurse, who had the look of a hemophiliac forced to juggle steak knives. All the nurses did. He had already called the pharmacy and was about to go downstairs to pick up the medicine.

"I'll get it for you," she said, and he beamed a brief smile at her.

"I'm here for the filgrastim for room 635," she said to the pharmacy technician at the window.

"And by the way, why's it taking so long today?" she added.

"We have a new wholesaler with whole new procedures, and today's the in-service, which of course means we're mostly out-of-service. I'm the chosen one, running back and forth for emergencies, lucky me."

The technician typed something in the computer, then frowned at the screen. He appeared about to speak, but stopped, frowned again, and disappeared into the recesses of the pharmacy. Why the frown? Miriam wondered, deciding to ask him when he came back.

But when would that be? The minutes ticked by. Miriam pulled an article out of her pocket on obscure diseases and started reading, but quickly grew impatient. She rapped on the window.

"Hello? Hello? Will you be much longer?"

No answer. Damn pharmacy, she grumbled, always working in slow motion. She heard a door slam. Had the man forgotten about her, and gone back to the in-service without getting her medicine? She tried the door and to her surprise it opened. Someone must have exited without locking it, which was a bad breach of protocol.

Good for Miriam, though. She'd been in the back of the hospital pharmacy once or twice with Josh and had a rough idea how things were organized. Maybe she'd get lucky and stumble on a vial of filgrastim if she couldn't find the tech.

"Anyone back here?"

No answer.

"Hello?"

Down one more aisle.

And then there was screaming, terrible screaming, and it was all coming from Miriam's mouth.