Comfort Zone

Chapter 21

Miriam made her way back to the war zone, picking up an additional frizzle of excitement. She tracked the cause and was surprised to see the hospital CEO Richard Quest talking to some of the staff. Saturday night and the CEO's paying a visit? Now I'm impressed, she thought.

Quest was frequently seen around the hospital and generally known as a hands-on manager, or to his detractors, a micromanager. When he found things to his liking, he was effusive with praise; when he didn't, the proverbial heads and other body parts rolled. Miriam had never dealt with him personally as her small practice was under the radar of the hospital, so she was again surprised when she saw him heading her way.

"Dr. Gotlin," he said with a broad smile, holding out his hand. "Richard Quest." She smiled back, noting his firm handshake. The CEO was a tall, fit man in his fifties.

Even more impressed.

"Remiss of me not to have called to see how you were faring after your traumatic ordeal in the pharmacy." He shook his head. "Terrible loss. Well you're a credit to the hospital, taking care of patients so late on a Saturday."

"Right back at you, Mr. Quest," she said.

"It's Richard. I'm here visiting your patient, actually. An old personal friend, and a great supporter of Miami Health, not to mention a longtime volunteer. Her daughter called me about her sudden deterioration. One minute she was a vital woman, the next comatose. Tragic. But you deal with this every day of course."

A great weight lifted from Miriam's shoulders. The CEO would understand the medical issues and could intervene with the difficult daughter. With relief, she explained the situation to him as succinctly as possible.

"Yes, I know," the CEO replied when Miriam was done. "The ER attending told me all about it. But the fact is that Lilly Fielding has been dealing with serious illness and discussed her wishes recently with her daughter."

"But there's no mention of any life-threatening illness in the chart."

"Likely another case of suboptimal charting, I'm afraid," the CEO sighed. "Please make a note to tell Dr. Powell to update the electronic chart when she returns." He scribbled something on his tablet.

Miriam struggled to find the proper diplomatic words to object, and distract the CEO from Tatiana's sloppy charting.

"Are you sure the daughter—understood—what her mother wanted? Studies show that many surrogates don't really know what their loved ones want. A pacemaker is such a simple intervention, surely--"

"She was very clear." The CEO looked directly at her, his voice sonorous, and Miriam fought the urge to lower her tail and slink away. Instead , she forced herself to straighten her shoulders.

"The daughter also asked me to sign a DNR order. Legally I can't sign one without written proof of a terminal illness."

"True. I suppose you could discuss this with the ethics committee member on call," Richard Quest said.

"That's me."

"Well, there you are. You already know about a patient's right to refuse treatment. And the designated surrogate's right in the patient's place, of course. And for your peace of mind, let me reassure you that Marilyn and Lilly are like that." The CEO crossed his middle finger over his pointer.

"Well, I'll let you go finish up your work. Remember, all work and no play..." The CEO walked away smiling, and Miriam went to look for the cardiologist.

She found him reviewing the data, stroking a little goatee that was a new addition to his face. Miriam knew him, but they hadn't had many patients in common. He looked up as she approached.