Comfort Zone

Chapter 29

Early the next morning, Miriam called the seventh floor and spoke to Lilly Fielding's nurse. There was no change in the patient's situation. Her heart was being paced, her daughter was by the bedside, and no one had seen her wake up long enough to hold even a brief conversation.

All the tests the neurologist ordered had come back normal. And no, a urine sample hadn't been sent for toxicology because she was wearing a diaper and there had been no way to collect it. The nurse tried to put a catheter in the patient's bladder to get the sample of urine, but the daughter had refused. Miriam could order a blood test for Xanax but it would take a few days to come back, time she might not have. Still no flumazenil.

Miriam paced her tiled floor, coffee in hand, and thought things over. It was today or never, since Lara only worked for Marilyn every other Friday from ten to six. How could she trust Lara, a young woman whose first suggestion involved kidnapping her employer's beloved Shih Tzu in an effort to get her away from her mother's bedside? The fact they'd settled on something slightly less awful was of only slight consolation. The plan could turn ugly, could backfire and ruin her entire life.

And what if she was wrong? Maybe Marilyn wasn't the villainess she seemed. The CEO of the hospital had vouched for her. Maybe she'd misjudged the situation big-time. Dammit, why wasn't Tati reachable? Would there be any harm in waiting the few days until she was?

Miriam got ready for work, still undecided. A few ants lollygagged around her sink; she grimaced but made sure not to drown them as she washed the breakfast dishes.

She parked in the doctors' lot far away from the corner spot of the day before, and headed into the safety of the doctors' elevator.

"Did you know I'm a terrible doctor whose only interest is the almighty buck?" Ezzy asked as she hopped on. Miriam raised her eyebrows in greeting.

"Plus they would have reported me, but I wasn't worth the time. Have you been yelped yet?" he went on. "That's from my latest review. It was written by a patient who wanted me to order an x-ray for back pain. I even took extra time to explain to him why we shouldn't do it, that it was bad medicine, not recommended, and would make him glow in the dark from the unnecessary radiation. I guess I didn't convince him."

"You did the right thing. This new focus on 'patient satisfaction' would be laughable if it didn't lead to worse care. Maybe death! It's like they're paying us to kill our patients!"

"Don't give them the antibiotic--or the narcotic--they want but don't need, and they'll go elsewhere, give you a poor rating and yelp you! Who thought practicing good medicine would be so dangerous?" Ezzy smiled, but Miriam could see the hurt in his eyes even behind his wire rimmed glasses. Public shaming was a terrible thing, confirming the worst secret fears people have.

I'm no good. Unworthy.

"Hey, anyone who reads a stupid rant and doesn't choose you as a doctor is NOT a patient you want anyway," she said.

"Oh for the good old days when it was only malpractice lawyers we hated!" Both young doctors smiled at each other, and Miriam recalled something Ezzy had told her in confidence the year before. He'd just survived his first malpractice suit, had even triumphed, but wondered why he still felt like he'd lost, like he'd been gutted.

"Now there are so many things to make us feel small, stupid, and guilty," she said.

"You got that right! Remember that medical staff meeting when Quest explained that patient satisfaction ratings were linked to insurance reimbursement, and how our numbers would pop up whenever we logged in to the EHR? Remember JK interrupting him, asking him about doctor satisfaction. Would that pop up too?"

They both laughed at the memory.

"Do you think the rumors could be true?" Ezzy said, hesitantly. "The terrible ones about JK and the missing narcotics?"

"No," Miriam said, sounding much more definitive than she felt.

"I don't think so either! On the other hand, doctors have problems just like everyone else."

Miriam left the elevator thinking about how she missed JK's jokes, but most of all she missed the rare moments when he let his mask slip. Then she would talk to the real JK, thoughtful and kind, until one of them ran back to the safety of a joke.

But he had his pain, too. Miriam suddenly remembered that he'd once come to her as a patient when his back went out and his primary wasn't available to give him the few days' worth of narcotics he needed. The memory jolted her. Was that how his addiction began, if he was indeed guilty? Oh, JK, why couldn't you confide in someone, let us help you?

Miriam sensed the turmoil before even reaching the nurses' station, realizing it wasn't just animals that could pick up fear pheromones.

"Doctor Gotlin, thank God you're here." Ms. Fielding's nurse was hyperventilating, standing next to a seated intern who looked like she was about to be sick. Miriam matched up the face to the photo shoot of new doctors posted at each nursing station every July. Ariana Lopez.

"She's—dead?" Miriam asked, heart dropping.

"No, not yet. But the pacer's out."

"The daughter—"

"Dr. Gotlin, I am so sorry!" Ariana burst into tears. "I'm so sorry," she said again, hiccupping.

The nurse explained that the intern was working with the cardiologist. She'd gone in to see the patient and, noticing she was more alert, tried to sit her up and examine her. The daughter had come back from the shower just then. Seeing the intern, she had berated her. Shaken, the nervous new doctor's hands must have slipped. The hub dislodged from the patient's neck and the pacing wire pulled out.

"It was loose," the intern said.

"It was secure when I last checked her," the nurse said firmly.

"I know you didn't sign the DNR yet. Do you think the code team can bring her back if her heart stops again?" Ariana asked. Miriam was thinking the same, and reassured the young woman, while trying to block out all thoughts of everything that could go wrong in that process. The team could be too slow and Lilly Fielding could lose precious brain cells in the process, the daughter could terrify the team into acting too timidly...

Miriam looked quickly at the monitor. The patient's heart was working on its own, which was not terribly surprising as a "sick" heart pacemaker often functioned intermittently. The problem was that the heart would very likely stop again.

Miriam raced into the patient's room to try again to convince the daughter to relent, but she was unyielding as ever. The patient, right neck now pacer-free but bandaged, appeared more restless and awake, but her eyes barely opened and any conversation was impossible. Finally Miriam gave in.

"Well, I guess it won't be long until her heart stops again. I'm sorry." And Miriam left the room, head bowed, without mentioning that she would call a code the moment that happened. As soon as she was outside, she raced back to the nurses' station and intercepted the distraught intern.

"Don't leave, Dr. Lopez" she said, gentle hand on the intern's shoulder. "I need your help. Even better, do you have a colleague who can join us?"

Miriam quickly called pharmacy to see if the Xanax antidote had been located. No luck. Next call was to Edna. An emergency hearing to challenge Marilyn's role could indeed be arranged.

"Maybe tomorrow, or the next day at the latest," Edna said.

Tomorrow could be too late. It was now or never.

Miriam punched in Lara's number, and texted the agreed upon word "Pancake." She could hardly breathe waiting for the answer back.

"Drenched in blueberry syrup."