Comfort Zone

Chapter 49

Late August in Florida, still hot enough to poach your eyeballs, as Herbie used to say. And nothing useful ever came out of July humidity, there was no "showers to flowers," just more sweat.

Even the Royal Poinciana trees had wilted, red blooms collecting in piles on the ground. Soon they would be entirely snuffed out, the trees bare, their flaming blossoms just a memory. Their fire would be slaked, and all anyone could do was have the faith and patience to wait for the following June.

Miriam thought about everything she'd been through as she drove to the hospital, swiping her card in the parking lot entrance box, gratified as usual by the green "accept." Perspiring profusely from the race from car to meeting room, she slipped into the empty chair, late as usual, hoping no one would notice her. No such luck.

"Dr. Gotlin," Doug Allen boomed, "Glad you could make it, and I mean that sincerely!" There were laughs all around, applause, and comments about good doctors putting their all into their work. Doug had called this special meeting to discuss the events.

Miriam thought back to her conversation with him after Lilly woke up, preferring not to remember his reprimanding words when he found out she'd done an ethics consult on her own patient. She was sure she'd become persona non grata at future ethics meetings, but instead here she was, looking around the table at smiling faces. Everybody was there, even Tim Courtney...Tim Courtney? What's he doing here? A surge of guilt went through her as she remembered her cowardice in failing to speak out for the rights of his elderly patient.

At Doug's request, she briefly presented the Lilly Fielding case, trying to keep a straight face. "...and so, Ms. Fielding woke up and changed her mind." Edna stared at her the whole time, her face expressionless, fully aware of all the details she was withholding. Wheedling them out of Lara was a piece of cake, especially since Lara wasn't on any no-gossip kick. So much for their pact of silence...

"Anything to add, Edna?" Miriam asked at the end.

"No, I think you covered it nicely, Miriam," Edna answered.

Doug said a few words, reminding everyone to call him for backup in sticky situations in the future, and, more pointedly and firmly, that consults could only be done on cases the consultant was not involved in. No exceptions.

Next up was the Lerner consult. It sparked a discussion about futile care, and about the DNR form Alison had found so daunting.

The committee members wondered if there were times that CPR was simply an inappropriate treatment option. Should it always be the default? If health care providers believed that chest compressions and intubation could harm their patient, or simply prolong death, why were they obligated to ask for permission to refrain from doing it? Should surrogates always be forced to decide, to sign the DNR order, even when it might cause them emotional pain?

Maybe the conversation could be tweaked. This is such a difficult situation for you, a doctor might say. We're doing what we can, and keeping your loved one comfortable, but if his heart stops, we won't try to restart it, knowing it would be futile and possibly hurtful to his well-being. This is our medical plan, is it acceptable to you?

"We need a policy on futile care," a social worker said, "including ways to improve communication."

"Maybe we can change the wording of the DNR form," someone added. "It has to comply with the law, but there must be a way to make it easier to read and less frightening to sign."

Miriam volunteered to be part of the sub-committee that would address those issues.

"Nice idea, by the way, the two of you going to the nursing home with Alison Lerner," the chairperson said. Edna explained that the younger Lerner sibling had taken the news well, had suspected his brother was sicker than Alison let on. He was even able to visit his brother to say goodbye before treatments were stopped. Alison had just called to say that her husband's health had improved, and he'd just been discharged from the nursing home.