“Hey, there wasn’t much point,” the doctor said. “The man’s lungs were full, his kidneys shot, and he had no blood pressure.”
David nodded absently. He stared at his patient while the ICU nurses unhooked all the equipment and IV lines. As they continued to clean up, David went over to the main desk and sat down. He began to wonder if he were suited to be a doctor. He had trouble with this part of the job, and repetition seemed to make it more difficult, certainly not easier.
Tarlow’s relatives came and, like the Kleber family, they were understanding and thankful. David accepted their kind words feeling like an impostor. He hadn’t done anything for John. He didn’t even know why he’d died. His history of leukemia wasn’t a real explanation.
Even though he’d now been informed about the hospital autopsy policy, David asked the family if they would allow one. As far as David was concerned, there was no harm in trying. The family said they’d consider it.
Leaving the ICU area, David had enough presence of mind to check on Mary Ann Schiller and Jonathan Eakins. He wanted to be certain that they had been settled and their respective treatments started. He particularly wanted to be sure that the CMV cardiologist had visited Eakins.
Unfortunately, David discovered something that gave him pause. Mary Ann had been put in room 206: the room that John Tarlow had so recently vacated. David had half a mind to have Mary Ann moved, but he realized he was being irrationally superstitious. What would he have said to admitting: he never wanted one of his patients in room 206 again? That was clearly ridiculous.
David checked her IV. She was already getting her antibiotic. After promising he’d be back later, David went into Jonathan’s room. He too was comfortable and relaxed. A cardiac monitor was in place. Jonathan said that the cardiologist was expected imminently.
When he returned to his office, Susan greeted David with word that Charles Kelley had called. “He wants to see you immediately,” she said. “He stressed immediately.”
“How many patients are we behind?” David asked.
“Plenty,” Susan said. “So try not to be too long.”
Feeling as if he were carrying the world on his shoulders, David dragged himself over to the CMV office. He wasn’t exactly sure what Charles Kelley wanted to see him about, but he could guess.
“I don’t know what to do, David,” Charles Kelley said once David was sitting in his office. Kelley shook his head. David marveled at his role-playing ability. Now he was the wounded friend.
“I’ve tried to reason with you, but either you’re stubborn or you just don’t care about CMV. The very day after I talk to you about avoiding unnecessary consults outside of the CMV community, you do it again with another terminal patient. What am I going to do with you? Do you understand that the costs of medical care have to be considered? You know there’s a crisis in this country?”
David nodded. That much was true.
“Then why is this so hard for you?” Kelley asked. He was sounding angrier. “And it’s not only CMV that is upset this time. It’s the hospital too. Helen Beaton called me moments ago complaining about the enormously expensive biotechnology drugs that you ordered for this sad, dying patient. Talk about heroics! The man was dying, even the consults said that. He’d had leukemia for years. Don’t you understand? This is wasting money and resources.”
Kelley had worked himself up to a fevered pitch. His face had become red. But then he paused and sighed. He shook his head again as if he didn’t know what to do. “Helen Beaton also complained about your requesting an autopsy,” he said in a tired voice. “Autopsies are not part of the contract with CMV, and you were informed of that fact just recently. David, you have to be reasonable. You have to help me or . . .” Kelley paused, letting the unfinished sentence hang in the air.
“Or what?” David said. He knew what Kelley meant, but he wanted him to say it.
“I like you, David,” Kelley said. “But I need you to help me. I have people above me I have to answer to. I hope you can appreciate that.”