“That’s absurd . . .” David shouted. “Why . . .”
“We were told that if you had any questions you should call Ms. Beaton,” Janet said. “Don’t blame us.”
David was beside himself with fury. The medical director did not have the right to leave such an order. David had never heard of anything more absurd. It was bad enough that these administrators were second-guessing him. But to intercede in patient care so directly seemed a total violation.
But David understood his argument wasn’t with the nurse. He left immediately to find his patient. He arrived to discover that Jonathan’s condition was indeed critical. He was in a coma and on a respirator just as Mary Ann had so recently been. David listened to his chest. Jonathan was also developing pneumonia. Twisting the IV bottle around, David saw that he was getting continuous intravenous antibiotics.
David went to the central desk to study Jonathan’s chart. He quickly realized that Jonathan’s course had begun to mirror David’s three deceased patients. Jonathan had developed problems of the GI system, the central nervous system, and the blood system.
David picked up the phone to call Helen Beaton when the ICU unit coordinator tapped him on the shoulder and handed him another phone. It was Charles Kelley.
“The nurses told me you’d come into the ICU,” Kelley said. “I’d asked them to call me the moment you appeared. I wanted to inform you that the Eakins case has been transferred to another CMV physician.”
“You can’t do that,” David said angrily.
“Hold on, Dr. Wilson,” Kelley said. “CMV certainly can transfer a patient, and I have done so. I’ve also notified the family, and they are in full agreement.”
“Why?” David demanded. Hearing that the family was also behind the change, his voice lost most of its sting.
“We feel that you are too emotionally involved,” Kelley said. “We decided it was better for everyone if you were taken off. It will give you a chance to calm down. I know you’ve been under a lot of strain.”
David didn’t know what to think, much less say. He thought about pointing out that Jonathan’s condition had gone downhill just as he’d feared, but he decided against it. Kelley wasn’t likely to consider anything he had to say.
“Don’t forget what we said yesterday,” Kelley continued. “I know you’ll understand our point of view if you give it some thought.”
David was of two minds when he hung up. On the one hand he was still furious to have been unilaterally removed from the case. On the other, there was an element of truth in what Kelley had said. David had only to look at his trembling hands to recognize he was overly emotionally involved.
David stumbled out of the ICU. He didn’t even look at Jonathan as he passed by. Out in the hall he checked his watch. It was still too early to go to his office. Instead, he went to medical records.
David pulled the charts on Marjorie, John, and Mary Ann. Sitting in the isolation of a dictation booth, he reviewed each chart, going over the respective hospital courses. He read all his entries, all the nurses’ notes, and looked at all the laboratory values and the results of diagnostic tests.
David was still toying with the idea that an unknown infection was responsible, something that his patients may have contracted while in the hospital. Such an infection was called a nosocomial infection. David had read about such incidents at other hospitals. All his patients had had pneumonia but each case had been caused by a different strain of bacteria. The pneumonia had to have been the result of some underlying infection.
The only common element in all three cases was the history. Each patient had been treated for cancer with varying mixtures of surgery, chemotherapy, and radiotherapy. Of the three treatment modalities, only chemotherapy was common to all three patients.
David was well aware that one of the side effects of chemotherapy was a general lowering of a patient’s resistance because of a depressed immune system. He wondered if that fact could have had something to do with the rapid downhill courses these patients experienced. Yet the oncologist, the expert in such matters, had given this common factor little import since in all three cases the chemotherapy had been completed long before the hospitalization. The immune systems of all three patients had long since returned to normal.