11
Evelyn Callas had spent a very busy morning in the Emergency Room. It was an accepted statistic in pediatrics: children were always sickest in February. It had been particularly difficult to concentrate. For a moment she acknowledged a tiny feeling of relief that she had been stationed at the E.R. today and Estol on the ward. Otherwise she would have been the appropriate person to tell Mrs. Phillips. She frowned guiltily and turned back to her patient. Later Evelyn checked the clock. It would soon be noon. When she looked up again, Dr. Carte stood in the doorway.
“Estol, what happened?” He looked pasty and tired. “Here, sit down.” He did, perching like an exhausted sparrow on the edge of the examination table.
“I told her and she’s very upset. She’s furious. She said Sara told her there would be no changes this weekend. She said something about how her kids were supposed to visit this afternoon. She kept asking me why. So I told her about the serum sodium that just came back from the lab. It’s a hundred sixty, Evelyn.”
“Really? Well, I’m not surprised. Have you got her moved out yet?”
“No, but the order’s been written. They’re working on it. Turns out there’s a pregnant nurse working ICU today, and they’ll have to transfer her out because of Mindy’s CMV.”
Outside the door of the Examining Room, Evelyn saw a nurse hovering with a buff-colored patient’s folder in her hand.
“Estol, I’ve got to get back. It’s a madhouse here this morning.”
“Yeah, me, too. Oh, Mrs. Phillips wants to meet with us and her husband. Shall I set something up for this afternoon?”
“Yes. Let’s do it at one-thirty. We can meet for lunch at one o’clock and discuss what we want to say. Tell her the Quiet Room across from ICU, and I’ll meet you at the cafeteria at one.” She pushed herself up and walked him to the door.
“Evelyn?”
“Hm?”
“On a hunch I took a sample of Mindy’s formula down to the lab and had them run a sodium on it. I just got the results back. It’s loaded. I’ll tell you about it later.”
“Yes, okay,” she answered. Her mind did not focus on this information. She was already thinking about her next patient, and worrying about what to say to the Phillipses at one-thirty.
The proof of this particular pudding, and this was how she looked at it, lay with the patient. If Mindy Phillips recovered in ICU, that would be proof.
Later, when so many people asked Evelyn why it never had entered her mind to have the formula tested, she could only shrug. It just had never occurred to her, to any of them, until it occurred to Estol Carte. She had thought only how to make the patient’s body reveal the information, how a test on the stool would disclose the presence of a foreign substance. She was not a detective. She was a doctor.
12
Priscilla Phillips, her eyes still red from weeping, her broad, fleshy face sunken and bleached, watched as her husband and Christine King eased Mindy’s portable hospital crib into the elevator.
Dr. Carte had told her to meet them at one-thirty in the Quiet Room, and it was her impression that they were going to discuss the move to ICU. But they were moving Mindy now. They weren’t waiting to discuss it. They didn’t care how she felt, or Steve, she realized. They didn’t care how Mindy might react.
Mindy was thrashing and screaming, her little face bright red. As they entered the elevator, the IV suddenly broke apart, and at once the watery liquid began puddling on the floor. Christine bent over the IV site on Mindy’s arm.
“It’s infiltrating again,” she said.
“Oh, I can’t stand it—not again!” cried Priscilla. The needle had come out only a short time before, while Mindy was still in her room, and Priscilla had collapsed in tears while they tried to reinsert it in the cut-down. If they lost this site, only the vein in the other arm remained. And now the needle was out again.
Finally they arrived at the second floor. Christine still held the dripping IV while Steve maneuvered the crib out of the elevator and down the hall to the door of the Intensive Care Unit. Christine rang the bell, and one of the ICU nurses came to admit them. There were eight separate rooms in the unit that ringed the central nurses’ station.
Steve and Priscilla helped push Mindy’s crib into her room. Priscilla had not had much time to talk to Steve. When he had arrived following her frantic phone call, he had been furious.
“Damn it—can’t you see it’s just the same old Kaiser runaround, Pris?”
“Calm down, Steve—”
“Hell, no! I’ve had it up to here with these jerks! That’s just the kind of crap they were pulling at the end with Tia.”
“This has nothing to do with that.”
“Maybe not, but it’s all the same kind of power-hungry play. Goddamn hospital. I hate these places.”
“The point is Mindy—what all this is going to do to her. They can’t do this to a one-year-old—”
“Yeah, and—”
“She needs me,” Priscilla interrupted heatedly. “I’ve got to make Carte and Callas understand.”
“Well, good luck, lady! That Carte's a cold sonovabitch and Callas doesn’t strike me as too much better.”
Priscilla nodded. They didn’t say much after that, as though consciously deciding that it was more important to focus their energies on the upcoming meeting.
The ICU Quiet Room was about eight feet square, with a small sink in one corner and room for a few chairs. Four chairs had been drawn up, two on one side of the room, two on the other, like the start of some elaborate game. Steve and Priscilla took chairs next to one another against the far wall. Dr. Callas and Dr. Carte came in, their faces expressionless. Priscilla noticed that Dr. Carte locked the door. For a moment no one spoke. Then Dr. Carte began.
Later, Priscilla could recall only the highlights. She remembered that she cried her way through the half-hour meeting. Dr. Carte never looked at her or at Steve. Formal and stiff, he told her first that they wanted to isolate Mindy because she was receiving sodium from somewhere. That it was important to change and monitor everything about Mindy’s treatment—the formula, the equipment, the nursing staff, everything.
“But the same nurses work ICU as Pediatrics,” Priscilla said at once.
“Everything will be much more rigidly controlled,” Carte answered.
“But I still don’t understand—”
“It’s simple, Mrs. Phillips. Mindy is getting excess sodium from somewhere—” began Carte, looking at the floor.
“What are you saying?” Steve broke in.
“Steve—”
“No, Pris—I want to know. If you’re saying what I think you’re saying, someone’s going through the wall!”
“Mr. Phillips—”
“I just want some answers, Dr. Carte.”
“Mr. Phillips, we believe this excess sodium is what Mindy had all along,” Dr. Callas said.
“No,” Priscilla protested, her voice shaking. “Mindy just had the flu at first. We all had it. Now maybe it’s from sodium, but not at first.”
Dr. Callas shook her head but didn’t answer.
“Well, what about visiting?” said Priscilla. “Can my sons visit Mindy? We’ve had this planned for so long. Sara said—”
“I’m afraid not, Mrs. Phillips,” Dr. Callas said. “The visiting in ICU is very restricted. Children are not allowed. You and Mr. Phillips can visit five minutes an hour.”
Priscilla started screaming then.
“She’s a baby! You can’t do that! She’s had so many changes!”
“It probably won’t be for long, only a couple of days,” Dr. Callas said.
“Can you at least make the time cumulative?” Priscilla’s voice was shaking uncontrollably. “Fifteen minutes every three hours?”
“No,” Dr. Callas said.
13
It was like dealing with a couple of two-year-olds, Evelyn thought. You say the same thing, slowly, over and over again, patiently, calmly, and you let them scream and cry and drum their little heels on the floor until eventually they hear you, and stop. Or just stop out of exhaustion or a sense of futility.
It was the way Evelyn had designed the meeting, but it was still difficult to live through. At lunch she and Estol had discussed strategy over a sandwich in the cafeteria. They had already reached the decision to transfer Mindy, and that was not to change. So the purpose of this meeting was really twofold: primarily, Evelyn felt, it should be a meeting for the parents to ventilate their feelings. She expected a mammoth explosion because that’s what you always got with those two. She and Estol would just have to sit there and take it.
Secondly, Evelyn had decided that she wanted to provide the Phillipses with the minimum possible amount of basic information about why they were moving Mindy to ICU. And that was going to be the hard part. Because by now she knew a great deal more than she had this morning when she had made the decision to transfer Mindy.
Estol had been brilliant, really. He’d made a quantum leap she had never considered. He had looked at Mindy’s intake and output of sodium and realized that the natural place to start was not the output but the intake. She was getting the sodium from somewhere, obviously, so why not start with the formula?
He had told her what he had done—taking a syringe full of Mindy’s formula to the lab and ordering a sodium test. When he had returned for the results, the lab tech informed him that the formula contained 4,480 milliequivalents per liter of sodium.
“I told her that was in the direction I expected, but seemed awfully high,” Carte had said at lunch. “And she called me back with a corrected figure of four hundred forty-eight. She’d forgotten to put in the decimal point. Still, of course, that was an unbelievable figure!”
“What’s the expected sodium content of Cho-free?” Evelyn asked.
“Fifteen milliequivalents. I looked it up.”
“So, what did you do next?”
“Well, I contacted the nursing supervisor and asked her to witness what I was going to do. Then back at the ward I took the whole bottle of Mindy’s formula out of the ward refrigerator and brought it back to the lab. I told the technologist to label it, make sure no one threw it out, and keep it in the lab refrigerator.”
“And then?”
“I returned to the ward. The nurse was already mixing new formula for Mindy, so I instructed her to change all the tubing, and keep the new stuff in the Medication Room—not to let it out of her sight. Then I thought I’d better get a control sample tested, so I took some of the newly mixed formula and ran that down to the lab. I haven’t received the results back on that yet, but when I got down there, they handed me the slip on Mindy’s most recent serum sodium. Since it was one hundred sixty, I figured I might as well use that as an excuse to move Mindy to ICU, as we’d discussed. And that’s what I did.”
“But what made you think to test the formula?” Evelyn was stunned at the simplicity of it.
“I don’t know. I guess maybe it was on my mind somehow—the fact that Mrs. Phillips was involved with that formula. You know, on Monday I heard Debby Roof on the phone to Mrs. Phillips, asking about mixing the formula. I thought Debby was talking to Sara. When I found out the nurses had to turn to the mother for what should be normal care in the hospital—I thought it outrageous. I told Debby, and wrote it in the orders, that no one but the nurses were to mix the formula. I didn’t make any real connection then. But it must have been floating in the back of my head.”
There was one other thing of paramount concern to Evelyn, especially in view of what Estol had discovered about the formula. It might occur to the Phillipses to check Mindy out of the hospital against medical advice. And to keep them from doing that, Evelyn realized she would have to be prepared to call security.
It did not occur to her that she and Estol might be the ones to need security. She expected anger from the parents, but later she was struck by the inappropriateness of their response. She saw Steve Phillips react way out of proportion to the situation. He seemed to burst into a towering rage.
She had always thought that Steve Phillips, at best, was a rather frightening sight. Not only was he mountainous, but he was naturally somewhat menacing, with brown eyes too small for his face, and very thin lips which narrowed and disappeared when he was angry, revealing yellow teeth. He had a short, meaty nose, and several small white scars around his brow and chin. And she couldn’t help herself: his strong southern accent made her wince.
And Steve was furious. When he screamed that threat about someone going through a wall, Evelyn had to swallow against a sudden chunk of fear hardening in her throat.
And why were the Phillipses so angry? she wondered. Why weren’t they more concerned? Why weren’t they worried that she and Estol thought Mindy’s health to be so jeopardized that they were insisting on the Intensive Care Unit? Wasn’t this how normal parents would react?
And why did it seem to matter so much that the boys couldn’t visit their sister? Instead of being scared, the parents fought. That was what was so strange. They argued, claiming that 160 was not so high, that it didn’t justify the ICU.
And then Steve Phillips had talked about enemies. He said that with his job and his wife’s, they were sure to have made lots of enemies over the years. It wasn’t a normal dialogue, Evelyn thought. The small room began to ring with the sound of raised voices. It was hard to tell what Mrs. Phillips thought, what anybody actually believed. All they were getting was pure, shimmering rage.
But Evelyn knew what really mattered to Mrs. Phillips. It was the part about the limited visiting. And that just added to Evelyn’s suspicions. Mrs. Phillips hadn’t really been all that upset until then, she thought. And in ICU, the woman’s every move would be supervised. She would never be alone with Mindy.
Evelyn’s hands shook as she unlocked the door of the Quiet Room to let the four of them out. The irony of the room’s name suddenly struck her. Never had that room, she was certain, been less quiet than it had been for the last thirty minutes.
Still, the meeting had accomplished what Evelyn had hoped. The Phillipses had harangued and screamed and cried, but they had not signed Mindy out against medical advice, and the situation had not escalated.