Patient (10 page)

“Have a good night, Officer,” the old man said.

Claude Malloche, his hair and fake mustache snow white, continued his mopping until he was certain the security guard was gone. Then he pulled a device from his pocket, opened the door to Gilbride’s suite in less than fifteen seconds, and dragged his mop and bucket inside. Quickly, he crossed the receptionist’s office, entered Gilbride’s, and closed the door behind him. The high-powered light and camera he took from his pocket were espionage quality. He spread out all the papers on Gilbride’s desk and rapidly photographed each one. Next he turned to the file cabinet.

Twenty minutes and three rolls of film later, Malloche was back in the hallway, humming the melody of a French folk tune as he nonchalantly worked his way toward the exit.

Chapter 12

IT SEEMED HARDLY POSSIBLE TO JESSIE, BUT OVER the next few days, life for her at the hospital became even more hectic and exhausting. In addition to her thirteen inpatients, she was covering Gilbride’s large service as well, while the chief continued to stump for publicity, new patients, and grant money like a manic politician. More than once, Jessie had to rein in her anger by remembering that harboring resentment was like drinking poison and then waiting for the other guy to die.

In the office, the calls, referrals, inquiries, letters, donations, and requests for interviews, personal appearances, and patient appointments made life a whirlwind, second-to-second affair. Even Gilbride’s unflappable secretary Alice Twitchell seemed to be fraying at the edges.

Then there were Jessie’s inpatients. She visited Sara in the NICU three or four times a day. Although Sara remained comatose, she was breathing on her own and showing other very soft signs that the coma was getting lighter. Not exactly startling improvement, but certainly no setback either. Jessie had resigned herself to being encouraged by anything even slightly positive. But she also knew her objectivity in Sara’s case had flown south. It was wrenching to see the expressions on Barry’s and the kids’ faces as they tried to come to grips with the reality that this might be all they got back of their wife and mother.

Dave Scolari was a different story. He was moving both arms fairly easily now, and even showing some action in his legs. Jessie’s quadriplegic patient, Luis Velasco, had become something of a fixture in Dave’s room—a cheerleader who saw in the linebacker the chance for a level of recovery that he, himself, would never be able to achieve.

After more than a week, Elsa Davidoff had finally managed a bowel movement and had been shipped off to a rehab center. Jessie wondered what the insurance utilization review people would say when they got a look at the reason for six additional hospital days. Actually, she didn’t care whether the UR people approved or not. If nothing else, she was striking a blow for pre-managed-care kindness and patients’ rights by honoring the elderly woman’s demand that she not be sent out to rehab until her colon had proven it could function.

Marci Sheprow was out of the NICU and, in fact, only a day or two from being out of the hospital altogether. Her family and Gilbride held twice-daily press conferences in the hospital auditorium, and late this afternoon, Marci herself would be wheeled down to participate for the first time.

Jessie had tried to take advantage of the gymnast’s celebrity by wheeling her into Tamika Bing’s room. Marci was charming and patient, but her visit evoked nothing from the mute teenager. Tamika, her laptop still open but untouched on her tray table, looked as if she knew who her visitor was, but she reacted no more than that. Soon, the utilization folks would be nipping at the department’s heels about her hospitalization, and plans would have to be made for her discharge. Jessie was pulling out all the stops to keep her as an inpatient because the therapists and psychiatrist were still hopeful and still pushing. She knew there was no way she would get approval to cover an in-hospital stay at a rehab center, and it was certain Tamika’s mother, who was holding down a factory job, wouldn’t be able to take her for daily outpatient therapy.

Alex Bishop continued to be a pleasurable island in the madness. Although they had yet to manage any extended time together outside the hospital, they had walked around the neighborhood for half an hour last night, and he had visited her on Surgical Seven a number of times. He continued to be a source of little surprises, including a better than passing knowledge of opera and, once she had given him instructions and turned over her Game Boy, a deft hand at Tetris. With her demanding on-call schedule, and his assignment to the evening shift, she feared they might be doomed to an unending in-hospital courtship. The drastic initial measure she opted for was to meet him tomorrow at noon in the North End—Little Italy—for lunch and two hours of strolling the shops and uninterrupted conversation. If the neurosurgical service managed to survive when she was tied up in emergency surgery, it could manage while she was tied up in veal scallopini.

Jessie’s aneurysm case, which she had done in the regular neurosurgical OR, had gone beautifully, but in the MRI-OR, the post-Marci deluge of patients had intensified an already existing problem—no available time. Marci’s three-and-a-half-hour case notwithstanding, the usual MRI-guided operation took anywhere from five to seven hours. Adding prep and clean-up time, that meant each of the two specially trained teams could do one case a day. A third team could be assembled from parts of the other two when absolutely necessary, but to try to do more than two cases a day was to ask for burnout and shaky judgment from the staff.

Already, the MRI-OR schedule was booked solid for more than three weeks. A number of those cases were appropriate for ARTIE, although Jessie was still uncertain whether she or the robot were ready. Patients with brain tumors were being reassured, as much as Jessie and Emily could justify, that waiting around at home for a few weeks would not lessen their chances of a successful operation ... unless, of course, there was a sudden complication like bleeding into the tumor or rapid pressure buildup from the unanticipated obstruction of spinal fluid flow.

Although Jessie did most of the preliminary patient evaluations, a number of the MRI cases were going to be Gilbride’s—all of them high visibility. Some of the new patients Gilbride dashed by and met on the fly, while the more important ones he would see in an evening office session. The lowest-level HCs he would not meet in person until they had been checked into the hospital the morning of their operation. Jessie knew that at this pace, with all Gilbride’s distractions and his marginal surgical skills, disaster was just a cut away.

It was six in the evening when the intensity of the day finally began to ebb. There were enough patients for Jessie still to see, and enough paperwork to catch up on, to keep her in the hospital until ten, but the way things had been going since
the
operation, home by ten-thirty was tantamount to a vacation day. Her first stop would be the NICU to check on her post-op aneurysm patient, and also on Sara. Not surprisingly, though, before she could leave her office, the phone was ringing again. Also, not surprisingly, the caller was her department chief with more work for her.

“Jessie, hi,” he began. “Sorry to be calling you so late about this, but I’m in the middle of taping
Talk of the City
for Channel Five, and I didn’t check in for messages until a few minutes ago.”

“That’s okay,” Jessie replied dully. “What do you need?”

“Do you remember me reading you a cable from a guy named Tolliver at the MacIntosh Foundation?”

“Yes, I remember. It’s hard to forget three million dollars.”

“Well, I just got word that he’s coming to check out our setup personally.”

“That’s terrific,” Jessie responded with little enthusiasm.

She sensed what was coming next.

“There’s just one problem. I’ve been invited to do a phone interview on the
Imus in the Morning
radio show at nine tomorrow, then I’m meeting with the hospital administration to discuss some extra lab space for the department. So I’ve arranged to have Tolliver contact you when he arrives at the hospital. Just show him around and be your usual charming self. Whatever he wants to see or do is fine.”

“But—”

“Take him out somewhere for lunch if I’m not back. Maybe that Sandpiper place. Just turn in your expenses to Alice and the department’ll take care of reimbursing you. She’s a real peach, isn’t she? Listen, the producer’s waving at me for something. I’ve got to go. Keep up the good work, Jess. Three million will buy a helluva lot of research.”

Before Jessie could insert a word, she was listening to a dial tone.

“All bleeding eventually stops,” she muttered, picturing Alex Bishop marching off into the sunset with a plate of veal scallopini. “All bleeding eventually stops.”

Jessie’s post-op aneurysm patient, a thirty-eight-year-old, high-powered businessman named Gary Garrison, was awake and lucid.

“Any stock tips?” she asked.

“McNeil. They make Tylenol. If this headache of mine doesn’t let up soon, I’m going to push their stock up all by myself.”

Jessie had him describe the pain and location. Then she checked his neurologic status and used an ophthalmoscope to examine the arteries, veins, and optic nerves on the back surface of his retinas, searching for the changes that warned of brain swelling.

“Not serious,” she proclaimed, finally. “Between your initial hemorrhage and what I did in getting that artery clipped, the structures in your skull have had quite a bit of trauma. They’re allowed to hurt. One more day, I suspect, and you’ll start to feel much better. Feel like leaving the unit?”

“Not really.”

“Good enough. That’s all I have to hear. I’ll explain things to your HMO in a way they’ll understand.”

“You’re the best, Doc.”

Jessie wrote out some orders and passed them to one of the nurses. Then she headed into Sara’s room. A candy striper stood at the bedside, massaging cream into Sara’s hands. The volunteer, whom Jessie had never seen on Surgical Seven before, was a waiflike brunette, maybe in her late teens, with wide, dark eyes and close-cropped hair.

“Hi,” said Jessie, startling the girl, who was engrossed in her work. “I’m Dr. Copeland.”

“Oh ... hi. I’m Lisa. I just started here.”

“Welcome to Oz. It looks like you’ve caught on quickly. I’m sure Sara appreciates the hand massage.”

“Thank you. I did a lot of volunteer work in hospitals when I was in high school. Now, I’m taking a semester off from college, but I wanted to do something that mattered while I was figuring out what comes next.”

“I thought you looked a little old to be a candy striper.”

“My mother says I’m a little old to be taking time off from college,” the girl said, grinning.

“Hey, I’m a neurosurgeon, and I
still
don’t know what I want to do when I grow up. Have you thought about medicine?”

Lisa blushed.

“I ... I don’t do very well in the sciences,” she said. “I’m considering working with kids—probably because I think I’m destined to always look like one. Do you want me to leave?”

“No. Of course not. I want you to keep at it. Sara Devereau is very important to me. And I believe that things like hand massages play a significant role in a patient’s recovery. I’ll be back a little later. Thanks for what you’re doing here.”

“Thanks for talking with me,” Lisa said. “Most of the doctors I’ve dealt with seem too stressed to stop and talk to anyone.”

Chapter 13

LATE THE NEXT MORNING, EASTMAN TOLLIVER, THE three-million-dollar man, arrived at Eastern Mass Medical on schedule. Jessie had returned to the hospital at six feeling irritable and frustrated. Instead of spending a few relaxing hours away from the hospital with the first man in whom she had been interested in a couple of years, she would be baby-sitting a foundation bureaucrat.

Gradually, though, as it usually did, her practice lifted her spirits. Her patients were all improving, or at least were no worse. Sara, though still unconscious, continued to show signs that her coma was becoming lighter. Shortly after rounds, Jessie successfully revised a spinal fluid drainage shunt in a long-term tumor patient—a nice procedure when it went well, simple and life-saving. And finally, Marci Sheprow had gone home, and with her went the stress of avoiding eye contact with her mother. The fallout from her surgery would go on indefinitely, but at least that chapter was closed.

Jessie had expected the worst from her job as escort to Tolliver. In fact, their time together proved a most pleasant surprise. He was distinguished looking, with dark, intelligent eyes, hair graying at the temples, sharply cut features, and perhaps ten pounds of excess weight. In addition, he was charming, urbane, and intelligent, and best of all, a seasoned bridge player.

Over crab Louis at the Sandpiper, they talked about the game, about his six years as executive director of the MacIntosh Foundation, and of course about ARTIE and Carl Gilbride. In what seemed like only minutes, an hour and a half had flashed by. During that time, Jessie had used her cell phone to answer a half dozen pages, the last few dealing with the burgeoning group in her waiting area.

“It’s really enjoyable talking with you,” she said, “but I’m afraid that if I don’t show up at my office soon, the patients waiting for me are going to unionize. What time this afternoon will you be meeting Carl?”

Tolliver absently twisted his thin gold wedding band and looked at her strangely.

“I assumed you knew,” he said.

“Knew what?”

“I spoke with Dr. Gilbride by phone this morning shortly after I arrived at the hospital. Apparently last night he was invited to be on the
Today
show tomorrow morning. He’s leaving directly from his commitment at the medical center and flying down to New York to meet with the producers. He’ll be back at noon, right after the show. Meanwhile, you were right there to wine and dine me as he promised, and as you have done most charmingly.”

“I ... I’m really sorry I didn’t know,” she said. “And did he say I would be your hostess until he gets back?”

Tolliver’s expression suggested he was used to the conflicts and spur-of-the-moment schedule changes that accompanied dealings with highly successful people.

“He did say something like that,” he replied, “yes.”

“Eastman, I’m a little embarrassed. I would have loved to have spent the afternoon and evening with you, showed you some of the city, or even played some bridge. But I’m on in-house call tonight.”

“Actually, as I told Dr. Gilbride, I have no problem starting the formal part of my visit tomorrow, because I really could use a bit of rest and relaxation. Maybe I’ll stop back this evening and follow you around. But most likely I’ll see you in the morning after I watch Dr. Gilbride on television.”

“Either way would be fine.”

Jessie said the words sensing that she wasn’t being perfectly honest. She really did prefer he stay at his hotel tonight rather than come back to the hospital to follow her around. Alex’s shift would be starting at three.

“Are you sure you’ll be all right?” she asked. “For obvious reasons, I can’t have you in to see patients. But you can wait in the lab with our robotics technician until I’m done. After that I’ll be happy to show you around the hospital.”

“I promise you I am very resourceful. Besides, I came to the hospital straight from the airport. I’d like to check in at the bed-and-breakfast where I’ll be staying.”

“Not a hotel?”

“Wherever possible, I prefer to have the foundation’s funds go toward medical research. Besides, this place comes highly recommended by our travel people. I have been promised that it is warm and charmingly decorated.”

“Where is it?”

Tolliver referred to a sheet in his jacket pocket.

“Hereford Street. They said it was walking distance from the hospital.”

“Only if you really love to walk. It’s in the Back Bay, not far from where I live. With luggage, I’d suggest a cab; without luggage, good shoes.”

“A cab it will be. I have been told that this B-and-B has a small but well-equipped exercise room. I think I shall avail myself of it this afternoon. Looking fifty in the eye is powerful motivation.”

“Exercise ... exercise. I vaguely remember once knowing what that was. I’m jealous.”

They walked the three blocks back to the hospital.

“Well, thank you,” Tolliver said after retrieving his bag from Jessie’s office. “I believe I’m going to enjoy my days here. And I hope Carl Gilbride knows what a jewel he has in you.”

“Oh, he tells me all the time,” Jessie replied.

WHEN JESSIE HAD finally finished seeing the last of her patients, Alice Twitchell brought in yet another stack of messages, hospital charts, and other Carl Gilbride-generated flotsam.

Jessie flipped through the pile.

“Lord,” she said. “There’s a couple of hours’ worth of work right here. Well, at least I’m through with the outpatients.”

Alice grinned at her sheepishly.

“I’m afraid I have to tell you that there is one more patient for you to see. He and his wife have been here for almost two hours. His name is Rolf Hermann. He’s a count or something from Germany, and he has a brain tumor. Apparently his wife spoke with Dr. Gilbride by phone. Now they’re camped outside his office, and she’s insisting that they’re not moving until they see him. Dr. Copeland, he’s staying over in New York tonight.”

“I know. Goodness, a German count. Talk about your HCs.”

“Pardon?”

“Nothing. Nothing. Listen, you go ahead and get a TV moved up to your office so we can watch the boss tomorrow morning. I’ll go talk to the Count.”

“He’s an impressive man. And his wife is very beautiful.”

“Thanks for the info. Dr. Gilbride didn’t say anything at all about this fellow to you?”

“No. As you know, he’s been forgetting to mention a lot of things lately.”

Kill!

“Well, take the rest of the day off as soon as you can, Alice,” Jessie said sweetly. “I’ll see you in the morning.”

While Jessie and the other surgeons in the department used the Harvard chairs lining the corridor as their waiting area, Gilbride had an anteroom of his own—a walnut-paneled, leather-furnished space across from his equally elegant office. The Count and his wife looked born to be in rooms as richly appointed. Seated across from them were two men and a woman in their late twenties, each of them trim, athletic, and dressed expensively. They were presented by Hermann’s wife as the Count’s sons and daughter—not her children, Jessie noted, but his. None of them stood to greet her.

Rolf Hermann, powerfully built, could have been forty but, judging by his children’s ages, was at least ten years older than that. He was square-jawed and craggy, with thick, jet black hair, pomaded straight back. He shook hands with Jessie and greeted her in heavily accented English. His wife, who introduced herself as Countess Orlis Hermann, was stunning. In her early forties, perhaps even younger, she had a high fashion model’s bearing and figure. Her fine porcelain face was perfectly offset by straight sun-blond hair, artistically cut just above her shoulders. Her beige suit almost certainly owed its existence to some exclusive designer. From the first moment of their meeting, the Countess’s pale blue eyes remained fixed on Jessie’s like a magnet, leaving no doubt in Jessie that this was a woman accustomed to having life go her way.

“Well,” Jessie began, clearing her throat, “it’s very nice to meet you both. I’m ... an assistant professor of neurosurgery here at Eastern Mass Medical.”

“That’s very nice,” Orlis said in fluent English, much less accented than her husband’s, “but we came to see Dr. Gilbride. I’m afraid an assistant
anything
just won’t do.”

Rolf stopped her with a raised hand and spoke to her forcefully in German. Orlis calmed visibly.

“I’m sorry,” Jessie said, “but Dr. Gilbride is in New York until tomorrow afternoon.”

“But that’s impossible,” Orlis said. “He said we should come today.” She held up an envelope of X rays. “My husband has a tumor in his head. Dr. Gilbride said he would remove it.”

Jessie could tell from the Count’s expression that he was taking in every word.

“In that case,” she said, “I’m certain he will. But until tomorrow, he’s two hundred miles away.”

“This is just not acceptable.”

Clearly the calming effect of the Count’s words had already worn off.

“Countess Hermann,” Jessie said, “for the past week Dr. Gilbride has been extremely busy. For the same reason you heard of him all the way across the Atlantic, so have others from all over the world, many of them very seriously ill. I have been helping with the initial evaluation and scheduling of most of these new patients. I will be happy to do the same for your husband. But not here in the waiting room.”

This time, Rolf Hermann leaned over and spoke softly into his wife’s ear. He squeezed her hand, completely enveloping it in his massive paw.

Orlis’s lips tightened. Finally, she nodded and passed the X rays over.

“Where do you want us to go?” she asked.

“My office can hold the three of us,” Jessie replied. “Your family would best wait here, or else in the chairs in the hallway just outside my office.”

Orlis gave the orders in German, and the Count’s children nodded.

“They will come to your office,” she said. “They and their father are very close. They are very concerned about him.”

Jessie led the entourage down the hall. Rolf Hermann walked rigidly upright with determined strides, although there was, Jessie noted, the slightest hitch in his right leg. She left the younger Hermanns in the corridor and motioned the couple to the two chairs by her desk. Orlis evaluated the space disdainfully, but finally took her seat.

“My husband understands English perfectly,” she said, “and he can speak it, although not as well as I. For that reason he has asked me to tell you his story.”

“That’s fine, as long as you know, Count, to speak up at any time. This is no school exam or contest here. It is your health. I promise you will not be graded on your English.”

For the first time, the Count’s smile held genuine warmth.

“Thank you very much,” he said carefully. “Orlis, please.”

“Two and a half months ago,” she began, “my husband had a fit—a shaking all over during which he soiled himself and became unconscious. What do you call that?”

“A seizure.”

“He had a seizure. We took him to our doctor, and he ordered those X rays.”

Jessie placed two of the MRI films onto the fluorescent view boxes on the wall to her right. The dense tumor, almost certainly a rather large subfrontal meningioma, glowed obscenely amid the much darker normal brain tissue. The location was dangerous, and the shape of the tumor suggested that it was the type of meningioma that was poorly contained, with extensions infiltrating the brain tissue surrounding it.. An ARTIE tumor if ever there was one.

“The tumor is right here,” Jessie said, pointing it out.

“Yes, we know. Our doctor referred us to a brain surgeon, but he gave us no confidence that he could remove my husband’s tumor without causing a good deal of damage. Our doctor then suggested we search for a surgeon in London or in the United States. We were in the process of doing that, and already had Dr. Gilbride’s name on a very short list of candidates, when he performed his miraculous operation on that young gymnast.”

“I see. Well, I’m sure Dr. Gilbride can help you. But you must know that surgery such as this is risky. Parts of the tumor are situated right alongside normal brain tissue. The dissection is extremely difficult. There may well be residual neurologic deficits.”

“We would prefer to speak with Dr. Gilbride about that.”

Jessie felt overwhelming gratitude that the Count would not be her patient.

“Very well,” she said. “He should be back sometime tomorrow afternoon. You can come back then.”

“Excuse me, Dr. Copeland, but we have traveled a long way, and we have no intention of leaving this hospital.”

“But—”

“My husband has had two seizures. If he has another, I want him here. We intend to pay in cash, so we will have no problem with your insurance or your health care system. I will be happy to leave enough money with your hospital administrator in advance to cover all the expenses of our stay, including my husband’s surgery.”

“Mrs. Hermann, I don’t know if we can do this.”

“Then I suggest you speak to the director of your hospital. I will be happy to speak to him as well.”

“I guess I’d better do that.”

Jessie went down the hall to Alice Twitchell’s temporary office, and was rather easily able to reach Richard Marcus, the hospital president. A few minutes later, she was back in her office. Marcus had confirmed what she already knew—running a hospital was all about money.

“The president of the hospital will be happy to meet with you in his office. We have a private room available on Surgical Seven, the neurosurgical floor.”

“Actually, we will need two. The Count’s children plan to stay near him as long as he is in the hospital. I assure you they will make it their business to be in nobody’s way. We will pay whatever rate you charge.”

Jessie knew better than to argue, and it was clear from the way the Count held his arms tightly folded across his chest that he had no intention of intervening again.

“Countess,” Jessie said, “if Dr. Marcus says it’s okay, and we have the room, you get the room.”

“And private nurses.”

“We have agencies that can provide you with that. The head nurse on Surgical Seven will know how it’s done. Anything else?”