Josh took the hint and wandered away, thinking he may have seen the patient alive for the last time. If she died, it would be the first patient to die that he had taken care of in his life. While he knew the day would come, as it does for any physician, it made his spirit churn. He thought about what Faith must be thinking.
After rounds the next morning, Reyenne was on a ventilator when Josh and Faith arrived at her ICU bay. This time, her pulse ox looked better, but she still had sunken eyes, and her skin was sallow. Josh looked at Faith. “I’ve never seen anyone die.”
“Jeez, Josh!”
“Well. What does it look like?”
“I don’t know. Maybe this.”
Together, they scanned the chart in the bedside computer. The patient had received regular doses of Tylenol for fever, had her oxygen setting on the ventilator adjusted several times, and had received her steroids. She had an arterial line in her wrist so that blood gas specimens could easily be taken, and blood pressure and heart rate could be continuously monitored. She had a fever.
“I don’t like this at all,” Faith whispered. “What do we do? Just stand here and watch her die?”
Josh wasn’t calm. “We don’t have anything else to offer her. We don’t know what works, anyway. Come on, Reyenne, it’s up to you now, girl.”
The two wandered away. They were both quiet at afternoon rounds and quiet in the apartment when they got home. Faith talked to Natalie briefly. “This patient we have looks really bad,” she told her sister. “Josh and I talked about what it looks like when someone is going to die.” There was a pause. “No, I just wanted to talk.” Another pause passed with nothing audible from Nat. “I’ll talk to you later. Tell Mom I called.”
“Just think, what if this were Natalie or Marla,” Josh said. “What if it were one of our parents. We would want to visit, we would want to hold their hand, and we would want to talk to them all the time.”
“If she dies, she leaves two other children behind. Who is going to take care of them? Where do they go? What will they think when they grow up?”
“Wow. I didn’t think of her other two children. Two boys. Two brothers with no mom.”
Faith didn’t say anything. Finally, she reached over, kissed Josh and said, “I’m exhausted. I have to go to bed.”
Josh sat and stared at his laptop for a long time, ingesting none of the information in front of him. Giving up on learning anything, he headed for the bedroom. He sat on the edge of the bed and watched Faith sleep for a long enough to contemplate her as a mother and savoring the idea that a little person would soon share this bed. That night, he held her especially tightly, as though she could slither away if he weren’t careful.
Chapter 25
Peggy jumped when the frosted window rattled.
“Now they are threatening to terminate me,” Brian said, sitting backwards in the aging, squeaky, rolling chair, arms crossed on top of the chair back, and resting his chin on his arms.
“Based on what you said last time you were here, I would say they have a point. They can’t have somebody in the operating room high on fentanyl,” Peggy said. “Who is ‘they?’”
“JD Thompson and Emily.”
“Who is JD Thompson, again?”
“The Dean of Faculty.”
“Sorry, I forgot. What are they expecting of you?”
“They want me to go to rehab, move on to a surveilled probation, and then a structured work schedule.”
“OK.”
“But I don’t need rehab. I use Percocet for knee pain. I had an old injury, had arthroscopic knee surgery two years ago, but recently I am having trouble again.”
“Since the surgery, did you have a period of time when you didn’t take any pain medicines?”
“No.”
“So, who’s been giving you Percocet for two years?”
“Dr John Ballinger, one of our orthopedic surgeons,” Brian said. Peggy knew this not to be true. Brian hadn’t been here a year yet. Who did he get it from in Lubbock?
“So, what about the marijuana?”
“What about marijuana? What I do in my off time is not any of anybody’s business. I use it for my knee.”
“Where do you get it?”
“Around.”
“Well, it looks to me like you have a decision to make. Either you address the problem head on, tackle it with all your heart and soul, or you let the actions take their course and wind up without a career, facing felony charges, and without a paycheck. You know this accounts for a significant part of our nation’s homeless.”
“I don’t see why everybody thinks I have such a problem. I haven’t missed work, I haven’t made any errors, and I’ve done everything everybody expected of me.”
“No, Brian, that’s not even what you have told me. Emily wants you to start a research project or join one in progress, do some medical school administration, or get active in teaching rounds. We have noticed you late or absent for rounds, irritable with students, nurses, residents, and fellows, and not very instructive. Then there are the board exams and a divorce. How much do you need? Perhaps a two by four upside your head would help, as my dad would say.”
“Those aren’t connected.”
“You don’t think so?”
“No. Why would they be?”
“Most opiate addicts can’t function at work, their interpersonal relationships deteriorate, and their concentration and mental acuity suffers.”
“Do you think my mental acuity is suffering?”
“From what you have told me about good performance on in-service training examinations which has now deteriorated to failure on boards, I would say the answer is a resounding yes.”
“So, you think my board exams are because of my opiates?”
“Yes. What does Dean Thompson say?
“The same.”
“What is he suggesting you do?”
“Get off my opiates and marijuana, go to rehab, for which they recommended the Pain Management Clinic here at the University, and reset my life and career goals.”
“The sooner you do, the better.”
“I don’t see how you have helped me.”
“Maybe not yet.”
“What do you mean?”
“Brian, you have to recognize the problem, then you have to let people around you who are skilled at dealing with this help you get a grip on it. From what little I know it’s recognizing the problem that is the biggest obstacle.”
“I don’t see it.”
“This is a medical problem like all others. What if you had lymphoma or cancer of the pancreas?”
“I would go to a doctor and get surgery or chemotherapy.”
“So, what’s the difference? You’re at risk of dying of this just like you would be of lymphoma or cancer of the pancreas. You will not get well if you don’t meet it head on.”
“This has nothing to do with lymphoma or cancer. This is not like that at all. This is me coping with a problem with my knee and coping well. Staying at work, continuing to function.”
“You mean like your wife, your tardiness, your pinpoint pupils, and your board exams?”
“I knew you wouldn’t help. I’m out of here.” Brian got up and left the room, mumbling unintelligible syllables. He closed the door gently, but the window rattled in protest.
Peggy wondered if he would turn the corner or wind up in a tent in a park. Knowing that people dedicated to his problem were working on him was reassuring, and she didn’t think there was anything she could contribute. Maybe being a sounding board was helping. But even cancer of the pancreas and lymphoma when doggedly treated don’t always end well.
Chapter 26