“The fun part of being a doctor,” I said.
She gave a sad smile, glanced over at the food servers. “They’re closing up. Want anything?”
“No thanks.”
“If you don’t mind, I haven’t had breakfast yet.”
“Sure, go ahead.”
She walked briskly to the metal counters and came back with half a grapefruit on a plate and a cup of coffee. She took a sip of the coffee and grimaced.
“Maybe it needs some steamed milk,” I said.
She wiped her mouth with a napkin. “Nothing can save this.”
“Least it doesn’t cost anything.”
“Says who?”
“What? No more free coffee for the docs?”
“Them days are gone, Alex.”
“Another tradition bites the dust,” I said. “The old budgetary blues?”
“What else? Coffee and tea are forty-nine cents a cup now. Wonder how many cups it’ll take to balance the books.”
She ate some grapefruit. I fiddled with my pen and said, “I remember how hard you guys fought to get the interns and residents in on the freebie.”
She shook her head. “Amazing what seemed important back then.”
“Money problems worse than usual?”
“Afraid so.” She frowned, put her spoon down and pushed the grapefruit away. “Anyway, back to the case. Where was I?”
“The baby screaming at you.”
“Right. Okay, again things start to look good, so again I taper off and terminate, set up an appointment in two months. Three days later, back in the E.R., two A.M. Another croup thing. Only this time the mother says the kid did pass out — actually turned blue. More CPR.”
“Three days after you terminated,” I said, making a note. “Last time it was two.”
“Interesting, huh? Okay, I do an E.R. checkup. The baby’s blood pressure is up a bit and she’s breathing rapidly. But getting plenty of oxygen in. No wheeze, but I was thinking either acute asthma or some sort of anxiety reaction.”
“Panic at being back in the hospital again?”
“That, or just the mother’s distress rubbing off on her.”
“Was the mother showing a lot of overt distress?”
“Not really, but you know how it is with mothers and kids — the vibes. On the other hand, I wasn’t ready to rule out something physical. A baby passing out is something to take seriously.”
“Sure,” I said, “but it could also have been a tantrum gone too far. Some kids learn young how to hold their breath and pass out.”
“I know, but this happened in the middle of the night, Alex, not after some power struggle. So I admit her again, order allergy tests, complete pulmonary functions — no asthma. I also start thinking of rarer stuff: membrane problems, an idiopathic brain thing, an enzyme disorder. They’re up on Five for a week, real merry-go-round, consults by every specialty in the house, lots of poking and probing. Poor little thing’s freaking out as soon as the door to her room opens, no one’s coming up with a diagnosis, and the whole time she’s in, there are no breathing difficulties. Reinforcing my anxiety theory. I discharge them and the next time I see them in the office, I do nothing but try to play with her. But she still won’t have anything to do with me. So I gently raise the anxiety issue with mom but she’s not buying.”
“How’d she take that?” I said.
“No anger — that’s not this lady’s style. She just said she couldn’t see it, the baby being so young. I told her phobias could occur at any age, but I clearly wasn’t getting through. So I backed off, sent them home, gave her some time to think about it. Hoping that as the baby approached one year and the SIDS risk dropped, mom’s fears would diminish and the baby would start to relax too. Four days later they were back in the E.R., croup, gasping, mom’s in tears, begging for an admit. I put the baby in but ordered no tests. Nothing even remotely invasive, just observation. And the baby looked perfect — not even a sniffle. At that point I took the mom aside and leaned more heavily on the psychological angle. Still no sale.”
“Did you ever bring up the first child’s death?”
She shook her head. “No. I thought of it but at the time it just didn’t seem right, Alex. Overloading the lady. I figured I had a good feel for her — I was the attending doc when they brought the first child in dead. Handled the whole post-mortem... I carried him to the morgue, Alex.”
She closed her eyes, opened them but focused away from me.
“What hell,” I said.
“Yeah — and it was a chance thing. They were Rita’s private patients, but she was out of town and I was on call. I didn’t know them from Adam but I got stuck doing the death conference, too. I tried to do some basic counseling, gave them referrals to grief groups, but they weren’t interested. When they came back a year and a half later, wanting me to take care of the new baby, I was really surprised.”
“Why?”
“I would have predicted they’d associate me with the tragedy, a kill-the-messenger kind of thing. When they didn’t, I figured I’d handled them well.”
“I’m sure you did.”
She shrugged.
I said, “How’d Rita react to your taking over?”
“What choice did she have? She wasn’t around when they needed her. She was going through her own problems at the time. Her husband — you know who she was married to, don’t you?”
“Otto Kohler.”
“The famous conductor — that’s how she used to refer to him: ‘My husband, the famous conductor.’ ”
“He died recently, didn’t he?”
“Few months ago. He’d been sick for a while, series of strokes. Since then, Rita’s been gone even more than usual and the rest of us have been picking up a lot of the slack. Mostly, she attends conventions and presents old papers. She’s actually going to retire.” Embarrassed smile. “I’ve been considering applying for her position, Alex. Do you see me as a division head?”
“Sure.”
“Really?”
“Sure, Steph. Why not?”
“I don’t know. The position’s kind of... inherently authoritarian.”
“To some extent,” I said. “But I’d imagine the position can adapt to different styles of leadership.”
“Well,” she said, “I’m not sure I’d make a good leader. I don’t really like telling people what to do... Anyway, enough about that. I’m getting off track. There were two more passing-out episodes before I brought up the psych thing again.”
“Two more,” I said, looking at my notes. “I’ve got a total of five.”
“Correct.”
“How old’s the baby by now?”
“Just under a year. And a hospital veteran. Two more admits, negative for everything. At that point I sat mom down and strongly recommended a psych consult. To which she reacted with... here, let me give you the exact quote.”
She opened the chart and read softly: “ ‘I know that makes sense, Dr. Eves, but I just know Cassie’s sick. If you’d only seen her — lying there, cyanotic.’ End of quote.”
“She phrased it that way? ‘Cyanotic’?”
“Yup. She has a medical background. Studied to be a respiratory tech.”
“And both her kids stop breathing. Interesting.”
“Yes.” Hard smile. “At the time I didn’t realize how interesting. I was still caught up in the puzzle — trying to arrive at a diagnosis, worrying when the next crisis was going to be and if I’d be able to do anything about it. To my surprise it didn’t happen for a while.”
She looked at the chart again. “A month passes, two, three, still no sign of them. I’m happy the baby’s okay but I’m also starting to wonder if maybe they’ve just found themselves another doc. So I called the home, talked to mom. Everything’s fine. Then I realized that in the heat of everything, the baby had never had her one-year exam. I schedule it, find everything intact, with the exception that she’s a little slow vocally and verbally.”