If a new set of bike wheels didn’t take two months to fabricate, Jeannie would have rammed the Ford F-150. The truck had cut her off with a left-hand turn—in a construction zone, no less—then puttered along below the posted limit. Among her training partners, Jeannie was the risk-taker. In the middle of a 50-miler, after she’d blown through a red light or turned left from a through lane, someone would mention her medical insurance. “What’s that deductible again, Jeannie?” Or, “You’re the only person who needs a health plan with collision.” The maneuvers may be unconventional but not, Jeannie thought, unsafe; she was a cyclist who took liberties with the rules of the road. The fact that she was a physician didn’t make her hyper-cautious. Her reaction to the truck wouldn’t normally be so extreme—distracted driver or not—if she hadn’t been riding home from an exceptionally difficult hospital shift. Not only was it her first one back after being cleared of medical negligence, it had ended with a particularly complex case. An eight-year-old girl had been admitted with flu-like symptoms, a stiff neck, skin rash, and confusion. After initial tests, Jeannie knew she was dealing with a classic case of bacterial meningitis. But then the father pulled her aside, and she learned the situation was anything but normal. “My wife wasn’t exactly truthful back there. Kara’s been like this for two weeks, not two days.” Gordon explained his wife had been taking their daughter to a Church-approved spiritual healer because their religion didn’t believe in medical science. Jeannie asked why she’d changed her mind and come to the hospital. “I forced it. I think Beth’s scared. We’re separated, and she had insisted on handling these types of issues—we have another child, a son, at home. Her home. But this time I had to intervene.” He was a thin man on a slightly short frame, and wore a polo shirt with slacks After a battery of tests Kara lay, listless, in a hospital bed while the staff interpreted the results and her parents bickered in the hall. Jeannie decided against initiating a dialogue with Beth; she was too busy healing her child to argue the merits of western medicine. Which is why she was caught completely off guard when Beth found her at Medical Records and said, “I love my daughter.” Jeannie was reviewing the chart of a patient whom she’d been unable to save. It was the case that had kept her out of the hospital for two months. Her coworkers had been cheerful when she returned—too cheerful, she thought—and Jeannie was relieved for time in Medical Records, where the air was less positively charged. The patient was a Ph.D. student who’d gone to Mexico for a bargain-priced root canal. His wife explained he was saving for a home, and cut corners wherever possible. By the time Jeannie diagnosed him with cephalic tetanus, the bacteria had spread through his body. It was true she hadn’t followed the rules, but textbook procedure rarely applied in emergency situations. Especially when you were trying to figure out what some medical dilettante had done wrong. The student’s young widow sued the hospital the same day the hospital launched their own investigation into Jeannie’s actions. She was cleared and allowed to resume working, but it was going to take the court longer to decide. As she looked at the written record of her decisions—diagnostic tests, treatments that seemed to work but then didn’t—Jeannie wondered what more she could have done. But in the case of this little girl, the mother wanted Jeannie to do less. “I have my reasons,” Beth said, her voice like a brisk wind. “Pardon?” She looked up from the chart. “I have my reasons for doing what I do. They’re rooted in absolute faith in God.” “I would never try to change your beliefs,” Jeannie said. “My husband thinks this is the right thing for Kara. I don’t agree. But I want her well.” “We’ll do everything possible for your daughter. But some would consider what you’ve been doing these past two weeks child abuse.” The slap across her face produced more awareness of air movement than pain. “I hope your son never contracts a cold; in your care he could end up dead.” Beth had both hands mounted on her hips, and leaned in for emphasis. “The grace of God will forgive many things. But what you and all these people here are doing—” A nurse with hair piled like a tower rushed up. “Dr. Hardaker, we need you in the ICU.” She hurried her off, although Jeannie would have preferred to stay. Upon learning there was no emergency, Jeannie said, “Do you know what she did to her own little girl?” The nurse nodded. “But you can’t change her. That’s not what we do.” “Well maybe a policy change is in order.” Jeannie climbed the stairwell for 20 minutes, step over methodic step to clear her head. She often found herself in here, lit by sodium-vapor light, when she needed to sort things out. Jeannie didn’t have children, but had once wanted them. Entering med school with pediatrics in mind, she put herself through by working children’s parties as a clown. She’d twist phallic balloons into things less phallic, perform simple magic tricks, then ride out the front door on a unicycle. One weekend her car broke down and she unicycled to the party. When the finale came she rode out the door and all the way home. This was how she’d come to cycling; the following week she bought a road bike and her car became her weekend driver. When she and her husband, Al, failed to carry a pregnancy to term, she decided children were a distraction, and focused on what she could do without them. She switched specialties and began an ER residency. But when she saw Kara, more helpless than other children she treated, Jeannie slipped a pair of shoe booties over her hands, drew shaggy goatees on each, and asked the little girl, “Do you know the story of the Billy Goats Gruff?” She didn’t mention Kara to Al when she’d reached home. Still in her bike gear and clipping around the tile on metal cleats, she recounted her ride home. “The driver didn’t so much as look at me. But he knew I was there. They always do that. If they don’t make eye contact, they think they can’t be held responsible.” Jeannie was a tiny woman—95 pounds on a 15-pound bike (and boy could she climb hills)—but she wouldn’t be pushed into the gutter. Al had a small belly and grey hair he kept in a short, neat ponytail. He worked at the local veteran’s hospital as a speech pathologist, helping those who’d witnessed ineffable things to talk again. Most of his clients had suffered brain damage in combat. A few were disabled in training. All were looking for a voice. A friend from school had developed a successful singing therapy practice that catered to pop stars. But Al preferred to coach those with something to say. In getting them to speak, he’d learned to listen. So after Jeannie recounted her incident on the road, he offered the following, “Just be careful. It isn’t worth it.” Jeannie said that she knew, safety first, she knew. “He wasn’t expecting me to catch him at the stoplight. Did he ever look surprised when I tapped on his window.” Cycling in the fall left her at her destination one sweaty, snotty mess. Al handed her a tissue and she wiped her nose. “You’d think he’d seen a crazy woman, the way he stared.”
Pretending it hadn’t been months since she’d last finished a regular work shift, Jeannie spent her first day off as usual—work around the house with Al, sushi at their favorite spot, and a cathartic bike ride. She met her training partners at the local coffee shop at 7, hydrated with caffeine then rolled out. 10 miles in, once they’d warmed up and left the traffic, Jeannie brought up the driver of the F-150. “Someone once threw a bag of McDonald’s out their window,” one of her friends said. “I ran over it and fell into another car. Chicken McNuggets sauce everywhere.” Jeannie was thinking about Kara, wondering if her parents had pulled her from the hospital. If they fought in front of her. And if her condition were still improving. Why am I thinking so much about this patient? She wondered. The situation was difficult, but any more so than the student who’d died trying to provide his wife with a house? A patient’s medical history was as complicated as their personal one. At the end of the bike ride, Jeannie resolved to leave thoughts of her patients, past and present, on the road. At home with Al she was always trying to limit her discussions of work. Though he’d never complain, she knew he couldn’t enjoy that type of talk. So when the hospital chief called that afternoon and said deliberations had begun, Jeannie didn’t mention it to Al. Instead, she suggested they re-caulk the window seals. But when they were working in the front and the neighborhood girl wheeled by (in a wheelchair—not a bicycle—that she’d been put in by cerebral palsy), Kara’s story tumbled out of her. “And I don’t know what I’ll find tomorrow morning.” Jeannie smoothed the white silicon into the joint between pane and glass with a finger, then wiped it on her pants. “Do the parents allow herbal remedies?” Al asked while pumping caulk into a fresh joint. “They didn’t object to the 500 milligrams of ampicillin, q.i.d.” “You think they’d leave the hospital?” Her voice was flat. “Could. Anything’s possible.” Working in an ER dulled the senses. A fifteen-car pile-up on the local news might as well be a fender-bender, because you saw the gruesome effects first-hand, and had to repair the damage. Compared to what went on in a hospital, the outside world was muted. What the medical profession didn’t numb, though, was a person’s ability to feel guilt. The fact that the hospital’s independent commission had cleared Jeannie did little to improve her sleep. Just because she wasn’t negligent didn’t mean she’d done everything possible.
The next morning Jeannie stashed her bike in the hospital locker room and clip-clipped to the nursing station, where she learned Kara’s blood pressure remained low. Under the bed sheets, the little girl’s sleeping body could have been a carpet wrinkle. Jeannie picked up the chart and noticed Beth in the corner, who rose and motioned for Jeannie to follow her into the hall. “I know,” Beth said and jerked her head towards the room. “I know what’s on the chart, the complications. But can you understand? I did what I thought was right. Can you understand?” She had a tissue wadded in her hand and used it to wipe her nose. Online last night, Jeannie read an article about a young girl who’d died from bone cancer because medical treatment went against her family’s religion. The parents were firm in their belief to the end, and upon her death issued a statement about it being God’s will. The article added that parents in these situations rarely change their minds. Jeannie asked Beth what it was she wanted her to understand. “I believed that healer would save my daughter. I did what I thought was right. Can you understand that?” Her voice was anxious. “Can you?” Jeannie understood why someone would believe in a spiritual healer: they dispensed religion-approved hope. Except it didn’t work. Not that her own success rate was much better; despite state-of-the-art equipment she wasn’t able to save that student. And his widow wanted answers. What could she tell her? That she didn’t administer a tetanus shot because she mistakenly thought an inconclusive wound culture was negative? To her the rules were only guidelines. Perhaps the student would’ve fared better under the care of a spiritual healer. While riding home, Jeannie turned right on a red and had to veer into the gutter to avoid oncoming cars. She managed to stay upright, but flatted out from a piece of glass. Crammed onto the sidewalk, replacing the tube as cars whizzed by, Jeannie was thankful for the flat. That she could continue far enough for her tire to find the glass shard meant her illegal turn hadn’t landed her on a car’s hood. At home, Jeannie helped Al barbeque vegetables and fish that they ate on the patio while discussing options for their next vacation—backpacking the Costa Rican jungle or renting an RV. Jeannie set her fork down. “I know I’ve always said we’re lucky we couldn’t have kids because of the freedom. But do you ever think it wasn’t luck, but God telling us we’re unfit for parenting?” Al said, “God doesn’t discriminate. Gordon and Beth had a child.” “Two,” she corrected, then recounted that day’s conversation with Beth. “She said thank you. Not in those words, but—” She stopped herself, and when Al realized she wouldn’t continue, he nodded. He’d dealt with his share of patients who, depressed by their injuries, had been unable to muster the optimism to thank him. But they could say something, and that was enough. “It’s just that we tried for so long, and things never worked. Maybe I’m not good at sensing clues.” She wondered if one regarding her career in medicine were trying to get through. Kara’s blood pressure returned to normal the next morning so Jeannie approved her for release. Gordon wasn’t there, but Beth had brought their son, Markie. The boy wore saddle shoes and carried a bag of shelled almonds that he offered—silently, with the baggie hanging off an outstretched arm—to the cute nurses. Jeannie gave Kara a box of shoe covers for her own puppet shows, complete with hand-drawn goatees, that she tucked into a backpack full of hospital gift shop toys. Jeannie had meant to say something to Beth before they left—precisely what, she didn’t know; most likely it would have been advice for Kara’s continued recovery cloaked in physician-speak—but she’d been called to assist on an epileptic seizure while Beth was signing papers. They were gone when Jeannie returned. The hospital room still had the vestiges of Kara’s brave little self—a half-full milk carton, tangled bed sheets, Kleenex tissues on the bedside table—things Kara didn’t need anymore. Jeannie didn’t need Kara, but she needed others like her—people she could heal. She pulled the sheets taut so a lump wouldn’t be mistaken for the girl. The chief found Jeannie late in the afternoon and told her a verdict had been reached. He offered her a lift to the courthouse but she opted to ride. “You sure? It’s rush hour.” Because Jeannie worked off-shift, she rarely rode in traffic. But risk was ubiquitous and she was ready for what would come. Jeannie assured the chief that she’d be fine and rolled out of the parking lot with a head-swiveling glance before merging into traffic. |