Green Hills Literary Lantern

 

 

 

 The Thirty Day Rule

 

 

Oblivious, old people on ventilators, in prison cell-like cubicles, surround us. Mouths open, veins filled with sedatives, lifeless eyes counting ceiling tiles.

A scream comes from cubicle four. I, along with the medical team, rush over. A pregnant nurse vomits into a wastebasket. She’s crying, screaming, shaking. She wipes tears from her eyes with the back of her hand, vomits again. She turns away from the patient.

The patient’s family starts yelling at the nurse.” How can this happen? What kind of care is this? You get back here now.” The F word, the C word, the B word. “What’s the matter?” I ask. “What’s going on?”

The nurse covers her mouth and leaves. The family pursues her, one male and two females. I step in front of them, halting their pursuit. 

“You can’t yell at the staff,” I say. “You can’t use that language.” My voice is firm, but I am not shouting. We can’t yell at families. Families rule.

“Don’t tell me what I can say,” screams one of the women. Then more F, C, and B words. The silver stud piercing her tongue is as large as a marble. 

“That’s it,” I say. “Call security.” My voice is louder, but controlled.

The guy sticks out his chest like a rooster, gets in my face, shouts at me like a baseball manager would an umpire. He points at my chest and says, “That nurse is neglecting our mother. You want her dead because she’s old and taking up a bed. We hear you joke about her.” I smell alcohol and cigarettes. He jabs my chest with his stubby, thick, finger. Jabs again—hard.

“Don’t ever touch me again,” I say. My hands are raised, but I do not touch him. “That you can’t do.”

Security arrives. I back down, but my chest hurts and I was a pretty good boxer so I want to hit him, just one little shot, fast, quick, clean. I would make it look like he slipped, help him up, accidentally put my thumb in his eye. I perfected that move and could hide it well. He freaking bruised my breastbone, and you know how that hurts. But if I hit him my career is over.

Anyway, the three of them see security and they leave me and proceed to scream at the  officers.  A 911 call is made. The family leaves cursing and threatening. One of them must have a rap sheet.  

Confusion lifts quickly, as it must in an intensive care unit. Nurses return to their cubicles. I enter cubicle four and ask, “Can someone tell me what happened?  Somebody get Annie, and get another nurse back in this room, stat.”  I rub my chest.

Jim, the nurse’s assistant, steps up. “Dr. Larco, I know what happened.”

“Tell me.”

He puts down a half filled urinal, takes off his latex gloves, washes his hands.

“That poor nurse, pregnant and all, and sick herself, is suctioning out the mouth of that patient. That patient’s been pretty much dead for a week. You can smell it.”

“I know.”

“Well, she’s suctioning the woman’s mouth, and she looks at this stuff coming up. She says, ‘Jim come here, somebody stuffed rice down this woman’s mouth.’”

“I look at what’s coming out of that old woman’s mouth, and it’s not rice because it’s moving and wiggling, and I say, ‘Those are maggots.’ See, Dr. Larco, I saw them all the time when I was in Nam, growing on the dead. Usually on their arms or legs. Never seen them pour out of somebody’s mouth. But the point is, the old woman is rotting and festering from the inside. The nurse throws up and here we are.”

I hear a woman’s voice, “Shit, not again.”

I turn, and it’s Annie, the head nurse of the ICU. She’s responsible, along with me, for what happens here.

“What are we going to do?” she asks. “This is the second time this year.”

“This has happened before?” I say. “How come I wasn’t told?

“That patient died the next day,” Annie says. “We did get a call from the funeral director, who was furious. He had to fumigate the funeral home. We told him we would pass his business cards out.” She smiled, but then got a worried look on her face. “This is not good.  It could get to the newspapers or You Tube.” 

“Administration’s going to hate this. Let’s go to your office and think this through.”

I follow her to her office, close the door behind us. She sits at her desk. Puts her head down. “Damn,” she says. 

There is silence. Then she opens her desk and hands me a pack of cards.

“These are the funeral director’s business cards.”

“Did you pass them out?”

“No, but I should, I’m sure he’d give me a percentage.”

“Annie, you run a great ICU. Some things are beyond your control.”

“I need some coffee.”

“Sure, black?”

“No, two creams and two sugars,” she says.

I leave and return with coffee.

“What do we tell administration?”

“The truth,” I say. “Let them spin it.”

“But they’ll blame me. I have seniority. I’m the most expensive. They’re looking for reasons to cut costs.” Her hands shake.

“Annie, we’ll get through this.”

“David, I need my job. It’s my lifeline.” 

“Your ex doesn’t help?”

“Not much,” and she glances at the picture of her children.

“How old are they?”

“Six and eight. I can’t lose this job.” 

“Maybe they’ll go after me. I have my enemies in administration.”

“They won’t touch you. You can afford an attorney.”  

“Annie, I won’t let you go through this alone.”

She looks up. “We did mouth care on that patient every hour. That lady was dead.”

“Not according to the hospital.”

“You know the family brought a dog in here,” Annie says. “That’s where the maggots came from. Flies are on the dog, the dog shakes them off, and they fly into the woman’s throat, lay eggs, and the maggot larvae come out of her tubes.”

I glance at the chart on Annie’s desk. “I saw that dog.” I say. “It was a mangy looking thing. I went to the medical administration and complained.”

“What did they say?” Annie asks.

“They told me that Dr. Anderson, the guy they brought in for quality control, said it was fine, that the dog would create a soothing environment. He also lets children visit, and he allows flowers in the ICU.”

“Flowers, the flies could have come on them.”

“Or the children,” I say. “Three –year-old kids are not the most sanitary creatures.”

Annie picks up the picture of her children, studies it, sets it down.

“Anderson’s responsible for the maggots,” she says and starts crying. The skin around her throat blanches red. “If I lose my job, what will I do?”

“We could try to blame Anderson, but it will be tough. The administration loves the guy. He has an M.D. and PhD. and was a safety engineer at NASA. They are so proud they found him; a lot of egos are involved.”

“The guy doesn’t know his ass from his elbow,” she says. 

“But he’s smooth. The board of directors likes to be stroked and he knows how to stroke them.”

“The guy never comes down here,” Annie says. “He doesn’t know how to take care of people.”

*     *     *

A week passes. The family is still mad. Annie and I have to meet with them in the corporate boardroom. Shari’a law, in a hospital’s kangaroo court. The hospital needs a human sacrifice, and we’re it.

The boardroom is spectacular. Heavy oak paneling, a long mahogany table sitting on a Persian rug, oil paintings. At the head of the table is our CEO. He wears a black suit and red power tie, his blonde hair combed back, his eyes a milky blue. He folds his hands in front of him, nails trimmed and polished. At either side of him sit the vice-presidents of the hospital, also dressed in black.  Next to them sit the medical administration in white coats. They’re all male and arranged by their salaries. Our tax exempt hospital pays the CEO eight million dollars.

Several chairs separate us from the administrators. I’m glad I’m with Annie. I won’t let her go through this alone. Usually we awkwardly avoid touching, but today I hold her hand, briefly. 

  The patient’s family is ushered in by the CEO’s favorite secretary. Her black skirt  short, her heels extremely high. The CEO smiles at her, she smiles back. The family sits to the side, not at the table. They glare at us, as do the administrators. Annie’s done and she knows it. I’m guilty by association. I’ll get letters. But Annie is correct, I will never deal with medical administration without my attorney, and they know it. And, they know she can’t afford one.

The CEO unfolds his hands, “We are here to look into what happened to Mrs. Yost.” He looks at the family. “We have invited the family here so they can see how we do things. We are transparent. Thank you for coming.”

They family nods and says “Thank you.” They are dressed sedately, only traces of  tattoos are visible at their wrists, necks, and ankles.

“We understand that Mrs. Yost, while in the intensive care unit was not being properly taken care of and grew.” The CEO stops talking and scans the room. “I hate to be indelicate, but she grew fly larvae out of her trachea. Evidently we failed to provide her with proper care.”

“That’s not true,” I say. “The lady was beyond our help. She was getting around-the-clock care. What happened was inevitable.”

The chief of medicine speaks, “I have been in several hospitals and never once heard of a thing like this.” He looks at the CEO who nods his approval.

“We did mouth care on that woman hourly,” Annie says. “My nurses are very well trained.”

“Somebody was goofing off,” Mr. Yost says.

“We tried our best to help your mother but she was eighty-five and too old to have that kind of operation,” I say.

One of the daughters speaks, “Her cardiologist recommended she have her heart valves replaced, and the heart surgeon agreed.”

“She had a cardiac arrest during the second operation,” I say. “And she never woke up and was never going to.”

“The cardiac surgeon said we should keep trying,” Mr. Yost says.

“Has he been around to see your mother lately?” I ask.

“No, but he was there every day for about a month.”  Yost points his finger at the administrators, then Annie and me, and says, “somebody screwed up and somebody has to take the blame.” His hands are shaking. He needs a drink.

Annie stands and says, “You know who should take the blame, Mr. Yost?  You, and you, and you.” She points at each family member. “You made us treat your mother long after it was hopeless. We had to cut a hole in her throat to put her on the breathing machine, then cut a hole in her stomach to feed her. The lady is basically dead, but you make us continue to treat her. Maybe you get a check as long as mom’s alive? We see that all the time. You’re to blame. You and her doctor who cares so much for her but after a month stopped seeing her. And you know why he stopped?  Because, if the patient lives for thirty days after the operation he’s not blamed for the death.  But if she dies in twenty-nine days or less, he’s screwed. That’s why after thirty days are up, he’s gone. He washes his hands and we have to deal with the maggots.”

Annie stands and walks out of the room.  

I want to run after her but stick around. Maybe I can limit the damage. The useless hospital attorney tells the family it’s an outrage and he will write a check now. He says, “We want to help pay for the funeral.”

One of the women jumps up and states. “She ain’t dead yet.”

“Oh, I’m sorry,” the attorney says. “In case she doesn’t make it, we will help.”

Mr. Yost stands up and says, “We have an attorney and he tells us not to accept a check today.”

This is going to trial. Annie’s finished.

*    *     *

A month goes by. The old lady finally stops breathing. I help Annie clean out her desk and carry her books and pictures to the car. She cries. Hospital security ushers her out to make sure she doesn’t steal anything. The work she did for the hospital doesn’t matter. She’s done. I want to hold her but I don’t, I can’t.

I call the heart surgeon and say, “You know Annie was fired over your patient, the one who grew maggots in her mouth.”

“She wasn’t getting basic nursing care,” he says.

“That’s bullshit. You didn’t want her to be a mortality statistic.”

“That’s ridiculous,” he says.

“You’re a fucking liar. You cost Annie her job, now she’ll be lucky to get a job in a nursing home.”

“Listen, I have to protect myself so I can be here when I’m really needed. If you had to work under the same statistical pressure you’d do the same goddamned thing. You don’t operate. You’re a non-combatant.”

I let this sink in. But then I ask, “Why would you operate on somebody that old?”

“The old ones are all that’s left. The waters are fished out. The cardiologists do all the easy stuff in the cath lab. This is all we get.”

I walk away. At least he is telling the truth. The case goes on to be reviewed by

 the hospital ethics committee. They decide that when a patient is on a ventilator, no flowers, no family pets or children will be allowed in the room. Insect-zapping devices have been installed in the ICU. Every so often you can hear the “zap” of a bug being electrocuted. Sometimes they spark. With all the oxygen around here, I worry about a fire. We are told it is safe. And, we haven’t seen any maggots since.

 

Olaf Kroneman was born in Detroit in 1951. He obtained his medical degree from Michigan State University in 1977. He did his internship at the Mayo Clinic in Rochester, Minnesota, a residency in internal at the University of Virginia, and a Harvard fellowship in nephrology at the Massachusetts General Hospital. He has been in private practice in the Detroit area since 1983. His fiction has appeared in Quiddity, The Forge, The Furnace, The Left Curve, The Healing Muse, Riversedge, and The Hawaii Pacific Review. His story “A Battlefield Decision” was nominated for a Pushcart prize. His story “The Recidivist” won the 2009 Writer’s Digest award for popular fiction. He lives with his wife, Mary, in Birmingham, Michigan. Contact him at drkroneman@yahoo.com  or visit his website www.olafkroneman.com