Time To Testify

Time To Testify A Novel

By John Haswell

Chapter One Night Call

By the time Dr. Jay Atwell finished his first year of residency at Parkland Memorial Hospital, he looked hollow– eyed and haggard. He had shed fifteen pounds from his six– foot frame and felt like a caged animal. Parkland’s obstetrical department had a reputation of having one of the best teaching programs in the United States, but it was also a baby mill, cranking out five hundred deliveries a month. For the privilege of working

eighty hours a week, residents were paid one hundred fifty dollars per month. Jay liked delivering babies and was certain he had found his niche, but his savings teetered on empty, and his wife hated their cockroach-infested South Dallas apartment. With his busy schedule they barely spoke. The crowning blow came when the chairman of the OB department issued an edict that prohibited any resident from working outside the hospital. Most residents worked part-time at walk-in clinics to make ends meet. If Jay couldn’t work an extra job, his family wouldn’t have food and he would have to leave the program. Frustrated, he reenlisted in the United States Navy. As a lieutenant, he reported for duty at the Bainbridge Naval Training Center in northern Maryland. The aging military facility center sat nestled on a bluff above the Susquehanna River, fifty miles south of Philadelphia, and only a buggy ride from the Amish settlements of Lancaster. Built during World War II and now nearly abandoned, the dilapidated wooden buildings and overgrown grass resembled a worn-out veteran gasping for air. Jay’s luck changed when his commanding officer found an opening for a second-year OB resident. Within fortyeight hours, he would begin the last two years of his

residency at Portsmouth Naval Hospital. At exactly 5:00

PM,

he dialed the black rotary phone

and waited, hoping Ellen would answer. Commander Ellen Jones, a single nurse in her early thirties, had short frosted hair and gorgeous blue eyes. Jay would like to have toasted her with a cold Michelob at his going–away party, but she was on duty that evening. “Labor and delivery, Ellen Jones.” “It’s Jay. I’m checking in.” “Hi, Jay. Isn’t this your last night?” “It is. I’m all packed. Anybody in labor?” “No, it’s spooky quiet.” “Any elevated temperatures?” “No, but the coffee’s fresh if you want to drop by. I’d like to see you before you shove off.” “I’d like to . . . but I can’t. The packers have been at the apartment all day, and the movers are coming at the crack of dawn.” “I’m sorry I missed your going-away party.” “Me too...I wanted to buy you a drink,” said Jay. “And I wanted to toast your transfer. I hope we meet again.” “I hope so too,” replied Jay. “Next time I’ll buy,” said Ellen. “At least you’re

getting to leave this dump.” “You can leave anytime,” he joked. “How do you figure?” “In The Wizard of Oz movie, the good witch told Dorothy to close her eyes, make a wish, and click her heels together three times.” “I’d like to kick up my heels, but I’m sure not going back to Kansas like Dorothy did.” “So what’s your plan?” “I’ll keep looking so I don’t become an old maid.” “That’s not likely to happen.” “That’s sweet of you. The only call I got today was from the 11–7 nurse. She claimed she was too sick to come in to work . . . sounded like she was at a party.” “So you’re stuck there all night.” “Yah, I checked through the undelivered OB charts.” “Any surprises?” “There’s seven women overdue and tonight’s a full moon.” “You believe that moon stuff?” “Maybe I do.” “Should I get tucked in early?” asked Jay. “Wouldn’t hurt.” “What’s your Ouija board tell you?”

“Don’t be a smart alec. My mother had one of those; she swore by it. I almost forgot. Dr. Hershey said to remind you that you’re assisting on Mrs. Foley’s repeat cesarean tomorrow morning.” “Anything I need to know?” “I talked to Mrs. Foley on rounds. She’s an interesting lady. Said the book club she belongs to had a speaker from up in Bryn Mawr. Mrs. Foley told the speaker she was having her second cesarean.” “And?” “That’s when this speaker lit into her, informed her in no uncertain terms that most of her friends demanded a vaginal birth rather than have a second cesarean. The speaker proceeded to tell her all about vaginal birth after cesarean. They call it VBAC. Mrs. Foley asked what I thought.” “What’d you tell her?” “I told her VBAC was dangerous.” “That’s for sure. I saw a VBAC birth my first year at Parkland. The lady ruptured her uterus; her baby died. The third year resident performed an emergency hysterectomy. It was the bloodiest thing I’d ever seen. Is Mrs. Foley having any contractions?” “No.”

“Let me know if she starts anything.” “Of course.” “Anything else?” “Dr. Hershey left early again...his golf clubs in the back seat of his Mercedes, said he was taking a retired admiral to the driving range to hit some balls. Then they were going to the Officers’ Club. God, he’s uppity.” Lieutenant Victor Hershey III was in charge of labor and delivery. He sported a preppy crew cut and dressed in the fashion of Gentleman’s Quarterly. He lived on base in a two-story house reserved for the base obstetrician. The house was conveniently perched on a corner of the base golf course. He bragged how he captained the Duke golf team for three years in a row. “He’s uppity, but he’s a great surgeon, and he’s got great hands.” “He’s got naughty hands.” “You’re joking?” “He acts like he isn’t even married.” “Maybe I’ll be single next time we meet,” added Jay. “Don’t say things like that unless you mean it,” said Ellen. “I mean it. My wife and son flew home to her parents’ yesterday, left me with most of the packing. I’m not sure

she’s coming back.” “I’m sorry you’re having trouble; it’s been the scuttlebutt.” “Do you gals know everything?” “Bad news travels fast. Stay in touch and be good to the OB nurses at Portsmouth.” “The OB nurses at Dallas were pros. They taught us lots of things that weren’t in the books.” “Good luck and smooth sailing.”

Jay parked the Buick station wagon in front of their off-base duplex and took a deep breath before he opened the front door. Inside he saw the stacks of sealed packing cartons. His son was gone, maybe forever. He stared out the window and cried. He ate the remaining two macaroni-andcheese TV dinners, watched the nightly news, and made a phone call to Sally. Tom was excited to see his grandparents. He took Ellen’s advice and turned in early, tuning the bedside radio to a classical station. He set the timer for sixty minutes. Eugene Ormandy was conducting the Philadelphia Orchestra; tonight’s program included The Overture to the Merry Wives of Windsor. He closed his eyes and reminisced about the time he had heard that overture in

New York City’s Radio City Music Hall. He remembered the enormity of the sounds, the joyous feeling, and he could visualize the ninety-piece orchestra rising slowly from the pit. He wondered what his life would have been like as a professional musician.

The phone jarred him back into the nighttime world of obstetrics. He fumbled, heard the sound of a plastic water glass bouncing off the floor, followed the cord, and pulled the receiver to his ear. “Jay, this is Ellen. You awake?” “What time is it?” “One thirty. Get in here right away.” “What’s happening?” “It’s Mrs. Foley. She’s in active labor.” “Dilated?” “Five centimeters. I’ve started an IV and put a catheter in her bladder. I’ve called the OR crew and the anesthetist; told them to hurry.” “Call Victor, then take her straight to the OR.” “Her belly looks weird, like a double-humped camel.” “I’ll be right there,” said Jay. He slipped on a pair of scrubs and cranked up his Buick wagon. A lone sentry recognized his window sticker,

snapped a salute, and motioned him through the gate. He bounded up the loose wooden steps, entered the back door of the hospital, and headed toward the operating room. He grabbed a cap and mask, heard gurney wheels vibrating, saw it rounding the corner, and helped push it into the operating room. The operating room technicians looked ready. Ellen flipped up her mask. “Is Victor on his way?” asked Jay. “I called him. His wife answered. She said he had too much to drink at the club last night. She tried to wake him. I told her to keep trying . . . that we were taking Mrs. Foley to the OR.” “I may have to do it without him,” said Jay. “How many cesareans did you do in Dallas?” “Enough.” “Here’s her chart. Take a look at her belly,” said Ellen. Jay flipped through the chart and stared at the last page. He flipped it shut, clenched his teeth, and frowned. “What’s the matter?” Ellen asked. “Did you read the summary from her first cesarean at Guantanamo Bay?” “No.” “It’s an old photocopy,” said Jay.

It stated that Claire Foley had had a high fever and a major wound infection after her cesarean. She had sustained second-degree burns on her abdomen during childhood. The next sentence completed the story. If she decides to have another pregnancy, she shouldn’t be allowed to labor because the uterine scar could be weakened by the postoperative infection. Jay got the message. Her past infection could make her vulnerable to a uterine rupture. Jay flipped up his mask and introduced himself. “Good morning, Mrs. Foley. I’m Dr. Atwell. I thought we had an eight o’clock date.” “I’m the impetuous type, couldn’t wait. Is Dr. Hershey here?” “Not yet.” Claire Foley had lively hazel eyes and russet hair. She squirmed with every contraction. He saw the brawny thick skin of her abdomen, her misshapen belly. Ellen was right. It looked like a two-humped camel. The lower hump felt like a distended bladder, but the catheter was draining clear urine. He gloved and did a pelvic exam. Her cervix was ten centimeters—full dilatation. “We can’t wait for Dr. Hershey,” said Jay. “Go ahead, Doctor,” replied Claire. Other than a distended bladder, the only other

possibility was that the lower bulge might be the bag of waters ballooning out through a hole in the old scar of her uterus, something he’d only read about in his textbooks. If Claire’s uterine incision was starting to break open, he needed to act fast. He tied up his mask, scrubbed, and peered into the operating room through a small window above the sink. The old operating room looked as abandoned as the rest of the base. The once-white ceiling panels, yellowed with age and peppered with black mildew, were loose, ready to fall on command. Fluorescent lights flickered, emitting mercurial hues, and danced rhythmically against the green floor tiles. “Excuse me, sir,” said a corpsman. “Mr. Hopper and I want to know what’s with the early-bird emergency.

We’re

all set up, sir.” “I’ll explain as soon as I’m scrubbed,” answered Jay. “Yes, sir,” responded the corpsman. Jay pushed his buttocks against the door, swung his hips inward, and stepped into the operating room, his hands held upward, soapy water dripped from his elbows. Claire Foley lay on her left side; Commander Jones held her in position. A wide leather retaining strap hung loosely over Claire’s thighs.

The anesthetist prepared the

spinal, mixed solutions from glass vials.

The scrub technician walked toward Jay and in two seamless motions gloved Jay’s sterile hands. At the end of each motion, the tech suddenly released the taunt rubber cuffs and intentionally snapped them against Jay’s bare wrists. “Good morning, sir, I’m Mr. Hopper, your early-bird scrub tech.

Behind you, tying your gown is Mr. Barlow,

your early-bird circulator.” Corpsmen knew how to sprinkle sarcasm into their rhetoric and then add “sir” to avoid insubordination. Ellen heard the snapping sound, the arrogant smartaleck talk. She walked to within inches of Mr. Hopper’s face, her hands on her hips. “Hopper, I got eyes in the back of my head, and my ears heard your smart mouth.

Both

you and your sidekick report to me immediately after this case. Do you understand?” “Yes, sir,” they answered. Jay knew they were pissed about the early morning call-in and he knew he didn’t have to take any crap from enlisted men. He passed it off. He motioned both corpsmen toward him. “Good morning, Hopper, Barlow,” said Jay. “Where’s Dr. Hershey?” they asked. “He’s stayed too long at the club last night.”

“Why the early wake-up, sir? Commander Jones instructed us to ‘move it.’ Expecting something unusual, sir?” “I’m worried about the strength of Mrs. Foley’s uterine scar. She had her last cesarean at Gitmo twelve years ago, got a nasty wound infection. Let’s hope her uterus holds together.” “Anything else you need, sir?” asked Hopper. “Yes. Have Barlow pull out a second suction machine, hook it up, and test it to be sure it’s got power and enough rubber tubing with a large bore metal tip so it won’t get plugged up with blood clots.” “Yes, sir,” said Hopper. Mr. Barlow heard the conversation and headed to the closet. Jay walked to the head of the table. “Is everything OK?” asked Claire. “I briefed the corpsman on your previous cesarean. You’ll be numbed up in a few minutes.” He glanced at Claire’s belly and saw the baby move. He glanced at Ellen. She looked sexy; the florescent lights made her blue scrubs iridescent; her blue eyes sparkled. She knew the importance of timing, what calls to make, and she had the room staffed and set up ahead of time. The anesthetist numbed Claire’s lower back with

Novocain; her intravenous fluids ran wide open. Victor had already ordered blood to be cross-matched. The anesthetist finished the spinal. Ellen helped turn Claire onto her back, adjusted the leather restraining strap over her legs, and placed the catheter under her leg. She positioned both arms, secured them on arm boards, and adjusted the height of the IV pole. Victor was nowhere in sight. “Hopper, you’ll have to assist me,” said Jay. “My pleasure, sir.” Jay moved to get a better look at Claire’s belly; the two humps persisted. Mr. Hopper finished the betadine prep of Claire’s belly. At that moment, Jay saw Claire’s baby do a sudden flip-flop. In a split second, Claire’s belly twisted from the distorted two-humped shape into one formless hump. Mr. Hopper froze. Jay knew immediately. Claire’s uterus had contracted forcibly enough to complete the rupture of the old scar and expel the fetus, as if it were a human cannonball, out into the abdomen. Ellen saw the convulsive movement. Jay took charge. “Hopper, drape now. She just ruptured. Barlow, when we’re draped, hand over the suction tubing and turn on both machines.” “Aye, aye, sir.”

Mr. Hopper flipped one end of the prefolded drapes across the table. He secured the suction tubing. Hopper slapped a scalpel into Jay’s right palm. The time had arrived. Jay wasted none. “Barlow, start the clock,” snapped Jay. He knew he only had a few minutes before the oxygen levels in the baby’s brain would drop to zero, and the baby would be dead. The instant his knife pierced the abdominal cavity, a sea of red flooded over the edges of the table, across the drapes, and splattered onto the green-tiled floor. “Scissors,” snapped Jay. He quickly widened the incision. Ellen tossed clean drapes onto the floor and pushed them under their shoes, so they wouldn’t skateboard on the slippery mess. Except for the sound of blood gurgling through suction tubing and the deafening high-pitched whine of both suction machines, the room fell silent. Jay hoped they weren’t too late. Even with both suction machines on high, the operative field overflowed with bloody fluid. He and Hopper scooped out the largest clots with their hands and flipped them into a metal basin. Jay found the baby lying on top of the left colon, still immersed in a pool of unclotted blood, its umbilical cord securely connected to the

afterbirth inside the uterus. “She’s ruptured,” Jay said. He reached in, found the baby’s legs, and pulled it out by its heels. “Stop the clock,” snapped Jay. “Sixty-five seconds, sir,” said Barlow. The baby was limp. Mr. Hopper suctioned its mouth and nostrils. Jay briskly snapped the baby’s heel with his index finger. “You’re right, sir,” said Hopper. “It looks like a hand grenade went off inside her uterus.” The baby grimaced, gasped for its first breath, and offered life. Jay and Hopper quickly double clamped the baby’s umbilical cord and cut it loose. Jay gently laid the baby into a warm receiving blanket held by the pediatrician.

Within seconds, they heard a robust cry.

“Mrs. Foley, your baby girl is fine,” announced Ellen. Jay hoped she was right. “Thank you, everybody.”

Claire turned her head and

shoulders, trying to get a glimpse of her daughter. “Ellen, when you’re freed up, go find Mr. Foley,” said Jay. “Tell him we got lucky.” “Tell him I get to name this one,” said Mrs. Foley. “Put her to sleep,” Jay told the anesthetist.

“We’ve

got a lot of work to do—remove the placenta, irrigate the

whole abdominal cavity, and remove all the blood clots before we can even start the repair.”

The wall clock said 5:30

AM.

His wife and son were

sound asleep at her parents’ house. He thought about Tom, the life he and Sally had created. If he had one wish it would be that she wasn’t so depressed, so hardened against his profession. His own emotions had been whiplashed enough. As usual, he throttled them and talked to the scrub tech, hoping his tears would float unnoticed, absorbed by his mask. “I found Warrant officer Foley slumped in a chair, having a cigarette. Said he was glad it was a girl; didn’t know if he could handle a boy with his gene pool. I told him you’d be out when you were done. You know...Portsmouth is damn lucky to have Lieutenant Atwell as a second-year resident. What do you think, Mr. Hopper?” “They’re damn lucky, Commander.” Jay motioned for Ellen to wipe his forehead. She noticed his moist eyes, blotted his forehead and cheeks. Jay clamped bleeders. Mr. Hopper tied them. The anesthetist reported Claire’s vital signs as normal. “She’s stable with only the Ringer’s solution.” “Start the first unit of packed red cells as soon as

it’s ready,” ordered Jay. Jay removed the afterbirth, dissected away the torn muscle, and reconstructed each layer. Forty-five minutes later the case was completed. “Nice call, Dr. Atwell,” said Mr. Hopper. “I’ve never seen anything like this in fifteen years, and I’ve never seen anyone open a belly as fast as you. I apologize for my mouth and the glove thing, sir.” “Thanks for the assist, Hopper.” Jay discarded his bloody gown, cleaned the blood from his shoes, and found Mr. Foley. “Congratulations on your new baby girl,” said Jay. “How’s my wife...is she going to be all right?” Mr. Foley asked anxiously. “It was a close call, but she’ll be fine. The pediatrician tells me Sarah looks normal. Your wife lost a lot of blood, but all her vital signs are stable. We’ll transfuse her with several more units of blood.

I’ll keep

a close watch on her.” “Where is Dr. Hershey?” “He’s not feeling well.” disbelief. “When can I see my wife?” “Soon.”

Mr. Foley scowled in

Ellen monitored Claire’s vital signs. Jay stayed in the recovery room at the nurses’ station, wrote his notes, and chatted with Ellen. “You did a great job, Jay. You saved two lives,” said Ellen. “Thanks.” “You said things were chilly at home.” “It’s more serious than that,” said Jay. “Didn’t your wife see a neurologist at Johns Hopkins?” “It didn’t help; nothing’s changed. Two weeks ago, she told me she couldn’t keep up . . . said she didn’t think she was meant for this sort of life. She told me the same thing back in Dallas.” “I’m so sorry.” “I think she’s going to bail out.” “Really?” “Her bubble burst several years ago. Being married to a physician isn’t Camelot you know. She said she wants to spend time with her parents, talk things over with her mom. They’re real close, too close.” “You think she’ll divorce you?” “Probably. She said that I’d be locked away in the hospital every day and most nights for the next two years,

and she’d be locked away in the house, and when I was home, I’d be too tired to be of any help.’” “Stay in touch, OK?” said Ellen. Jay walked back through the hallways to the labor-anddelivery ward, his steps slower, more measured. He heard the first-morning chirping of birds, the distant sound of a bugle calling new recruits to the parade ground. He phoned Victor. A Mayflower van sat parked in front of their condominium, side doors open, ready to load. The first rays of dawn were visible. He thought about what had happened in the operating room. He knew how little time separated light from darkness, how only minutes separated triumph from disaster, and how only seconds separated life from death. He hoped Sarah would be normal. He remembered how one of the staff doctors at Parkland Memorial had defined obstetrics: the senior staff doctor had said that obstetrics was either awfully simple or it was simply awful.

Chapter Two Leaving Alone

After the moving van pulled away, Jay drove back to the hospital to check on Claire’s postoperative condition. He found her sitting propped up, her feet dangling over the

side of the bed, holding on to a table with one arm and picking at her food with the other. A preteen girl sat near the bed and bore a striking resemblance to Claire. “Hi, Doctor,” said Claire. up.

I wondered if you’d show

I thought you’d forgotten about me.” “Not likely.” “This is Mariah, our oldest daughter. She’s checking

on her competition.” Mariah rose from her chair. “Thanks for helping my Mom. Sarah’s beautiful. I gotta get off to school. See you soon mom.”

She pecked her mother on the cheek and scurried

out the door with her book bag flung over her shoulder. “She looks like you,” said Jay. “Yes, she does. Thank God she acts better than I did at her age.

She goes to school up in Lancaster, a

Mennonite school, stays with my cousin during the week, and comes home on weekends. When I was her age, I gave my parents tizzy fits.” “Really?” “I don’t know how much you know about Mennonites, but when we’re teenagers, before we’re baptized into the faith, we’re allowed to run wild. It’s called rumspringa. Mariah is my rumspringa baby.” “We call it sowing our oats.”

“I got pregnant and married Brad when I was seventeen.” “Your running wild days are over.

Another pregnancy

would likely kill you. In any case, I hadn’t forgotten about you, just busy, checking out, leaving for Portsmouth.” “Have your ears been burning?” “No, should they be?” “Ellen and I have been talking about you. She told me that you’d read what happened to me in Gitmo, saw the shape of my belly, and knew I was about to rupture my uterus.” He nodded. “You sure look better than you did after surgery,” he replied.

“Elizabeth Arden does wonders.”

“Do you promise not to get pregnant again?” She laughed and held on to her lower stomach with both hands. “Brian said he’d sleep on the couch for a while. He’ll be sorry he missed you.” “How’s your baby girl?” “She’s beautiful. She’s in the nursery. We named her Sarah after Brian’s mother.” “How many unit of blood did Dr. Hershey give you?” “All four.

Now he says my tank’s only three-quarters

full; iron pills will do the rest. I hate those things. They make my stomach cramp.” She paused for a moment. “Did you know Brian and Ellen were called to Captain Neil’s

office yesterday?” “No.” “He called Ellen and told her to hand carry my chart to his office. He read her nursing notes, your notes, and asked her questions. He saw where she’d called Dr. Hershey and that his wife couldn’t wake him up, saw the old records from Guantanamo. Then the captain called in Brian and Dr. Hershey. The captain reamed out Dr. Hershey and made him apologize to Brian for not being fit for duty.” Jay’s eyes drifted downward and away. “That’s only part of it,” said Claire. “The captain told Dr. Hershey he planned to insert a letter of reprimand into his personnel files.

He made Dr. Hershey read the

letter. He told him that if he signed it, he would remove it at the end of his tour of duty if he didn’t screw up anymore.” “Did he sign it?” “Not right away.” “What happened?” “The captain said, ‘Dr. Hershey, you’re a bright young doctor. You can spend the remainder of your service here delivering babies, or if you prefer, I can have you transferred to a destroyer, get some sea duty. It’s up to you.’”

“He signed it?” “Yes, then the captain told him he didn’t have a replacement for you, so until he found one, Dr. Hershey would have to stand duty every night.” Jay was quiet. “I hope it teaches him a lesson. My husband is in JAG. He could make it tough for Dr. Hershey.” “Life isn’t always fair. Last night we got lucky.” “Doctor, my baby and I were lucky—lucky you were on duty, lucky you knew I was about to rupture.

Ellen told me

you knew exactly what happened. I’ll always be grateful. You and Ellen will be in our prayers. Let’s keep in touch.” Jay nodded. “I have to go and visit the captain before driving to Portsmouth Naval Hospital.” “Good luck. If my uterus acts up, I’ll find you...don’t try to hide.”

Jay walked out the door and through the dingy hallways toward the captain’s office. He had a warm feeling about helping Claire, a feeling of confidence. He felt he was ready for any challenge a residency might offer; his private life was another matter. He turned into the hallway leading to the operating room, hoping to see Victor. He found him in the doctors’ dressing room, looking subdued. Jay asked about his visit with the captain.

“I got my ass chewed out,” said Victor. “I’m sorry,” said Jay. “It’s my own damn fault; then I made an even bigger mistake. My father called, and I told him what happened.” “And?” “He’s really pissed off. reprimand.

He objected to the letter of

Said he knew plenty of important people in

Washington and planned to call somebody.

I told him to

butt out; it might get me transferred to some damn destroyer. He’s mad as hell.” “I hope it blows over. I came by to tell you how much I enjoyed working with you this past year.” “Thanks. I’m grateful you were smart enough to spot a ruptured uterus. Hopper and Barlow told me what happened. I read all your notes. You literally saved Claire Foley and her baby and you saved my ass from really big trouble. Give me a call when you’ve finished your residency. I might need some help. My father expects me to join his OB practice when I’m done here. He tells me he’s retiring, but he’ll probably just keep working and try to manage my life too.”

“Come in, Lieutenant.” The captain heard Jay chatting with his secretary. “I’ve been expecting you. Close the door behind you.” He pointed to a chair, chewed on a

peppermint Lifesaver, and complimented Jay on his military service, his handling of Mrs. Foley’s case. “I’ve inserted a letter of commendation into your personnel jacket. You saved the life of Claire Foley and her infant daughter.” He didn’t mention Victor. “Commander Ellen Jones gave me a full report. I asked her if she thought Mrs. Foley was trying to deliver vaginally, pull off a VBAC delivery. Commander Jones didn’t think that was the case. She confirmed you did one hell of a job. I talked the chief of OB at Philadelphia Naval Hospital and told him what happened. He said you were damn lucky that Mrs. Foley was in the operating room when her uterus blew apart. My hat’s off to you.” “Thank you, sir.” “The navy needs the likes of you.” “Thank you, sir.” “Are you aware that malpractice cases are on the rise in civilian life, especially in OB? Military physicians don’t have to contend with that crap. I know that some women are trying to have their babies vaginally after a prior cesarean. It’s too damn dangerous. I’m calling the CO down at Portsmouth. He and I were in the same medical class. I’ll tell him you’re on the way and how lucky they are to have you. That’s all, Lieutenant.”

The captain handed Jay his personnel file and both saluted. “Thank you for your help, Captain.” Jay pivoted 180 and walked out the door.

Chapter Three Ellen

Jay reported to his new commanding officer at Portsmouth Naval Hospital, then strapped himself in for a two-year roller-coaster ride. The schedule: thirty-two hours on, twelve hours off, rounds at 0630, clinics at 0830. Surgery, emergencies, and deliveries filled every waking minute. Five hundred deliveries per month left the residents exhausted. Difficult and unusual cases were air evaced into Portsmouth from smaller military facilities. Sally and Tom returned. Neither she or Jay knew when to call it quits. New learning experiences never stopped. A young corpswave tried to abort her pregnancy. She inserted potassium permanganate tablets into her vagina, thinking they would make her bleed. It did. Before Jay could stop the bleeding, the caustic tablets had burned a hole through her vagina and into a major artery. Her pregnancy

continued. An officer’s wife was gang-raped while her husband was on sea duty. Jay sewed up the five-inch laceration. One of the drunken offenders confessed he had thrust his entire fist into her vagina. Claire’s case taught him the truth of “once a cesarean, always a cesarean.” The teaching staff warned the young residents that some women were demanding VBAC, that they resented repeat cesareans, were angry about the maledominated decision-making process in obstetrics, and that the residents would be pressured to perform the procedure. He witnessed a woman bleed to death; her womb had ruptured while she was trying to perform a home VBAC delivery. On another case, Jay performed a hysterectomy on a woman who attempted a VBAC. They weren’t as lucky as Claire. Furthermore, Jay had seen the panic in the eyes of fourteen-year-old girls who denied they were pregnant as they were delivering screaming newborns. He understood the need and the right for women to be able to control of their reproductive organs. Sally and Tom flew back to Wisconsin. They never returned. She visited Jay’s father. Within a week, his father called. “Is it true you’re getting divorced?” his father asked. “Yes, it’s true,” Jay confirmed. The silence was

awkward. “Your mother and I stayed together through tough times.” “I’m sure.” “Don’t give up on your marriage.” “Have I embarrassed anyone?” asked Jay. “Divorce isn’t part of God’s plan.” “It wasn’t part of mine,” said Jay. “What about your son, Tom?” “What do you want me to do, try to get custody?” “Of course not.” “Father, I’m not asking for your permission or your blessing.” “You’re not getting either one,” said his father. “Does God require all couples to stay married?” asked Jay. “God gave us forbearance and repentance.” Jay gave his father the last word. “It will be the first divorce in our family,” said his father. “I know you’re disappointed.” “We’ll pray for both of you.”

Jay didn’t strike back. His father needed to distance

himself. One divorce was one too many. His father needed time. Jay would give him all he needed. With one year of residency remaining, their divorce was final. A Mayflower van hauled away most of their furniture. Jay sobbed uncontrollably. His promises to visit Tom were well-intentioned. Months passed. When Jay did visit Tom, the strain of leaving was worse than either imagined. Tom was nearly hysterical the last time Jay boarded the plane back to Portsmouth.

Jay recognized the voice on his answering machine. “Hello, stranger, this is Ellen Jones. Remember me? I closed my eyes, made a wish, and got my transfer. They assigned me to the Oceana dispensary near Virginia Beach, only twenty minutes from Portsmouth Naval Hospital. I’m in charge of family planning. I tracked you down through hospital personnel. Call me. We never got to celebrate your transfer; dinner and drinks are on me.” He dialed the clinic number. “Commander Ellen Jones, Family Planning.” “If I make a wish, do I get to see you?” “Yes, you do. How are you, Jay?” “My heart jumped when I heard your voice,” said Jay. “I got lucky...I requested the Norfolk area, and I got

it.” “Want to get together?” asked Jay. “Sure. How’s tonight, the Norfolk Officers’ Club, six thirty?” “I’ll be there,” said Jay. He drove through the tunnel that connected Portsmouth to Norfolk, past the tattoo parlors, through the main gate. Tall colonial pillars guarded the entrance to the Officers’ Club. He spotted Ellen immediately; her blue eyes sparkled. “It’s great to see you again,” said Jay. They embraced for the first time, holding each other longer than mere friends would. “It worked,” she announced. “What worked?” “I closed my eyes, made a wish, and clicked my heels three times. How do I look?” “You look great and I like your perfume.” They embraced again and he kissed her on the lips. “I’ve wanted to kiss you for a long time,” admitted Jay. “I’d hoped so,” she added. They ordered cocktails. “I’m sorry about your divorce. Bad news travels fast.

So how are you really?” “Except for missing my son, I’m happy.” “How is he?” “When I call, it’s OK. When I visit, it’s bad.” “Will you get custody?” “I doubt it.” “I’m buying tonight, remember?” “Rank has it’s privileges,” admitted Jay. They toasted. “So how’s your residency?” “Demanding, but I love it.” “I wanted to see you . . . talk to you. The military isn’t very big.” She took a deep breath. “I keep seeing people I’ve known from previous duty stations. Friends of mine were stationed at White Sands Missile Range the same time as you. They lived next door to you. Remember the Hawaiian Commander?” “Of course.” “His wife saw you professionally. She danced with you at parties, told me your marriage was a mismatch, especially education wise. What happened?” “God only knows. A relative of mine told me he thought I felt guilty over my mother’s death and that I married someone I could take care of...who knows for sure?”

“There’s a couple of single nurses at the hospital who would like to get their hooks into you. We gals are always fishin’ for doctors.” “I’m vulnerable, but if you’re fishin’ I’ll nibble on your bait.” Ellen let out a howling laugh. “I’m vulnerable too you know.” “How so?” “Every time I get happily involved with someone, they get transferred, and I end up crying for six months. Let’s just enjoy ourselves, OK?” Jay ordered the second round of vodka tonics. “A lot of this was my own fault,” he confessed. “Let’s not get too analytical.” “But it’s true. In hindsight, I didn’t have enough experience dating. In college, I was afraid I’d get someone pregnant. If that had happened, there was no way I’d ever gotten through school. My sophomore year, I dated a cello player, a transfer from Smith College. She was hot, more than I could handle. I wanted to get involved sexually but didn’t dare, so I throttled back.” “Most doctors are socially awkward,” said Ellen. “You mean we’re socially retarded.” “That’s true too,” she replied.

“I blunted my feelings,” added Jay. Ellen reached over and took his hands in hers. “Jay, you did more than blunt your feelings, you buried your feelings. You need a partner closer to your equal, somebody independent, someone who can keep up with your high-energy level.” “Like you?” “I’d jump if I thought I had a chance,” said Ellen. “Your neighbor said it sounded like Sally had a postpartum depression.” “She did. She never fully recovered. Going back into the navy was my idea. I thought if I could be around more . . .” “Marriage is a roll of the dice. You’re not the only one who’s flunked Marriage 101. I was married once and madly in love. My prince came. Then after five years, he wrote me a letter. He left me. I was devastated.” “Why would anyone leave a beautiful gal like you? “I found out the reason we couldn’t have children was my fault. My fallopian tubes were scared shut. He asked for a divorce. Not being able to get me pregnant and have children was too much for him. It’s been six years. Anyway, that’s enough of the past.” “I can’t imagine anyone leaving you,” said Jay.

“Thank you. That’s a kind thing to say.” “What’s the news?” “Brad Foley got promoted to full Commander.” “How’s Sarah?” “She’s beautiful and her development has been normal. She’ll be two years old—sensitive and shy. Claire is so very grateful to you. She talks about you all the time.” “That was one hell of a night. How’s Victor doing?” “The same as before—he played golf . . . uppity. He kept his nose clean. Went back into practice with his father. No more run-ins with the captain.” They ate, talked, and toasted each other. She nudged him onto the dance floor. The four-piece musical combo was invitingly smooth. They’d never danced together. It didn’t matter. They held on and moved slowly. “I have a confession to make,” said Ellen. “I don’t hear after-hour confessions unless you put money in the poor box,” joked Jay. They both laughed so loud other couples stared. “You mentioned the amorous cellist from Smith College. I too played cello, for three years. Just holding that instrument between my legs made my thighs stronger than using Suzanne Summer’s Thigh–Master.” “I’ll be very careful,” nodded Jay.

“They’re flabby now.” They giggled and danced close to each other. He enjoyed the touch of her warm body and her perfume. “It’s been ages since I’ve held anyone this close,” Jay admitted. “See what you’ve missed?” “If I’d stayed married, I would have cheated.

I never

did, but I wanted to,” admitted Jay. The combo played “You’d Be So Nice to Come Home To.” Jay pulled her closer. Then they played “Almost Like Being in Love.” She snuggled in, holding his hand against her breasts, their legs intertwined. They stayed cheek to cheek. He kissed her, whispered in her ear. She smiled and led him off the floor. They left.

In her apartment, they kissed passionately. He followed her into her bedroom. They made love several times. He held her closely, kissed her lips, her breasts. “I’m at a loss for words,” said Jay. “I finally got to make real love. I’m happy it was with you.” “You’ve been starved for years,” she whispered. He nodded. “When can I see you again?” “Soon, OK?” “Wild horses couldn’t keep me away.”

“Call me at work,” she said. “I want to hear your voice.” Jay craved intimacy. He called Ellen at work. Once a week, they met for drinks; he brought her flowers. They danced at the club and sometime stayed for dinner. For the next few months, she offered her body and her heart—no strings attached. She climaxed easily, and he felt like a real man again. “I fantasize about you at work,” admitted Jay. “The nurses catch me daydreaming. They hear me talking to you. They tell me to be careful; they think I’m in love.” “The guys know I’m seeing someone. I tell them they’d be jealous if they knew what was going on in my mind.” They had common interests and enjoyed being together. Once inside her apartment, they loved nonstop. He loved to kiss her, and she loved being kissed. She snuggled beneath him and guided him inside her moist slip, moored him, then anchored her legs against his back. He stayed until released from her moorings. “Kiss me; start slowly,” she would whisper. Thrusting rhythmically into her soft velvet, she guided his hands and mouth to her favorite zones, climaxed when she was ready, and then rested in his arms.

“I love you, Jay. Please just hold me.” He kissed her blue eyes, told her how happy she’d made him. “Tell me again and again, please. I need to remember,” Ellen murmured. “I’ve never been loved this way,” said Jay. They fell asleep in each others arms. When he awoke, he looked into her blue eyes and kissed them again. “When will I see you?” she asked. “I’m not sure.” “You’ll be transferred soon, right?” “Life is so damn complicated.” “I’ll be miserable. I know it,” she said. “I love you very much, Ellen.” “But I can’t give you any children.” Tears gushed down her cheeks. They promised to stay in touch.

Chapter Four Ann

With the last two years of his residency completed, Jay loaded up his Buick wagon and headed up the eastern seaboard to his next duty station, the U.S. Naval Air Station, Patuxent River, Maryland. The entire area was a peninsula, surrounded by the waters of the Potomac River, the Chesapeake Bay, and the Patuxent River. He was the obstetrician in charge of labor and delivery and outpatient services. He called Ellen every week. She cried each time they said good-bye. Three months later, Jay boarded his own social roller

coaster. He signed up for a singles’ dance class sponsored by the social arm of the Officers’ Club. The first week, he enjoyed the music, the dancing, and the new steps offered up by the instructor disc jockey. By the second week, he was ready. “Change partners and say hello,” the disc jockey called out. Jay turned to the left. “Hi, handsome. I’m Ann.” They danced off together. “I’m Jay.” “I saw you enjoyed the alley cat dance?” “I did. I’m a cat on the prowl,” admitted Jay. The next selection was a slow dance. He held her as close as she permitted. Her full breasts, pressed firmly against his chest brought an erection. Before Ellen, it had been too long, and now that he was back in practice, his responses were swift and strong.

He inhaled deeply a

second time and caught the aroma of her perfume. “I like your fume. I caught your scent earlier toniight.” “You sound like a hound dog on a hunt,” queried Ann. “That’s why we’re here, isn’t it?” “You’re the first to mention how I smell.” “Has it got a name?”

“‘Charlie.’ Revlon makes it.” “New?” “Not really; I got it at the Navy Exchange.” “Do you always smell this good?” “Only when I’m laying down a trail.” She tilted her head and chuckled. “You followed every step I threw out,” admitted Jay. “Did I pass the Arthur Murray exam, Doctor?” “You’re a Ginger Rogers.” “Thank you, Mr. Astaire.” “How did you know I was a physician?” “I saw you at the dispensary in a long white coat.” “Were you sick?” “I’m not the sickly type. My daughter had a checkup.” The mixer finished, and the DJ continued with close danceable music. Jay and Ann didn’t change partners. The DJ played Cole Porter’s “You’d Be So Easy to Love” and “You Made Me Love You.” Jay sang along as they danced the remainder of the night. They ended up chattering until the club closed. “I’d like to see you again,” said Jay. “I’d like that too.” “May I call you?” “Sure, why not.”

“If you’re not busy, I’ll come by, pick you up.” “My two girls will want to come along too.” “Do they like Dilly Bars?” “Yep.” “We’ll drive to the Dairy Queen. I’m a big spender.” She smiled and walked away to her car. Jay watched her, saw her strikingly pretty figure, her clear white skin, and glistening auburn hair. He liked her sparkling personality. Her husband had died in a freak air accident. Jay called Ellen, and a man answered. Ellen took the phone and said, “I’ll call you back.” Jay wasn’t surprised. She called Jay and told him she thought they should both go ahead and date. “Let’s see what happens,” said Ellen. “I’m seeing someone too,” Jay added. “Does she have any children?” “She lost her husband, has two girls, and doesn’t want any more.” “Where’s she from?” “Southern Illinois.” “Is she independent?” “That’s for sure.” “Good. I’m happy for you.” “I know one thing, Ellen.”

“What’s that?” “I love you very much and always will,” said Jay. “Let’s stay in touch.” With little left to say they finally hung up.

Jay and Ann dated and danced. He bought her flowers, presents, and after three dates, they went to bed. Each evening he picked an orange hibiscus bloom from the tree near his office and brought it to her. She pinned it into her hair. He took her picture and put it on his office desk. She encouraged his advances, was easy to love, and wanted all he could offer. He called Ellen once more. “I’m seeing a flight surgeon,” Ellen replied. “Is he good to you?” “Yes, but he’s not as funny as you.” “Is he married?” “He says he isn’t.” “I care about you, Ellen . . . being able to love you was the best thing that’s happened to me.” “Jay, I know that you’re serious about me, that you didn’t just want a romp in the hay, but I felt I probably couldn’t have you.” They were both quiet. They agreed to check up on each

other. Months passed. Jay moved in with Ann. They acted like newlyweds, and they continued to court. Her daughters—Alexis, age eight, and Kate, age six—both piled in bed with them. Both previously married, they checked each other out at close range. Ann was working on her social work degree. He saw and felt her independent nature. She was self-assured. They were smitten, but realistic enough to know that they carried baggage. They talked about their past and their plans for the future. Jay led the way. “I’ve made a couple of decisions that will affect our lives,” he announced. “I’m listening.” “I’ve decided to get out of the navy and go into private practice.” “That’s not a problem for me. What’s the second?” “I’d like to spend the rest of my life with you.” “Is this a proposal?” “It is.” “I’ve made some decisions too,” Ann replied. “What are they?” “I decided I like your proposal.” “Is that a yes?” “It is.”

“Letting me live with you could have been a huge mistake.” “I would never have agreed unless I thought we had a chance. The children gave you thumbs-up.” “Private practice will be crazy. I’ll be gone a lot. I’m already married to a jealous mistress.” “I’ve survived loneliness. My husband was overseas for months at a time. At least you’d be in the same town.” “We talked about having children?” “Yes, and we agreed—no more. There’s one more thing.” “What’s that?” “I’d like to continue my education.” “I’d be disappointed if you didn’t.” Jay got down on his knees and took her hands. “Will you marry me someday?” “Yes, I will, when we both agree we’re ready.” “Let’s toast to that.” “Let’s drink the whole bottle. We may need it,” laughed Ann. “I’ve got to find a place to open a practice and a house for you and the girls. Got any ideas?” “Yeah. Back in the Midwest . . . close to my parents, but not too close.” “The Midwest, it is.”

“At least we talked about it.” “I talked to my mom . . . told her I was dating someone. She asked if I was in love . . . I told her yes.” With his two-year payback nearly completed, Jay began searching for a location. Ann got out a map, showed him where she grew up, and showed him which towns weren’t too close to her parents. They placed a pin on her hometown and drew a circle with a radius of one hundred fifty miles. It encompassed part of Kentucky, Illinois, and Indiana. “You realize neither of us has met the other’s parents,” said Ann. “We don’t need their approval.” “Look for a place with a college, OK?”

Chapter Five Clarkesville Memorial

The drive through southern Indiana left Jay exhausted, his knuckles and his ego bruised from knocking on doors. At 7:00

AM,

he left the McCurdy Hotel and headed north to check

out the hospital in Mount Cross, Illinois. He opened the car windows and inhaled the fresh air, absorbing the country view. The farmers had finished the morning milking. Behind the lead cow, each herd walked away from the barn on their way to graze in the lush pastures. The portrait of dairy farms set in rolling country reminded him of his roots. One farmer drove an old faded tractor, the same model Jay had driven as a boy. He remembered a book entitled A Furrow, Deep and True, a historical novel of how his ancestors had settled in Wisconsin. He tuned the car radio to the bottom of the FM dial and found an NPR station. The announcer said the station was located on the campus of Clarkesville Junior College. Within minutes, he saw the sign, Clarkesville City Limits, population 20,000. Then he saw a blue-and-white hospital sign.

His stomach made overtures, reminding him he’d

skipped breakfast. Perhaps the FM station and the sign were prophetic. He checked the rear mirror and turned onto the first side street, tires screeching. He followed the arrow toward

a faded three-story yellow brick structure. It squatted on an entire block, looking worn and tired.

Across the

street, children ran from playground swings toward the twostory school.

He pulled his washed-out Buick wagon into a

parking lot reserved for doctors and slipped in-between a shiny black Lincoln and a baby blue Cadillac. The sign said Clarkesville Memorial Hospital. Maybe this would be his lucky day. Maybe the doctors’ surgical lounge had some leftover snacks to quiet his tummy, and maybe this town needed a newly minted, go-get-’em–type obstetrician. The entranceway doors slid open automatically and closed behind him. His nostrils recognized friendly odors; he drew them in, feeling at home, and waved to an elderly pink lady sitting behind a desk. The switchboard operator was working a crossword puzzle and didn’t look up.

A

loudspeaker squawked, “Would a doctor please come to the emergency room?” He had walked thirty feet into the main hallway before he heard the squishy cadence of crepe-soled nursing shoes. The rhythm quickened like a torpedo approaching a target. He looked up, spotted a nurse heading directly toward him. She was attractive, midthirties, with her hair pulled up into a severe bun; a white cardigan lay efficiently over

her shoulders. Her white uniform was as spotless as new snow and so highly starched it gave her skirt a distinctive rustle with each step. She clutched a clipboard with both hands, pressing it firmly against her generous breasts, both aimed at him.

Her pursed lips and cold eyes spelled

serious. In a flat, atonal voice, she asked, “May I help you?” Her clear white face was expressionless; she resembled Dianna, a Greek goddess, perfect from her bun to her white shoes. She had both her big guns locked in at him. “Yes, you can help. I’m Dr. Atwell . . . looking for the doctors’ surgical lounge.”

He realized he had been

speaking directly to her nametag: Chief Nurse. “I’m Lauren La Fonte, the chief nurse. You can take the elevator at the end of the hall up to the third floor. The doctors’ surgical lounge will be directly in front of you as you get off.” She was downright pretty though her voice sent out a chill. He tried his warmest smile. “Thank you, nurse.” She turned to leave, then turned back again. “I haven’t seen you here before. Are you new in this area?” She remained flawlessly formal and spoke like a sentry guarding her territory. Her stiffly starched uniform matched her personality.

More warmly than before, Jay said, “Yes, I am. You’re right on both counts. I’m new—a trained obstetrician leaving the navy—and I’m looking for a community where I can set up a practice.” Until then, her voltage output had been low, leaving Jay wondering if she had a pulse. She was a difficult read. Her thin red lips formed a faint smile or smirk. “Our town could sure use one more midwife,” she said. “Go on up and talk to the doctors. I’ll send the administrator up. He’ll want to meet you.” Was her comparing him to a midwife an intentional zinger?

As she walked away, he caught the faint whiff of a

fragrance he recognized— White Shoulders, which his mother had worn.

He could still visualize the pink package with

the cameo of a woman’s exquisite porcelain shoulders. He wondered why such an attractive, good-smelling lady was so ceremonial. Why would she compare him to a midwife? He ducked into the elevator and slapped the third floor button.

As

it

squeaked

and

groaned

its

way

upward,

he

noticed the side panels, scratched and smudged black by the rubber gurney bumpers. The elevator jerked to a stop, and the door slowly opened. A red sign announced Surgery Authorized Personnel Only. Immediately to the left, two large double doors

opened pneumatically. The cool breeze of gasses gushed toward him as if the entire operating room had exhaled, its breath saturated with the odor of anesthetics and antiseptics. An orderly wheeled a patient toward the recovery room. The surgery doors hissed, snapped shut. Another red sign with smaller letters read Doctors Surgical Lounge. He pushed open the door, peered in, and knew he’d seen it all before. The lounge was Spartan and permeated with the stale stench of a locker room. A linen hamper stood, piled with sweaty, bloodstained scrubs. Some hung over the edge; some had dropped on the floor. Metal lockers lined one wall, last names written on white surgical tape across the top.

Above the lockers were

wooden bins stacked with clean gray scrubs partitioned into small, medium, and large sizes.

One window opened to the

outside world. Chairs cushioned in bright orange vinyl sat around a flat coffee table. The surgery schedule was plastered with Scotch Tape above the rotary one-line wall phone. A small bathroom connected. He spotted his breakfast, an assortment of donuts on a cafeteria tray. Several flies had already arrived. He started toward the tray. Then he saw a young man sitting in the corner of the lounge. The man wore scrubs, rubber surgical gloves, and was polishing two pairs of OR shoes. A

tuft of blond hair escaped from his scrub hat, “Hello, I’m Dr. Jay Atwell.” The young man looked up at him. “Hi, I’m Derek, an orderly.” He studied the doctor. “You’re the same guy that pulled into the doctors’ parking lot in a beat-up old station wagon. You’re a doctor?” “Guilty as charged.” “Give me a second.” He removed his gloves and extended his hand. “Welcome to Clarkesville Memorial. I’m Derek Brooks, operating room orderly. If you’re hungry, better help yourself before they’re all gone. I saw you pull in between the Lincoln and the Cadillac.” “My old wagon stood out didn’t it?” “I noticed you stayed in your car for several minutes. Was something wrong?” “No, I was thinking about my father.” “Reminiscing?” “I was thinking about when I graduated from med school. My father told me never to drive a Cadillac into his yard.” “Didn’t he like Cadillacs?” “It wasn’t talking about cars; he was giving me advice, Polonius’s advice to Laertes: ‘Don’t look too good nor talk too wise.’” “That’s from Hamlet.”

“He was reminding me not to get the big head just because I was a doctor. Maybe someday I’ll have a Cadillac and take my dad out for a spin.

He’d like it more than

he’d admit.” “The owners of those two fancy cars are the cockiest surgeons on the staff. I don’t clean their shoes.” Jay stirred a pack of sugar into his cold coffee, took a test sip, and listened while Derek chattered on. The young orderly wasn’t afraid to voice his opinions, even to a stranger. He was a good–looking kid and intelligent. He had fair skin, clean fingers, and well-cared-for nails. Why was he playing Cinderella to some of the doctors? “What are you doing here in Clarkesville, Doc?” Derek asked. “I was on my way to Mount Cross, Illlinois. My stomach growled; I saw the hospital sign. I’m in the navy, an obstetrician and I’ll be a civilian soon. I’m looking for a place to launch my practice . . . thought I’d ask the local doctors, see if this town needed another obstetrician.” “So, how’d you find the lounge?” “The chief nurse gave me directions.” “You met the bitch?” “She is a bit cool isn’t she.” “Ice water runs in her veins.”

Without uttering a word, he opened his locker and pulled out a pair of women’s red pumps. He inserted them into the bottom of a shopping bag. Then he removed a fulllength red chiffon ballroom dress, held it close to his body with his left hand, and extended his right leg to check length. “It’s for my second job,” said Derek. “Really, what do you do?” “Work at a night club. I do impersonations; it pays better than this job.” Derek quickly folded the dress into the shopping bag, placed it back into the locker, and carefully closed the metal door. His openness was refreshing. “Dr. Atwell, I don’t have a clue if this town needs another obstetrician, but I’ll go through the operating rooms and spread the word that you’re here looking.”

The rumble of gurney wheels transporting patients, the odor of anesthetics, and the medical chitchat, which filtered through the door, were familiar. The clanging of steel instruments against steel basins belonged to the urology department across the hall. The lounge was quiet for a few moments. Jay’s thoughts turned to Ann. Both were serious about restarting their lives together, but there’d be no Brady Bunch. She read his psyche, his appetites, and

helped him tune in to the sixties, women’s needs, and his own emotions. Because of her, he had become a better physician. The pill had changed the balance of sexual power.

Women could control pregnancy and had the freedom

to be sexual within or outside marriage. He acknowledged his idealistic bent, his Protestant work ethic. He knew he was untested in the real world, but believed he was marketable and wanted to practice where he was wanted and needed; so far, he hadn’t found that place. He thought about calling Victor to see if he needed a partner but never did. They were of different worlds, and the idea of being salaried and dependent made Jay determined to gut it out, to keep looking. Derek reappeared. “I’ve spread the word. Let me know if you need anything.

One more thing—the nurses want to

know if you’re married.” “Keep ’em guessing, OK?”

Chapter Six Doctors’ Lounge

Jay listened and watched.

The only phone rang constantly,

the intercom buzzed, and nurses called doctors to come scrub. Specialists and family physicians paraded through, networked with colleagues. Internists toted black medical bags; stethoscopes looped over their necks, pockets filled with papers and records. Some stopped to talk; some sampled the free donuts. He felt at home within the beehive of medical chitchat. One physician wanted a curbstone consult. Another wanted a written consultation. One left a trail of powdered sugar all the way to the door.

One physician wearing a

rubberized apron seized two glazed donuts and placed them into his locker like a squirrel preparing for winter. A man darted into the bathroom for a pit stop. He quickly reemerged. “Hi. My name is Charlie. I’m one of the anesthesiologists. Derek’s told everyone you were in the lounge. Did he talk your ear off?” “He tried.” “He’s a good worker, keeps us entertained too. He’s

danced into every operating room and announced that you were in the lounge searching for a place to practice obstetrics. Quincy Sadler, our OB man, called in to schedule a case. I told him you were here looking. He’d like to talk to you. Can you come back later?” “I can be back about three.” “I’ll tell him. One of his patients miscarried and needs to be cleaned out. He scheduled her for a dilitation and curettage. Derek’s a nice kid but a bit of a fruitcake. Confused about his gender, if you know what I mean.” “He didn’t act confused to me; he told me about his second job.” “The nurses loan him their high school formals. I haven’t seen his act. Some of the doctors call him a drag queen.” “That stereotype is outdated, don’t you think? I like him, whoever he is,” said Jay. As Charlie squeezed out one door and back into the surgical corridor, a tall slender man forcibly pushed his way through the main door. The man, who was in his late forties, walked with a limp and wore a gray suit, which matched his gaunt, pasty complexion. He stopped, peered into Derek’s locker, saw the stash in his shopping bag, and shook his head. He walked directly toward Jay.

“I’m Reggie Lehman, the hospital administrator.” His handshake was weak, his toupee obvious, and his voice milquetoast. “I’m Dr. Jay Atwell.” “Lauren sent me up to meet you. I was on a longdistance phone call with the hospital’s attorney. We can’t do anything these days without their approval.” “Who’s Lauren?” “The chief nurse, Lauren La Fonte. She said she met you.” “Ah! The hallway patrol. I must have looked suspicious. She pulled me over, checked my ID.” Reggie forced a grin. “She does more than patrol the hallways. Sometimes I think she runs the place. She said you’re looking for a place to practice.” “Right. I’m a fully trained obstetrician and getting out of the navy soon. An Evansborough clinic made me an offer.” “Was it good?” “It was an insult. What I’ve learned is that I can start a solo practice out in the boondocks of southern Illinois, or I can join a big-city multi-specialty group and be low man on the pole.” “Those aren’t the only options,” said Reggie.

“I hope not. I told ’em no thanks. I wasn’t ready to be an after-hours low-paid lackey. I’d keep looking.” “Good. I’m glad you stopped by. This area is heating up. Our hospital is becoming a regional medical center, and there are good prospects here in Clarkesville. Quincy Sadler is looking for help. Have you met him?” “I’m coming’ back to meet him.” “Drop down to my office before you leave.

I’ll give

you information about the hospital, what the town has to offer, and an application for staff privileges.” They stood up. Lehman’s grip felt stronger. Reggie picked up the last donut and placed it in his pocket. Derek cracked open the door. He looked petrified. “Has Lehman gone?” “Yes. Why?” “Small town.

I’m friends with his son.” Derek

grabbed the shopping bag, the red shoes, and turned toward the door. “Leaving?” “My shift is almost over. I want to get this bag out of sight.” “I’m leaving too, driving to Mount Cross then coming back here to meet Dr. Sadler. It’s back to Evansborough tonight.”

“Doc, if you get bored, I work at the Heart and Soul Lounge. Tonight it’s improv.” “Is the club close to the McCurdy Hotel?” “Yes. Take US 41, south. The club is on the left, just before the bridge to Kentucky.” “Thanks, Derek.” Jay walked toward the maternity ward. He stopped at the nursery window and counted seven newborns in bassinettes. In the nursing station were four nurses; one was charting, one held a newborn, and two others stood in front of the drug cabinet. They stopped talking as he approached. “I’m Dr. Jay Atwell.” “Hello, Doctor. We know who you are,” said Maria. “Are you the Chief OB nurse?” “She’s off today. We knew you’d show up,” she replied. “How so?” “Our chief nurse called, told us there was an obstetrician in the building looking for a place to practice. She told us to give you a tour.” “Does she know everything that’s going on?” “She thinks she does,” said Maria. “At home, it’s a different story. She has two well-developed teenyboppers.

One of ’em skipped school today.” They all snickered. “How many deliveries does Clarkesville’s OB department have?” “We run about twenty a month...two hundred fifty a year. Here’s the statistics for last year. It shows how many deliveries for each physician. This area could use another obstetrician.” Jay listened. “The local doctors leave town whenever they please without getting anybody to cover their practice.” “Isn’t that abandonment?” asked Jay. “They get away with it. They just tell us to find whoever’s in town. We nurses all agree that this town needs another OB. You’d have plenty of patients—real quick too,” added another nurse. He listened carefully to each nurse. Labor and delivery was better than at his last duty station. “We hope you come here. Dr. Sadler sees himself as the only rooster in the hen house. We’d all send you patients and I’ll come be your office nurse,” said Maria. Jay smiled. “Thanks for the tour and the invitation.” A cleaning lady stopped mopping and said, “Doctor, the nurses are right. Clarkesville could use you.”

The elevator groaned to the first floor. Mr. Lehman’s secretary handed him a legal-size envelope. Most specialties were covered, and the only obstetrician was Quincy Sadler.

Chapter Seven Sister Agnes

The detour into Clarkesville quieted his stomach, and there was still time to check out Mount Cross before meeting Clarkesville’s only OB man. Jay had little firsthand knowledge of Catholic reproductive policies. He had dated a Catholic girl and remembered her telling him that if there was a choice between saving a pregnant mother or her child, the church’s priority was to save the child. The Mount Cross Hospital was immaculate, and after a brief tour, the guide ushered him into a sanctuary where he met privately with Sister Agnes, the mother superior.

She was rotund, a pleasant appearing woman who sat perfectly erect, her head squeezed by her white headdress. Two four-foot gold-plated crosses flanked her plain wooden desk, and a ten-foot golden crucifix hung centered behind her. She fielded Jay’s questions. He wanted to be enlightened on Catholic reproductive policies. First, he asked about sterilization. “How restrictive are policies on tubal sterilization?” “Doctor, female sterilization by any means, whether by removing a portion of a tube or by simply suturing a tube closed, is forbidden by the Catholic Church.” “Are there any loopholes or alternatives?” “Not many.” She smiled. “Is it permissible to surgically remove the womb as a method of sterilization?” asked Jay. “It’s not against church policy to perform a hysterectomy as long as there’s a medical indication, even if doing so prevents future pregnancies.” She was telling him something, and he wanted clarification. “Sister Agnes, are the indications for hysterectomy very strict?

Let’s say a woman doesn’t want further

pregnancies but has other disorders with her uterus.” “It’s not much of a problem. The physician requesting permission to perform a hysterectomy appears before a

committee.

The committee consists of two staff doctors and

me.” “Does the committee approve most requests for hysterectomy?” “Most cases are approved.

We realize that most of

the women who request a hysterectomy have had a number of children, and most have a history of recurrent or chronic anemia.” Jay wanted to know more. “Anemia usually results from childbirth or heavy uncontrollable menstrual cycles. Most requests for hysterectomies are approved,” the nun added. He detected a faint smile, a twinkle in her eye. Her answers sounded warm and fuzzy, contrived. “What you’ve told me is that physicians understand the rules

and

that

everyone

is

in

compliance

with

church

doctrine as long as the physician can document some sort of history, like anemia.” “Basically that’s correct, Doctor.” “Sister Agnes, all physicians know the definition of anemia is very pliable and arbitrary. Laboratory error alone can make anemia appear to exist when it doesn’t.” “What are you saying?” He paused a moment, then mirrored her story. “What

you’ve said is that your hospital doctrines sanction hysterectomy for fuzzy reasons. The church permits a major operative procedure with major complications such as death and an expensive six-day hospitalization, yet the church prohibits outpatient tubal ligation, which has few complications.

That is an insult to women and to

physicians.” “Well, Doctor, this is a Catholic hospital.” She bristled, her face flushed red. “I see nothing wrong with our policy.” “Thank you for the education, Sister Agnes.” Jay

stood

and

left

without

saying

what

he

really

thought. This hospital’s reproductive policies degrade women, make them second-class citizens, thought Jay. He wondered if Sister Agnes received special absolution to distort the truth or if she was required to say Hail Marys as penance. Jay knew he couldn’t practice in a hospital where a religious pimp held him hostage. He rolled down the car windows, dialed Clarkesville’s classical FM station. Beethoven floated through, purging any thoughts of Catholicism, softening his psyche.

Chapter Eight Decision Time He waited for Quincy Sadler in the lounge, sans donuts and hot coffee. The only leftovers were the bouquets arising from the ashtrays heaped with crushed cigarette butts and a hamper still filled with soiled surgical scrubs. He heard a banging sound. His eyes focused on the door. It vibrated as if a SWAT team had kicked it in.

A

man in a Western hat cocked to the side strutted toward him, his hand outstretched toward Jay. “Quincy Sadler here,” announced the gravelly voice. Jay stood up, his eyes focused on a gigantic silver belt buckle.

“Happy to meet you. I’m Jay.”

The buckle was too big to be tasteful. It displayed a cowboy on a horse, and on it was engraved 1st Place Cutting Class. They shook hands for several seconds. “Sorry about the noise. My boot hit the door harder than expected.” He watched for Jay’s response. “It got my attention.” Jay knew the kick was intentional, like a trumpet fanfare for a Roman emperor. The flourish made Quincy appear bigger than his five foot five. Jay knew all about the Napoleonic small-man complex, and Quincy fit the bill. Quincy removed his silver white Stetson and placed it above his locker, on top of clean scrubs. They stood still, sizing each other up. Quincy wore horn-rimmed bifocals on a weathered face, with tobacco-stained teeth just inside a smug grin. Jay’s eyes fixed on a large turquoise stone secured between the leather strings of his Bolo tie. “You like it?” asked Quincy. “It’s gorgeous. Where’d you get it?” asked Jay. “Albuquerque.

Libby bought it for me last year. I

won the cutting class championship. Libby’s my wife. The turquoise was fashioned by Hopi Indians. It was the first year we pulled our big trailer to Ruidoso to see the AllAmerican Futurity.”

“What’s a Futurity? What do the words cutting class mean? I know it’s not about skipping school.” “The Futurity is the world’s richest quarter horse race.

The

winner

takes

home

a

purse

of

more

than

$1

million bucks. It’s an annual event. With any luck, I hope to be there every year.” “So, what’s cutting class?” “Cutting is different. That’s an event where a cowboy and his horse move in unison, from side to side, so you can direct

the

movement

of

a

cow.

Riders

are

required

to

separate a cow from a herd . . . move it across an arena. Speed counts.” Quincy

wrinkled

his

nose.

“This

place

smells

worse

than my horse stalls.” Quincy was affable, had a wry smile, a cocky swagger, and a puffy strut all rolled into one. “I’m sure glad you’re here, Jay.” Quincy removed his cowboy boots by jamming each heel into the bootjack and pulling upward. The boots looked expensive, like rattlesnake skin. He saw Jay staring. “They’re Tony Lamas—most comfortable boots I’ve ever had.” “Who’s Tony Lama?” Quincy smiled at the young doctor’s naiveté. “Tony Lamas are the best boots ever made,” said Quincy. Something brown flaked off one of his boots, and Jay

caught a whiff of manure. Quincy turned and checked around for leftover donuts. He walked over to an unlocked locker, smiled, and removed two donuts still neatly wrapped in a paper towel and flashed a wink. “Our

urologist

hides

donuts

like

a

squirrel

hides

nuts.” He gave the donuts a test squeeze, “They’re a little hard.”

He offered one to Jay.

“No, thanks. Derek passed the platter earlier.” “You didn’t touch him, did you?” He grinned, let his wrist flop. “I think I did. Is he contagious?” Quincy raised his eyebrows, dressed into scrubs, and lit a Marlboro. “What can you tell me about OB in Clarkesville?” Jay asked. Quincy exhaled from both nostrils and looked directly at Jay. “I’ll tell you flat-out: there’s plenty of opportunity here in Clarkesville. And there’s enough work for you too.” “That’s encouraging.” “If you decide to practice here, I’d support you, but I want you to know I’m not looking for a partner.” “That’s still the best offer I’ve had.” “It’s not an offer at all. I’m saying there’s room

here for you.

I’d do what I can to help you, even send you

some patients.” Jay saw a lean man in a suit enter the lounge. The man reached for the wall phone and dialed. The man sported a bow tie and a well-trimmed mustache. Dr. Sadler gave the introduction. “Jay, meet Bill Van Buren, general surgeon.” Bill’s hands wore talcum powder; Jay’s fingers dripped with sugar granules. “Jay’s an OB, did a hitch in the navy, looking around for a place to practice.” Bill listened while he dialed the phone. “I’ve picked up experience in the navy,” said Jay. “And I’ve passed the first part of my boards.” Bill Van Buren listened as he gave preoperative orders for a hysterectomy. “Will passing board exams make a difference?” Jay asked.

Bill turned his way, smiled, nodded approval, and

flashed a thumbs-up sign. “I doubt it,” snapped Quincy. “At least not here in Clarkesville. I never bothered with ’em, and I’m doing fine.”

Bill looked amused, but was careful to keep his

smile hidden from Quincy.

He flashed Jay a quick wink and

left the room. “Van Buren’s got his boards in general

surgery, but I don’t really think it’s important,” said Quincy. A nurse knocked on the door. “We’re ready in room 4, Dr. Sadler.” After his case, Quincy topped off the hamper with his scrubs and redressed. “Come on, we’re going to my place for dinner. Libby and I want you to see our horses.” Jay wanted to tell Ann about Clarkesville. It wasn’t far from her parents’ home. He thought she’d like the idea of having a riding horse for the girls. Her father had Tennessee Walkers. Two

cars

and

a

pickup

truck

stood

in

Quincy’s

driveway. Five pairs of well-worn cowboy boots were lined up just outside the back door. Loud dogs darted in and out between the kitchen and living room. Libby was standing at the sink. She grabbed a towel, wiped her hands, and opened the door. “Hello, I’m Libby. Quincy called, told me about you. I told him to bring you home.

Kids, get the damn dogs out

of here, now!” The children were well-mannered. Two tall teenage girls looked like their mother. The boy looked fifteen. All three were dressed to ride. “Meet Quincy Jr., Jayne, and Christy. Kids, this is

Dr. Atwell. He’s thinking about practicing here,” added Libby. “Great! Maybe then we could go to more horse shows,” said Quincy Jr. “Maybe,” said Quincy. “Quincy says if he’s gotta die, he’d rather be kicked in the head by his horse than get dragged through a bunch of malpractice suits,” Libby offered. “I just want to spend more time riding my horses,” Quincy grumbled. “Tell me about malpractice. Are women pushing VBAC here in Clarkesville?” asked Jay. “Some of the teachers talk about it,” Libby answered. “I’m a teacher’s aid. One of the teachers said she belonged to an organization called the Cesarean Prevention Movement. I dismissed it as bull.” “It’ll be a gray day in hell when I do VBAC deliveries,” said Quincy. “I’ve seen three women rupture their uterus; one of them died,” said Jay. The oldest daughter piped up. “Mom, did you know several girls in my class are already on the pill? They’re only freshmen.” “Don’t get any wild ideas, sweetie pie.” Libby served

Swiss steak, corn, french fries, and mashed potatoes. All six sat around a large oval wooden kitchen table. Libby handed Jay a large photo album. “Take a look at our spread.” The photos showed a completely enclosed indoor riding arena, the longest horse trailer Jay had ever seen, and a herd of registered quarter horses. The two girls whispered to their father, bugging him about riding. “After we’re done talkin’ you can ride,” said Quincy. “Can’t you talk faster so we can go ride quicker?” said the youngest. “Don’t talk smart young lady or you won’t be ridin’,” said Libby. Dr. Sadler raised his eyebrows. “Jay, you asked me earlier about the importance of passing board exams.

I’ve

never put faith in boards. Frankly, some board certified docs don’t have a lick of sense. They’ve been doing the same thing wrong for fifty years, and they call it experience.”

He laughed.

Jay had heard differently. “As far as competition, there isn’t much . . . only one older man I was in practice with for a while. I struck out on my own. I’m happy I did. He’ll be retiring soon. The only other doctors doing OB are family physicians.

I do

most of their cesarean sections, but I can’t do it all and live to tell about it.

Work is gettin’ in the way of

riding my quarter horses.” With all the cowboy tack and wearing apparel, Jay felt like he had just walked into the set of a Western movie. The two girls pulled on their father’s arm, whispered in his ear. “When can we ride?” Jay looked at his watch. “It’s time for me to saddle up my car and ride to the bunk house.” Both girls giggled. “You can’t saddle up a car, and you don’t have a bunk house,” said Christy. “No I don’t, but it’s time I go back to the hotel.” He shook hands with Quincy and Libby. “I’ll see you at your office tomorrow,” said Jay. He wanted to tell Quincy yes about coming to Clarkesville, but he wanted to talk with Ann.

Jay held his Buick wagon at sixty miles an hour back to his hotel and called Ann. “I’ve found a place to practice,” said Jay. “Where it is?” “I’ll have to go it alone, but I can make it here.” “Where, Jay? What town?”

“Clarkesville, population twenty thousand, fifty miles north of Evansborough.” “I’ve been through there on the train,” said Ann. “It’s a hundred fifty miles from your parents’ home. It’s got a junior college, and who knows, maybe the girls can have their own horse to ride.” “They’d love that.” “The town needs another obstetrician. I met the one who’s here.” “What’s he like?” “Cowboy

type.

Wants

more

time

off.

Got

a

bunch

of

quarter horses.” “How’s the hospital and staff?” “One hundred fifty beds, and most specialties are covered. It pulls in patients from fifty miles in each direction.” “I hoped you’d like that area. I said a little prayer.” “It reminds me of Wisconsin.” “The girls and I could stay with my parents for a few weeks while you’re getting started. My mom will be thrilled.” “I made a visit, met your mother and father. They said they hoped we’d settle close by.”

“They’ll be OK; don’t worry.” “They didn’t mention us getting married.” “Mom didn’t mention it either, but she called me, told me she thinks you’re wonderful. They like you—Mom said so!” “She fixed her cornbread.” “Good, wasn’t it?” “I’m driving back to Clarkesville tomorrow to see about office space. “Let’s live together in Clarkesville.”

Chapter Nine The Heart and Soul Club

Jay wanted to celebrate their settling on a place to practice. He headed south to where Derek worked his second job. He looked for a dinner lounge. There were no X-rated marquees with flashing lights. Back in Dallas, he’d seen several burlesque signs. One had announced Chris Colt and her forty-fives; another flashed the Nun’s Bad Habit. The local ordinances probably didn’t allow anything more than teasing the Southern Baptists with a little cheesecake. Jay spotted the marquee of the Heart and Soul Club. It read, “We welcome couples and singles. No cover charge.”

He walked in. A small four-piece combo was playing their theme song, “Heart and Soul,” a Hoagy Carmichael classic. Carmichael was a Hoosier who’d gone to college in Bloomington. It appeared to be a supper club. Couples ate, some sipped cocktails at the bar, and several couples slow danced. The combo consisted of a trombone, trumpet, alto sax, which doubled on clarinet and flute, and a drummer with a full trap set.

A keyboard sat near the brass players.

To the left was the bar. Young women already occupied most of the bar stools. They smoked, nursed drinks, smiled, and advertised. The stage was twenty by forty, with a Vegas-type backdrop. Jay propped himself up against a back wall and listened to the music. After scattered applause, the group swung into a medley of oldies Jay recognized—“Shine on Harvest Moon,” “For Me and My Gal”—and finished with “Up the Lazy River,” another Carmichael classic.

Jay enjoyed

the music; he thought about how he missed playing in a combo. Since college, his only music had been singing in church choirs. The Chamber of Commerce brochure said Clarkesville Junior College had a music department and a concert band. The small combo picked up the pace and broke into a

well-known two-step named “Proud Mary.”

Jay walked to the

end of the bar, ordered a drink, sat, and listened to the group. A hint of marijuana drifted past his nose. The combo followed up with “I’m Sorry,” a Brenda Lee hit. The crowd was enthusiastic. With just four musicians, the arrangements were tight, but they played great harmony. Jay sipped his Manhattan and chewed the maraschino cherry. “Hi, Doctor,” said a man’s voice from behind. Jay looked straight ahead, past the maze of whiskey bottles and through the cracked mirror, and saw the distorted image of a well-dressed man, outlined in pink from the neon signs. Jay felt uneasy, spun the stool slowly toward the voice, wondering who could possibly recognize him. The man smiled, then laughed, and extended a firm handshake. “Jay, imagine meeting you in here.” The man sported a thin neatly trimmed mustache and a trim figure. “You look like Errol Flynn. Do I know you?” “I’m the swashbuckler type.” He held two whiskey sours in his left hand. Jay was baffled. He knew he’d seen him before, but where? “Relax, I’m Bill. Bill Van Buren, remember me?” “No.” “Earlier today?” “Where?”

“In the doctors’ lounge. You were talking to Quincy Sadler.” “Now I remember. You phoned in orders . . . gave me a thumbs-up about my boards. You just scared the bejesus out of me.” “I’m here for diversion,” said Bill. “I came to celebrate.” “I’ll drink to that,” said Bill. “Come have a seat with me and my lady friend. Let’s toast one together. My friend told me to come rescue you before the bar girls moved in.

Some aren’t too clean.”

Jay was amazed. Bill was married, wore a wedding ring, and had a lady friend. No pretense, no masquerade. He followed Bill to a small booth occupied by a young woman in her early thirties. She smiled and patted the seat cushion, signaling Bill to slide across the red leatherette and sit close to her.

He gave her a kiss and placed their two

drinks on the table. “Maggie, this is Jay.” Jay reached across and shook her hand. Soft, no tobacco stains.

Her eyes were kind.

“I met this young doctor in the Doctors Lounge this morning. He’s checking us out, talked to Quincy, looking for a community that needs an OB man.”

“Clarkesville could use one more.” “Mind if we talk a little shop?” asked Bill. “Of course not, silly.” She snuggled closer, her hand on his thigh. Jay saw her dark roots, her bleached blond hair, and her obvious cleavage. Bill winked at Jay. “How’d you find this place?” asked Maggie. “Derek. He told me he had a second job . . . invited me to drop in if I had time.” “Where’d you meet him?” Maggie asked. “He served me breakfast in the doctor’s lounge, leftover donuts, and cold coffee. He vanished as soon as Reggie Lehman appeared.” “You picked up on that?” Bill smiled. “Is the administrator concerned about him working at a club?” asked Jay. “There’s more to it,” answered Bill. “You’re perceptive, Jay,” said Maggie. “Reggie’s son comes here. The two are good friends. I don’t meddle.” “He started working here on a lark,” said Bill. “He’s done better than he expected. Now he’s trapped . . . he supports his mother with the extra income. I trained in New York, and being around gays wasn’t a big deal. Someone nicknamed him Coco.”

Maggie kept one eye on the bar crowd and one on the combo. She started to lip-sync the words, moving her fingers to the rhythm of “How Deep Is Your Love,” a Bee Gee favorite. The alto sax reminded Jay of Charlie Parker. “I’m delighted you’re looking at Clarkesville,” piped up Maggie. “The first person I met was a female hallway patrol officer.” “What patrol officer?” asked Bill. “She’s a cross between a Greek goddess and Broadrick Crawford, the actor who starred in Highway Patrol.” Maggie’s eyes darted back to the conversation. “Have I missed something?” asked Bill. “I only walked thirty feet into Clarkesville Memorial when she pulled me over. She wanted to know who I was and what was I doing in her hospital.” “Who you talking about?” asked Bill. “Lauren La Fonte, the chief nurse. Then she compared me to a midwife. Is she usually so cold acting? Bill shrugged. “I don’t know her well.” Maggie let out a belly laugh. “Bill, you’re so damn naive.

I’ve known Lauren for twenty years, and she’s one

cold bitch, always has been. If she had smiled, her face would have cracked. Jay’s description is on the money.

She’s a good-looker, but she can turn on a dime and doesn’t much care for men, even if they are specialists. I work part-time as a newspaper reporter in the Clarkesville area, mostly community-interest stuff. I stay out of the hospital.” “I assume we’re off-the-record?” asked Jay. “Anything said here is strictly off-the-record, right?” Maggie glanced over at Bill. “For sure,” nodded Bill. “Then I met Derek in the doctors’ lounge. He offered me donuts and coffee.” “Derek borrows gowns from the girls in the OR,” said Bill. “His impersonations are good. In fact, he’s had offers for bigger money in St. Louis and San Francisco. Turned ’em all down . . . didn’t want a career in the business. He’s got a better set of legs than most of the girls in the OR.” “Better than mine?” asked Maggie. She gave him a quick poke in the ribs. “Of course not.” Bill chuckled. Maggie looked at her watch. “Derek’s due on in a half hour.” She excused herself, walked directly to the bar, talked to an older man who quickly escorted two girls off their bar stools and out the front door. Then she returned.

“Maggie helps manage the place. She’s sort of a female maitre d’, keeps an eye out for problems. The bouncer does the rest. So, where else have you looked?” “The big clinics in Evansborough offered peanuts. Today I visited Mount Cross. I crossed it off the list. Sister Agnes gave me a homily on the evils of sterilization and how they rationalize hysterectomy for sterilization.” “I had Catholicism crammed down my throat as a child in New York. I hated it; saw religion for what it is—a narcotic for the poor. Have you settled on a place to practice?” “It’s probably Clarkesville.” “Good. Are you in town tomorrow?” “Yes, I need to rent office space and an apartment.” “I heard you tell Quincy you’d passed the first part of your boards. Where’d you train? “Wisconsin. One year residency at Parkland in Dallas, two years at Portsmouth Naval Hospital. I passed the first part of my boards six months ago.

They said it was

important?” “It is. It separates the men from the boys.” “Sadler blew me off when I mentioned boards, said he didn’t need boards.” “I heard him.

He’s wrong. Passing your boards makes a

difference. I know for a fact that Quincy took the first part, didn’t pass, and he’s professionally jealous of those who have passed. He’ll be jealous of you too. It’s wonderful you passed the first part. You’re to be congratulated.” “Thank You.” “I’m double boarded—general surgery and thoracic surgery. I’m a member of the American College of Surgeons. Clarkesville’s not a real big place, but it’s a decent location. You’d be busy. It’s better to be a ‘big fish’ in a small pond.” Bill smiled and sipped his drink. “Are you going into practice with Dr. Sadler?” “Don’t be so damn nosey,” Maggie inserted. “No, I’m not. Quincy told me he had a partner once. I thought I’d just start up solo.” “You’ll find professional infighting, jealousies, and politics. I did.

You’ll need some support. Let me know.

I’ll be around and can guide you through the maze . . . at least give some advice.” The stage lights raised as the house lights faded. Bill moved closer to Maggie. A snappy drum roll quickly followed. An announcer dressed in a red sequined tuxedo and matching spats took the microphone. “Ladies and gentlemen . . . tonight we are proud to

present our opening act . . . straight from Vegas. The one . . . the only . . . the enchanting, Ms. Carol Channing.” The combo did a slow four-measure vamp as amber spotlights focused on Derek.

He moved slowly downstage,

impersonated Carol Channing movements and lip-synced the words to Hello Dolly. His gown was gorgeous, made of bright red sequins, with a feathered red boa, long white gloves, and his new red pumps. After his performance, the MC told a few corny jokes. Derek came back onstage. He did a striptease to the music of “Let Me Entertain You,” complete with a glove-removing routine, hip gyrations, bumps, and grinds, all in rhythm with the drummer’s rim shots and high-hat cymbals. He received a standing ovation. It was time to leave. Bill had chatted with him more than Maggie, who kept her hand high on Bill’s thigh and watched the bar crowd. “Maggie, I enjoyed meeting you. Bill, I’ll drop up to the surgical lounge tomorrow after I find office space.” “I’ve got a hysterectomy scheduled at ten tomorrow. If you’re around, I could use an extra set of hands. I’m chief of staff, so I can clear it.” “I’ll plan to help.” “You two have jabbered nonstop all night,” pouted

Maggie. “Before you leave, I want to add a woman’s viewpoint. Jay, you can do well in Clarkesville . . . if you’re available. That’s crucial. Quincy Sadler is a fine doctor, but he’s out of town a lot, riding his horses. He’s been my gynecologist, and over the past three years, his office has canceled me out more than I’d like.” Both men listened. “Whether you’re single or married, women know the importance of having a reliable man around. Pregnant women feel abandoned if their doctor is out of town or unavailable, especially during the last few months of their pregnancy. I want to wish you good luck.” “Thanks, Maggie.” Her viewpoint rang true, her voice sincere, and her eyes showed a soft kindness.

The next morning Jay rented office space three blocks from the hospital, found a small apartment, and sealed both deals with a handshake. Bill was in the lounge when Jay arrived. He had completed two minor cases and was waiting for a call to scrub. “I’ve cleared you to assist. We’ll be in room 2.” “I’ll be right there.” “Maggie likes you, thought you were perceptive.” Jay changed into scrubs, walked down the hallway to

the scrub sink, and turned on the water with his knee. “Welcome aboard,” said Charlie, the anesthesiologist. “Bill told me he needed help this morning, and since I’m on the Credentials and Audit Committee, I checked up on you. The American Medical Association book says you’re for real. If you need anything, ask the girls. I’ll go put her to sleep.” The circulating nurse for Bill’s case peaked around the corner and said, “Morning, Doctor. When you’re ready, come on in and get gowned up.” Bill knew his way around the inside of a belly and wasted no time. His movements were fluid, more skilled than some of the senior staff men at Portsmouth. Bill had Jay perform some of the cutting and suturing so he could evaluate the young doctor’s technique. As they were closing, Derek appeared in the doorway. “Have a good time last night?” asked Derek. “I did. I enjoyed the show . . . great job . . . I especially liked the way the combo played the Bee Gees’ ‘Ain’t No Woman Like the One I Got’ and the Patsy Cline number . . . the guys are good.” Charlie leaned in and whispered to Jay, “The OR girls want to know if you ‘got it on’ last night. I told them it wasn’t any of their business, but that I’d ask.”

Bill turned his head. “Tell ’em I got laid several times.” “That’s not news,” Charlie laughed. “We all know you’re well-fed and well—” Bill stripped off his gown, lowered his mask. “My partner and I need assistants all the time,” he said, turning to Jay. “We’d be happy to have you assist while you’re building your practice.

We pay standard assistant’s

fees, fifteen dollars for the first hour and ten for a half hour.” “I could use the money, need the experience, and it’s a nice way to start the day,” answered Jay. “My partner purchased new exam tables; put the old ones in storage.

We’ll save them ’till you have a chance

to look ’em over. They’re in good shape, and the price is right.” “I’ll buy ’em.” Jay grinned.

Jay entered Quincy’s private office. Quincy sneered. “Heard you assisted Bill this morning.” “A hysterectomy.” “What’s the indication?” “Fibroid tumors.” “He and his partner are known as ‘skin and contents.’

They cut out anything that isn’t nailed down.” “This one was definitely indicated,” snapped Jay. “What’s your decision? Are yah comin’?” “Yes. I plan to send in my application for privileges and apply for an Indiana license. I gotta start back to the base. It’s a ten-hour drive.” “I’m glad. I’ll help all I can.” “Thanks.” “One more thing.” “What’s that?” “I’d be careful if I were you. Hanging around at the Soul Club could hurt your reputation.

The place is loaded

with faggots. Did Bill introduce you to his out-of-town whore?

She’s from east of here, an ex-Mennonite. She got

kicked out of the church.” Jay didn’t answer. Except for stopping to fill the gas tank, Jay drove the seven hundred miles nonstop. It was midnight when Ann saw his car lights through the front windows. She met him at the door; their torsos meshed.

Chapter Ten A Final Salute

A formal good-bye to the captain and a farewell party at the club were all that prevented Jay from driving out the front gate of the Naval Air Station, a civilian again. The thought of cutting the military’s umbilical cord made him testy. “I’ll miss the navy, won’t you?” asked Ann. “I’ll miss their regular paychecks.” “Both Alexis and Kate were born at Cherry Point,”

smiled Ann. “I won’t miss the military’s insistence on blind obedience. When they say jump, everyone says, ‘Yes, sir. Right away, sir. Anything you say, sir. And how high, sir?’ If I stayed military, I’d probably end up an alcoholic.” “Why do you say that?” “I saw the career officers at White Sands Missile Range. They were all alcoholics. They went across the border to Juarez and bought rum and vodka for eighty-nine cents a gallon.” “That life’s not for me.” “I examined a captain’s wife last week. Her liver felt like a washboard, classis cirrhosis. She looked up at me and said, ‘Doctor, no lectures please, and don’t order any liver tests.

I’ve tried to quit drinking, and I know

all about my cirrhosis.’” “I’ve heard the military’s motto: ‘If we wanted you to be married, we would have issued you a wife.’” “One time I tried to report a case of domestic violence. I got nowhere, fast. The captain said she could call the chaplain.” “I’ve seen the black eyes. Women slap on extra makeup and a pair of sunglasses. They call us women dependents. That says it all. Dependency isn’t any fun. You haven’t

lived it. I’m going back to school to finish my social-work degree.” “I’d be disappointed if you didn’t.” “I’ll need to hear those words,” said Ann. “You’ll hear them. I love you very much.” “Remember when we met? It was like a dime store novel—our personal version of As the World Turns. When do you check out with the captain?” “One hour from now.”

The

senior

medical

officer

was

a

career

classic:

salty, blustery, and usually with the smell of yesterday’s booze on his breath.

He heard Jay in the outer office.

“I signed your release, Lieutenant. Come on in, sit down,” he bellowed. Protocol demanded one last visit with the senior medical officer. He alone granted permission to leave the Naval Air Station. He initialed the request, pushed it back across his desk toward the young lieutenant. Jay tucked the paper into his personnel jacket along with his DD 214 discharge papers. “I’m sorry you’re leaving,” said the captain. “You did good work . . . the navy thanks you for it.” “Thank you, sir.”

Jay was sitting directly in front of the captain’s oversized teakwood desk, the captain’s name and rank carved into a bulky mahogany plaque. Mementos of his military career were everywhere.

Autographed pictures of him glad-

handing dignitaries and test pilots filled the wall behind him. Humility wasn’t one of the captain’s virtues, and today he had a twinkle in his eye. He leaned back in his big chair and started to chuckle. “I still laugh when I think of the time you took me on inspection.” Jay remembered it well. “I

can

still

see

the

look

on

your

face.

When

you

pushed open the door to the operating room, there he was, your third-class corpsman, sound asleep on the operatingroom table. I thought you were going to shit.” The captain laughed

so

hard

that

tears

came

to

his

eyes.

He

could

hardly light his cigarette. “I was humiliated,” said Jay. “It was the same corpsman that got caught sneaking into the wave’s barracks at midnight.” They both laughed.

Jay didn’t smell any liquor on the

old man’s breath. “I heard congratulations are in order; you passed the first part of your obstetrical boards, correct?”

“Correct, Captain. Thank you, sir.” “My hat’s off to you. I hear you’re headed for the Midwest.” “Yes, sir, Captain.” “Are you going in with a group?” “No, sir, I’m starting up solo.” “That’ll be tough.” “I’ve checked out a town called Clarkesville and talked to a local physician.” “An OB doctors there?” “One. He’s practiced there for seven years.” “Will he help you?” “Yes. Said he’d refer me patients and told me there was plenty of room but that he didn’t want a partner.” “Why not?” The captain stopped fidgeting. “He had a partner once; didn’t want another.” “What happened?” “I’m

not

sure.

He

said

having

a

partner

was

like

having another wife, and one was enough.” They both laughed. “Captain, the other thing I learned is that he’s got a habit.” “Drugs?” “No, horses; he likes horses. He’s got twenty stables

and a huge indoor riding arena.” “Race horses?” “No, quarter horses: Lots of them. His whole family rides. He does ‘cutting.’” “I know about cutting. Saw it out west.” “He wants more time to go play with his horses.

If he

likes those horses like he says, and if I’m available to work when he’s playing, I’d be busy.” “Horses are a habit, and horse people aren’t always too stable. Sorry about the pun. Be careful and good luck, Lieutenant.” Jay stood and snapped a quick salute. The captain snapped one back.

Several of Jay’s colleagues wanted to toast him one last time at the Officers’ Club while the bubbly was happy hour cheap and before he walked the plank and headed for civilian life. He wasn’t excited about the cheap booze, but he wanted to say good-bye to his buddies and couldn’t say no to the free hors d’oeuvres. Tonight they were serving mouth-watering Maryland blue crab cakes. It might be years before he had that treat again. Ann sat as close to Jay as the old Buick station wagon

would

permit,

the

windows

rolled

down,

her

head

cocked against his shoulder. Her auburn hair brushed by the breeze, accented

by

a

bloom

of

yellow

hibiscus

Jay

had

plucked from the bush outside his office. He brushed her cheek with a kiss. “Ann, you’re absolutely radiant.” “Thanks . . . you’re pretty handsome yourself.” Like a young lovebird, she slipped off her shoes and perched her feet up against the dashboard, wiggling her toes to play in the afternoon sun. Jay and Ann pulled into the Officers’ Club parking lot, their station wagon fully loaded. The club was located at the tip of Cedar Point, a scenic peninsula where the Patuxent River met Chesapeake Bay. “I feel sick to my stomach when I think about what happened here,” said Ann. “It haunts me too,” said Jay. A field of black-eyed Susans extended from the O Club to the tip of the peninsula and belied the tragedy that took place there.. “Please don’t talk about it tonight,” said Ann. Not talking about it was easy, but Jay couldn’t erase the memory of what had happened where the river met the bay, where lovers parked.

It was here at Cedar Point where

a catholic service wife, a mother of five, chose to end her

life by walking out into the water until she drowned. The one-line

message

she

had

left

said:

“I’m

going

to

the

chapel to pray.” Some philosopher said endure what you must and enjoy what you can. Birth control was forbidden. With no alternative, a religious knot tightened like a vice around the woman’s psyche. After her sixth child, she had a major postpartum depression, a “psychotic break.” She stopped feeding and diapering her newborn and took her life the same day she was released from in-patient psychiatric ward of the Bethesda Naval Hospital. Every time Jay thought about the Catholic Church and its oppressive doctrines, he became infuriated. Jay and Ann pushed open the heavy wooden doors to the

club

and

heard

a

chorus

of

Anchors

Away.

Several

flyboys, already well lubricated, had jumped the gun on happy hour

and

joined

in

with

several

of

Jay’s

medical

buddies, their glasses raised, nutshells scattered over the sticky floor. They toasted everybody that walked through the front door. “It’s good I’m not on duty tonight,” observed one of Jay’s colleagues. “Don’t try to keep up with the flyboys.” Jay advised. After the two groups were untangled, the doctors

adjourned to a corner, and the young pilots returned to the bar. The base pediatrician came over and toasted Jay. “I’ll miss seeing you at deliveries.” “Try to stay out of the captain’s office, OK.” “Did you have to kiss his ring today?” “No, but I got close enough to know he was sober.” The base surgeon, a career commander with twenty years’ service, tugged at Jay’s sleeve, motioned him aside. His eyes were already glazed, his breath whisked. “I want to talk to you before you head out. I was in private practice before I reentered the service, and it was damn tough, and it will be tough on you too.” “I’m finding out,” said Jay. “Private practice is different today. It’s even tougher now. What’s malpractice insurance gonna cost you?” “Five hundred a year.” “You know physicians in the military don’t get sued.” “I’ve heard.” Ann listened in. “You can’t escape malpractice in civilian life. I talk to my civilian buddies, they tell me it’s vicious.”

He

took Jay’s arm and said softly, “I know I’m just another leftover alcoholic serving my time, but it used to be, when a baby was born deformed or retarded, people would say it was ‘God’s will.’ They don’t say that anymore. Do you know

what changed?” “I’m not sure, Commander.” “Well, God retired. You can’t sue God, so they go after the doctors.” “That’s not a pretty picture.” The surgeon was getting wobbly. “It’s a nasty picture. You’ll meet the little scumbag lawyers soon enough. The legal part of medicine has changed. It used to be that you were innocent until proved guilty. Not anymore. Nowadays, you’re guilty until proven innocent. When you get sued they say, ‘Don’t take it personally, Doctor.’ Who in the hell are they kidding? Jay, try to cover your ass and watch out for the little bastards.” He continued to sip away at a glass of pure scotch. “Thanks, Commander.” Jay tried to slip away, but the surgeon kept talking. “Jay, you’re a damn good OB man. I’ve scrubbed with you, and if you should ever change your mind, decide to come back into the navy, call me, and I’ll help arrange decent duty.” “Thanks, Commander. I changed my mind once before.” They clicked their glasses together one final time. Jay headed back to the group of doctors, and Ann joined him. “Interesting conversation,” said Ann.

“Wasn’t it though . . . that’s the commander I told you about, the drinker with the cirrhotic liver. He’s the best example I know of why I’m leaving the navy. He’s a good surgeon when he’s sober, but he’s a dead-in-the-water alcoholic.

Did you see his spindly thin arms and the

cirrhotic potbelly? It means his liver can’t keep up with all the cheap booze.” The captain and the commander were both chronic alcoholics. The service bubbled with them. social life was drinking.

Their entire

The Officers’ Club happy hour

prices were tempting, and many career officers yielded. Officers’ wives passed their days entertaining, drinking, playing bridge, and many of them were alcoholics. Jay

noticed

a

man

staring

at

him

from

across

the

lounge. He was a full commander, had massive shoulders, ones he’d seen before. The man nodded, whispered to his wife,

and

then

walked

directly

toward

Jay,

his

hand

extended. “You’re Dr. Jay Atwell?” “I am.” Jay took a sip of his vodka tonic and chewed some beer nuts. Ann stayed on his arm. “Do I know you?” “Yes, but it’s been four years . . . you might have forgotten. I’m Brad Foley . . . attached to JAG.” “Am I in trouble with the law?” The deep lines in

Foley’s face looked familiar. “No. It’s understandable you don’t remember. You were a little busy when we met, but I’ll bet you remember my wife.” “Why is that, Commander?” “You and Commander Ellen Jones were busy helping her in the operating room back in Bainbridge.

You saved my

wife and my daughter. You remember Commander Ellen Jones? She called us . . . told us you were stationed here. Remember the night?” Ann squeezed Jay’s arm. Jay’s jaw dropped as he recalled the nightmarish event. “Your wife had a cesarean section at Gitmo?” “Affirmative, Doctor.” “She ruptured her uterus.” “Right again. There she is, Doctor. She wants to tell you something.” Brad Foley turned, signaled her to join him. The nightmarish night flashed through Jay’s mind. The petite woman grasped Brad’s arm and smiled. “Did he remember us?” “Yes, he remembers.” “How could I forget?” said Jay. “Your name is Claire, right?” “Yes.”

“Claire and Brad, I’d like you to meet Ann.” “We’re happy to know you. Your man saved both my life and my daughter’s life.” “How is Sarah?” asked Jay. “She must be four. What does she look like?” “Like her mother.” Brad smiled. billfold and showed her photos.

He opened his

The young girl in the

picture wore a covering over her hair and looked like Claire. He remembered Claire was a Mennonite. “Brad and I mention you in our prayers. We’ve been so grateful to you and Ellen,” said Claire. “We were lucky,” said Jay. “Don’t be modest.

I’ve talked to many

obstetricians about my case. I was the one who was lucky, lucky you were there and made the diagnosis.” Claire squeezed Jay’s arm. “I’ve wanted to thank you so many times . . . now I have.” Jay saw tears well up as she reached up and kissed Jay’s cheek. Brad placed a Kleenex in her hand. “You’re leaving the service?” asked Brad. “Yes, Ann and I are leaving in two hours, heading to the Midwest.” “That’s our old stomping ground. We met at the Mennonite College in Goshen. We have family in Indiana.

Brad says we might just retire there.” “You heard of Clarkesville?” “Yes, it’s close to where we grew up. I told Brad it was you singing songs at the Western Show. You were singing with Ann.” “That’s right,” said Ann. “I hope we can stay in touch. Ellen told us Dr. Atwell was stationed here at Pax River.” “Who’s Ellen?” asked Ann. She squeezed Jay’s arm. “She was the nurse in charge of labor and delivery when I delivered Sarah,” said Jay. Claire gave both Ann and Jay an extra hug. Brad reached into his pocket and gave Jay his card. “Good luck, Doctor. If you need anything in the legal field, call me,” he said. The Foleys walked away and rejoined their group. Jay and Ann said final good-byes and closed the club door behind them. They drove slowly so they could savor their last views of the beautiful Chesapeake Bay, the twostory colonial houses, and the medical facility. He snapped his final salute to the guard and rounded the corner past the only drugstore in Lexington Park. It was a pharmacy, liquor store, and gambling casino all rolled into one. Gaming was legal in St. Mary’s County.

Visible were the players, spinning the one-armed bandits, mesmerized by the game of chance. One woman crossed herself, then pulled the lever. It was all by chance. It was by chance that Claire and Brad had stepped back into Jay’s life. It was by chance that Ann had entered his life. He felt charmed, as if he had hit the jackpot.

Chapter Eleven Main Street

The sun was setting over Washington DC as they headed west toward Clarkesville. They took turns driving. Soon the morning sun warmed the car. Ann reread the Chamber of Commerce brochures, especially the part about the twoyear Junior College, the peaches, the cantaloupe, and the watermelons. “I want to enroll in their junior college.”

“Someday I’ll play in a band.” The rolling landscape was calming. Huge tulip trees shaded the riverbanks; fluffy white cottonwood seeds floated in through the open car windows. They slowed the car to a crawl as they entered Clarkesville, circled the courthouse, and drove down Main Street twice to get a better look at the women’s shops. Finally, they pulled into the doctors’ parking lot and slid in between the baby blue Cadillac and the black Lincoln Continental. “The big ones belong to surgeons,” Jay explained. “Wow, I’d like to drive one.” Jay entered the hospital, retrieved his forwarded mail, and checked into the Rainbow Motel. After they rested, Ann and Jay headed to her parents’ home to check on her girls.

Jay headed back to Clarkesville the next morning and found an office-supply store. “I’m Steve, Steve Andrews. What can I do for you?” Steve was pleasant; in his late twenties; early stocky; and wore glasses, short sleeves, with no tie. “I’m Jay Atwell, a new obstetrician and I need five copies of my Indiana license and some business cards.”

“My wife told me about you,” Steve said as he sized up the new doctor. “She said now she’d have a choice of OB men. Have you met Dr. Sadler?” “I have.” “He’s busy, not available . . . out of town most every weekend.

My wife told everybody at church we’ll be

starting a family. I go with her. Maybe she’ll see you.” He smiled and winked. “What’s your wife’s name?” “Vivian, she’s one intelligent woman . . . two degrees . . . teaches at the college. She’s picky . . . reads a lot . . . wants natural childbirth . . . joined an organization that supports natural birth . . . asks tons of questions.” “Good.” Jay paid cash for the photocopies. “I’ll be back soon. I’ll need lots of printing—OB forms, patient information, and pamphlets.” “I’m your man, Doc. I’ll give you good service. You can proof the business cards tomorrow.” “Tell Vivian to look for my announcement in Sunday’s paper.”

Jay pulled into the doctors’ parking lot, entered the administrator’s office, and hand delivered one copy of his new Indiana license to the secretary. “Add this to my

application for staff privileges.” Reggie heard his voice. “Come in, Doctor. I’ve got good news. Your application was approved last night.” “Does that mean I can start to work?” “Yes . . . immediately.

Your privileges include

complete obstetrics, gynecology, and any other emergency room work you feel you can perform.” “I can hang out in the ER?” “That’s right, Doctor. Both the Credentials and Audit and the Executive Committee approved your application last night. Bill Van Buren was there and said nice things about you, told us you’d passed the first part of your boards. Congratulations.”

Reggie’s handshake was firm.

Jay headed toward the doctor’s lounge. He’d arranged to meet the field agent of his malpractice carrier. The rep wore no necktie and chewed on the stub of an unlit cigar. Jay handed him a copy of his Indiana medical license and filled out paperwork. The yearly premium was $1,200.00, quarterly payments of $300.00.

His office had three exam rooms, but barely enough furnishings for one room. The ambiance was Norman Rockwell. Metal speculums came as a gift from a local physician, who was leaving to begin a psychiatric residency.

He’d said,

“Psychiatrists don’t do pelvics—too risky . . . too much transference.” Furniture came from a secondhand store— straight-back wooden chairs, red and yellow plastic chairs, and two secondhand exam tables from Bill.

They were metal,

light green, early fifties, and came with matching metal cabinets and stools.

He slid his hands across the old

tables, wondered what kind of patients had lain on them and what problems they might have had.

The metal was cool and

smooth, ready for action. He drove to the newspaper office, asked for advertising. They pointed to Georgette Cohen’s desk. “I’d like to place an ad announcing the opening of my practice,” said Jay. Her eyes scanned him, her gold bracelets jingled. “Hello, Doctor. Have a seat. We’ve been expecting you.” She pointed to the chair. Her perfume was heavy. “I’m a new obstetrician gynecologist setting up practice.” “Yes, I know,” said Georgette. Georgette was attractive, in her early twenties; wore showy gold bracelets and upscale clothes to show off her figure.

Her lavender silk blouse was designer sharp

without revealing cleavage. Her snug skirt showed a firm figure. She walked to a filing cabinet several times, left

nothing to chance.

Other staffers pretended to be busy.

“What else do you know about me?” “Our editor briefed us about you, told us your application had been approved.” “How would he know that?” “He’s on the hospital’s board of trustees. He was at the meeting last night.” “Anything else you know?” “I’m a reporter too; I cover the hospital. Ads are my main job.” “I’m only allowed to advertise my practice one time. I want to get it right.” “I’ll get it right, Doctor.” She typed, and he double-checked. “We’re happy you’ve chosen Clarkesville. Your ad will be in Sunday’s paper and run for two weeks.”

Chapter Twelve Open for Business

Myrtle was the first patient through the door on opening day. Cigarette smoke and BO permeated her clothes. Nothing hid her halitosis. Jay’s nurse sprayed the entire office with Lysol after she left. Jay saw anybody, took all comers.

That first afternoon, the back door creaked. The sound of footsteps came up the hallway. Jay swiveled his chair and saw a pair of glasses on a balding head peer around the doorframe. “I’m Dr. Joe Huffman. You’re the new obstetrician?” “That’s me.” They shook hands. He took a moment to look over the young doctor. “Have a seat,” said Jay. “Can’t stay . . . come to say hello, to welcome you to Clarkesville. When a new doctor comes to town, I pay him a visit.” “I was getting bored.” “I remember the feeling. I’ve been here over thirty years. I ought to quit.” He paused, pursed his lips. “My temper’s gettin’ short . . . I work mornings, fish in the afternoons. If I didn’t fish, I’d go crazy.” “Glad you came by.” “How about I drive you around the town . . . give you a tour before I go fishin’?” “It’s a deal.” Joe’s hair was thin and sandy red. He had a fair complexion; his hands and face were plastered with age spots, the kind farmers and sailors get from being out in

the sun. “I remember when I first opened up. It was so slow I could

hardly

feed

my

family.

Now

I

got

too

damn

many

patients.” “I’ll be back in an hour,” Jay told his nurse as he followed Joe out the door. They climbed into his two-door blue

Buick.

As

Joe

drove,

Jay

noticed

his

faded

short-

sleeved shirt with a frayed collar, beige slacks, and brown penny loafers. “I want you to see my office,” Joe said. “That will tell you more about me than any words. Patience isn’t one of my virtues.

You’ll find that out.”

His speech was curt, matter-of-fact, and without extras. On the way he pointed out other doctors’ offices, telling Jay how long each had been in town. He never spoke about anything personal. “I enjoy delivering babies. Been doin’ it for a long time.” “How many have you delivered?” “Lost count . . . thousands I guess. I’ll send you some.” No fancy words, just short statements. He pulled up in front of a wooden building, which looked ten feet wide and thirty feet long. It needed a paint job.

“Here’s my office. I always park in the back. The outer waiting room is unlocked so patients don’t have to stand outside when it’s raining or snowing. It’s first come, first served. I take care of the north-end folks; they’re mostly poor, no insurance.” Inside was a single exam room with a desk, a chair, a doctor’s scale, and an old-model exam table without table paper. Joe picked up six small glass syringes. “Here, take these. They can be re-sterilized. It’ll save you some money, help get you started.” He locked the door and pointed to his car. “I trade cars every two years . . . the same dealer. I always get a blue Buick, standard shift, no radio, no air.

I don’t want my patients to think I’m rich.

My buddies say I’m a frugal old bastard, maybe I am, but I’ve never been robbed. It’s better you don’t look too good nor talk too wise.” Joe sounded like Jay’s father. The only thing Joe said on the way back was “If there’s anything I can do to help you, let me know.” End of conversation. “Thanks for the tour and the syringes. I hope the fish are bitin’.” Joe drove away, windows down, with rod and reel in the back seat. Jay asked his nurse about Joe. She said his

wife died suddenly ten years ago.

On the advice of several physicians, Jay went to visit Lou, a recently established physician, whose office was on the second floor of a new bank building.

The

waiting room was standing room only. Jay heard Lou say, “Just take the pills once a day. I’ll check your pressure in two weeks. And don’t stop fishin’, OK?” Lou completely filled his heavily starched white coat. He had no neck; his balding head attached directly to his shoulders, his smile as wide as his face. His jowls bounced when he walked, vibrated when he talked. He mixed metaphors, desecrated verbs, and his syntax and grammar were absent. “Glad you come. How can I help?” asked Lou. “Some of the docs told me see you, get advice on how to get my practice kick-started.” Lou leaned forward. “Tell yah a secret. I was a sales long before I got into medicine, developed people skills. Get yourself a pack of business cards, ride the circuit, say hello to every one of them outlying doctors. There’s a bunch of ’em; shake their hands, tell ’em who you are . . . sit and visit. I told each one of ’em, if they send me any of their patients on referral, they’d get ’em back. I won’t

steal their patients. My waiting room started fillin’ up fast.”

He pulled out a glass vial filled with red liquid.

“This here’s B12, make sure you give shots . . . B12 and penicillin . . . folks believe in ’em.” “Thanks, Lou,” said Jay. “One more thing, at Christmas I send my referring doctors a real nice present, and candy for their nurses. Be available when your patients go into labor. Now be sure and tell your pretty wife, I’ll deliver your next newborn free.” He laughed, shook Jay’s hand, and disappeared into an exam room. The receptionist laughed. “Lou hasn’t delivered a baby since he was an intern at Wishard Hospital in Indianapolis.” Jay took Lou’s advise and visited all the outlying physicians, shook their hands, and slipped his business cards under the glass tops of their desks.

Jay and his family settled in. It took less than two minutes for Ann and Jay to tie the knot before a justice of the peace. Nosey neighbors asked questions. On evening rounds, nurses peered out to see what Ann looked like and count the number of children in the car eating Dilly Bars. It was late summer, and calliope music filled the

evening air, along with the odors of fried corny dogs. Neon lights from a Ferris wheel and a tilt-a-whirl moved across the sky. The OB department paged him. They had admitted a welltattooed walk-in patient from the carnival. She was starting labor and needed her fourth cesarean section. Her blood count was half what it should be and matched her cotton-candy complexion. She was a pica eater, a person who craved and ate dirt and munched on Argo starch. She received two blood transfusions before the anesthesiologist would agree to giving her an anesthetic. Two days after her cesarean, she held her newborn against her stapled incision and signed out against medical advice, saying, “I gotta catch up with the carni.” An OB nurse told Jay, “We called Quincy first. He said to page you because you needed the experience; after all, you had passed your boards.” It confirmed what Bill had told him about professional jealousy.

Jay needed income. Each morning, he checked with the OR supervisor to see if any of the surgeons needed an assistant. “Dr. Atwell, our eldest surgeon wants some help on a hernia repair,” said Derek. “It might be an interesting

scrub.” The gray-haired surgeon owned the baby blue Cadillac. His dress was dapper—bow tie, brown-and-white spectator shoes, and a coy smile behind a neatly trimmed white mustache. He resembled affluent characters in F. Scott Fitzgerald’s novel The Great Gatsby. According to Derek, the surgeon flirted with every skirt, especially the operating-room technicians. He had emphysema and sometimes became so short of breath he needed extra oxygen. He kept a spare oxygen tank in his locker. During the surgical repair, the elderly surgeon kept up a spirited sexual repartee with a buxom instrument technician, who rested the tips of her breasts on an instrument stand. His persistent chitchat bubbled with sexual innuendo. Navy protocol prohibited such chatter. Jay had witnessed Ellen Jones stop inappropriate talk in its tracks. The surgeon asked the buxom technician if she would go out with him. Finally, he asked if he could have sex with her. In a soft but audible voice, she coyly answered. “Oh Doctor, you know I’d like to. I really would, but it could be a problem.” “Why would it be a problem, sweetheart?”

“Well, Doctor, it’s this way. I know how experienced you are, but have you ever tried to shove a wet noodle up a wild cat’s ass?” The room went silent except for the grinding of the surgeon’s false teeth. As soon as the last suture was in place and tied, the elderly surgeon ripped off his gloves and stalked out of the operating room muttering profanities. The anesthesiologist filled in the rest of the story. “It’s like this. A woman learned about the surgeon’s escapades and called the surgeon’s wife to complain. She asked the surgeon’s wife if she knew about his escapades. To her credit, the wife answered, ‘Yes, honey, I know all about them. He’s been doing it for years. Don’t worry; he’ll get around to you sooner or later.’” The OR girls released small bursts of giggles. Jay saw them wink and smile at each other after they had flipped down their masks. There was no grievance committee, no referral to the human relations department, nor incident reports. One OR tech whispered, “If the old fart ever got a good blow job, he would probably keel over dead.”

Jay’s daily practice was an assortment of women, men, and children while he waited for his obstetrical practice

to mature. His black medical bag came in handy for house calls. Someday he would show it to his grandchildren. Within six months, his afternoon office schedule was full, and new OBs were making appointments. Vivian Andrews arrived for an annual exam. “I’m a teacher at the college,” she announced, “and I’m ready to start a family.” She was twenty-eight, wore no jewelry except a wedding band, and smiled through minimal makeup. “When I get pregnant I want to do it right,” she said. “I want natural child birth, and I don’t want a cesarean . . . none of my family ever needed one.” Jay had heard those words before. He fielded all of her questions and left time for discussion. “I’ll be back pregnant,” she signaled. Jay overheard his office staff giving their unsolicited opinions. “Something about her is unsettling,” said Maria. “For one thing, if she’s a teacher at the university, she can afford to look better,” said his receptionist.“Her dress came right off Kmart’s sale rack. Some of the brainy ones like the plain look. I call it frumpy.” “Did you see her hair? What she needs is a haircut. I don’t know how you can be so damn sweet to some of your

patients,” added Maria. “We see some strange ones,” Jay replied noncommittally. “Strange isn’t the right word, Doc. Some are off the curve.” It was football season, and the hard maple trees had turned red and yellow. On weekends, Jay was the emergency room’s doc-in-the-box. He hung out there, sutured lacerations, and set simple fractures. Sports-minded physicians traveled out of town and tailgated in stadium parking lots, unconcerned about coverage. It wasn’t long before Jay learned that he had upset several local doctors when he instructed parents to bring their child back to his own office for suture removal. Under past board-game rules, the patient always returned to the original doctor. Do not pass go! He had unknowingly violated ground rules in their Monopoly game. “I gotta talk to yah.” Joe Huffman chuckled as he drew Jay aside. “Several of my buddies, especially my old friend—the Jock Doc—are upset with yah.” “Why’s that?” asked Jay. “They think you’re stealing their patients.” “Are they worried about the patients I suture up in the ER?” “Yes. All of us have more patients than we can see. We

can’t live long enough to see all of them every time they call. You shouldn’t worry one damn bit.

Anytime you suture

up someone in the ER, you go right ahead just like you’ve been doing and tell them to come back to your office for suture removal. It’s the right thing to do. We haven’t had any competition for years, and my old friend is feeling a little insecure. He’s worried about his pocketbook, and he’s already got enough money. Don’t worry, I’m goin’ fishin’.” Joe walked off laughing. Local doctors shucked off many of their no-pay patients, sent them over to Jay. Jay had several thousand dollars worth of uncollectables. He sought advice from his attorney, who told him to come in for consultation and bring along the patient’s ledger cards. In his attorney’s office, he met a burly man who described himself as being in the “sporting” business. The attorney explained that the man was the local bookie, the one man in town who knew who was good for money.

The bookie quickly went through the

stack of ledger cards like a card dealer at a casino and made two stacks: one small stack to give to the collectors and one large stack, which were uncollectible.

Chapter Thirteen Competition

Quincy was jovial Monday morning as he made his rounds, dressed in his best Western attire and bragging about his horses and the ribbons they had won that weekend. He chatted with each new mother Jay had delivered in his absence.

Two of the mothers were socialites, who shared

the same hospital room. They voiced their irritation with him for being out of town when they delivered; then both told him how very satisfied they were with Dr. Atwell’s nurturing care. The nurse spotted Quincy’s frustration; his smile turned into a smirk. It brought back feelings he’d had when he was a junior partner, when he wasn’t in total control. He stopped talking, his face flushed, and his jaw tightened. He cut short his rounds, left the OB ward, and marched into the doctors’ lounge. The OR nurses and technicians were gathered at the OR supervisor’s desk receiving their daily assignments. They

spotted Derek hightailing out of the doctors’ lounge toward the supervisor’s desk. Derek whispered to the others, “Didn’t you hear the noise? It was spooky. Dr. Sadler kicked the hell out of his locker.” “We wondered what the ruckus was about,” said the supervisor. Derek

demonstrated

how

Quincy

repeatedly

kicked

the

locker while muttering, “Goddamn it. Atwell’s makin’ a name for himself, and he’s doing it with my patients! That’s what I get for inviting the young SOB into town.” The supervisor sighed, shook her head. “Oh my god, here we go again, and it’s only Monday.” “He’s hot all right, steamed up like a Brahma bull ready to charge, smoke coming out of each nostril,” said Derek, who put his own personal spin on the event, mocking Dr. Q by holding his index fingers alongside his lowered head, pretending to be a bull. “It’s predictable,” said an older nurse who shrugged her shoulders. “Most of us know he’ll blow sooner or later,” said another. “Yeah,” said another. “Like déjà vu. start to bad-mouth the young doctor.”

Next, he’ll

“Oh, be nice.

He’s not so bad,” said another nurse.

The nurses knew Dr. Sadler was a fine doctor, knew he could be a sweet guy. But they also knew he had a mean streak and reverted to character assassination to get even for his own insecurities. “I’d hate to see him start a hate campaign like he did against his former partner,” said the supervisor. “Yeah, let’s hope he doesn’t do it to Dr. Atwell too.” “You can’t be out of town as much as he is and expect your OB patients to be thrilled when you’re not available for their deliveries,” said another. “I’m going to go scrub up for my case,” said an OR tech. Derek walked back up the hallway and peeked into the lounge; saw the huge dent in the midsection of Quincy’s locker; saw Quincy sitting quietly, alone in the lounge, staring straight ahead, talking to the other doctors as if nothing had happened. Quincy interpreted the event as a wake-up call. In the past, if one of the local family docs caught a baby when he was

absent,

it

hadn’t

been

a

big

problem;

his

patient

always returned to him. Quincy saw Jay as his adversary. Quincy snuffed out his cigarette and walked out into the main OR hallway wearing a wide smile, looking as if the

morning had been routine.

The staff knew he could change

colors faster than a chameleon. “Good morning, ladies,” said Quincy. He greeted them warmly, as if nothing had happened, and walked toward the scrub sink. In a moment’s time, Quincy had calmly made up his mind to cut Jay loose. From now on, he would check out only buddies who couldn’t pose a threat. The OR supervisor smiled and said, “Good morning, Doctor.”

Chapter Fourteen Vivian’s First Pregnancy

Three young women had just finished settling their accounts at the front desk. When they checked in, they told the receptionist Maggie had referred them. They said, “Our employer wants to be sure we’re clean, healthy. Food service told us we need a slip stating we were free of disease.” On the way out the door, one of the girls said, “Thanks, Doctor. we’ll be coming back with some of our friends.” Jay’s office nurse smirked. “They sure looked healthy to me. They’re all busting out of their bras.” She winked at the doctor. “They needed a pelvic, a pap test, a test for

syphilis, and a prescription for birth control,” Jay replied. “How’d they get referred up here to you, Doc?” asked Maria. “Those gals work at a Heart and Soul Club in Evansborough.” “That’s classified information,” replied Jay. “Did you notice that all three listed Mennonite as their religion? Does the word rumspringa mean anything?” “No.” “It’s a Pennsylvania Dutch word. It refers to the time given to young Mennonites teenagers to cut loose before they come back home and decide if they wish to be baptized into the Mennonite faith. They’re vulnerable during this time. Maggie is Mennonite. She helps manage the club and understands their need to be protected, takes them under her wing.” His staff looked puzzled. Jay had checked each one and given each a note that stated, “This person is free of communicable disease and OK to work.” He also gave each of them a prescription for birth-control pills and the address of the nearest Planned Parenthood affiliate. His nurse showed him the results of a pregnancy test. It belonged to Vivian, and it was positive. When he looked up, his eyes met those of Vivian’s.

“We did it!” she said, sporting a wide grin. “Congratulations,” said Jay. Maria took Vivian into an exam room, filled out lab slips, and gave her a new prenatal appointment. In the next exam room were two seventeen-year-old girls. “We both want to start birth-control pills. I need them because I’m having sex, and my friend wants to take them to make her boobs bigger.” “I don’t have any problem prescribing pills if you’re sexually active, but not for breast enlargement.” Her friend quickly said, “I’m active too.” They had their exams; watched a movie on contraception, STDs, the use of condoms; and received a prescription for birth-control pills. Word spread to the college campus that Jay prescribed pills, and he volunteered at the local Planned Parenthood. Young men came to be tested, and they received a supply of condoms. Jay hired an extra part-time nurse to help with the busy afternoon schedule. His home phone was so busy he ordered a private line for his wife and a separate line for the girls.

Jay was in the doctors’ lounge sipping coffee, reading the morning paper and waiting for an early morning delivery, when Bill Van Buren entered. “Jay, can you help me with a case?” “Sure. What’s up?” “A guy brought his lover into the ER. The nurse said he laid him on the gurney, kissed him, and left to go have a seat. They found him in the waiting room, huddled up in a corner, crying.” “What’s wrong with your patient?” “He’s got a vibrator stuck up his ass . . . in so far his friend couldn’t pull it out, and it’s still vibrating.” He chuckled. “The two run a gift shop here in town. Maggie shops there when she needs a quality gift.” “Is anesthesia comin’?” “No. With your help, I think I can extract it. The nurse can give him some of the Trilene gas you guys use for deliveries. You can retract. We’ll do it like with a breech delivery.” Bill quickly removed the ten-inch vibrator. “Are you keeping him overnight?” asked Jay. “No, I’ll give him a prescription for cortisone rectal suppositories. He’ll like that.”

Vivian’s pregnancy was textbook normal. She read all the expectant motherhood books, was a model patient, and delivered a healthy son uneventfully with Steve by her side and the grandparents asleep in the waiting room.

Jay’s nurse knocked harder than usual on the exam door and cracked it open. “It’s labor and delivery. Josh Roark needs your help immediately. The nurse on the phone sounded frantic. He’s in trouble with a breech. They want you pronto.” Jay ran out the back door across the parking lot and took a shortcut up the back stairway to the delivery area. Total distance: two hundred yards. Only two things can go wrong with breech births, and both were bad: either a prolapsed umbilical cord or a trapped head. He hurriedly passed a group of women, noses pressed against the small windows of the delivery-room door. “Do what you can, Doctor,” whispered one woman. He grabbed a cotton mask and scrub hat, pushed open the inner door, and saw eyes of heartbreak and despair. Then he saw the limp body of a newborn baby, everything visible, except it’s head. It was stuck in the young woman’s pelvis, the torso of the baby lay over Josh’s forearm. The odor of Trilene gas saturated the room.

The baby appeared full-

term. Josh held its lifeless body with his right arm. The room was quiet. An anxious nurse spoke to the anxious mother, “The OB man’s here. He’ll help you.” The exhausted mother lay with her legs up in stirrups. Their eyes met. He nodded. She tried to smile. He put on a gown and gloves. “I can’t get the head out,” said a worried Josh. “I’ve tried every maneuver I know. It’s been over fifteen minutes, the baby’s gone. I called for an anesthesiologist— he’s in the middle of a case. I even tried piper forceps.” Why hadn’t the baby’s head followed through? Jay knew the mechanics of breech delivery. “By now the infant’s head is too deflexed from pulling down,” he explained to Josh. “Slip your middle and index finger over the babys’ cheek bone, just below the eye sockets, right next to the nose; try to push the baby’s head toward its chest. That way we can get the smallest head diameter through the inlet. Hook two fingers of your other hand over the baby’s shoulders for some gentle traction downward. I’ll stay on her belly and try to flex the babys’ head and push it through the inlet of the pelvis at the same time, OK?” “OK, I’m ready.” “Nurse, have the young lady take ten very deep breaths

of the Trilene.” They waited as the nurse held the mask over the patient’s nose and mouth. They counted to ten. “Start now,” said Jay. The patient was still in pain but permitted their maneuvers. “I think it’s coming down . . . very slowly . . . yes I can feel it coming,” Josh reported. Suddenly the babys’ head popped out, and Jay recognized it was hydrocephalic. Its enlarged head had hung up in the birth canal.

There wasn’t anything Josh could

have done differently. Jay cut the cord, swaddled the baby for the mother to hold as soon as she awakened. “Thank you,” groaned the patient, unaware that the baby was abnormal.

Josh delivered the placenta. Pitocin

was injected to help the exhausted uterus contract. The patient held her lifeless baby, covered it with kisses.

Nurses held her closely as she sobbed.

“Your baby couldn’t come out because its head is larger than normal,” said Josh. “Is that what they call a waterhead baby?” “Yes, and it isn’t your fault.” One of the nurses baptized the infant. Jay stayed in the background, wrote a consultation note to explain what part he played in the delivery.

Jay and Josh went into the OB lounge. “Thanks, I appreciate you’re bailing me out,” said Josh. “Delivering a hydrocephalic breech vaginally is next to impossible. We’re lucky we didn’t have to do a destructive procedure and drain spinal fluid off the brain.” “Have you done that?” “Unfortunately, yes. It won’t be long before all breeches are delivered by cesarean section because of the increased risk.” “After today, I’m sending all my breeches to you. One thing’s sure: my old man was right again. He practices out in the country, east of here. He talked to one of your old navy buddies, a retired commander.

The guy told Dad you

were one hell of an obstetrician, that you’d saved his wife’s life, something about a ruptured uterus.

Is that a

true story, or did my dad make it up?” “It’s a small world.

I’ll tell you the story

sometime.” “Thanks for helping me out. I won’t forget.”

Josh

pulled on his cowboy boots and Western hat and went home to feed his cattle.

Chapter Fifteen Settling In

All the staff doctors who delivered babies crowded into a third-floor conference room to attend the required monthly obstetrical meeting. The meeting was a step back in time, like entering Sleepy Hollow in Rip Van Winkle. Anything related to obstetrics was coincidental. Once inside, someone clicked the remote control to the Sports Channel. The Jock Doc played self-appointed analyst

and gave statistics, shooting percentages of the high school basketball games. “How much money did yah loose, Joe?” he snorted. “Not a red cent. Besides you still owe me from last year, you cheapskate.” “You’re a sore loser, chafed because we whipped the heck out of your pretty little city boys in the finals last year,” answered the Jock Doc. “Just ’cause my nephew was high man, don’t take it so personal. Your nurse was happy. She’s from out in the sticks. She’s related to me you know.” “That’s her problem. When you goin’ to pay up?” Their banter was good-natured and entertaining. They chuckled, poked fun, and debated the pros and cons of Bobby Knight—the new IU basketball coach—and how they might get seats for home games. For a moment, they changed channels. “How many babies were born last month, Lauren?” “Fifteen, no cesarean sections.” Quincy continued to talk about his horses, Joe about fishing, and the Jock Doc about sports. They laughed at each other’s jokes, and the meeting ended when the donuts disappeared. When the family physicians started to leave, someone said, “Dr. Atwell, we’re happy you’re here on the staff.” There was no educational program, no case report, or

any mention of in-service training for the OB nurses.

At the following meeting, Jay asked a question. “Does the hospital have any destructive instruments?” The doctors looked at each other and shrugged their shoulders. “They’re only necessary in emergencies to decompress a baby’s oversized waterhead so it can be delivered vaginally,” said Jay. “By now you’ve all know about the hydrocephalic breech Josh had last month. If the head had been any bigger, we’d have been in trouble.” “I saw a hydrocephalic when I was a student,” said the Jock Doc. “The senior resident thrust the biggest needle I’d ever seen straight into a baby’s skull. He drained all the water off. He finally had to crush the baby’s skull to get it delivered . . . it just about puked my guts.” “I haven’t seen those instruments since I started ten years ago,” said Quincy. “I’ve never seen them,” said Lauren. “They should be wrapped up and labeled,” said Jay. “They’ve never been used as far as I know,” said Quincy. After the meeting, Lauren and Jay discovered the

instruments in the delivery room, tucked away in the back of a drawer, unlabeled. “Get them re-sterilized and labeled,” demanded Jay. “I hope they’re never used,” said Lauren. “Are you Catholic?” “Yes.” “They’re important, just in case.”

Six months later, Jay questioned the hospital’s bylaws on sterilization.

He and Quincy agreed the bylaws were

passé and needed revision. Quincy spoke first, “The people that passed our sterilization rules are so old they must all be dead by now. The present rules say that if a woman is twenty-five years old and wants to be sterilized, she must have five children; if she’s thirty, she has to have three children; and if she’s forty, she has to have two children. That’s more than a little behind the times.” The room was quiet. Jay spoke up, “At my last duty station, there was a Catholic mother of six, who intentionally drowned herself because of being forced to have unwanted children.” Lauren cringed.

“Women should be permitted to have sterilization whenever they request it, just like men,” said Josh. “I agree,” added Quincy. Eyebrows were raised; shoulders stiffened. Then Mr. Lehman said, “I’ll have to call the hospital attorney . . . get a legal opinion.” “Send him a copy of these,” said Jay. “They’re the latest guidelines from the American College of Obstetricians and Gynecologists.” He slid a copy across the table. “Over at the Mount Cross Hospital, the doctors have to fabricate a diagnosis to sterilize women. Even then, the woman has to have a hysterectomy in order to prevent pregnancy—that’s abusive. It makes women second-class citizens.” “You’re correct,” said Dr. Fred Harrison. “I tie women’s tubes whenever I can.” “While we’re on the subject of sterilization, I have a question to ask,” said Jay. “Do ministers and priests have carte blanche privileges to waltz through our hospital, day or night, walk into any patient’s room and pontificate their value systems?” “I’m sure there’s nothing in writing,” said Reggie. “Last week,” continued Jay, “I made evening rounds and found one of my patients sobbing her heart out.

She had

delivered her third child and had a postpartum tubal ligation. I checked over the nurse’s notes, asked her what was wrong.

Between sobs, the patient told me a Catholic

priest—a man she didn’t even know—came to her room and asked how she was doing. My patient is not even Catholic. She told him she had a beautiful new baby and had just had surgery so as not to have more children.

The priest

promptly scolded her, reprimanding her for having the sterilization.

Then he told her, ‘You shouldn’t have been

sterilized. It’s against God’s tenets, and God will surely send you to hell and damnation.’” “Reggie, you had better have a talk with all the priests,” said Fred. “That’s unconscionable, disgusting.” “I told Reggie and the hospital chaplain I never want a Catholic priest to ever make rounds on any of my patients again,” said Jay. “Some are pedophiles,” said Josh. “I don’t want ’em making rounds on my patients either.” “I’ve delivered lots of babies and done lots of cesareans. It’s about time we update our sterilization policy,” said Fred. “There’s no reason why women shouldn’t have the same rights as men. The churches preach they’re against abortions.

Frankly, I am in favor of legalized

abortion, and I’ll probably catch hell for saying so.

The

hospital should permit sterilization anytime a woman wants it.” Jay handed out copies of national guidelines that supported a policy for women to have a sterilization procedure anytime they wanted it. The meeting adjourned.

Each year brought more technology and new concepts. Some ideas were easy to understand, but some required a longer learning curve. Each spring Jay returned from his annual meeting with new information for the nurses. He encouraged Lauren to schedule in-service training and told administration they needed to provide continual medical education for the OB nursing staff. He informed administration that women were coming to his office requesting VBAC births and that the hospital should have a training program on how to identify and treat OB emergencies, especially seizures, hemorrhage, and complications of VBAC, such as a ruptured uterus. He handed out new national guidelines that all OB units should be able to perform emergency cesareans within thirty minutes. Most of the OB nurses were well trained, experienced, and willing to learn, but some were content to pass any free time thumbing through Avon and Tupperware catalogs, balancing their check books, and waiting for the change of

shift.

The only time Jay heard from Sally was when she needed money for Tom. He visited each summer, wanted to make money, and like other young boys, found his way into the melon fields. The farm owner drove the tractor while young field hands picked up the ripe cantaloupe and loaded them onto a flatbed trailer. Tom was happy. He returned home with a wad of dollar bills big enough to choke a horse. Alexis and Kate attracted eager young men. Jay installed a private phone line for the girls, and the driveway resembled a used-car lot. Boyfriends ran their cars over the driveway light posts and lawn sprinklers faster than he could replace them. Riding horses taught Alexis and Kate to handle the larger two-legged steeds. Ann worked full-time at the mental health center, shopped, fed the multitudes, and altered prom dresses. Jay handled the photo ops in front of the fireplace, arranged baseball trips to Bush Stadium in St. Louis, and shopped trips for school clothes.

Chapter Sixteen For Better or Worse

Jay felt on cloud nine, had a twinkle in his eye, and a spring in his step just thinking about how lucky he was to be married to Ann. Ten years had slipped by, their wedding anniversary only three days away. Ann gave permission for both girls to attend a weekend sleepover. Ann and Jay headed out the driveway to the only restaurant in town that furnished dinner music. They giggled as the pianist led off with his personal version of “Claire de Lune.” It was always the same. He always added glissandos, which would have made Debussy shutter. They emptied two bottles of Pinot Grigio during their

entrée. The pianist left, and a three-piece combo started playing dance music. Ann was radiant, content, and secure. He held her hand and read her a love poem he had scribbled on a blank prescription. Then he gave her a diamond tennis bracelet. They danced all evening and only left for home when the combo quit for the night. At home, she slipped into her new negligee. Jay liked seeing her full breasts, enjoyed touching and kissing them. He felt manly as he snuggled close to her, whispered to her how in love he was and how beautiful she looked. He kissed her longingly and passionately, held her in his arms. His erection perfectly timed, they began to make love. Ann was receptive, everything perfect—until the phone rang. Jay tuned it out as he climaxed. Predictably, the phone stopped after the seventh ring. With a half-satisfied but resigned smile, Ann told Jay to call the answering service, see if they had picked up a message. “It’s not like we haven’t been interrupted before,” she groaned. “I’m sorry,” said Jay. “You’d think we could have sex on our anniversary without somebody calling.” “I should be used to it, but I’m not,” Ann sniffled. Jay called the service. The emergency room needed him. “Shit, it’s the ER; I’m on backup call.”

He dialed just as Ann started crying. She headed for the bathroom and slammed the door. “Damn it anyway,” Jay muttered. The ER nurse gave him the bad news. “Honey, I got to go. They got a teenager. They think she has a pregnancy in her tube. She’s in shock. It can’t wait.” “Why couldn’t they call Quincy or a general surgeon?” “They tried, couldn’t find either one.” “Just go on, Jay. I don’t like it; I never will. We have no time alone. I’ll never get used to it. Shit.” He heard glass breaking. “I’ll be here when you get back, but I may be drunk.” “I love you, Ann.” He heard her sobbing as he walked through the house toward the garage. By the time Jay had stabilized the young girl’s blood pressure and removed her bleeding fallopian tube, it was 2:00

AM.

Ann’s car wasn’t in the garage when Jay arrived home. She’d taken midnight drives before, sometimes to their office, sometimes down Main Street to look in the store windows of the women’s dress shops. She always came home. He sat at the kitchen table and waited. Finally, her headlights flashed up the driveway. She parked, walked into

the kitchen. “How is she?” asked Ann. “Stable after three units of blood, but she’ll never have any children. She’d blown out a tube with the pregnancy, it had to be removed, and the other tube was totally blocked with infection, probably from gonorrhea.” “I’m proud of you, Jay. Glad it wasn’t one of our girls. Who was the girl? Did you know her?” “She’s the youngest daughter of the editor of our newspaper, home for the weekend from Purdue. Her mother and father were devastated. They didn’t know she was pregnant. She hadn’t told anybody.” “And I thought I had problems,” sighed Ann. “I guess it’s too late to get drunk,” joked Jay. “I’ll drink to that,” said Ann. Both cried so hard they laughed. They held each other for several minutes. “Let’s just go cuddle,” Ann remarked. “I got an idea,” said Jay. “Why don’t we schedule a three-week vacation, disappear out of town to some exotic island, leave the kids with relatives, and give no forwarding telephone number?” “We still have time before the sun comes up.”

Chapter Seventeen Dropping out of OB

Family practice physicians began to drop out of delivering babies. The reason was economics. Their main income came from office visits and hospitalized patients. Spending time out of the office wasn’t profitable. Besides, all branches of medicine were becoming specialized. Jay received calls from nurses and family doctors when

they were in trouble. The phone rang at 4:00

AM.

“This is the OB nurse. Dr. Huffman wants you to come in and do a stat cesarean. He’s already called the OR crew and anesthesia.” “I’ll be right in,” sighed Jay. Joe was seventy years old and when he made up his mind it was final. His fuse was short and grew shorter with each year. One of Joe’s patients was overdue. He had induced her labor and became impatient when she didn’t dilate up fast enough to suit him. He broke her bag of waters. The baby’s hand and arm came out through the vagina. He hadn’t realized the baby was lying crossways. An emergency cesarean was mandatory. Joe had broken a cardinal rule. After the cesarean, Jay questioned Joe and talked to him about what had happened.

Joe realized his actions had

caused the problem. His face flushed, matched his red hair, and he stomped off. Joe hung on, delivering babies into his late seventies. He quit only after his arthritic hands prevented him from suturing or assisting at surgery. He continued to fish but rarely came around the hospital.

In the middle of office hours, the phone rang.

“It’s Josh. I think you’d better come over to OB.” “What’s going on?” “The delivery-room nurse asked me to call you. Dr. Shell is in trouble and doesn’t know it.” I’ll be right over,” said Jay. Jay ran to OB and recommended an immediate cesarean. Dr. Shell was ready for help. He had repeatedly attempted a midforceps delivery—without success. According to the nurse, he had applied the forceps several times and pulled on the baby’s head until the baby’s scalp had lacerations, which required stitches. The nurse said he didn’t know when to quit, didn’t know when to call for help, and didn’t have the technical skills to do obstetrics. Josh had convinced Dr. Shell to call for Jay. After the emergency cesarean, Dr. Shell was grateful, taken aside by his peers, and admitted he should stop delivering babies.

Alexis and Kate zipped out the driveway to college. Jay had taught them the value of Walgreen’s low prices. Each month Jay received his monthly medical bill from Walgreens. The pharmacists knew both girls by name. When they shopped for cosmetics, cotton balls, and small appliances, the pharmacist lumped all their purchases under the category of medical supplies. They would smile, sign

their names, and Jay would receive the bill. He complained to Ann. She reminded him, “Well, you taught them well. You always told them if they couldn’t find it at Walgreens, they don’t need it. Apparently, they found it.” Alexis and Kate finished college, became engaged, and Jay walked them down the marriage aisle.

Chapter Eighteen Don’t Take It Personally, Doctor

It was a late Friday afternoon in June. All the trees had budded out, and the air was fresh and clean. Jay’s office nurse knocked on his private door. “Dr. Atwell, there’s a sheriff in the waiting room; he wants to talk to you.” Jay walked up to the receptionist area and opened the

sliding glass window. “What can I do for you, Sheriff?” “I’m here to deliver this subpoena. Sorry, Doctor, I hate this part of my job.” Jay took the envelope, noted the return address: the Indiana Department of Professional Regulation. He walked slowly back to his office, shut the door, took a deep breath, and slowly opened the envelope. The one thing every obstetrician fears most had happened. His heart sank as he read the first few lines. Blood drained from his body, and his pulse quickened. There it was in black and white: Dr. Jay Atwell, MD, named as a defendant in a malpractice suit. The complaint and summons were formal. They spelled out the names of the plaintiffs, including the names of the child’s parents, and the negligence claimed. He ran his hand through his hair, now sprinkled with gray. It was his first malpractice suit. He called his office staff together. “I’ve just been sued. It’s about the baby I delivered five years ago. I’ll need a few minutes alone.” “Take your time. There are only two patients left.” The baby had been born vaginally, appeared normal at birth, but later found to be mentally retarded.

Most

juries assigned total responsibility to the delivering physician. Juries bought into the philosophy that the delivering physician was captain of the ship and what ever happened was his responsibility. Juries were sympathetic toward any retarded child, believed that the obstetrician must have done something wrong, and they awarded huge settlements to the retarded child. He worried about Ann, how she would feel. After he composed himself, he finished seeing the last two patients and told his staff to lock the front door, turn off the lights, and go home. “We’re sorry, Doctor,” said his staff. “It’s so unfair, and we know you weren’t responsible for the child’s condition.” After his staff had gone, Jay stayed at his desk and read through the entire complaint several times. Then he called Ann. “There’s no easy way to say this. I got sued today.” Ann was quiet for a moment. “I’m so sorry, Jay. I don’t know what to say.” “The lawsuit names me as the defendant in the case of the young child I delivered who developed a neurological problem similar to cerebral palsy.” “I’m always been thankful my girls were normal,” said Ann.

“I hoped I’d never get sued, but I guess I should have expected it.” “I remember the alcoholic surgeon at Patuxent River. He said you’d be sued,” said Ann. “The public equates any bad result as being malpractice.” “Try not to worry,” said Ann. “Yah, I know. I’m not supposed to take it personally. I do take it personally, and I don’t need anybody to tell me how I should feel.” “Tell me about the case,” said Ann. “The patient’s pregnancy and labor were normal. She requested and received a saddle block anesthetic. The delivery was easy—no forceps, and the Apgar scores of the baby were all normal, eight at one minute, and ten at five minutes. There was no negligence, yet I get nailed.” “Do they have a case?” “Sure they do. They have a retarded child to parade in front of the jury. The problem for me is in the nurses’ notes. If anyone’s liable, they are.” “How’s that.” “None of the nurses ever recorded the babies’ fetal heart rate while we were in the delivery room, before the saddle block, after the saddle block, or any time just

before she delivered. That’s a period of over twenty minutes. The legal issues are obvious.” “And?” “The law says, ‘If it wasn’t written down, it didn’t happen.’ The second issue is the ‘captain of the ship’ philosophy.” “What do you mean?” “The delivering physician is known as ‘the captain of the ship.’ He’s responsible for anything and everything, even what the nurses do or don’t do. If anything goes wrong, the courts hold the doctor responsible. The doctor has full responsibility without full authority.” “Who reviews nursing notes?” “There’s no chart review for them, only for doctors.” “Jay, I’ll have supper ready.” Driving home, he thought about the expert speakers he had heard at the spring meeting. Six insurance company representatives had warned obstetricians that malpractice premiums were about to skyrocket. They said that festering anger tinged with self-pity was the engine that fueled most malpractice cases. Lawyers capitalized on both.

Jay knew

medical experts on cerebral palsy had already shown the incidence of cerebral palsy was the same, year in and year out, even though the percentage of cesareans had increased

fivefold. Experts knew that even a long labor didn’t cause the problem in the majority of cases, but juries still blamed doctors and awarded blockbuster verdicts against them. Ann met him at the door with a glass of Zinfandel. Two weeks later, Bill showed up at Jay’s office. “Jay, I want to talk to you about the unthinkable, about your malpractice suit,” said Bill. “Let’s go have a beer at Woody’s. It’s only three blocks form here. I’ll drive.” “I’d love to unwind,” said Jay. “Hop in,” said Bill. Jay was quiet as they drove. They ordered two frosty drafts and began. “Nobody talks about their malpractice cases, especially about their feelings,” said Bill. “No, and I’ve got plenty of pent-up anger,” said Jay. “There aren’t any courses instructing us on how we should feel or how it affects the people around us. I got my first lawsuit about five years after I started practice. I’ve never really been the same since.” “I feel cynical, angry, and depressed,” admitted Jay. “I went ballistic,” admitted Bill. “I didn’t even know you’d been sued.”

“We’re told not to talk about it.” “That doesn’t solve anything.” “No. It does more harm. A lawsuit changes your psyche . . . it saps your human kindness. I got depressed, cynical as hell, angry, couldn’t sleep, and it showed.” “How did you wife handle it?” “Worse than I thought. One night after she had too much to drink, she asked me what I did wrong.” “Really?” “After that, I had trouble getting erections. She drank more; we didn’t talk . . . we were never close again. That’s about the time I met Maggie at the Club.” “None of the staff have said anything to me.” “They’ll stay away from the subject, or they’ll say they’re sorry, but they will assume you’ve done something wrong.” Bill explained how his referrals dropped off for several years. “My case hung on for six years. The suit was finally dropped for lack of evidence. If you want to spill your guts again, call me. We’ll go have a beer. Maggie knows how bitchy I got. I told her you were sued. She said I should talk to you.” “I’m glad you did.”

The attorney assigned to Jay’s case was a local attorney who practiced general law. The plaintiff’s attorneys were also local, had offices across the street from the courthouse. As the trial grew closer, Jay grew testy. Ann was quiet. He thought she had lost confidence in him. He felt alone. There was no communication from his attorney. None of his colleagues talked to him about the case. Jay’s attorney never called him to discuss the case, never returned Jay’s phone calls, nor did he give Jay any guidance on how to handle an upcoming deposition. Jay was furious when he finally discovered that his local attorney had not taken time to respond to the required interrogatories. Interrogatories are a series of written questions submitted by the plaintiff’s attorney that must be answered in writing, under oath, within a certain period of time.

The case was complex and involved a combined

malpractice suit against three parties: the anesthesiologist, the hospital, and Jay. Jay knew his local attorney lacked the experience to handle a malpractice case. Jay took charge, called the insurance company’s home office, and requested help.

Three

weeks before the trial, Jay was assigned an experienced trial attorney; it was too little, too late.

Ann read the records of the retarded child’s admission to a hospital. She discovered that a social worker had interviewed the child’s mother, who had stated she had received emotional support from her sister who also had a retarded child. Jay advised his new lawyer. He got a court order to have a sample of the child’s blood sent to Northwestern University for chromosome analysis. The report proved the retarded child had abnormal chromosomes. Without assistance, Jay researched the causes of mental retardation, then made posters that listed the causes of mental retardation, including pictures of normal and abnormal chromosomes. Experts had shown that 70 percent of all retardation originated during the pregnancy, before labor started. For the retardation to be caused during labor, certain criteria had to be met: evidence that the baby was born in a condition of metabolic acidosis, with very low Apgar scores; the child had to have a spastic quadriplegia; and no evidence of infectious or genetic disorder. In Jay’s case, the baby was not depressed at birth, had no quadriplegia, and no infectious component. Jay was prepared to defend himself. The trial started. Bill showed up each day and sat with Ann.

The first witness was the anesthesiologist. He looked and sounded frightened.

His attorney and insurance agent

knew they were vulnerable. The plaintiff’s attorney was ready to parade the retarded child in front of the jury when the judge called a recess. During a recess, the attorneys for the hospital and the anesthesiologist settled their liability. For Jay, it was too little, too late—a game of divide and conquer. The two settlements left Jay as the only remaining defendant. That only fueled the greed of the plaintiff’s attorneys. Jay’s insurance company was vulnerable for a large loss if the plaintiff won.

Even though Jay’s attorney believed Jay

might win the case, the home office advised them to settle the case. “Ann, I have no choice. I either have to take the advice of my lawyer and settle the case within the limits of my policy or go to trial. If I lose, the jury might award millions.

If the award exceeds the limits of my

insurance policy, I’ll be stuck with a huge debt. They could own our house, our practice, and future earnings for years to come.” “You don’t have a choice do you?” “Not really.” As they left the courthouse, he promised himself that

if there were a next time, he would take his chances with a jury and not let lawyers decide his fate. The experience had a profound effect on how he practiced medicine, his attitude toward the hospital, and the legal profession.

“What are you doing, Jay?” asked Ann. “Making a list of lawyers’ wives that are my patients.” “What for?” “I’m writing a letter to each of them.” “Why?” “I’m releasing them from my professional care. It’s my protest against the local scumbags who were supposed to defend me and who sued me.” “You won’t care for them anymore?” “That’s right.” “That’s harsh.” “It’s the only leverage I have. I’ll give each of them thirty days to find another physician.” “How many are your patients?” “I’ve delivered seven out of the twelve.” “They won’t be happy.” “I’m banking on that.”

Chapter Nineteen Roe vs. Wade

An earthquake struck the Clarkesville area and Jay was in the delivery room when it hit. He had just placed a newborn inside a metal bassinet and closed the lid. Hunks of the ceiling landed directly on top of the bassinet. The baby was safe and unharmed. The epicenter was in the Madrid fault near Cairo, Illinois, and did enough structural damage to prevent use of portions of the hospital. Within

eighteen months, a new hospital was completed and everyone that could was expected to help make the move into the new structure. Derek sounded hysterical when he called Jay. “The OR supervisor fired me because I couldn’t help with the move into the new facility.” He slipped into the back door of Jay’s office, his eyes bloodshot and his nose a beefy red.

Jay’s nurse

ushered him into an empty exam room and closed the door. Jay gave him time to tell his story and then called Bill. Together they talked to Derek. “I told the supervisor I couldn’t help with the move because I was already scheduled to work at the club that weekend,” Derek said. “What’d he say?” “He smirked . . . said if I didn’t show up to consider myself fired.” Bill shook his head. “Firing you is dumb.” “He’s been trying to get rid of me for years. Now he’s got an excuse,” said Derek. “I’ll have a talk with Reggie,” said Bill. “Reggie pops into the club now and then looking for his son.

I’ll

tell him to have some compassion. He knows better than to fire you.”

“God I hope,” sobbed Derek. “I need to ask you something,” inquired Bill. “Go ahead,” said Derek. “Are you and Lehman’s son still together?” “Not anymore. I don’t even know where he is.” “Did you know he’s in treatment?” said Bill. “No, what kind?” “Mental health issues.” “He’s got plenty of issues, the past sex abuse. He told me some priest did it to him.” “He’s doing well. Jay’s wife works in mental health. She’s one of his therapists.” Derek was finally able to pull himself together and leave the office. “I’ll call the club manager,” he said. “I just can’t go on tonight.” The hospital moved into its new digs, Derek kept his job, and the male OR supervisor never let on that his decision to fire Derek was overruled.

Ann received her master’s degree in social work, and her appointment book filled up quickly with referrals from medical professionals and by word of mouth. Clients included doctors and doctor’s wives, lawyers and their wives, and children.

Jay’s malpractice case left him with a bitter attitude. He pushed administration to schedule more education classes for OB nurses, courses on record keeping and documentation, and then he pressured the hospital Rules and Regulations Committee until their archaic policies on sterilization were liberalized to give women the same rights as men—that is, sterilization on demand. He learned laparoscopy (Band-Aid surgery) at Johns Hopkins University, purchased his own instruments, and performed female sterilizations on an outpatient basis.

Women flocked in

for the outpatient procedure, especially Catholic women from surrounding parishes. With only a Band-Aid over the small incision, their family priests were never the wiser.

Before Roe vs. Wade, Jay had referred two physician’s daughters to New York City for abortions. After the procedure became legal, Jay flew to Miami and took a course on how to perform abortions. The instructor of the threeday course said, “Remember all the women you told ‘you’ll never get pregnant because your cervix is too small’? Guess what? Those are the women who get pregnant, and those are the ones who request abortion.” The course included the easiest way to dilate the cervix. Jay learned how to use laminaria, a special brand

of Japanese seaweed. After it is dried and sterilized, it is placed inside the woman’s cervical canal twenty-four hours before the abortion. The seaweed absorbs water from the body and slowly enlarges the diameter of the cervix so that dilatation with instruments is unnecessary, eliminating the most painful part of the abortion procedure. Jay bought his own instruments and notified Reggie and Lauren he planned to do first-trimester abortions in the hospital operating room. The hospital attorney notified Reggie in writing that the hospital’s nursing service must provide assistance for the procedure. Then Derek called. “Doc, you gotta know this,” announced Derek. “What’s going on?” “Monsignor McCarthy is rooming around the hospital. He’s personally talking to everyone and anybody who works in either the ER or the OR.

It’s because you’re doing

abortions. He wanted to talk to me too. I just walked past the old fart, but I listened to what he was telling the OR girls.” “What’s he telling them?” asked Jay. “He’s telling them abortion is immoral, sinful, that they’ll all go to hell if they help you with the procedure.”

“Thanks, Derek. I’ll go talk to Reggie.” Jay’s pager went off. The voice said, “Call your office immediately.” Maria, his office nurse, answered. “Doctor, the front door of your office has been painted with ABORTIONIST in big red letters.” Jay felt goose bumps. The hair on his neck stood up and bristled. “Call the police, report the vandalism, then take a sheet, and cover it until I can get a painter. Let me know if there are any threats or suspicious phone calls. This morning someone fired bullets through the driver’s side of my car. It must have happened when I was up in OB last night. The police dug out the slugs. They’re supposed to watching my office. Ann’s upset. Someone tried to force her off the road on the way to the store yesterday. She reported the license number to the police.” Jay walked to Mr. Lehman’s office, fire in his eyes as he pushed through into the latter’s inner office. “Reggie, you know what Monsignor McCarthy is doing?” “Yes, it’s disgusting,” said Reggie. “He has no right to impose his will on hospital personnel. I demand he stop talking to hospital employees about abortion.” “Calm down, Jay.”

“Don’t give me orders. I’ll start legal action against him and the hospital it you don’t stop him. For your information, someone painted ABORTIONIST on the front door of my office.” “That’s terrible. What the priest is doing is wrong and illegal.” “Why didn’t Lauren stop him?” “She’s Catholic, you know.” He raised his eyebrows. “So what?” “She said she didn’t know what the priest was doing until after it was over.” “Sounds like bull to me,” said Jay. “All she does is hunker down in her office all day. I’ll start legal if it happens again,” threatened Jay.

He stormed out of Reggie’s

office. Publicly, the doctors were against abortion, but five or six doctors referred women to Jay for termination of pregnancy.

Even one of the town’s youngest priests called

and invited Jay to participate in a call-in radio show, which openly discussed the pros and cons of abortion. One caller threatened Jay if he didn’t stop doing abortions. A priest called Jay and wanted to send him a member of his flock for an abortion. Jay entered his office and slammed the door. “We’re

getting prank calls at home,” he said to his staff. “Ann’s angry as hell and worried sick. She thinks someone might try to kill her and the girls. The phone company has given us a number to call if we get any prank calls. They can trace everything. If you girls get any threatening calls, dial this number immediately. It signals the phone company to trace the call.” “It’s probably the Right to Life loonies or some selfrighteous Catholics,” said Maria.

Two weeks later, Jay was a panelist at a town hall debate. In front of the town’s five hundred people, Monsignor McCarthy took Jay to task for his liberal views. From the podium and in front of the full auditorium, Jay admonished the monsignor, “I find it incongruous that I recently received a phone call from a local priest who wanted me to perform an abortion on one of his parishioners.” Because the ER nurses refused to help, Jay loaded up those patients requesting abortion, placed them onto a gurney, and pushed them to the OR and back to the recovery room after the procedure. The recovery-room supervisor asked, “Doctor, do you want your abortion cases segregated, away from the other

patients in the recovery room?” “Why, are they contagious?” asked Jay. “No, of course not.” Derek was waiting for Jay in the hallway. “Dr. Calvin is looking for you. He’s been back in urology telling everybody you’re using fake names on the operating-room schedule for abortions.” “I can hardly wait to hear his views,” said Jay. As soon as Jay stepped into the lounge, Doctor Calvin stepped into Jay’s face. “Doctor, I want to talk to you.” There was hatred in his eyes. “My name is Jay.” “I’ve got a bone to pick with you,” announced Cal. “Pick away.” “Doctor, this time you’ve gone too far, way beyond the lines of propriety.” He shook his finger in Jay’s face. Bill saw Calvin’s anger and stepped in-between the two men. “Back off, Cal,” said Bill. “Your insistence on performing abortions here in Clarkesville is giving a bad name to the community and to our hospital.” “That’s a gross exaggeration,” said Bill. “Cal, are you speaking for administration, or is this

a personal value?” asked Jay. “Both. I’m calling a special meeting of the Credentials Committee,” said Cal. “What’s the charge, Your Lordship?” asked Jay. “Don’t get smart. There will be more than one charge. Our office gets a copy of the OR schedule. An hour ago, my office secretary called in tears.” Derek stayed in the corner listening. Bill stayed close in case anything got physical. The Today Show blared in the background. Jay snapped off the TV. “Why was she crying?”

Jay asked.

“You scheduled a woman for an abortion this morning. You used the name of my office secretary instead of the person’s real name,” said Cal. “I don’t think so,” said Jay, “but if I did something wrong, I apologize.” “What you did is illegal, and it intentionally embarrassed my employee.” Jay bristled. “So now you’re a lawyer too? You ought to do your homework first, or is that all part of your Christian leadership?” “Be careful, Doctor,” Dr. Calvin warned, inches away from Jay’s face. “My name is Jay. You’re the one who should be careful.”

“I know your name, Doctor.” “And I know you’re against abortion,” said Jay. “Yes, I am.” “So am I, but for some women, it’s the best part of a bad deal.” “I doubt that, Doctor.” Bill stepped in between them again.

“Cal, I’ve done

abortions right here in this hospital when they were illegal. Jay is performing a legal procedure, and there’s nothing you can do about it. The hospital attorney said so.” “Let me explain to both of you,” said Jay. “I don’t use fake names or bogus names on the OR schedule. If you don’t believe me, here, look at my patient’s chart.” Jay shoved the patient’s chart under the urologist’s nose. His patient had the same name as the office secretary. “From a legal point, you’re the one who’d better be careful, or I’ll charge you with defamation of character and have you in front of your own committee,” said Jay. Bill smiled. Derek smirked. The urologist’s face turned crimson; he turned away and promptly took off for his office. Jay opened the door to the hallway and called, “Aren’t you going to apologize?” Dr. Calvin kept walking. “Good job,” said Derek.

“Go easy on him, Jay,” said Bill. “Don’t worry. I’m on the Credentials and Audit Committee and the Executive Committee.” “I know a few things he doesn’t,” said Jay. “Our two daughters tell my wife whose sons have knocked up which local girls, and I have a record of the girls I’ve referred to Louisville for abortions. I know whose son got several of them pregnant.” Bill laughed and said, “Don’t look at me, I had a vasectomy years ago.” Jay quickly dialed the urologist’s office, talked to the young lady with the same name, explained what had happened, and apologized for any embarrassment. Later that day, Jay performed an abortion on the runner-up in a local beauty contest. Her real name was Snow White.

The OR girls giggled.

“Which one of the six dwarfs is responsible?” they asked. “She blames Grumpy,” said Jay. “I hope I don’t get a call from a Walt Disney lawyer.” Walking back to his office, Jay thought about the urologist’s son, now a senior in college. The talented young man had attended their daughter’s sixteenth birthday party. Two months later, Jay referred the same young man’s

girlfriend out of town for a termination. A close friend of Jay’s girls, their son would whisper a thank-you in Jay’s ear when no one watched or could hear. His father, a pillar of the community, never wavered in his antiabortion stance. There were no questions asked when Ann disappeared to the office and perform a quick pregnancy test for friends of Alexis’s or Kate’s.

Two months later, Monsignor McCarthy staggered through the automatic doors into the emergency room and collapsed beneath the check-in window, blood leaking through his pants onto the floor tiles. His sallow color brought the services of several nurses. He lay in a disheveled heap, glassy-eyed, clutching his rosary with one hand and his groin with the other. He grunted a series of Hail Marys, with portions of the Apostles’ Creed. Two orderlies lifted him onto a gurney, pushed him into an exam room, and removed his blood-soaked black trousers. They saw his mutilated scrotum and called for a surgeon. He clutched his rosary to his throat, hid his face, and asked for God’s forgiveness, finishing the entire prayer of the Blessed Elizabeth of the Holy Trinity before Bill arrived. Someone had surgically excised the priest’s testicles.

As soon as the nurse injected Valium, his repentant crying ceased. “Call the OR and alert anesthesia,” said Bill.

Two weeks later, the sheriff’s office called. The monsignor’s housekeeper had found a pistol in the rectory. Tests showed it to be the same gun that had fired shots into Jay’s car. A psychiatrist told the doctors that the monsignor had a sudden psychotic break, and instead of suicide, he had performed his own self-mutilation with a butcher knife. Rumors spread. Some thought it was a redemptive measure, absolution for his past sins of pedophilia. He disappeared from Clarkesville.

Chapter Twenty Vivian’s Cesarean

Vivian smiled as she announced her pregnancy. Jay’s office staff knew she expected an easy time, and everything was uneventful until she became concerned about the baby’s position. “You don’t look very bubbly today,” Jay commented. “When’s the little rascal gonna turn?” asked Vivian. “Most babies are in the breech position at this time. Only 4 percent stay upside down.” “I’m almost thirty-two weeks.” “That’s right.” “So when’s it gonna turn?” she asked. “Most turn before thirty-eight weeks; occasionally,

they turn in labor.” “And if it doesn’t turn?” “You get a cesarean section again.” “Can’t you turn it?” She pulled out a pamphlet and handed it to Jay. It was from the Cesarean Prevention Movement. Jay knew the organization. He knew there was a local chapter and heard Vivian was a member. Several of his patients were disciples of the movement and had chosen to deliver their next baby out of town by VBAC. “Some can be turned,” he said. “I don’t want a cesarean.” Her lips were pursed, her eyes glared. “Sometimes they can be turned—and they stay turned, head down—but more than half go right back to the breech position,” advised Jay. “In our training, we turned babies that were crossways. They’re called a transverse lie. Changing a breech can be dangerous. It’s being done more often, but under ultrasound guidance.” “You’ve got ultrasound.” “That’s right, but the procedure shouldn’t be done in the office setting,” said Jay. “Why not?” “Because if the baby gets tangled up in its cord and

the baby’s heart rate drops, an immediate cesarean has to be done. It’s called cord entanglement.” “Can’t you turn it over in the hospital?” “I’m not sure I want to,” said Jay. “Why not?” “Because some authorities on the subject believe it shouldn’t be done at all. Nature may be trying to tell us something.” “I don’t want a cesarean section unless it’s absolutely necessary. There’s too many done . . . needlessly . . . the rates are too damn high, right here in Clarkesville.” “I haven’t had much experience turning babies, and there is the additional problem of being able to do an immediate cesarean if necessary. That would be a logistical nightmare, and it can’t be done at Clarkesville Memorial.” “So?” “What I can do is this: once you get to within two or three weeks of delivery, if the baby is still breech, I can call the university hospital in Indianapolis and see if they are willing to try to turn your baby.” “Let me think about it. I’ve got one more question. Have you ever heard of a woman placing a flashlight between her legs, pointed toward the vagina? The article says that

a breech baby sees the light and turns toward it and does a somersault and turns head down.” “I have heard of that.” “What do you think?” “You’ve got nothing to lose except batteries.” “Steve thinks some of the women in my group have gone wacko.” Jay didn’t respond. Vivian left the office crying. “Is she going with the flashlight method?” asked Maria. “She must have seen the article in Sunday’s paper,” said Jay. “And she’s got two degrees?” added Maria.

At her next visit, Vivian was visibly shaken. In spite of advice she received from friends, her baby hadn’t turned. Her eyes were moist as she choked back tears. After Jay checked the position of the baby and heard the heartbeat, she let loose. “I’ve tried everything, and the little stinker won’t turn.

I elevated the head of the bed, the foot of the bed.

I prayed. I even called our minister and asked him to pray. I even tried the flashlight—nothing worked,” said Vivian. Jay pulled his ultrasound machine over to the exam table. Seeing her baby move, seeing the four chambers of

the heart, and counting its fingers and toes would offer some reassurance—some peace of mind. Her baby was still in a frank breech position; both legs were straight and extended upward with toes near its head. The afterbirth was clearly visible at the top of the uterus where it should be, eliminating it as a factor in preventing the head from entering the pelvis. “Steve and I talked about going to Indy. We’re not sure what to do. I’ll think about it over the weekend. Can I call you Monday and let you know about going?” “Of course, and please call me if any labor starts” said Jay. The receptionist handed her an appointment card. Vivian walked slowly toward her car, pulling her son behind her. “The gals in the Cesarean Prevention Movement have really done a number on her, Doc,” said Maria. “One of my neighbors told me the women in the group are downright nasty. She hears it firsthand from a couple of teachers at the university. One of them is the librarian, and she doesn’t even have a kid,” said his receptionist. “The librarian is our patient,” added Jay. “I remember her,” said Maria. “I was in the exam room

when she threw off her drape . . . said she didn’t need it...that she was liberated.” “I worry about breeches. If her bag of waters breaks and the umbilical cord drops out of the vagina, that’s a real emergency.” “Can’t the nurses set up for an emergency cesarean?” asked Maria. “Of course not.” “What happened to the cross-training program?” “It stalled.” “Didn’t the OR supervisor make a training video?” asked Maria. “She did. It tells and shows the OB nurses exactly what to do.” “Didn’t OB use it?” “Once or twice.” “What’s the holdup?” “Bureaucratic bull.” Added Jay.

In the middle of dinner, the phone rang. It was Steve. “She’s starting some labor, Doc,” said Steve. “Contractions are only ten minutes apart, but we’re going in.” “Take her in now. Tell her not to eat or drink. I’ll

meet you there.” “I’ll be glad when this is over,” said Steve. Jay called labor and delivery. “Mrs. Vivian Andrews is on the way. Sounds like she’s in labor—she’s breech. Call the OR and see if any of the OR girls are in house. If they are, tell them not to leave. Warm up the ultrasound machine.” Jay drove over the speed limit, leaped up the back stairways, and entered the rear entrance. “She’s here—five cm dilated,” said the nurse. “Contractions are every five minutes, and they’re hard.” “No urge to push?” “Not yet,” said the nurse. Jay put the ultrasound transducer on Vivian’s belly. “Vivian, it’s still breech. We’ve got to do the cesarean now,” Jay said. She frowned and said a couple cuss words under her breath. Jay barked out orders. “Call the OR crew. Tell them to come over and hurry. I’ll call anesthesia.

As soon as the

catheter is in and the permit signed, take her back to the section room and get her positioned for the spinal. Steve, put this gown on. Here is a cap and mask. Stay here until the nurse comes to get you.”

He dialed the anesthesiologist on call and looked at his watch so he could time the setup to delivery interval. Two techs ran over from the OR and began their setup. The anesthesiologist arrived in fifteen minutes. “Dr. Atwell, you patient doesn’t want a catheter,” said the nurse. “Tell her it’s mandatory so I don’t cut into her bladder,” barked Jay. The nurses took Vivian back to the cesarean section room in twenty-five minutes. Jay delivered the baby in forty minutes. Steve sat next to Vivian, holding her hand. When Vivian and Steve heard the robust cry of their new healthy son, they laughed and cried together. Vivian fell asleep as Jay sutured. “I’ll go tell the grandparents,” said Steve. He disappeared into the hallway, supported by a nurse on each arm, his face pasty white. The following Sunday, Vivian and Steve returned to church, holding their new son. The minister announced the new birth, and Vivian stood up and showed off her newborn baby. Steve never let on that he disagreed with Vivian’s stance against cesareans and her association with the movement. He now had two prospective golfing buddies to take over the family business when he retired.

For the next two weeks, Ann listened as Jay ranted on about the problems setting up for emergency cesareans. She decided she’d heard enough. “Jay, last night I heard you talking to Josh Roark. You sound so angry.” “I am angry.” “You’re crabby half the time. Is this about cesareans? You kept talking about thirty minutes.” “Yes, it’s all about emergency cesareans, and it’s all about thirty minutes. The office girls tell me I’m crabby too.” “What’s going on?” “Two nights ago, I did an emergency cesarean for Josh. The baby’s heart rate dropped to between sixty to eighty beats per minute. We couldn’t start the cesarean for over an hour.” “How’s the baby?” “That’s the reason I called Josh. He says the baby’s OK—no seizures, and blood gases are normal.” “What’s this thirty-minute thing?” “That’s what I’m angry about. Five years ago, ACOG published national guidelines that stated that all OB departments should be able to start an emergency cesarean

within fifteen minutes.” “Could anybody start one that fast?” “Not many. A few of the big teaching hospitals could. Fifteen minutes wasn’t realistic, and it invited lawsuits.” “Now you say thirty minutes?” “Two years ago, our national organization got more realistic. They pushed the starting time up to thirty minutes. Thirty minutes is doable, even in small hospitals, provided the OB department is organized and the nurses are trained to set up and scrub.” “Are your nurses trained?” “No.” “What happened?” “The training program got stonewalled.” “Who stonewalled it?” “The OB supervisor and Lauren. They say they’re doing everything they can.” “But they’re not?” “Hell no. That’s why I’m so damn angry,” said Jay. “And you’re between a rock and—” “I was lucky with Vivian’s breech. If she’d had a prolapsed cord, the lawyers would have had a case against me. I’m ready to get out of town.” “Jay, when are you going to quit OB?” pleaded Ann.

Jay stared straight ahead and frowned. “I don’t know.” “How’s your blood pressure?” Ann asked. “Better. I’m on a beta-blocker.” “You could have a heart attack like your mother did.”

Chapter Twenty-one The Big Easy

During their flight to New Orleans, Jay kicked back, sipped on a vodka tonic, and rechecked his seminar schedules. The Big Easy was a perfect place to step away from his practice and socialize. “How many years have we been going to this meeting?” Ann asked. “Nineteen straight years,” said Jay. “Does Quincy go to meetings?” “Not many.” “How does he keep up?” “He doesn’t.” “He’s busy.” “Sure he is, but patients don’t know who keeps up and who doesn’t. They’re more interested in how deep the carpeting is in the waiting room.” “He never came to our party,” said Ann. “You mean when I passed my boards? I knew he wouldn’t come.” “How did you know?” Ann asked. “The first time I met him he said he didn’t need to be certified. He made fun of those who were.” “I caught flack from the doctors’ wives for going back to school. They wanted to know if I was trying to show them up,” said Ann.

“They’re jealous.” Jay looked at Ann and smiled. “I’m glad you come with me each year. Many of the guys come alone; sometimes it’s the money.” “I wouldn’t let you go alone.” She snuggled in. “Besides, you said guys in group practice have to take turns.” “That’s true. We can go every year.” “Will I find you looking over the exhibits?”

She

grinned and raised her eyebrows. “Possibly.” “You mean probably.” “Did I promise not to buy anything this year?” “No.” She laughed. “But you tell me the same story every year. The ultrasound machine you bought five years ago was the same price as the new car you promised. What seminars did you sign up for?” “Hot-button issues: malpractice and cesarean-section rates.” “Any early-morning seminars?” “Nope, I’m gonna order room service, hot beignets smothered in powdered sugar.” He compared notes with his peers and visited with his old navy friends. Jay would turn fifty-five in August. His worry lines had deepened, his hair was now totally gray,

and OB wasn’t fun anymore. Solo obstetrics was a dinosaur, and the 24/7 showed. The taxi driver knew the doctor was a conventioneer and knew he was checking in along with five thousand other obstetricians. They chatted during the ride to the hotel. “You like the baby business, Doc?” asked the taxi driver. “Yes, except for the lawyers. Watching the sun rise from the delivery room is getting kind of old, as stale as the coffee in the lounge.” “You came to the right place to kick back. Go on down to the Cafe Du Monde, get some good coffee and pralines, slip over to Pat O’Brian’s, listen to them dueling pianos, and drink some hurricane punch. That’ll take your mind off work . . . help you unwind.” “Sounds like the right move to me,” said Ann. Jay looked serious and had his mind elsewhere. “I’ve got a plan so I can unwind permanently, but I need to hang on for a couple more years. I hate to quit OB.” “Why not quit? What plan?” “Why quit OB? I love OB. It’s my life’s work. Besides, it’s my cash cow. It permits you and us to come to this meeting every year,” snapped Jay. “Without OB, we couldn’t come to the annual meetings?”

“That’s right,” said Jay. “So what’s this plan?” She waited for his response. “I’m not quite sure of everything, but with my mother’s genes, I know I should give up OB before I keel over. I’m tired of having all the responsibility without the authority.” “Care to explain that?” “I’m trying to be realistic. Most of my stress comes from OB. I don’t want to get another lawsuit. The OB department still can’t get an emergency cesarean started within thirty minutes, and the administration has stonewalled every effort to cross-train.” “Can’t you and Quincy demand it?” “We’ve tried.” “So what’s your plan?” “Every year I hear the same story. Guys are uprooting their families, moving to states where the malpractice is affordable, selling Amway and vitamins to keep their income stable. A few are ‘going bare’ without insurance. They transfer all their assets into the wife’s name so it can’t be touched.” “At least our kids are through college.” “Here’s my plan: I don’t want to go bare—it’s expensive and risky. I think I can keep my bottom line the

same if I supplemented my income with in-office mammography and bone-density studies.” “One-stop shopping?” “Breast cancer hits one of every ten women, and having mammography available in-house means more women will be screened. Having bone density available in-house means that more women will be aware of osteoporosis.” “It sounds good.” “Reggie didn’t think so.” “You talked to Reggie about your plan?” “I talked to the radiologists. I asked them if they wanted to read my mammograms. They talked to Reggie. Reggie was miffed I even spoke to the radiologists. I thought they were independent contractors. Reggie told me the radiologists had signed a do-not-compete clause and couldn’t work outside the hospital.” “So you’re checking out in-office mammography and bone-density machines?” “That’s my plan,” said Jay. “I glanced through your program,” said Ann. “Its legal stuff, mostly CYA.” “Defensive medicine . . . document everything, and if there’s any problem, do a cesarean.” “What’s your rate?”

“Twenty percent,” said Jay. “Your patients are higher risk, right?” “Sure are.

First-time mothers are older. Many are

overweight, diabetic, or have high blood pressure.

When I

started practice, they were eighteen to thirty, stayed at home. Now they’re working, career women. They’ve delayed having babies until they got their education, and they’re not willing to quit work even if they have a problem.” “You were forty-five and just starting to get some gray in your temples when you started having trouble getting back to sleep after a night delivery,” said Ann. “You’re fifty-five now. It’s time you take care of yourself.” “It seemed like the whole world is asleep, and I’m up there still awake delivering babies, watching the sun rise or the sun set.”

The meeting was a sanctuary for Jay. He waited in line at the Hilton while Ann watched their bags. There were doctors wall-to-wall. “Hi, stranger,” said a voice in the next line. Jay turned and saw Victor Hershey. They shook hands. “It’s been a while,” said Victor. “Close to twenty years.”

“It’s great to see you. You look good, still sporting a crew cut, a touch of gray like mine.” Victor was dressed as if he had stepped from Gentleman’s Quarterly—spiffy, sophisticated, his forehead well wrinkled. “Where are you practicing?” Victor asked. “Southern Indiana, a town of twenty thousand called Clarkesville. Are you still in West Virginia?” “Yes.” “And your father?” “He finally retired . . . died last year. I got a partner.” “How’s your wife?” “We divorced . . . two years ago.” “I’m sorry,” said Jay. Victor shrugged it off and registered. “What postgrad courses are you taking?” Victor asked. “Malpractice and C-section Rates. You?” “None. I quit OB five years ago, got nailed big time. It cost my insurance carrier over a million—that was enough for me. I only do surgery. My insurance premium dropped from $120,000 to $30,000 when I quit OB.” They shook hands.

His grip was still as firm as ever.

“Playing golf I’ll bet.” “Every day. I’ll see you, Jay.”

Victor smiled his pleasant wide grin. There was no let’s-get-together. There never had been. Jay watched him walk toward an attractive young blond. They disappeared into the crowd of obstetricians. Jay had wanted to compare notes and ask how his last year went at their old duty station. For five full days, Jay went to his meetings and gathered information for his plan. “Before we leave New Orleans, I’ve scheduled a treat for us,” said Ann. “What is it?” “Breakfast at Brennan’s.” The next morning, they relaxed at Brennan’s in the heart of the French Quarter. “Did you get your plan started?” Ann asked. “Yes. I got all the information I need.” “Now, let me tell you my plan. I had the salesman put it away until you could try it.” “Try it on?” “No, try it.” “Usually, it’s a fancy suit.” “Not this time.” “What is it?” “You’ll never guess. If Victor can play golf every day

and Quincy can go ride his horses, then you can do something you enjoy too.” “I give up.” “It’s a tuba.” Jay stopped eating, grinned, and put his fork down. “You’re right. It’s about time. I’ve put if off for years. That combo we heard at the hotel brunch, I haven’t been able to get that guy who played tuba out of my mind.” “That’s all you’ve talked about for the last three days.” “His tuba was full of dents, but he sounded fantastic,” said Jay. “The one I put on hold has plenty of dents too.” “Dents make it sound better.” “The meetings are over. After breakfast, we’ll hail a cab and go to the biggest music store I’ve ever seen.” “I haven’t even held a tuba in thirty-five years.” “All you’ve held is new babies; it’s time you held something else. You’re planning to slow down. What better way than to play tuba in the Junior College Band or in a brass quintet? It would be good for you. You’ve talked about it for the last twenty years.” “You’re right. I need a push.” “Besides, you’ve admitted to me that even you’ve

started to pull the trigger faster on cesareans than you used to, to avoid lawsuits.” “You’re right about that. I want to get out of OB before I have another lawsuit. Without cross-training, I simply can’t wait to do a cesarean until fetal distress is blatantly obvious.” They took a taxi to the music store, took the elevator to the fourth floor, opened the black case, and dusted off the instrument. He ran his hands over the well-dented tubing, felt the nicks and scratches, then held the instrument in his arms, wondering who had played it before. He whipped out the corroded mouthpiece with his handkerchief and blew a few scales. He hadn’t touched a tuba in thirty-five years. It was like finding a long-lost friend. If his plan to discontinue OB was to succeed, it meant he had to have something to replace obstetrics. What better way than to cradle a tuba in his arms? It couldn’t replace a newborn, but it would be something he loved and cherished. “Let’s buy it and ship it home,” he said as he replaced the instrument into its case. He knew Ann was on target. He would try to join the Junior College Band.

Chapter Twenty-two Cross-training Stonewalled

After he arrived home from New Orleans, Jay’s two main concerns were medical malpractice and implementing his own plan to discontinue obstetrics. His entire meeting had been devoted to how the legal profession had invaded his profession like a cloud of locusts.

The words medical and

malpractice became medmal. Jay’s old navy commander was right when he said the bastards would sue everybody. “How was New Orleans?” asked Josh. “Hot beignets, hot coffee, and hot jazz,” replied Jay.

“I delivered a couple of your gals.” “Any problems?” “Both were easy. What’s new on malpractice?” “It’s worse than ever.

Lawyers from insurance

companies came to lecture. They stood at the main podium and encouraged doctors to do more cesareans.” “You’re joking. They said that?” “They

literally

encouraged

obstetricians

do

more

cesareans. Do as many as you can, it helps reduce lawsuits. It made the local TV news in New Orleans. The other thing they emphasized was to document everything.” “What’s Quincy’s cesarean rate?” “Higher than mine, and my rates are high enough,” said Jay. “But yours are indicated. You document your reasons. His are fuzzy, and everybody knows it.” “I’ve tasted malpractice, and I don’t care to go back for seconds.

They said yesterdays’ threat of malpractice

is todays’ reality. They told us to expect a visit from the lawyers; that 75 percent of OB doctors get sued more than once in their lifetime.” “That’s scary as hell.” “Again and again the speakers emphasized starting emergency cesareans within thirty minutes. You and I know

is we can’t get that done. Did the OB supervisor schedule any cross-training classes when I was gone?” “None I knew of,” answered Josh. “It’s a damn shame. I’m gonna have another talk with Lauren.” “That’s a waste of time. She’s a gutless wonder, scripted like a politician. The fly in the ointment is the OB supervisor. She’s stonewalled the whole training program. We’re stuck with a Catholic chief nurse.”

Jay resented the hospital’s unkept promises to crosstrain OB nurses, and as years passed, he got angrier. He kept a record of each time he couldn’t start an emergency cesarean within the thirty-minute standard, and he sent letters to Reggie and Lauren to remind them the OB unit couldn’t meet national standards. In his letters, he referenced patients by name and hospital number. His navy days taught him how to write a memo and leave a paper trail. He had the support of other members of the obstetrical service, even Quincy’s, but it was passive support. The hospitals’ unkept promises put everybody in a vice. It meant unnecessary danger to the unborn child, and it put the obstetrician and the hospital in danger of a lawsuit.

Obstetrics had always been the stepchild of surgery, and at Clarkesville, the operating-room staff provided all the personnel necessary to set up and perform cesarean sections.

When a cesarean was needed, OB called the OR,

and the OR scrub techs were sent to OB. Sometimes all the techs were busy, which meant a delayed time before an emergency cesarean could begin. Often the interval was over an hour. Electronic fetal monitoring brought new standards. If fetal monitoring detected distress in the baby, national standards demanded that a cesarean begin within thirty minutes to avoid brain damage to the fetus. The administration repeatedly promised to cross-train, and for years Jay trusted them, believed their big lies. Jay became more and more vocal. He couldn’t believe the administration was so uncaring. They weren’t worried about malpractice. One week after they had returned from New Orleans, Ann saw Jay zoom up the driveway faster than usual. He entered the kitchen and slammed the screen door, nearly pulling it off its hinges. “What’s the matter?” asked Ann. “It’s the same old crap.” “Rough case?”

“Emergency cesarean. It took one hour and thirty minutes to get started.” “How come?” “Because admin won’t cross-train the OB nurses.” “You face is red as a beet,” noticed Ann. “My blood pressure probably sky-high. I’m going to call Reggie at home, wake the son of a bitch up.” “Want to talk to me first?” “It’s all talk—that’s the problem. The fetal monitoring strip showed severe prolonged fetal distress; the baby’s heart rate stayed at 65–80 per minute. The OB nurses looked like zombies. They just stood in the hallway— wouldn’t lift a finger to help.” “Did you ask them to help?” “Of course, I did, right in front of the patient! My patient heard me chewing on them. She started to cry. She asked me why they wouldn’t help.” “And?” “What I said was loud enough for everybody to hear. I told her some of the nurses were lazy and didn’t give a damn. I told the nurses if they weren’t going to help to just go back to the nurses’ lounge and read through their Avon catalogs, or go get a job stocking shelves at night at a grocery store. I’ll probably get reported.”

“Was it your patient?” “Yes. Josh came in to help. He was feeding his horses when I called. He got there in fifteen minutes. I finally opened the sterile packs myself. The OR techs were busy with a case. I called the backup anesthesiologist. It was a disaster. The baby was Apgar 3 and 6 at delivery. The pediatrician drew blood gases. They were way below normal. It took fifteen minutes before the baby pinked up and had regular breathing. I’ve had it. I’m going to see a lawyer. I mean it” “Give up OB. You’ve delivered half the town,” said Ann. “That’s what you always tell me.” “I’m telling you again.” “And when I quit, who’ll give a damn?” “I don’t know. Jay, you can’t live long enough to deliver all the babies. Your battle with administration has made you nasty. It’ll destroy you.” Jay listened. “I’ve heard you rant for hours,” said Ann. “I know your battles are legitimate. You’ve been a very successful physician, and you’ve always given me emotional support— when I needed it—but everything comes with a price, and you’re not the only one involved. There comes a time when

battles have to end.” “You want me to quit OB.” “Isn’t it time you muzzle your mistress?” “Ann, I’ve ordered the new equipment. I’m close to stopping OB.” Ann continued, “You’ve said that before. I hope you knew how much we all missed you when you were gone delivering babies. All the snapshots of Christmas mornings show you dressed in scrubs. You either just finished a delivery or were getting ready to leave for one. The girls and I missed you more than you’ll ever know. I remember two after-prom parties. You and I were chaperons—you got called. One time we were on Main Street watching the homecoming parade, both girls were in the Queens Court riding on a float. You had to leave. During Alexis’ sweetsixteen birthday party, you had to leave. I know I’m not supposed to complain, but being married to you has been hard on us too. I’ve cried a lot. I still get angry having to share you.” “I’m truly sorry,” said Jay. “I didn’t plan it that way.” “When will you quit OB?” “In six to eight months,” promised Jay.

Jay decided to wait until morning to talk to Reggie. He turned more sarcastic, and his fuse was short. The national meeting had reminded him that the problem was serious. He intended for the hospital to meet their promises, intended to hold their collective feet to the fire. He thought he could get a straight answer from the OR supervisor. He had delivered her babies and performed her hysterectomy. “How was New Orleans. Get your fill of coffee and beignets?” asked the supervisor. “Sure did. I also have my fill of this administration. I got a question for you.” “Go ahead,” said the supervisor. “About two years ago, you made the cross-training video, setting up for cesareans.” “Sure did, the one for OB.” “Has OB showed it to their nurses?” asked Jay. “Sure, we went through it with ’em on several occasions.” “What’s your take on why the program still isn’t up and running?” “Our techs have done everything but stand on their heads to get it running. They agree the OB gals should do

the cesareans.” “What’s the problem?” asked Jay. “The chatter is it’s the OB Supervisor. Lauren La Fonte put a gal in charge that doesn’t want to cross-train the nurses. Our techs are scheduled to train, but the OB supervisor cancels out, says there’s not enough help on the ward or someone is sick; she’s always got an excuse. She’s against cesareans, she’s pro-VBAC. Is the thirty-minute start time still the standard?” she asked. “Yes, of course. We heard tons of speakers at the meeting. They all said the same. If your hospital’s OB department can’t get an emergency cesarean started within the thirty minutes, they should close the department and stop delivering babies.” “I know what happened last night. The OR girls briefed me. They said the OB girls stood in the hall, wouldn’t help, wouldn’t do anything. I’ve already put it in my report. How’s the baby?” “So far it looks OK.” “They told me you got a little nasty with the OB gals, told them they were lazy, to go read their Avon catalogs.” “Yeah, I said that, and I meant it. My wife says my personality’s gone to hell. A lot of good it does. The hospital has an obligation to the unborn babies, and it

hasn’t fulfilled that obligation. If they try to take away my privileges, I’ll see them in court.”

A week later, Derek cornered Jay. “I gotta talk to ya, Doc. I know you’re upset about the cross-training program. It isn’t the OR girls who were dragging their feet, and it’s not the majority of the OB nurses either. The OR techs tell me the resistance is from the OB supervisor.” “It’s hard to prove.” “I talked to Dr. Van Buren about your program to cross-train.” “And?” “He knows it’s the right approach. He said anytime he tried to get a new program going, he met resistance. He said people resist anything new, and they blame the messenger.” “And I’m the messenger,” answered Jay. “The OB supervisor thinks Clarkesville’s cesarean rates are too high. She thinks the thirty-minute guideline is meaningless.

She flat out told one of the OR techs

she’s never seen a problem even if they couldn’t get started within thirty minutes.”

“She works days, doesn’t know what goes on between 3:00

PM

and 7:00

AM.”

“You’ve got standards?” “National standards. The hospital agreed to them.” “What’s the OB supervisor trying to prove?” “It’s a control issue. She’s promoting VBAC. She downplays the risk to the baby or the mother.” “The techs think she’s a cold bitch; she’s a new graduate with a four-year diploma, thinks she walks on water.” “Reggie says it’s Lauren’s job. When I ask the OB supervisor, she plays Goldilocks. You know . . . nothing’s quite right, not enough time, not enough staff, too many patients, too much to do, the nurses are sick. She was sick.” “One of the OR techs heard her bragging that your alarm system will never be installed as long as she’s supervisor.”

Jay decided to have a one-on-one with Lauren. He walked into her outer office, asked the secretary if Lauren had time to talk. “Of course she does, go right in,” said the secretary.

Jay quietly closed the door behind him. Lauren didn’t know he had consulted with a lawyer before going to New Orleans and that he had considered filing a lawsuit against the hospital’s administration for failure to comply with national standards. Lauren remained an attractive woman. Neither her clear porcelain skin nor her stiffly starched uniform showed a crack or a wrinkle. Her cold, unmodulated voice broke the illusion just as it had twenty years ago when she stopped him in the hallway and compared him to a midwife. “What can I do for you, Dr. Atwell?” smiled Lauren. “It’s what you can do for the unborn,” answered Jay. “And what is that?” “Lauren, I want an explanation. For five years, you said I could trust you to cross-train OB nurses to set up and scrub on emergency cesareans.” “You can trust me.” “You mean I should have faith in you?” “Yes.” “Should put a picture of you on my dresser, light a candle? I don’t think I can do that.

I have no faith in

you.” “I guess we haven’t gotten it done yet.” “You guess right,” said Jay.

“We’ve had problems,” said Lauren. “Five years of problems? Lauren, I know you’re aware of the national guidelines. I’ve sent a copy to you and Reggie every year for five years. They recommend any hospital that does obstetrics must be able to set up for an emergency cesarean within thirty minutes. What’s happened? Why isn’t the training program in place?” He sat back. Lauren stiffened, her starched uniform rustled. “We’re sorry for all the delay. We’re doing the best be can.” “All you give is promises, lip service.” “Mr. Lehman and I have had discussions on how best to accomplish the in-service, coordinate it with the surgical nurses. We just haven’t gotten as much done as we should. We know that.

We are truly sorry your program hasn’t

gotten started.” Jay thought about her response. “Lauren, you’re sorry? Sorry is just a gratuitous euphemism, a polite term that means you don’t care whether a baby has brain damage. You say you’re sorry that my program hasn’t gotten started? The program isn’t about me, for God’s sake. The program is for the fetus. These are national guidelines to ensure that an OB department can respond in time to salvage an infant

before it gets brain damage, cerebral palsy. That’s what managing fetal distress is all about. It isn’t about me.” “I’m sorry,” admitted Lauren. “Is sorry all you know how to say? Sorry isn’t an answer, it’s an excuse.” “We’re trying, Doctor.” “No, you’re not. You and Reggie walk in lockstep. Both of you trivialize the importance of the program. You’ve been stalling for five years.” “Has it been that long?” “Lauren, you’re out of touch with reality. You sit behind a desk and go to meetings all day. You don’t get sued if a baby has problems, and your OB supervisor doesn’t want the OB nurses cross-trained?” “She told me the cross–trainning was implemented.” “She’s tells you what she wants you to hear. She’s pooh-poohed every idea I’ve proposed, including the alarm system you approved. What happened?” “I thought it was installed.” “You’re out of touch Lauren. She wants fewer cesareans. She wants our OB unit to perform dangerous VBAC deliveries. Women will rupture their uterus, and babies will die. Our OB unit can’t even set up for an emergency cesarean, and she wants VBAC. The OB supervisor is

dangerous. Lauren, you’re an ineffective leader.” “That’s uncalled for, Doctor.” “It’s straight talk—you’re ineffective.” Jay kept his voice low. “I’ve been chief nurse for fifteen years.” “And you’ve been an ineffective chief nurse for fifteen years.” “I’ve worked hard.” Why after five years isn’t the program implemented? Why?” “I’ve tried.” “The OB supervisor you hired orders the nurses not to help during an emergency cesarean setup. She stonewalls the program. They refuse to even lift a finger during an emergency. What’s going on?” “Doctor, you know there isn’t anything going on. We’re doing as much as we can, and I want to assure you the training program will get started.” “Lauren, you know I support women’s rights, but I can’t understand why the administration has stonewalled cross-training.” “We’re not stonewalling the training.” “Then why isn’t it done? Without it, we can’t start an emergency cesarean within thirty minutes. If you’re not

willing to help a fetus that’s getting beaten up in utero, then the perception is you’re proviolence.” “You know that’s not true.” “Have you no shame?” asked Jay. “We’re not proviolence.” “You’re pinching off the umbilical cord, its lifeline, turning off the oxygen, like pulling the plug on an ICU patient.” “That’s absurd.” “And who gets sued if there’s a problem with a baby’s brain after fetal distress?” “I understand what you’re saying.” “No, you don’t. You don’t get it. You get a sanitized view of obstetrics. You don’t get sued, the obstetrician gets sued. It’s my ass on the line, not yours.” “Yes, Doctor.” “Yes, waited

Doctor

for

an

isn’t

answer,

an but

answer, none

Lauren.”

came.

He

paused,

“Lauren,

you’re

incompetent. The same goes for Reggie. When can I see the training in action? When will it be?” “Soon.” “What the hell does that mean?” “It means soon.” “Lauren, rumor has it that the OB supervisor is a

member of the Cesarean Prevention Movement. That’s her right, but what you don’t know is that several doctors have told me that she talks to their labor patients and tells them not to have a cesarean section. Two of my patients told me that she preaches VBAC in the hospital prenatal classes. She outright tells cesarean-section patients not to have another cesarean, but to have a VBAC delivery. Her position as supervisor doesn’t entitle her to preach her special version of obstetrics to private patients. Two OB nurses can confirm what I said. I plan to talk to my lawyer about this.” Jay stood up and left. There wasn’t much more he could do. It was like talking to a mural. She was still the same cold bitch that Derek had called her. Jay had told his attorney he could show a conflict of interest against the OB supervisor, and he wanted to force the

hospital

program.

The

to

implement

attorney

the

advised

required

him

that

if

cross-training he

sued

the

hospital, it would cost Jay over $100,000 in legal fees, and even if he won, he might lose hospital privileges. He remembered the bullet holes in his car. Jay would begin his plan and then get out of OB as fast as possible.

Chapter Twenty-three Waiting for Disaster

Although Quincy and Jay didn’t socialize, they had common obstetrical concerns. Quincy always expected Jay to give him an update on the highlights of ACOG’s annual spring meeting. They stood together at the chart rack. “What did you learn at the convention?” asked Quincy. “There’s good news and bad news. The food was great.” “What’s the bad news?” “Malpractice is worse.” “Can you hang around ’til I finish rounds?” asked

Quincy. “Sure.” “Tell me the highlights.” The nurses rolled their eyes. They knew Quincy relied on Jay for the latest updates. Quincy downplayed the importance of attending meetings but knew Jay would give him an honest update. He watched Quincy limp back toward the nursing station. He had fractured his leg in a cutting contest, and multiple orthopedic screws had slowed his gait. His cocky swagger had disappeared. They walked into the doctors’ lounge, sat down, and talked about the issues presented at the meeting, including the discouraging news about malpractice. That issue frightened both men. At the end of their discussion, Jay told Quincy that he had confronted Lauren about the issue of cross-training, that she had given him the usual excuses, and that he was furious. They agreed that the OB service section was an ineffectual stepchild of the surgical section and irrelevant. “Why don’t we disband the OB service section?” asked Quincy. “It would be one less bureaucratic meeting,” answered Jay.

“At the next meeting, I’ll make the motion and you second it.” “We’ll talk to the other members and see if they will agree to disband.” At the next OB meeting, Quincy made the motion, Jay seconded it, and all the members quickly voted to disband the OB section, and make it a subsection of the surgical services. After the vote, both Quincy and Jay stood up and walked out.

The chief nurse, assistant administrator, and

the OB supervisor looked shocked as they nibbled their donuts. Jay wrote one last letter to the hospital administrator.

In it he told Reggie there was still no

printed manual for setting up for emergency cesareans as administration had promised, there was still no alarm system as promised, and it was his professional opinion that the Clarkesville Memorial Obstetrical Unit was a disaster waiting to happen. He highlighted the last part, wanting Reggie to understand what he thought.

“Doctor, you have a new patient today,” said Maria. “Says she was a friend of yours, from navy days. Her name is Claire Foley. Ring a bell?”

“Of course.” “She’s in room 1.” He opened the door and saw Claire Foley, a big smile on her face. “It’s been twenty-two years. I told you I’d find you,” Claire said. They hugged each other. “It’s good to see you. I assume you’re not pregnant.” “I had enough of that.” “Where’s Brad?” “He retired five years ago; we live in the country fifty miles east of here. He’s fishing. I thought it was time for a checkup. What better man than you?” After her exam, they talked over old times. “How is Sarah?” asked Jay. “She’s fine. She’s been accepted into nursing school at Clarkesville Junior College.” He thumbed through pictures of both her girls. “Does Sarah have any idea what happened the night she was born?” “Yes, but not the details.” “What’s Brad doing?” “Donates his time, gives free legal advice to the Mennonite community, fishes.”

“Thanks for the Christmas cards.

I usually get one

from Ellen. The last one said she worked part-time in Indy.” “We hear from her regularly,” said Claire. “Did you know she got married?” “No.” “To a retired military man. It lasted for a couple of years. They went their separate ways. She came down to see us, and we drove by your office. She wanted to see you, talk to you. I’ve got a recent picture of her.” She pulled out several pictures. “She’s still gorgeous,” Jay remarked. “You know, we girls talk a lot. It’s no secret Ellen had a major crush on you. She talks about you, wants to know if we’ve seen you.” “I had feelings for her too.” He wondered if Claire knew how close they were. Claire didn’t press for more information, and he didn’t give any. “We’re so grateful to both of you,” said Claire. “Call us. Brad can take you fishing.” “Say hello to Brad and give my very best to Ellen. Tell her she’s very special and looks great.”

Two weeks later, Maggie arrived for her annual exam. She had moved in with Bill after his wife died, still

sporting her bleached hair.

After her exam, she unloaded.

“Jay, there’s scuttlebutt over at the paper that you should know. It’s not confidential stuff.” “Go ahead.” “There’s a new local chapter, right here in Clarkesville, of an organization called the Cesarean Prevention Movement. Have you ever heard of ’em?” “Yes. The group advocates natural childbirth, no fetal monitoring, and promotes VBAC. They’re hard-line, angry. Several of my patients left promotion flyers in my waiting room.” “Georgette’s getting ready to write some feature articles about this group.

She said the OB supervisor is a

member, a vocal advocate for the group.” “The OB supervisor wants the hospital to promote VBAC, and yet OB can’t set up for an emergency cesarean.” “Georgette’s interviewed the group. She plans to write a series of Sunday feature articles on the high cesarean-section rate at Clarkesville Memorial.” “That

confirms

what

I’ve

heard

too.

It’s

not

good

news, no matter what.” “She wants to interview all the doctors who deliver babies.

Be

careful

what

misquoted.,” said Maggie.

you

tell

her.

You’ll

be

“If she quotes the OB supervisor as against cesareans, it might be a conflict of interest with her job as OB supervisor.” “I’ve never met her.” “Derek knows her.” “Gotta run, Doc. Deadlines. Let me know if there are any problems. In the meantime, I’ll keep my ears open.”

Within six months, Jay had implemented both office mammography and bone-density testing. His patients appreciated the one-stop approach. He finally limited his practice only to gynecology. Ann was right. He was fiftyeight years old, and his seven thousand deliveries was enough. Maggie was right about Georgette’s articles. Initially, they were not inflammatory, but he recognized that the issue of cesarean-section rates as a time bomb. The issues she wrote about were topical and of community interest.

Georgette lit the fuse and watched it burn. Her

first articles were general. She didn’t “name names,” but in subsequent articles, she printed angry quotes from women in the Cesarean Prevention Movement. Nothing was going to stifle their ardor. They wanted credibility, thrived on the publicity, and granted interviews to surrounding-area

newspapers. Headlines read: High Cesarean Rates at Local Hospital. Georgette sharpened her focus, ready for the kill. Her article featured a local woman who had undergone VBAC deliveries as if she were a heroine in a battle for women’s rights. Her articles gave simplistic answers to complex obstetrical questions, giving readers the impression that cesareans were rarely necessary. Community interest increased. Georgette interviewed all the delivering physicians, wanting to know the reasons for their cesareans, and did they think too many were performed at Clarkesville? Did they favor VBAC deliveries? She sniffed around like a hound dog after a possum up a tree. Not all the doctors agreed to talk. She tried phone interviews, sent survey forms through the mail, her version of twenty questions. Some questions were simple; many needed complex answers that required a full page. She called Jay’s office and requested an appointment for a professional consultation. He knew she was there to interview him about her feature story. She arrived, filled out the paperwork, and was ushered into an examination room.

He glanced at her answers to the office

questionnaire.

Her writing was clear, correct spelling,

and all she wanted was a routine checkup—a Pap test and

advice about a problem.

She checked yes to oral

contraceptives and no to any prior pregnancies. She was prettier than he had remembered, more mature, and not as loaded down with cheap, jingly bracelets. He spotted the yellow legal pad under her black hobo purse. She wore black two-inch pumps, a matching black skirt and jacket, with a light blue blouse, which showed enough cleavage. She sat with her legs crossed at the ankles. “Thanks

for

seeing

me,

Doctor.

My

last

exam

was

several years ago. I’m overdue for a checkup, and besides, I might have a problem. I’m itchy just outside the vagina,” she said. He checked over her request list, her past history, gave her plenty of extra time to add information not already on the form, private things, things people don’t put in writing. “OK, go ahead behind the curtain.

My nurse will be

in. I’ll check it out, do your pap, and breast check.” She smiled and disappeared behind the privacy drapes. He cracked the door, signaled for a nurse. After her exam, she redressed and sat down.

He dictated his notes.

“Your exam’s normal. The itching is from a small amount of yeast, which normally turns a yellow when it

dries on your panties. It can be itchy when it meets the sensitive outside structures.

It probably doesn’t need to

be treated, but I’ll write a prescription for a cream that contains an antifungal and a small amount of hydrocortisone, in case it persists or bothers you.” “Great.” “If there’s any problem with the results of your Pap test, we’ll call you; otherwise, we’ll send out a letter with

the

results

in

about

three

weeks,

OK?

Is

there

anything else, anything at all, any other problems?” “No, not really, but can I ask you a couple questions about the cesarean-section issues at Clarkesville Memorial? I’m

interviewing

as

many

physicians

as

I

can

for

the

newspaper, my articles.” “I’ve read your articles. Actually, you probably noticed the waiting room is standing room only, and you’ve got a bunch of questions. Would you send me a questionnaire?

I promise to fill it out and send it back

to you.” She stiffened. “Well, OK, of course, and thanks for the checkup.” “Good seeing you again. I like your outfit. You look sharp,” said Jay. “Thanks,” said Georgette.

She stopped up front to settle her account. His office nurse pulled him aside. “How can you be so damn nice to some of these bitches? You saw the stretch marks on her breasts.” “Of course, her belly had them too. Did you see her old episiotomy scar?” “Sure did.” “Some gals choose to adopt out their babies. That’s a private matter. It’s our job to sift through the information, use our powers of observation.” “I don’t trust her,” said Maria. “Me either. Did you notice the silhouette of a playboy bunny on her lower abdomen from the tanning parlor?” “Yah, and she probably hops from bed to bed.”

Georgette’s questionnaire arrived within two days. Jay took the time to type up thoughtful in-depth answers to each of her questions and returned the questionnaire. Georgette printed nothing of what he sent. Because of the high cesarean rates, the hospital’s board of directors pressured Reggie to do something to defray the adverse publicity. The board wanted the cesarean-section rates for each individual physician published in the newspaper, but peer review laws prevented

their release.

Reggie announced that the hospital

subsidized the obstetrical department to the amount of approximately $250,000 per year. Most of the subsidy was in the form of salary to the OR techs to set up and perform cesareans at the OB ward.

Chapter Twenty-four Vivian Wants a VBAC

The entire office staff giggled as a first-semester freshman closed the front office door after her checkup.

The young student requested birth-control pills. She reasoned that she wanted her monthly cycles to be regular, a familiar request. After her exam and without any moralizing, Jay prescribed oral contraceptives. The staff stopped giggling as Jay approached. “And what is the joke du jour?” he asked them. They looked sheepish and tight-lipped. “It’s about the young coed,” his Maria answered. “When she arrived, she assumed she’d be examined by a female doctor. She was nervous—her first pelvic. We tried to reassure her you were an okay kind of guy, easy to talk to, and that you’d examined hundreds of college-age girls. She finally gave her consent with one caveat.” “And that was?” She said, “Well, OK . . . just as long as the doctor’s not too young and too good-looking.” “And what did you girls tell her?” “We said, ‘Honey, our doctor is the right guy for you. He’s definitely not too young, and he’s definitely not too good-looking.’” Everyone erupted into laughter including Jay.. “That’s great. Wait ’til I tell Ann. She’ll get a good belly laugh too.”

Vivian was the last patient of the day. She had been Jay’s patient since he opened his practice. Her dress code remained conservative. Maria spoke to Jay privately, “Dr. Atwell, I’ve been watching Vivian in the waiting room. She has been there for twenty minutes, walking back and forth like a caged animal. She’s almost giddy when she talks.” “Thanks,” said Jay. When Jay entered the exam room, he immediately noticed the difference in her behavior. Vivian was standing up. She was effervescent, her mood bordered on euphoric, different from her usual conservative, reserved self. After they greeted, she sat down on the front edge of her chair and launched into a prepared monologue. “Dr. Atwell, together we’re going to set Clarkesville Memorial back on its ears,” she said. Her mood was eerie. He watched and listened. Though not sure, he had an idea where she was going with the conversation. She continued, “I want to be the first VBAC patient to be delivered at our local hospital, and I want you to do my delivery.” He remained silent. Vivian remained animated, full of enthusiasm, close to maniacal, as she raced on through her monologue. She was wound up, but her pupils looked normal.

She wasn’t sweating. Jay went down a list of mental conditions: the early manic phase of bipolar disease, a sudden clarification of a major life event, an epiphany? She was usually much more sedate.

What was he hearing,

seeing? As she talked, she showed him a book she had brought to the office. “This is Silent Knife,” she said. “I have so much to tell you.” Listening was important, cathartic, therapeutic. “Silent Knife is sort of my bible,” she continued. “It promotes natural childbirth without the modern-day technology stuff.

You know what I’m talkin’

about—no electronic monitoring, no wires, no shaving, no laying flat in bed. I want to walk around in labor, and I don’t want another scar on my belly.” She chattered on, wild-eyed, as if mesmerized by her belief system, repeating herself, “I want a VBAC. Please do my VBAC delivery here, please.” She stopped now and then, her lips quivering, waiting for a positive response from Jay, and thinking she would get her way. She even folded her hands together as if in a mock prayer. Please, dear God, pleading and begging him to do her VBAC locally. She had made up her mind. “Let’s

do

your

exam.

My

staff

will

want

to

leave

soon,” said Jay. “I’ll get ready. You can tell me if I’m healthy enough for another baby,” Vivian said. She went behind the curtain, and he cracked the door, signaling for the nurse to enter. Vivian trusted him enough to approach him with a completely new idea, a new value judgment. She needed time to vent.

He was familiar with her bible, as she called it.

When she had her last baby, the breech, she had told him about the cesarean-prevention organization. He had made a note in her record.

The book told all about the evils of

having cesarean sections. Her change in mood reminded him of what he’d learned in psychology, about identity formation, about searching for something, that missing ingredient in her life.

She

wanted validation. He worried about her obvious change in behavior; it confirmed her involvement in the Cesarean Prevention Movement. The group had the evangelistic fervor of a crusade. She redressed after the exam, and they talked, longer than usual. Finally, he said, “Vivian, you’re certainly healthy enough to have another pregnancy . . . and I admire your spunk. I really do.

I’m sympathetic with your not wanting

another scar on your belly—that’s for sure.” Then he spoke

slowly, “Vivian, I don’t share your enthusiasm for a VBAC birth at our hospital. It is simply too risky, and I’ll bet you know why. Then again, maybe you don’t.” She cocked her head and said, “I’m listening.” “If there’s one thing you should know, it’s you don’t want to go into active labor and attempt a VBAC here in our hospital. Trust me on that point.” He paused a few moments, giving her time. “I’m not sure about everything,” she snapped, “but I think I know the basics. So why is it all that risky? Besides, other hospitals the same size as ours are doing it. I know they’re doing VBAC in Evansborough. Why can’t we?” She sat back in her chair, shifted her weight, gave Jay a quizzical, inquiring look, and waited for his answer. She sounded determined, wanted answers, needed information. “It’s just too risky to be done in our hospital. Here are the reasons: The obstetrical staff and the hospital staff can’t respond quickly enough if a VBAC turns ugly. If you developed a complication, a ruptured uterus, and needed an immediate cesarean or a complete hysterectomy because of bleeding, it couldn’t be done.” Vivian’s lips tightened, curved downward ever so slightly in disbelief; a deep furrow appeared on her brow.

She waited for him to continue.

He saw her mood change.

Jay continued, “We couldn’t set up quickly enough to save your baby. Our blood bank can’t do a type and cross match quickly enough for a big emergency, especially in the middle of the night, and the anesthesiologists take calls from home; they don’t stay in the hospital at night when they’re on duty.” “Is

that

critical?”

she

popped

back.

“They

live

nearby, don’t they?” He continued, hoped she really heard him on the point, “Yes, Vivian, it is critical, and yes, some of them live fairly

close,

but

there

supposed to follow.

are

specific

guidelines

we’re

The OB department is supposed to be

able to set up and actually start an emergency cesarean within thirty minutes.

That’s thirty minutes from the time

we actually make a decision to do a cesarean section, until we actually make the incision. Sometimes we can’t even do it in sixty minutes.

I’ve worked on that project for about

eight years.” She sat further back in her chair, swallowed hard, looked down, took a breath, and then looked straight at him. “Vivian, if you want to know the truth, I’ve been screaming at administration for years. I’ve sent more

letters, documented the time, the date, the patient names, and hospital numbers. I’ve got copies of letters I sent to Reggie Lehman and Lauren La Fonte telling them our start-up time is way over the thirty-minute time frame. I can’t get them to move. They’ve stonewalled every effort I’ve made.” Vivian looked wounded.

She repositioned herself,

moved farther back into her chair, and took a deep breath. He discussed VBAC statistics—how they came from big teaching hospitals, contained selected patients, which included only those with a low transverse incision; that her incision was a low vertical. “My professional experience makes me doubt the widespread practical application of VBAC.

I’ve seen too

many women who had thin uterine scars starting to rupture when I did their repeat cesarean. I stopped taking any new obstetrical patients over a year ago. On occasion, I do cesareans for other physicians, but not as the primary physician.

I know several well-qualified OBs in

Indianapolis who do VBAC deliveries. I’ll write down their names. They’re board certified, and besides, I believe you already know of Dr. Newberg. She’s delivered several girls from town.” He told her if she decided to become pregnant and undertake a VBAC delivery in Indianapolis, and that if

weather conditions prevented her from keeping an out-oftown appointment, he would be glad to check her, but he could not be her physician for the pregnancy. He recorded the same in her chart. His staff was ready to lock the front door and turn off the front lights just as they had finished.

With a

quick, soft tap at his door, his office nurse alerted him they would be leaving soon. Vivian rose up slowly, reluctant to discontinue the discussion or to leave the office, unwilling to accept his stance about a local VBAC, sad she couldn’t convince him to do her delivery. She turned to Jay. “Steve says I’m crazy, I should quit while I’m ahead. He thinks I’ve lost my mind, especially about VBAC.” She left. He walked to the waiting room, locked the front door, and watched her walk unhurriedly toward her car. She sat perfectly still for several minutes before driving off. He worried about how she had glossed over dangers of VBAC births, concerned that the local movement presented VBAC with a weighted positive spin.

He locked the back door and

walked slowly toward the hospital to make his evening rounds. On that day, he had connected with the young

Catholic college student who wanted birth-control pills. Did he connect with Vivian?

Chapter Twenty-five The Presses Roll

Georgette’s articles applied simplistic answers to complex obstetrical problems. She implied that local obstetricians were authoritarian, arrogant, mercenary, and behind-the-curve on the latest way to deliver babies. Her slant implied a scandal, whipped-up support for the Cesarean Prevention Movement; provoked outrage against delivering doctors; and it sold newspapers. Josh Roark was quoted as saying, “There are

approximately seventy billion cells in a human body, and if anything goes wrong with any one of them during the first twenty-one years of life, the delivering doctor can be sued.

Women who propose VBAC are living in a dream world

because a uterus ruptures once every two hundred deliveries during VBAC. Would you board an airplane if the risk of crashing was 1/200?” The paper quoted Dr. Joe Huffman as saying, “I’ve been the victim of two nuisance lawsuits. After that, I couldn’t get insurance. VBAC is too risky, especially at small hospitals.” Georgette’s article quoted a family physician: “Women aren’t tough anymore; they’re afraid of labor pains and view a cesarean as a way to beat the pain game.” Another physician said: “Malpractice law firms advertise on TV that if anything goes wrong during the birth of a baby, and I emphasize anything, the parents deserve big dollars and can get them when they sue.” Another physician said: “I really like obstetrics, but I feel like a gun is aimed at my head. I invested many years of my life in order to be a doctor, but a lawsuit could devastate me. Women will do anything to avoid pain,

and

it’s

not

just

the

mother

who

complains

about the hardship of childbirth. Often the family prefers the immediacy of a cesarean rather than the discomfort of a

long, difficult labor. We hear the relatives say, ‘How long are you going to let her lie there and suffer?’” Fred Harrison was quoted: “I’m seventy years old. I’ve delivered

eight

thousand

babies,

seen

everything,

and

a

planned cesarean section is absolutely the safest way to have a baby.” Georgette quoted local women who belonged to the Cesarean Prevention Movement as saying: “A vaginal birth after cesarean is much safer for both mother and infant than the risk of major surgery could ever be, and our organization has never heard of a woman who had a ruptured uterus or who died during a VBAC.” Jay was furious when he read the article. Didn’t anyone check the accuracy of her sources? Didn’t her editor question her stories? Jay called the editor of the newspaper. “Your wife and your two daughters are my patients,” said Jay to the editor. “Thank you for taking good care of them, Doc.” “As the editor, the buck stops with you, right?” asked Jay. “That’s right, Doctor.” “Then why don’t you check the validity of Georgette’s Sunday features. Why do you permit her to print value

judgments on a life-and-death subject based on simplistic, inadequate information, lies, and half-truths?” “That’s a strong language, Doctor.” “Do you have medical knowledge?” asked Jay. “Of course not.” “Don’t you use experts to check for authenticity?” asked Jay. “We can’t check everything, but we can try harder.” “Did you know that English and Israeli doctors have shown that it’s safer to have your first baby by cesarean than vaginally?” “No, I didn’t know that.” “I answered the Georgette’s questionnaire, took time and typed out four pages of information. I sent it to her, yet she included nothing of it in her expose. Her articles are a sham,” said Jay. “That’s unfortunate,” said the editor. “That’s an understatement. You ought to fire reporters who don’t do balanced journalism. Don’t you worry about slander or liability?” “Not like you guys,” the editor laughed. “Hell, Doc, we just print retractions.” “You’re attitude sucks. You know nobody reads retractions. They get tucked away on the back page in small

print. “That’s right,” added the editor. “So as long as you sell newspapers, right?” “There’s nothing you can do about it, Doctor.” “Oh yes, there is.” “What’s that?” “Haven’t you heard of the First Amendment?” “I run the paper Doctor and I’ve got more ink than you.” “And I run my medical practice, not you.” “So?” “I will protest through your wife.” “How you gonna do that? She doesn’t run the paper.” “You wife is a nice lady. I’ll miss taking care of her. It’s too damn bad she’s married to a jerk like you. The next time she has a female problem, tell her not to call me. Tell her the reason is because you don’t give a sh —— about printing the truth.” “I wouldn’t tell her that.” “No problem. I’ve got a printing press too. I’ll send her a letter officially discharging her from my care, and I’ll tell her the reason is that I’m protesting your newspaper’s sloppy, inaccurate editorials.” “That’s unethical.”

“So you’re lecturing me on ethics?” That’s a laugh said Jay. The editor gave no reply.

By now, Georgette’s feature articles had a life of their own, like some monster from space. Jay worried the articles might convince young mothers that VBAC wasn’t dangerous. Her Sunday feature article read: “Doctors Shouldn’t Be Permitted to Run the Hospital . . . Cesarean Rates Too High. Many Cesareans Said To Be Done For Doctors’ Convenience.” Nurses were quoted as saying: “We’re uncomfortable being asked to open sterile packs and assist with cesareans . . . We’re not trained to be an operatingroom technician . . . We shouldn’t be required to learn or perform anything new and different than our present OB nursing duties . . . We dislike being pulled off the ward to work on another ward where we’re unfamiliar with medical, postsurgical, or pediatric protocol.” Georgette’s articles were like throwing gasoline on red hot briquettes. The next Sunday, Georgette’s feature article was entitled, “Local Woman Takes Her Own Life into Her Own Hands.” The article detailed a young woman’s personal account of her successful at-home VBAC delivery attended by

a midwife. The article portrayed her self-reliance as an exaggerated virtue. The article told how the young woman had delivered her first baby by cesarean in another town because of preeclampsia. Quincy had performed her second cesarean. The article painted the young woman as a heroine and explained how she had gone home after her two cesareans and how she felt disconnected. “I had more than the baby blues . . . an overwhelming disappointment, an unexplained sorrow . . . I had my next delivery by VBAC, a pure birth,” she described it. “I felt everything was true, the beauty, the emotional fulfillment, and the indescribable joy associated with a baby coming through the vagina.” Her mother was quoted as saying, “I’m so proud of her . . . now she’s a complete mother because she had a vaginal delivery, like I had mine.” The article failed to mention that the same woman nearly lost her life during her second home delivery, and her newborn died shortly after the VBAC delivery.

Jay

hoped

the

articles

wouldn’t

encourage

women

to

attempt home delivery and hoped Vivian would use her good judgment if she had another baby. Josh believed Vivian was directly involved with the movement. The hospital’s board of directors reacted to political

pressures and called for an official investigation of the high cesarean-section rates at Clarkesville Memorial.

They

authorized Reggie to hire a team of out-of-town experts to investigate and mediate disputes and grievances.

The

team’s job was to examine the entire obstetrical service, the cesarean-section rates, and make recommendations. Physicians received a list of the prospective experts, and the hospital encouraged the local physicians to give their opinions and any objections they had to any of the experts. Jay objected to several big-city physicians. He objected to several retired academicians who had practiced only in well-equipped teaching facilities. He felt the big-city fellows might not be able to relate to rural circumstances. He also objected to the fact that the local physicians wouldn’t be interviewed or be able to give their input to the experts, for they had been instructed not to talk to the experts. Jay had a chance meeting in the hallway with one of the consultants and took full advantage. He knew the physician was a retired obstetrician and had practiced in New York City. “I’m Jay Atwell, one of the local obstetricians. I’m a board-certified obstetrician, recertified, and I haven’t missed an annual clinical meeting in twenty-five years.

As

you know, the administration doesn’t want us to speak with you. I guess they’re afraid we will taint your opinion.” The physician said nothing, but nodded in agreement. “I want you to know that for eight years, I have tried to get this administration to cross-train OB nurses so they can set up for emergency cesareans so we can meet ACOG’s standards. For eight years, the administration has stonewalled the program. We live in constant fear of delivering babies that are depressed at birth, and some of these babies may be mentally retarded because of it. We can’t come close to performing an emergency cesarean within sixty minutes, much less thirty minutes.

The reason you’re

here is because there’s a group of fringe lunatics in our community who see their mission in life to reduce cesarean rates by performing VBAC here in a hospital that can’t even set up for an emergency cesarean.” “Dr. Atwell, we’ve met those loonies before, and they’re a problem.” “At Clarkesville, we don’t treat statistics, or rates, we treat patients.

The decision to do a cesarean isn’t up

to some HMO or insurance-company physician, it’s a decision made at the bedside, not at a conference table by an actuary.

There isn’t a cesarean I ever regretted doing,

but there sure are some vaginal deliveries I had wished I’d

done by cesarean.” “I couldn’t agree with you more,” said the out–of–town expert. “Thanks for the chat.” They shook hands and walked away. The hospital board never published the findings or conclusions of the out-of-town experts except to say they were actively recruiting more obstetricians for the community.

Chapter Twenty-six The Back Pew

Jay and Ann arrived late for church, near the end of the opening prayer, but in time to sing the first hymn, “Rock of Ages.” He and Ann had served on several committees, but their attendance had become sporadic. Ann claimed she had lost all her religion after she served on the session. They both liked the previous minister, but he left the pulpit unexpectedly. His wife complained to the session that she had found him in bed with a young woman, who had played Mary Magdalene in the church’s production of Jesus Christ Superstar. Vivian had tried out for the same role. The session sent the minister to the Menninger Clinic in Topeka, Kansas, for psychiatric evaluation. The present pastor’s sermons were dreary, uninspiring. The organist was employed at the hospital as an operatingroom technician, and he would intentionally raise the tempo of the hymns until the minister turned and frowned. The choir sat up front and looked great in their new crimson robes, but had insufficient critical mass to perform anything but simple four-part hymns. Jay missed singing in the choir. He was counting the days. In only two weeks, he and Ann would fly off to Boston for his annual spring meeting. He hadn’t seen Vivian professionally since her last

office visit, a year earlier. This morning was the first time he knew she was pregnant. During the morning greetings, Vivian turned; Ann saw her profile, and nudged Jay. “Vivian looks like she’s due,” said Ann. “I didn’t know she was pregnant.” “One of my nurses told me her test was positive, but I’d forgotten.” “She looks happy.” Vivian flashed a big smile, patted her tummy so they could see, and then sat down. The preacher gave a canned sermon on the parable of the Good Samaritan. After church, he and Ann chatted with the Steve and Vivian. Their two boys were healthy, hard to corral, and ready to go play. When they were small, Jay would slip gum over the church pew and drop it into their waiting hands. “I’m due in about two weeks,” said Vivian. Then she paused and expressed her concern. “My doctor hasn’t performed an ultrasound, and I’ve been wondering if it’s another boy or a girl.” No ultrasound surprised Jay.

He did not know her

doctor. He didn’t ask, and she didn’t volunteer.

Jay

remembered her opposition to technology. After the recessional, they continued to visit. Jay offered to do a

quick ultrasound scan, see if it was a boy or girl. If they wanted to know, they could drive down to his office. “It’s no problem,” said Jay. Vivian acted as if she wanted to know, but dropped her chin a bit. “I don’t want to impose on you,” she said. “I stand by my offer; my office is only five blocks away.” Jay and Ann drove the short blocks to the office in case they decided to accept. “Did you notice her feet?” said Jay. “We all get that stuff at term. I remember how mine looked. All I could get on was my house slippers.” Jay had a new ultrasound unit, an Ultra-Mark 4, made by ATL Corporation, with all the bells and whistles. It cost thirty-eight thousand. Ann’s comment had been “There goes the new car you promised.” “Remember the patient who told me she didn’t want an ultrasound exam because it might knock the ears off her baby”? They laughed. While they waited, Ann looked over her Monday schedule, and Jay went to unlock the front door in case Vivian showed up. Jay’s philosophy had been that there had been three important innovations in obstetrics in the last twenty years: ultrasound, ultrasound, and ultrasound.

If used

early, the woman’s due date could be calculated to within a few days.

The notch-stick method was passé. Any physician

who followed a high-risk patient would certainly be wise enough to order an ultrasound to confirm dates.

Maybe

Vivian had declined an ultrasound exam. Women change their minds, especially near term.

Jay remembered Vivian’s

medical history, knew that her menstrual cycles weren’t regular. Her due date could be off by four weeks; two weeks either way. Vivian never showed up. Ann sensed his concern. “Leave well enough alone, Jay. She’s not your patient.” “If she’s doing a VBAC, I hope the hell her doctor knows what he’s doing,” Jay snapped.

Chapter Twenty-seven Boston and Bird

It would be their first trip to Boston, and it was the first time Jay didn’t need to worry about leaving town. He was ready; airline tickets, hotel reservation, tickets for postgraduate courses, every thing in his briefcase, and he had no OB patients. Ann had her sights set on shopping at Copley Square. Jay wanted tickets to see Larry Bird. Larry, the star of the Boston Celtics, was due to retire and the Boston Garden was scheduled to be demolished.

He called Josh to be sure he could cover his practice. “No problem,” said Josh. “I don’t have any OB patients to worry about.” “Give me a ring just before you go.” In the past, Jay had been exhausted just getting ready to leave town, and when the meeting was over, he was reluctant to come home because of the work that awaited him. He called Josh the night before leaving. “Ann and I are leaving in the morning. I have no patients in the hospital.” “Stay as long as you want. Let me know when you get back, and I’ll give you the skinny on what was going on. Hope you get to see Larry.”

“How many years now,” asked Ann? “Twenty straight.” Jay smiled. “Did you sign up for any early-bird seminars?” “Not this year. I want to see Les Miserables and Larry Bird.” “OK with me. Les Mis is four hours long, you know.” He purchased tickets for both events through the Concierge. Larry Bird was a local Indiana boy who played at Indiana State and was winding down his long career with the Celtics. They nicknamed him the Hick from French Lick.

Jay continued to brood about Vivian. His thoughts of VBAC experiences kept resurfacing, and they weren’t good thoughts. He may have discontinued obstetrics, but he hadn’t severed every neuron in his brain that had obstetrical pathways. He knew that having an ultrasound was not a requirement for all OB patients. It wasn’t considered a standard-of-care requirement, but Vivian was a high-risk patient, and past experience told him that Vivian should have had an early ultrasound scan for dating purposes. It worried him that Vivian might want a VBAC delivery to feel included in a group. Maybe it was a liberating process, the chic thing to do. VBAC offered an interesting fit. He and Ann attended the opening night party sponsored by Ortho Pharmaceuticals, a major company that sells birthcontrol pills. The next night, they saw Larry Bird play basketball at the Boston Garden. The next day Jay stewed about a VBAC demonstration in front of the convention center. “Jay, for god’s sake, stop obsessing. Enjoy the meeting.

Don’t you have a course to go to?”

“Yesterday, I attended a course that discussed VBAC. More and more speakers are worried about complications. The insurance companies are making the decisions in health care, not the physicians.”

“How do you mean?” “Two speakers reported that insurance companies make women go through a trial of labor before they’ll pay for a repeat cesarean. The companies actually demand proof and withhold payment to the physician unless the patient undergoes the trial of labor.” “That’s ridiculous,” said Ann. “They’re worried about their bottom line, not safety to the mother and baby. Did you see the demonstration yesterday?” “No.” “Women are protesting against the high cesareansection rates. They want to call all the shots—do-it-allnatural without pain medication.” “I’m glad you stopped OB,” said Ann. “So am I. They’re irrational. They view having a cesarean as personal failure.” The next evening they met for cocktails. “Did you see the protesters in the Convention Hall?” asked Jay. “No, I was shopping,” said Ann. “It’s like Clarksville, women demanding VBAC,” said Jay. “A woman on our bus tour told me her husband quit OB

because his insurance premium cost $200,000. He’s already been sued three times. Now he’s selling Amway products and doing hair removal. I told her you quit last year.

Who is

going to deliver our granddaughter’s babies?” By the end of the convention, Jay was ready to return home. This time his desk wouldn’t be piled high with problems. They arrived in Clarkesville exhausted but satisfied. He listened to his answering machine. One message was from Steve Andrews. He sounded terrified. “I’m taking Vivian to the hospital to get checked before we set out for Indy . . . Vivian’s having hard contractions, wants to be sure she’s in labor . . . if she can make it to Indy.”

Steve’s voice trembled.

As soon as he unloaded their luggage, Jay drove to the office. He learned what had happened. He went to the hospital record office and asked to see Vivian’s last admission. Jay’s name had been typed in as her attending physician. Why? The emergency room had a list of physicians to cover walk-in obstetrical patients, and Jay’s name wasn’t on the list. The nurses in OB knew Jay had stopped delivering and was out of town. Jay had posted a note on the OB bulletin board that Josh was covering his gynecology patients.

The record office gave Jay a complete copy of Vivian’s chart. He didn’t believe Vivian would intentionally give his name as her attending physician. Sometimes the admitting clerks would put anybody’s name in the slot just to get the paperwork completed. Besides, admitting clerks had no way of knowing whose patient was whose. It wouldn’t be the first time they made a mistake. The nurse’s notes told the story.

They had charted

that Vivian arrived having strong contractions, which grew closer and more intense and then abruptly stopped. The notes described Vivian’s pain as if “something was ripping.” Vivian and Steve were undecided whether to have a cesarean at Clarkesville or to proceed to Indianapolis for a VBAC delivery. The OB nurses notified the on-call physician responsible for walk-in OB patients. He didn’t come in to check her. Instead, he instructed the nurses to tell Vivian “he didn’t believe or do VBAC and that she should go to Indianapolis for her VBAC delivery.”

He also said he

didn’t do cesareans, but “he could arrange one if she wanted one.” The nurse also documented what Steve Andrews had said to Vivian: “You’re the one who got us into this mess. You’re the one who wanted to do this damn VBAC thing.”

According to the notes, Vivian finally insisted on being transported to Indianapolis by ambulance because Steve was too nervous to drive.

The nursing supervisor in

charge made Vivian sign an AMA release form, certifying that she was leaving the hospital against medical advice. Jay called the ambulance service that transported Vivian and learned that Steve rode up front with the driver. Steve had talked to the driver about how his wife had wanted a VBAC delivery.

In all innocence, the driver

asked Steve, “What the hell is VBAC?” The nursing notes sounded defensive, as if they were more concerned with the chartsmanship than with patient care. The head nurse had paged a general surgeon who didn’t return his call. The OB nurse finally called Josh. He knew Jay didn’t have any obstetrical patients and suggested Vivian proceed to Indianapolis if her contractions had eased up. Jay called a colleague who practiced at the same Indianapolis hospital. According to him, Vivian arrived at the hospital in profound shock and nearly died. The on-call obstetrician performed an immediate cesarean-hysterectomy. Vivian’s nine-pound–eleven-ounce son was stillborn, lying free in the abdominal cavity. Her uterus couldn’t be saved, A total hysterectomy was performed. The infant had torn its

way through into the abdominal cavity, nearly identical to Claire Foley’s case.

Chapter Twenty-eight The Disaster

Jay was seething angry. He hurried to the doctors’ lounge and told everyone he saw about Vivian’s disaster. “Vivian Andrews ruptured her uterus right here in our labor-and-delivery area. The nurses didn’t have a clue as to what happened. To make it worse, no doctor came in to examine her before she was transferred to Indianapolis. For

the last eight years, I’ve been telling nursing service to educate the nurses about VBAC and how to spot the major complications. They ignored me. My guts told me something bad was going to happen. I warned both Reggie and Lauren in writing that the obstetrical unit was a disaster waiting to happen. They ignored every recommendation I made and blew me off with gratuitous promises.” “I thought VBAC was the in thing to do,” said one doctor. “That’s all superficial spin. Quincy and I know better. What happens during a VBAC rupture is simple to understand. A uterus that has a prior cesarean scar can handle only so much pressure. Many patients who were about to rupture have said they can feel something tearing inside. When the uterus ruptures, the hard contractions suddenly stop. That’s key. What happens is classic textbook, and no one picked up on it. A uterus that is rupturing can’t contract anymore because its muscle is torn, and like any torn muscle, it refuses to contract. It’s like a baseball pitcher that ruptures his biceps throwing too hard or a sprinter that snaps his Achilles’ tendon in a four-hundred-meter dash.” “I snapped my Achilles’ tendon in high school,” said an orthopedic surgeon. “I was in a cast for months.”

“To make things worse, the on-call doctor didn’t come in to examine her. There was a hired doctor in the emergency room that day, and he didn’t examine her either. There’s a printed posted protocol in the ER that says a physician should have checked her, especially before transfer.”

Ann and Jay called the Andrewses, expressed their sympathy, and visited with them at their home.

Jay went to

graveside services. He saw strangers walking toward the single canopy in the cemetery, the pile of dirt, the abandoned tombstones with untrimmed grass. He saw a group of women and recognized them as members of the Cesarean Prevention Movement. Several had been his patients. It made the hair on his neck stand up. His heart pounded. He wanted to scream at them, ask them if they were happy for Vivian and her dead baby. As far as he was concerned, they’d helped cause her problem. Off to the side, away from the others, Jay saw a young woman dressed in Mennonite clothing. She looked vaguely familiar. Steve held on to Vivian. They both knelt and placed flowers on the small casket. Jay stayed in the background and left as soon as the minister finished his prayer.

Two weeks later Jay attended the monthly surgery service meeting. After preliminaries, he asked for permission to speak. He wasted no time in telling the whole membership what had happened to Vivian. “During the past five years, I have repeatedly written letters to administration and nursing services, reminded them that our obstetrical department was a disaster waiting to happen. I have the letters to prove it. Unfortunately, that disaster happened here in Clarkesville Memorial Hospital less than four weeks ago. It happened right here on our obstetrical unit like I had predicted. An obstetrical patient ruptured her uterus. Her baby was alive while she was here, but eventually—probably on the way to Indianapolis—it was catapulted out through the hole in her womb and into her abdominal cavity, where it died. Vivian Andrews nearly died, and she lost her uterus.” He paused for a moment, allowed the group to catch its breath. “The obstetrical unit here at Clarkesville is still a disaster waiting to happen, and yet our administration does nothing to educate its OB personnel to recognize obstetrical emergencies, nor has it ever implemented crosstraining its OB nurses to set up and scrub for emergency

cesarean sections. For years, I have done everything I could to implement cross–training. I have warned you and sent you letters. It is my professional opinion that Vivian Andrew’s baby was alive here at Clarkesville, and if she’d had an emergency cesarean, her baby would be alive today. Clarkesville Memorial is about to get sued big time because they didn’t listen and they didn’t act. Shame on you, administration!

Shame on you, nursing service!

Shame on

both of you!” For several minutes, everyone stopped eating free donuts; heads turned in Jay’s direction.

The hospital

administrator’s eyes glanced toward Jay, but avoided eye contact. Jay started in again. “I repeatedly reminded you in writing, by certified mail, to implement risk-management programs, educational programs, and to cross-train obstetrical nurses for emergency cesareans. Today, it still takes more than an hour to start an emergency section. The ER doctor, hired by this hospital, had a written job description, which clearly mandated that he check a patient in Vivian Andrew’s condition before transport to another facility.

It is my

professional opinion that Vivian Andrews ruptured her uterus right here in our hospital. No one recognized the rupture, that she almost died on the way to Indianapolis,

and that she lost her baby because of this hospital’s negligence and their failure to act.” The hospital administrator’s color turned pasty as blood drained from his head. Jay talked on. “What

I

reported

here

today,

in

this

meeting,

had

better show up in the minutes of this meeting.” Jay thought about the glib comments from the editor of the local newspaper and wondered if Georgette’s articles may have encouraged Vivian to continue with VBAC.

He

thought about the hospital board, the administrator, the chief nurse, and the chief OB nurse. He wondered if any of them ever felt a twinge of collective guilt about what happened to Vivian. The meeting quickly adjourned. Outside the record office, Jay talked to Josh. “I hear you gave ’em a tongue-lashing this morning,” Josh began. “I told ’em what they didn’t want to hear,” said Jay. “I hope some heads roll.” “Don’t bank on it; a prophet has no honor in his own territory,” Jay replied. “They’ll make you out the bad guy. Nobody likes the messenger. They’ll try to blame you.” “The lawyers will have a field day.”

“Did you hear our OB supervisor resigned? She finally delivered her baby.” “Where’d she deliver?” “University hospital. She was two weeks overdue. She got induced, her baby developed fetal distress, and had an emergency cesarean. The baby has a malformed heart.” “She must be devastated,” said Jay. “Did you see the latest hospital directive?” “No.” “It said that any money generated by the operatingroom nurses who go to OB to set up or assist on cesareans will be returned to the operating-room budget.” “Maybe that will get the OB nurses moving,” snapped Jay. “Don’t bet on it,” answered Josh. “The directive also said that any nurses found using the hospital computer system to do online shopping will be fired. I got a laugh out of that one.”

The motivation to cross-train OB nurses suddenly changed. The subsidy to OB stopped. OB nurses quickly learned to set up and scrub in on cesareans. The thirtyminute start-up time was within reach, but too late for Vivian.

Within a month, board members ordered an internal audit of the cross-training issue. Jay wondered what happened. Two weeks later, his office received a call from the newspaper editor. “Dr. Atwell, the editor of the paper wants to come by and talk to you today. Is later this afternoon OK?” “Why not? Tell him to come in the back door at four thirty,” said Jay.

At four thirty, Jay heard the back door open and footsteps coming up the hallway. “Come in and have a seat,” said Jay. “And to what do I owe this visit?” “I wanted to give you an update,” said the editor. “On what? Where to have a safe VBAC delivery?” “I don’t blame you for how you feel.” “Sir, let’s get one thing straight—you don’t have a clue about how I feel.” “Last weekend the hospital board did an internal audit,” said the editor. “Five of us spent the entire weekend reading through piles of documents. We found and read through seven of the letters you’d written to Lauren and Reggie urging changes, their correspondence back to you, their promises, and Reggie’s correspondence with our

hospital’s attorney.” “And?” “Your letters went back eight years. You outlined serious deficiencies in the OB department. Reggie and Lauren repeatedly promised you they would institute education for nurses, cross-training the OB nurses. They promised an alarm system, and there were letters from the hospital attorney to Reggie that recommended the hospital adopt any measures necessary to ensure emergency cesareans be performed within the guidelines recommended from your national organization. All the board members were furious that no action had been taken. Yesterday we confronted both Reggie and Lauren.” “It’s a little late for Vivian Andrews, isn’t it?” “I won’t comment on that.” “I’ll bet you won’t.” “What I wanted you to know, off the record, is that the entire board voted unanimously to implement the crosstraining you recommended over eight years ago.” “So what year will the program be implemented?” “Immediately.” “Want a bet? I’ve heard that song before. So what was Reggie’s response?” “Right now he still has a job.”

“And Lauren?” “She’s been given the option of early retirement or to resign.” “And?” “She’s taking early retirement in six months.” “And when will these findings be published in your newspaper?” “I don’t know,” answered the editor. “You wouldn’t want the public to know, would you?”

Chapter Twenty-nine Involved or Meddling Jay called his malpractice insurance company, advised them of Vivian’s disaster, and sent them copies of all of her hospital charts and her office record. Their return letter stated that they had reviewed all records and that Jay had no liability for Vivian’s disaster because he had no doctor-patient relationship with Vivian during her pregnancy. He felt relieved. He agonized over whether he should be honest with Vivian and tell her what he knew. “Ann, did you read the letter from my insurance

company?” “I read it,” said Ann. “I know exactly what happened to Vivian, where it happened, when it happened. I think I should call Steve, tell him I’d like to give him my professional opinion.” “Jay, I know you’re angry at the hospital. You have every right to be. None of this was your fault, but I’m not sure you should get involved. It doesn’t always pay to be too honest. It could get you into trouble. That’s what my daddy used to say.” “My dad never told me not to be too honest; besides, the insurance company told me I have no liability in the matter. You’re skeptical, aren’t you?” “Yes, I am. Look, if you’d feel better, go talk with Steve, tell him what you believe happened. They deserve to know the truth.” Jay called Steve and asked if he could talk to him about what had happened to Vivian. Steve was in favor of the visit.

“Ann and I are devastated by what happened to Vivian and your baby. I wanted to tell you what I know about her case. There isn’t any easy way to say this, but it’s my professional opinion that Vivian ruptured her uterus while

she was right on the OB ward in Clarkesville Memorial.” Steve was startled. “You’re telling me she ruptured here . . . in the local hospital?” “That’s exactly what I’m telling you,” said Jay. “How do you know that?” “I’ve read the nursing notes.” “They say that?” “No, but it’s all in their notes. The nursing notes describe everything. They state that Vivian had harder and harder contractions until she felt a ripping sensation. Suddenly her contractions stopped. This is a textbook description of a ruptured uterus.” “And it happened in Clarkesville Memorial?” “That’s hard to believe, isn’t it?” “Yes, it is.” “It’s true that the diagnosis of a ruptured uterus is a difficult one to make. Most of us don’t see one very often, but they’re more common than you think, especially nowadays with women attempting VBAC.” “I wish she’d never tried it . . . we’d have a live baby now,” sighed Steve. “Steve, the thing is this: when a woman has had a cesarean, and she’s in hard labor, the possibility of a ruptured uterus should be foremost in every nurse’s and

doctor’s mind because it’s always been the most feared complication. The nurses weren’t educated on the subject, and they should have been kept up-to-date.” “Weren’t there educational programs on the subject?” “No.” “Why not?” “Good question. I pleaded with nursing service to educate the nurses on the problems associated with VBAC deliveries.” “And?” “Nothing happened—that’s the problem. The other thing you should know is that the rules at our hospital clearly state that the on-call doctor for walk-in OBs had a written obligation to come in and check Vivian before she was transferred to another facility.” “A doctor should have examined her?” “Absolutely. Besides that, the emergency room physician, hired by the hospital, had an obligation to check Vivian. It’s all in the written protocol. What happened to Vivian at Clarkesville Memorial was blatantly wrong.” Steve was quiet for a moment. He took a deep breath. His eyes were moist. He reached for a Kleenex. “Thanks for coming. I’ll talk to Vivian tonight.

Before you go, there’s one thing that happened. I got a phone call from Georgette Cohen, the editorial writer at the paper.” “I know her.” “She wanted to interview us about the whole ordeal.

I

told her no. Then she told me she already had an article ready to go in the paper . . . that if we didn’t grant an interview, she would just put it in the way it was. It sounded like a threat. We agreed to the interview because we wanted to be certain the information in the paper was accurate.”

Within a week, Jay received a call from the Andrews’ attorney, Collin Farrow. He enlisted Jay’s help. Jay’s insurance agent gave Jay permission to give him any information he wanted. Jay told Collin that he’d been critical of the local hospital’s obstetrical policies and that he’d openly criticized the administration and nursing department for their failure to stay up-to-date. He told Collin how the hospital had promised to cross-train nurses so the delivery room could set up for emergency cesareans required by ACOG. He mentioned writing a letter to the administration stating that the obstetrical unit was “a disaster waiting to happen.” Later, Jay gave Steve a three-

ring binder, crammed full of documentations critical of the hospital. Steve gave it to Collin.

Jay missed obstetrics but filled the void by playing his tuba in the Junior College Band. Their children had scattered. Alexis and Kate were married and had children. Tom lived in Florida. Jay had enough. He and Ann visited the Gulf Coast and made the decision to semiretire in Florida. On one of his trips, he answered an ad. The state of Florida needed physicians. He learned if he was an employee of the county health department, he would have sovereign immunity. That meant he couldn’t be sued for malpractice except under most conditions. Jay studied for six months, passed the threeday test, received a Florida license, and found a job with the Hillsborough County Health Department doing office obstetrics and gynecology. Only weeks before they moved to Florida and only a few days before the statute of limitations ran out on Vivian’s malpractice case, Jay received a certified letter from the state of Indiana. It stated that Collin Farrow had included him as a defendant in Vivian’s malpractice case. Jay was furious. Ann was livid. “I feel like calling her at home,” Ann bellowed. “She

had to agree to this. Damn it all. What’s she trying to pull?” Jay phoned Collin. He reassured Jay it was a mere formality. Jay called his insurer, who also reassured him that nothing would ever come of it. “I’ve known all along you shouldn’t have gotten involved,” said Ann. Your office gals said they never liked her. They thought she had a screw loose.”

Jay’s colleagues and friends gave them a going-away party, with speeches that embellished his talents beyond reality and stories about the lives he’d touched. Jay remembered prescribing birth-control pills for his colleagues’ daughters or how he’d referred several out of town for abortions or had performed early terminations in his office—secrets he would carry to Florida. One week before they left town, Vivian called. Ann answered; she covered the mouthpiece. “It’s for you. It’s Vivian Andrews, our born-again Christian friend.” Jay grimaced and took the phone. “I wanted to tell you I’ve dusted off my old clarinet and that I’ve been getting some counseling from our minister. He says I can play clarinet solos at church,” Vivian began.

“That’s good. Playing again will be good for you,” said Jay. “I know you’re leaving soon, and I needed to tell you I never intended for you to be named in our lawsuit, and that’s the truth. I want you to believe that.” “I thought it was strange. I signed affidavits for your lawyer, and now he adds me to the lawsuit.” “I’m sorry he did that. I didn’t want you included— that’s the honest truth . . .” her voice trailed off. “I’m sorry too.” “I hope you enjoy Florida.” They hung up. “That was one strange phone call,” said Jay. “What did she want?” asked Ann. “It was a half-ass apology for including us in the lawsuit.” “Strange timing; why now?

It doesn’t make sense

unless she feels guilty.” “It makes perfect sense psychologically. By her suing me, she transfers her own self-guilt to someone else. That way she doesn’t have to internalize it.

It frees her of

the dumb decision she made to get involved with VBAC.” “That’s one Christian I’ll try to forget.” “Your daddy always said, ‘That’s too much sugar for a

cent.’” “God, I’m glad we’re leaving.” “Me too.” “There are two things I want to do before I leave here.” “What’s that?” Jay asked. “I want to eat some catfish.” “What’s the second?” “Drive me down Main Street; I want to see what the dress shop has in the window.”

Chapter Thirty Don’t Worry, Doctor

Jay moved to Florida, but not to retire or to play golf. He practiced obstetrics at a rural county health clinic and volunteered at Planned Parenthood. Ann worked

full time for a social service agency. Each day Jay drove to Ruskin, Florida, the vegetable capital of the world. Most of his patients were Hispanic migrant workers. It made him appreciate the many patients who fall through the health care cracks. His Indiana attorney, Danny Gallagher, told him not to worry. “Your malpractice case will eventually go away.” Jay joined a concert band.

The Andrews’ malpractice case continued to simmer, winding its way through Indiana’s Medical Review Panel. Four years later, a panel of lawyers and physicians concluded both Clarkesville Memorial and the on-call physicians there had failed to comply with an appropriate standard of care. The same review panel cleared Jay and all the Indianapolis obstetricians who had attended Vivian. The Andrewses settled the case with Clarkesville Memorial and the on-call physicians for four hundred thousand dollars. “Don’t worry; you’re not involved,” said Danny. “Enjoy Florida.”

Two years passed. The phone rang. It was Danny Gallagher. “Who was that?” Ann asked.

“Danny Gallagher,” announced Jay. “Is the lawsuit over?” “Hell no, it’s not over. He gave me the same bull he did the day we left Clarkesville. Today, he said, ‘The case against you will eventually be dropped.’” “I asked him when. He said he didn’t know.” “And?” Ann shook her head, put her paper down. “I’ve had a bad feeling in my gut,” voiced Ann. Two months later a letter arrived. “Look at this,” said Jay. “Who’s it from?” “My lawyer, Dannyboy Gallagher. It confirms what you thought. I shouldn’t have gotten involved. Either the Andrewses want more money or Collin Farrow has encouraged the Andrewses to go after me in spite of the fact that the Medical Review Panel cleared me. How greedy can they be?” “It was your idea to be the Good Samaritan,” snapped Ann. “I know that.” “Next time, maybe you’ll listen.” “Maybe.”

Over the next three years, the case against Jay wound its way up through a series of three judicial panels. The

final panel consisted of three Indiana Superior Court justices. After the Superior Court judges reviewed the case, Danny called to announce that the judges didn’t understand the case, so they ruled 2–1 to permit his case to remain active. “Son of a b——, look at this. In spite of all the pounds of paper, all the legal maneuvers to have the case dismissed, the letter states that my case has a trial date and a date for a deposition.” Jay dialed Danny’s law firm. “Are you still going to tell me not to worry?” “A deposition is just a ‘fishing expedition,’” said Danny. “So what do they expect to catch?” “They want to catch you saying something that might incriminate you as liable for Vivian’s problems. Collin Farrow will grill you; ask you questions he already knows the answers to. He’ll try to intimidate you, confuse you, and he’ll try to twist everything. That’s why they call it a fishing expedition; to see what you will tell. The rule is volunteer nothing.” “Why here?” “Easy. Collin has a condo down in Fort Myers. Besides, it’s like spring break—get away from the snow.”

Jay enjoyed the gorgeous view from their condo. It looked over a marina, directly west onto the Gulf of Mexico. He watched the seagulls and pelicans do lazy circles in the clear blue sky, waiting for the fishing boats to return, looking to receive free handouts. “I’m not happy that Collin Farrow is coming here to our building,” snapped Ann. “It’s better than me flying back to Indiana.” “Don’t you dare let that scumbag in this house.” “I’ll keep an eye on the buzzard.” “Please be careful.”

Danny rang the doorbell. He was late, and the deposition was scheduled to begin in two hours. He offered a handshake, a wide smile, and a stocky physique, which barely fit into a three-piece legal suit. He strode into the living room and looked out over the balcony toward the gulf. “You got a gorgeous view.” “Let’s discuss my case, OK?” snapped Jay. “Jay, I checked your whole file. I saw you’ve had experience with depositions.” “Damn good thing too because you sure haven’t given me

any instructions. I assume you’re here to help me, but you haven’t called me to prepare for a deposition . . . and you show up two hours before it’s scheduled. I oughta sue your ass for malpractice.” “Sorry. The plane was late.” “That’s a crappy answer.” Jay took a deep breath. “Thanks to inept legals, I’ve had experience at depositions. What the hell have you been doin’ with my case for the past seven years?” “Tell me what happened with your first case,” said Danny. “Haven’t you read the files?” “Yes, but I want to hear it from you. I want to get your take.” “I’ll give you my take. I’d been in practice five years, had an incompetent local attorney, and I was poorly represented.” Jay told how the baby he’d delivered contracted severe mental retardation, how his local Clarksville attorney had no experience defending a malpractice case, how the insurance company’s home office recognized the problem and, finally—at the last minute— brought in a more experienced trial attorney from Indianapolis. “It was a three-ring circus, too little, too late,” said Jay. His face reddened.

“Go on.” “The case was settled without prejudice after the trial started. My insurance company paid them $100,000.” “I read through the entire file on the flight down. You’re right—it was handled poorly,” admitted Danny. “You haven’t represented me well either . . . I’m worried sick. I don’t understand the bull. This case has dragged on for seven years. Something is either drastically wrong with you or the legal system.” Danny listened. “You haven’t been able to get me out of this case. You kept sending me letters; it must have cost the insurance company thousands. Nothing gets accomplished. On four occasions, you told me not to worry about anything, just enjoy Florida. On four occasions, you’d told me, ‘I’ll get you out of the case,’ but you still haven’t. I think you’re full of bull.” “Your case hasn’t gone as planned—that’s for sure.” “That’s the understatement of the century. I now understand the legal system, and it sure as hell isn’t about justice; it’s about winning and losing.” “Remember, the deposition is like a fishing expedition,” said Danny. “They’ll bait you . . . see if you’ll nibble . . . try to catch you off guard. Every word

is recorded and admissible in court as evidence. Remember, they know the answer before they ask the question.” “Tell me something I don’t already know, okay?” snapped Jay.

Jay and Danny were quiet as they waited in the lobby. Collin pulled up in a Z3. He looked fifty; lean, wiry, with an easygoing disposition. They all shook hands. Collin talked about his condos and how he enjoyed the Florida sunshine. The atmosphere remained light and congenial until the court reporter nodded that she was ready. It started easy enough. “State

your

full

name,

your

full

address,”

asked

Collin. Collin’s questions grew more personal. They were purposively lengthy and convoluted. Jay made Collin repeat many questions. Jay would say he didn’t understand and ask Collin to rephrase questions. Jay did it purposely. Jay showed he was ready; he answered only after a pause long enough to think about the answer. Then he answered yes or no, added nothing. Sometimes he told Collin that what Collin had asked wasn’t really a question, but a statement. Collin grew irritated, relentless, but continued to ask the same

question many different ways to see if Jay would change his story. Jay never changed his answers. After two hours, they agreed to a ten-minute bathroom break. Danny was pleased. He had objected many times to the wording of questions and several times objected to Collin’s questions based on his “badgering of the witness.” Danny was under pressure to win the case. If he didn’t, he knew the insurance company wouldn’t send him any more cases. After seven hours of deposition, Danny told Collin it was long enough and that he had to catch the last flight back to Evansborough. Collin insisted he needed more time.

Collin requested an additional deposition, and an Indiana judge granted his request. The court also ordered a mediation session.

Jay’s life with Ann became more testy. He had nightmares that left him drenched and fatigued. Within days after the deposition, he noticed clots of blood in the toilet bowl. Colonoscopy revealed bleeding polyps and ulcerative colitis. His gastroenterologist told him the stress of his malpractice case had started the bleeding. Ann grew visibly nervous. Her father was a lawyer and judge, and she’d worked as a paralegal before becoming a

social worker. She flagged pages of instructions for Jay on how to testify, searched the Internet on what words he should use, and on how to dress in court. She knew lawyers, had worked for several, and didn’t trust Collin Farrow. Her unsolicited advice was never ending. It got on Jay’s nerves. He finally told her to stop it. “You’re driving me nuts with all your advice,” snapped Jay. “Sorry. I feel as if I’m on trial too.” “You’re not,” Jay added. “But I feel that way.” “I need your emotional support, not your legal advice.” “I feel emotionally drained.” “Me too. Ease off, will yah? There’s not a damn thing they can do to me. Besides, I didn’t do anything wrong. It’s the legal system and the greedy lawyers.” “Your being a Good Samaritan got you in a bunch of trouble,” said Ann. “Maybe it did, but I’d do the same thing again, in a heartbeat.”

Chapter Thirty-one Come-to-Jesus Meeting

Jay flew back to Indianapolis, and Collin continued to pound away during an additional three-hour deposition. During lunch, Danny explained the reasoning of the courtordered mediation session. “We lawyers refer to a court ordered-mediation session as ‘hostage negotiation.’ It basically means the court wants all parties to make one last shot at a settlement before the case goes to trial. If you were to agree to a

settlement, there’d be no trial.

You’d settle everything

right there and then. You instruct your insurance company to pay a small amount of money, and walk away.” “What does Collin want?” “Thirty-five thousand dollars.” “That’s not very much,” said Jay. “It’s peanuts.” “Why so little?” Jay asked. “He thinks he’ll lose the case if it goes to trial. At least that’s what we think.

Any amount that low usually

means he has conceded defeat. When a lawyer’s case is fatally weak, they call up their client, schedule a meeting, and inform them they should try to settle for whatever they can get.

It’s called a come-to-Jesus

meeting.” “That’s an interesting expression. What’s the derivation?” “A spin-off from revival meetings—sinners came to repent.” “You’re saying that Collin had a come-to-Jesus meeting with the Andrewses?” “We think so.” “And that he told them they should take what they could get and not go to trial?”

“Exactly.” “Why thirty–five thousand?” “Collin implied that amount. He told us Vivian incurred expenses for a ‘tummy-tuck operation.’

The

insurance company denied payment, said the procedure wasn’t medically necessary even though it had been caused by the last cesarean section.” “And they want to settle?” asked Jay. “Collin said the Andrewses would be happy to settle. Your insurance carrier would reluctantly write them a check for thirty–five thousand. You could go back to Florida.” “So if I agree to settle the case, I can walk out of here, fly back home to Florida, and drive over to Magic Kingdom and ride Cinderella’s Golden Carousel with my grandchildren?” “That’s it,” said Danny. “You sound like Bob Barker, the host of The Price Is Right.” Jay laughed. Danny winced. “It’s your call, Doctor.” “Thirty years ago, I was involved in a lawsuit, and I didn’t have a choice. I had to suck it up. I never had my day in court, didn’t have the opportunity to testify. I thought I could have won the case. I only had a few gray hairs then. Now I’m snow-white now and sixty-eight years

old. Ann and I have discussed the pros and cons of a settlement. Frankly, instant gratification has never been my style,” said Jay. “What’s your answer?” “I’ll go to trial. Besides, if I lose, what the hell can they do to an old man like me? They can’t touch my retirement. They can’t take my house or my wife, and they can’t take my ego. For seven years, the bastards have bounced me like a yo-yo. It’s time to put Collin on the end of the string, let him dangle over the cliff. Maybe the string will break. Do you remember what they said about Larry Bird during the NBA play-offs?” “No.” “They said, ‘When opponents look into Larry Bird’s eyes, they’re looking into the eyes of an assassin.’ I say, let the little bastard sweat.”

Danny would tell Collin no thanks to any settlement. Jay’s insurance representative encouraged Jay not to settle. They had something else in mind for Collin if Jay won the case. After the deposition, all the attorneys met separately with the mediator. Then they all went up the elevator to the top floor and were ushered into a plush

conference room with a gorgeous panoramic view of north Indianapolis, straight up North Meridian Street. The mediation attorney gave the court-ordered pep talk and added conciliatory platitudes about how wonderful it would be to avoid a heated and expensive trial. Collin spoke directly to Jay, each word cool and measured. “Dr. Atwell, you have been a wonderful doctor. You have had a distinguished career, an exemplary reputation, and you have been most cooperative with the Andrewses. They appreciate that you have always tried to do the best for your patients.”

He continued to spout gratuitous rhetoric,

complimenting Jay on how he had been so great in helping seek justice for the Andrewses, and tried to persuade him to settle. Jay sat motionless and silent throughout Collin’s long pauses. Jay stared directly at Collin; they made eye contact several times. Then Collin began to fidget; his soft slow compassionate voice slowly changed. He became more and more animated, spoke faster, louder, and fumbled for words. His neck veins began to bulge. Then he exploded. “What’s your ego worth, Doctor? How much money does it take? It’s always about money, isn’t it, Doctor? How much does it cost?”

Collin didn’t get it. It wasn’t about money at all. He glanced at Vivian’s drab dress, her cheerless expression, her head bowed, her hands folded as if in prayer. The four hundred thousand dollar settlement hadn’t lifted her depression. It hadn’t replaced the grief and guilt of losing her child, and it couldn’t replace her torn womb. Steve’s eyes were frozen moist. Frustrated, Collin stood up, glared at Jay, and headed toward the door. He signaled the Andrewses to follow. Jay’s insurance lawyers told Jay about Collin’s poor win-loss record in the courtroom. During the last five years, Collin had initiated thirty-five malpractice cases and won only three. Jay’s insurer had spent large sums of money defending physicians against Collin’s frivolous lawsuits. They told Jay that if he won his case against Collin, his insurer carrier intended to file a case for malicious prosecution against Collin and to use Jay’s case as an example. The insurance carrier would pay all expenses. An hour later, after both sides had met separately with their attorneys, they all reassembled with the negotiator. Years earlier, after his first malpractice case, Jay had made a promise to himself. It was his turn to speak,

and he spoke directly to both the court negotiator and Collin. “I do not wish to settle this case; I will go to trial,” said Jay. “Is that your final decision?” asked the negotiator. “It is,” said Jay. Collin rose, signaled to the Andrewses, ushered them out of the room. Jay flew home to Sarasota.

Chapter Thirty-two Back Home Again in Indiana

Three weeks later, Jay and Ann flew back to Indianapolis. The closer the ATA flight got to Indy, the closer Jay’s disposition matched the cold drizzle that pelted the jet’s exterior. After two trips to the lavatory, his belly continued to cramp. He chewed more Imodium tabs. Ann slept. “Time to wake up. We’re about to touch down,” Jay whispered.

Ann heard the sarcasm in his voice. She didn’t react. Jay felt like a wrongly arrested criminal, cuffed, and brought back to stand trial. His ego was battered. He felt humiliated, but he knew there was nothing any court could do to hurt him. He retrieved the book that had fallen from Ann’s lap when she’d dozed off. She didn’t budge. The plane gave a last heave as it stopped at the gate. “Are we here? How long did I sleep?” asked Ann. “You didn’t utter a peep.” She stretched her arms and reached for her cosmetic bag. Ann was particular about her appearance and wore good perfume. He remembered when they’d first met, how he’d held her in his arms at the Officers’ Club dance. She’d worn Charlie. Meanwhile, Jay continued to sprinkle his rhetoric with indignant sarcasm. “Ann, we’re not in Kansas anymore. I’m not the Wizard of Oz, and you’re not Dorothy.” He vented his anger. The lawsuit nagged him, and he took it personally. It strained their marriage, and for seven years, his top legal gun had shot blanks. For seven years, Danny Gallagher had been outmaneuvered legally, powerless to untangle the knots in the noose that linked Jay to a bizarre malpractice case. He and his wife had done a slow burn, and their fuses were short. Jay was on a roll.

“Isn’t this wonderful,” announced Jay. “The two of us returning to our honeymoon city.” “Maybe I’ll go shop this time,” spouted Ann. “I’ll go along. Let’s shop for a new lawyer. Then we can see our judicial system at work.” “Try to be serious. People can hear you,” said Ann. “I’m way past worrying about what other people think. All I gotta remember is to tell the truth and not let the bastards grind me down. Behind their smoke and mirrors, it’s all bull.” “Please, Jay, don’t be so irreverent.” “You’re right, of course,” he snorted. “I didn’t come up here to be reverent or repent at some come-to-Jesus meeting. Don’t expect me to be holier-than-thou as the screws tighten. Irreverence is my way of coping; I’m just letting off steam where it’s safe . . . so I don’t blow up in court. It’s my own defense mechanisms kickin’ in.” “I understand that.” “If pimples

I’d

practiced

practiced

law,

medicine we’d

all

the be

way dead

these or

in

little jail.

Speaking of pimples, I just spotted Dannyboy. He’s here waiting.” “Try to be nice.” She squeezed his hand. “Honey, you look great. I’ll try to talk nice, but

we’re not in Mister Rogers’ Neighborhood, we’re in Collin Farrow’s Neighborhood.” Jay popped open his umbrella. Danny was the company’s legal gun. His handshake was firm, but his smile tight and forced.

Except for a vest that was two sizes too small, he

looked like an ad for Brooks Brothers. The legals go for perception. They all look alike in their predictable dark three-piece suits. “Have a good flight?” Danny asked. “Lovely flight,” said Jay. Danny looked preoccupied. His banter was curt and to the point. He drove Jay and Ann straight to their hotel, his mind in pretrial mode, and his wide smile stretched taunt. Jay hung on as Danny barely negotiated the entrance ramp to Interstate 70. “Danny, you’re tailgating,” said Jay. “If you want to qualify for the Indy 500, the racetrack is only a couple miles north of here.” Danny stared straight ahead. “The Indy 500 is one big race,” said Danny. “Indy is one big city, 1.5 million, the twelfth largest

city

in

the

United

States,

home

of

the

Motor Speedway and Eli Lilly.” “If you remember, Ann and I lived in Indiana for twenty-eight years; we know the town. How about tellin’ me

something I don’t know.” Jay winked at Ann who picked up the conversation. “Danny, we had our honeymoon here,” said Ann. “We shopped at KeyStone at the Crossing, north side.” “Do you like Florida?” Danny asked. “It’s OK . . . too hot . . . I miss the seasons,” Ann replied. Danny remained silent. Ann continued, “How long is this trial going to last?” “Probably a week.” “We’ve been hanging in limbo for eight long years, and I’d like to get on with my life,” said Ann. “We’ve canceled several trips,” said Jay, “all because of this damn trial. Two months ago we canceled a trip to Disney World with our grandchildren because I had to fly back here because somebody saw Jesus.” “I’ve given up on having a normal life a long time ago,” Ann murmured. Danny remained silent. Jay felt comfortable when he saw the downtown skyline. The city looked dingy without the clarity given by Florida sun. Danny fidgeted. Jay tried lighter conversation. “Are the Pacers in town?” “I don’t follow the NBA.” Danny had pretrial jitters.

Without any warning, Danny unleashed a barrage of staccato chatter. “After you get settled, I want you both to come up, so I can brief you on the courtroom timetable. We got a lot to talk about, details. I want to go over all of it with you. As soon as you’re checked in, rest a bit, and finish dinner, come to my room. Your room is on the same floor, right down the hall. Ann, you come too.”

Danny’s room was engulfed with stacks of legal briefs, files, cardboard boxes full of papers, yellow legal pads, bulging briefcases, and room service coffee pots, cups strewn everywhere. “I’m ready for war,” said Danny. “I’ve got to win. If I don’t, they probably won’t send me anymore.” “What exactly do you mean?” Jay asked. “The insurance guys made it clear: they expect me to win this case . . . it’s the way they told me. It meant no more cases unless I win this one.” Jay’s mind was vibrating with information, and Danny was motivated to protect his own career. “I’ll be working most all night. That’s the way it is before a trial; I’m used to it . . . just me alone with my coffee. See you at breakfast.”

The next morning they rode off to court. Danny explained that a pretrial conference is when both attorneys meet with the judge to discuss the issues of the trial. “Would you like to be included?” Danny asked Jay and Ann. “Of course,” they answered. Jay and Ann sat in the back pew of what resembled a minicourtroom. They were glad they attended. The assigned judge had just finished another trial and wasn’t totally familiar with the real issues in Jay’s case. Jay learned that it was during the pretrial conference that the two opposing attorneys would update the judge on what they saw as the issues in the case and what evidence they planned to present. Then they would try to get the judge’s blessing. The judge didn’t allow Collin cart blanche permission to admit certain evidence that Collin felt was crucial to his case. Collin wanted to show that Jay should have warned Vivian never to have a cesarean section at the local hospital. The judge refused permission because there was no evidence that Vivian had ever requested a cesarean while she was at Clarkesville Memorial. Jay heard Collin whining and pouting to the judge. He was theatrical and used the poor-me approach, similar to a coach talking to a referee, hoping to get a more favorable

call the next time.

Jury selection followed. Jay noticed that Collin was blowing his nose, using handfuls of Kleenex, and popped cold tablets in an effort to fight off an upper respiratory infection. The selection process itself was comical, sad. Two prospective female jurors were memorable. They resembled the Dixie Chicks. Collin questioned an attractive lady in her early forties who wore a matching black leather jacket, leather skirt, and calf-length leather boots. Her blouse was upscale, a stunning deep brown leopard print. When Collin questioned her about legal prejudices, she spoke with authority, “I don’t trust lawyers. I’m married to one, and I know how they lie. My husband is on the run, disbarred. I don’t know where he is, but I know he is probably doing something illegal.” The

judge

immediately

dismissed

her.

She

rose

and

sashayed out of the courtroom. Collin questioned another young woman about awards for pain and suffering. She was in her thirties, long blond hair, dressed in a short bright yellow skin-tight skirt, yellow blouse, and matching stiletto heels. She answered the judge: “I don’t believe in awards for pain or suffering

or anything like that.” Collin dismissed her. One prospective juror cried when questioned about her beliefs in awards for pain and suffering.

She said one

time she had needed a cesarean, but her baby had died before they could do it. Collin found her acceptable. A male juror, whose wife worked as a nurse on a maternity ward, was also accepted and served as foreman. The countdown to trial was exactly twelve hours.

Chapter Thirty-three Serving up Justice

The spring drizzle continued as Jay, Ann, and Danny made their way back to the city-county building, which housed the Marion County Superior Courts.

By size alone,

she looked regal, threatening, and squatted on the entire block of East Washington Street. They walked closer. Danny pulled his tote, piled high with black legal briefcases. Jay saw the building’s age. She looked worn and tired, her dark gray limestone in need of a face-lift. They ducked in through the front door, inhaled the musty, sick odor of old municipal buildings, and rode a jammed elevator to the second floor. Jay wondered what sort of justice the old courtroom had dealt over the years, what the structure had stored up for him. An elderly black janitor stood outside superior courtroom 5. He watched the incoming processional, leaned his chin against the top of a broomstick handle.

Jay

smiled. He nodded back. Maybe it meant good luck. “Follow me,” said Danny. “I’ll show you where to sit.” “See you later,” Jay said to Ann. “Good luck, honey.” Ann squeezed his outstretched hand, handed him a note, and headed for the back row. The plaintiff’s attorney and his entourage had already arrived and secured their positions behind a row of wooden

tables. Jay counted five: Vivian and Steve, their attorney, and two additional legals. They acted psyched up, like prizefighters waiting for the starting bell. Jay’s seat was farthest away from the judge’s perch, as if he were an afterthought. For the first time, Jay learned he had a co-counsel, a friendly chap who looked like the Brooks Brothers ad, without overlap. Danny did the introduction, explained that when he had an out-of-town trial, he needed someone who knew the locals and had quick access to a reference library. Jay read Ann’s note: illegitamus non-carborundum. He glanced back at Ann and smiled, she nodded. Long ago, when Ann was particularly troubled about an incident, Jay had given her a paperweight with that same inscription, Latin for “Don’t let the bastards grind you down.” The courtroom’s atmosphere was cold, matching the outside weather. Jay sipped tepid coffee from a Styrofoam cup, did what he was told, and tried to make eye contact with the jury. A malpractice trial would be a gut check. He kept Imodium tabs in his pocket, just in case his gut became testy. He remembered a poem by Ella Wheeler Wilcox: Laugh, and the world laughs with you; Weep and you weep alone. For the sad old earth must borrow its mirth,

But has trouble enough of its own. Jay viewed himself as gray haired and grandfatherly. Like many others his age, he had a good run and was now retired. He kept busy spoiling his grandchildren, mystifying his own children, and playing tuba in several bands. Ann sat in the same row as several insurance representatives, who loathed Collin and what he represented. They viewed Collin a true shyster, who had cost their company buckets of money defending innocent clients. It was time for opening statements. Jay hadn’t yet witnessed Collin’s courtroom hiss but knew his reputation as a silver-tongued attorney. Collin would try to sell his brand of snake oil to the jury and let Jay’s fate swing in the cool Midwest air. Collin was first to address the jury. “We will show that the defendant, Dr. Jay Atwell, had a duty to care for Vivian Andrews, the plaintiff. That he had a professional obligation to Vivian Andrews. It is a fact that Dr. Atwell actually wrote in Vivian Andrews’s office chart that he would be available to help her anytime she needed him.” Jay knew that was an outright lie. “The

defendant, Dr. Jay Atwell, should have notified Vivian Andrews he would be gone out of town and arranged for better coverage when he left town . . . when he left for a convention to have fun with his pals. He also had a moral obligation to arrange coverage when he was off partying with his OB friends at a plush resort.

He should have done

more to help . . . to inform, to tell Vivian Andrews about the slipshod procedures at the local hospital so that she would know not to go there for care.” Collin’s monologue lasted about fifteen minutes. He told the jury the defendant was a poor excuse for a doctor, and he personally hoped he never had to be in a foxhole with him, because he probably wouldn’t help anyone if they got in real trouble. The jury was attentive to his smooth, impassioned rhetoric; his courtroom movements perfectly choreographed. Danny Gallagher gave his opening statement. He informed the jury of Jay’s background, his training in the specialty of obstetrics and gynecology, and that he had delivered Vivian’s first two children: the first a normal vaginal birth, and the second by cesarean because of its breech position. Jay had seen Vivian in his office for an annual checkup at a time when Vivian was considering

getting pregnant and having a VBAC. Danny explained how Jay had advised Vivian at great length on the risks associated with VBAC, that she must not consider having a VBAC at the local hospital, and that he couldn’t be her doctor for a VBAC delivery because he wasn’t taking any new OB patients. Danny explained how Jay had told Vivian that if she chose a VBAC delivery, he would be happy to see her professionally; that is, if she couldn’t keep an out-oftown appointment because of, for example, bad weather. Danny told the jury that Vivian Andrews never once asked for his services during her entire last pregnancy, and that Dr. Atwell never considered her his patient for her last pregnancy. The only time Dr. Atwell ever saw Vivian was when they chatted after church services.

Chapter Thirty-four Vivian Takes the Stand

“Mr. Farrow, call your first witness,” instructed the judge. “I call Vivian Andrews, the plaintiff in this case,” barked Collin. Vivian wore a two-piece navy blue suit with an offwhite blouse. She looked sad but composed as she stepped up into the witness box. Collin took his time with her. “Mrs. Andrews, would you please tell the jury, as best you can, your relationship with the defendant, Dr. Jay Atwell. Tell us about your last pregnancy. Take all the time you need.” Collin was respectful, gentle, and soft as he stepped back and away. Vivian started slowly, told her whole story. “I went in to see Dr. Atwell, at his office, for my annual exam.

He was my doctor, always had been. He had

delivered both of our sons, and I trusted him completely. I asked him if I got pregnant again . . . would he please deliver my next child by VBAC at our local hospital. I told him we could make history, be the first ones to do VBAC at

our local hospital. We talked together a long time that day.” Her testimony was natural, spontaneous, and convincing. She stopped periodically, taking a deep breath before continuing. “Basically, Dr. Atwell advised me against having a VBAC at the local hospital. He told me that, at the present time, it was too risky because the hospital didn’t yet have the ability to set up for emergency cesareans, but that there were training programs in progress to solve the problem. He told me about several doctors in Indianapolis I could go to for a VBAC birth.” “So he referred you to out-of-town specialists, gave you their names?” “Yes, he did.” “What else did he tell you before you left the office that day?” “He told me he would be happy to see me anytime, check me if I couldn’t get to an out-of-town appointment, that he’d be available anytime I needed him, to help me—that sort of thing.

I never dreamed he wouldn’t be around to

help me when I needed him the most.” She retraced the latter part of her pregnancy. “When I went into labor, I was surprised when we called Dr. Atwell’s home phone and he didn’t answer. Steve drove me to the local hospital, to be examined, before going on to

Indianapolis. They told me Dr. Atwell wasn’t available to check me, to take care of me. They told me he was out of town.” “You expected him to be available?” asked Collin. “Yes, of course, I did. I never dreamed he wouldn’t be available if I needed him. I thought he would tell me if he was leaving town. He implied he’d be around and be my backup doctor. Even the times I chatted with him after church services, he never said he’d be gone. I felt helpless; I didn’t know what to do.” Jay quickly scribbled a note and nudged his cocounsel. The note said, “Remind Danny that in Vivian’s deposition, she said her relationship with Dr. Atwell was strictly a social one.” The cocounsel handed the note to Danny. “What happened then?” asked Collin. “After our local hospital couldn’t help me, even after I begged for a cesarean, we hired an ambulance to take me to Indianapolis. The ambulance ride was horrible. I felt like I was going to die.” “In fact, you did almost die, didn’t you?” “Yes, that’s what the doctors told me. I lost my baby, my uterus, and I’ve never been the same.” Vivian cried, and

the testimony stopped for several minutes. Several jurors wiped their eyes. “Vivian, tell the jury how you felt after your ordeal.” “I’ve never been whole since then. Life was ripped out of me. I’m less than whole . . . without my baby and my womb . . . I’ve never been the same physically or emotionally. It’s as though my whole personality died, rotted away. I’m not the same toward my children. I’m not the same toward my husband, and I can’t help it. I can’t be intimate anymore; my whole life has deteriorated to nothing.” “Your witness, Counselor,” said Collin. The male jurors fidgeted; women jurors were in tears. On cross-examination Danny was thorough, but gentle. “Was it your choice to attempt a VBAC birth?” “Yes, it was my decision,” answered Vivian. “No one made you?” “No.” Near the end of his cross-examination, Danny glanced

at his notes. “Vivian, did you really believe you had a professional doctor-patient relationship with Dr. Atwell during your last pregnancy?” He waited for her answer. None came. He turned and walked closer. “Let me rephrase my question. Isn’t it true, Mrs. Andrews, that in an earlier deposition, I asked you that same question, and you said your relationship with Dr. Atwell was strictly a social relationship?” He turned toward the jury, then looked back at Vivian, waiting for an answer. “Yes, I said that,” she said softly. “I couldn’t hear your answer. Would you speak a little louder please?” “Yes, I said that,” Vivian answered. Then she pursed her lips tightly, the corners of her mouth turned downward. Danny turned away, faced the jury for several seconds, then turned toward the judge. “No more questions, Your Honor.”

Chapter Thirty-five Steve Testifies

Steve Andrews was next to take the stand. His testimony was believable, but he sounded stiff and uncomfortable. Collin guided him. “Mr. Andrews, can you tell us about your wife’s last pregnancy?” “Vivian told me she wanted a third child. She didn’t want another cesarean. She wanted a VBAC-type delivery, so

she went to see Dr. Atwell, got a checkup. He told her she was in good shape to have another baby. She wanted him to do the delivery at our own local hospital. She told him they could make history by having a VBAC delivery. She was really excited about doing it, making history, because at the local hospital, there were battles going on between the administration, the doctors, and nurses, all because of the high rate of cesarean section. Many women who’d had cesareans at Clarkesville wanted to deliver their next baby normally, by VBAC. The battle spilled over into the local newspapers.” “Go ahead, Mr. Andrews.” “Dr. Atwell told my wife she was a good candidate to have VBAC, and recommended several doctors in the Indianapolis area who performed VBAC deliveries.” “Mr. Andrews, can you tell us in your own words just what happened that day, the day your wife went into labor?” Collin waited. “That Sunday morning, after breakfast, I took my beeper and headed out to the golf course. My father and I played eighteen holes, and when we finished, I went to the office to catch up on paperwork. Vivian called and wanted me to come home because she was starting contractions. When

I called Dr. Atwell’s home phone, I was petrified. He didn’t answer. “Then what happened?” “We drove to the local hospital. They put her in a wheelchair, took her up to the maternity floor. The OB nurses told us Dr. Atwell was out of town. I couldn’t believe he was gone. He’d promised to be our backup doctor.” “What happened then?” “Vivian was in bad pain. Several times she told the nurses she wanted to have a cesarean and get it over with, but

then

she

backed

off.

Told

me

she

wanted

a

VBAC

delivery.” “Then what happened?” “One of the nurses told us we could drive to Indianapolis quicker than the Clarkesville hospital could set up and perform an emergency cesarean section.” Testimony came to a sudden halt. The judge called both attorneys to his bench and warned Collin Farrow “not to go there” because at no time was there any testimony to verify that Vivian ever

requested a cesarean section. Collin intentionally tried, through Steve’s testimony, to get certain facts into evidence, specifically that Vivian had asked for a cesarean, that the hospital did indeed have a problem in setting up for emergency cesarean sections, and that Jay Atwell had not properly warned her. After the judge’s warning, the testimony continued. Steve Andrews described how, without help from the local hospital, his wife had to sign out AMA—that is, against medical advice—and how he arranged for a local ambulance to transport Vivian to Indianapolis. “Go ahead,” said Collin. “The ambulance trip to Indianapolis took one hour and forty minutes. I almost lost her. After we arrived at the Indianapolis hospital, I spent over an hour alone in a room, not knowing what was happening to my wife, unable to get information from anyone.” “How did you find out what happened?” “A chaplain and a doctor come into the waiting room. They gave me the bad news that the baby was dead and that Vivian was critical. The doctor told me he had never witnessed a ruptured uterus, had only read about it in his

books.” “And then?” “My two boys . . . they got to hold the lifeless body of their new brother in their arms. The nurses had dressed the baby in the new blue clothes they had brought from home.” “And what is your relationship with your wife?” “It’s gone.” “Could you explain?” “My relationship with Vivian changed that day—her attitude toward me, toward the rest of the family. It left her totally detached from all of us. She’s never been the same person . . . she was cold, indifferent, both emotionally and sexually. I even bought some special things for her from Victoria’s Secret, but it didn’t do any good.” “Did you seek professional help, counseling?” “Yes, we did. We got help from a local counseling service. We were both depressed over our son’s death.” “Your witness, Counselor,” said Collin. Cross-examination was short. Steve testified that despite the fact that Dr. Atwell hadn’t treated Vivian for two years before the incident, he should have notified them

when he was going out of town, and that it was Dr. Atwell’s duty to have notified them if he wasn’t available for backup.

Chapter Thirty-six Impromptu Theatre

Collin made his move, tried to get the judge to bend, and tried to get permission to place several documents into evidence—documents Jay had given to him, documents that

were not complimentary to the local hospital. If the documents were allowed into evidence, the documents would make the hospital personnel look like a bunch of country bumpkins. It could have given credence to Collin’s story that Jay hadn’t sufficiently warned Vivian about how bad things were at the local hospital. The judge absolutely refused. Jay heard the judge tell Collin that “those documents were irrelevant since at no time had there been any evidence presented that a decision was ever made to set up and perform a cesarean section at the local hospital.” Collin’s nostrils dilated, his face turned purple, and his neck veins budged. Collin stretched out both arms, his body in the shape of a crucifix, and started to lecture the judge. “My evidence, my whole case, is in those documents,” said Collin. “It is pivotal, Your Honor, and I have better things to do with my time than to stay here, standing in your courtroom being abused by you.” Collin’s temporal veins pulsated. The judge simmered in his perch. Then Farrow raised his voice even louder. “Your Honor, this is my whole case, and you won’t even let me try it. What am I supposed to do?”

Collin came close to a contempt citation. The judge appeared visibly upset. He quickly pounded his gavel and declared a recess, then adjourned court for the day.

The next morning, Collin apologized to the court. The trial resumed. Collin now tried to prove that a doctorpatient relationship existed between Jay and Vivian and that Jay had a duty to Vivian. As evidence of that relationship, Collin pointed to Jay’s office notes and his church conversations with Vivian.

He cited Jay’s offer to

help out in case she needed him as a backup doctor. Even expert witnesses for Collin testified they doubted Dr. Atwell had a doctor-patient relationship with Vivian. Dr. Newberg, Vivian’s obstetrician in Indianapolis, testified. She stated that the three of them had previously decided that if Vivian remained undelivered when Vivian and Steve arrived for her Friday appointment, Dr. Newberg would admit Vivian that very day for an induction of labor. “In hindsight, I wished I had admitted Vivian that day rather than delaying the delivery over that weekend. When I called to make arrangements for admission that Friday, the OB supervisor told me that many of the labor-and-delivery

nurses simply were not available. The hospital has scheduled an in-service training, and staffing was very limited for an induction of labor. I explained to Vivian and Steve that I wasn’t on-call that weekend, but it would be acceptable for Vivian to return home, as long as she had a locally available backup physician and as long as she and Steve would return to Indianapolis early Monday morning for admission and an induction of labor.” She further told the Andrewses she had an obstetrician available on call over the weekend, and she would advise him of Vivian’s case.” The judge called a recess. The court clerk walked to the rear of the courtroom and approached Ann. She spoke to Ann, “I’ve been watching you throughout the trial. I wanted to ask you what you do to make your hair so beautiful, so silver.” “Thank you very much,” said Ann. “I don’t do anything to change my hair color. It turned totally gray waiting seven years for this trial to be over.” During the same recess, Jay walked over to say hello to Dr. Newberg.

They had never met. He wanted to say hello

and ask if she had gone to the last ACOG spring meeting. She told Jay she had never gone to any of the national meetings. “They’re too expensive,” she said.

Jay told her

he was happy to meet her and then left. Collin became paranoid over what he had observed during the recess. When Dr. Newberg re–took the sand, he grilled her on just what was the exact nature of her conversation with Dr. Atwell during the recess. Dr. Newberg was a bit taken aback by his question. She explained, “Dr. Atwell simply came over to introduce himself since we had never met. He asked me if I had attended the most recent ACOG meeting—that was our entire conversation.” Two other expert witnesses were of no value to Collin. One told the jury he thought Dr. Atwell’s criticism of his hospital mandated Jay notify Vivian so that she would know not to take a chance and deliver VBAC at such a hospital. However, both of the two experts agreed that Jay didn’t have a doctor-patient relationship with Vivian. Like Dr. Atwell, they too had open fights with the administration of their hospitals, and were frequently at war over their own hospital policies. They also wrote critical letters to their administration.

“The plaintiff calls Dr. Josh Roark to the stand.” Josh entered the courtroom dressed in full cowboy attire. He wore a denim shirt and pants with silver belt buckle, a blue short-sleeved jean vest, and Tony Lama boots. He positioned his well-worn Western hat at eye level, on the wooden ledge of the witness stand, clearly visible to the jury. “Dr. Roark,” said Collin, “are you a licensed physician in the state of Indiana?” Josh smiled. “I’m just another health care provider— that’s what we’re all called these days.” The jury chuckled, caught his down-home style, and listened.

Josh was unique, an unforgettable rogue, rough

on the edges but smooth as silk, down-to-earth, and believable. “And do you deliver babies?” “Not anymore,” answered Josh. “Why is that, Doctor?” “Too risky.” “Did you like delivering babies?” “Bringing a new life into the world was a real joy.”

“Did you work with Dr. Atwell?” “Yes, I did. Whenever I got into any trouble delivering babies—and that was pretty often—Jay Atwell was the first person I called—” “Just answer the question,” interrupted Collin. “Let the doctor continue,” said the judge. “Dr. Atwell was the best obstetrician in the whole area, and I trusted his judgment,” said Josh. “When he quit delivering babies, I quit. Most good physicians quit because of the fear of malpractice.” “You were covering for him when he was in Boston?” “Yes, sir, I was.” “Where you called when Vivian Andrews was in the hospital?” “Yes,

sir,

they

called

me,”

said

Josh.

“I

was

feeding my horses.” “Did you go in and see her?” “No, sir, I didn’t. I knew she wasn’t one of Dr. Atwell’s

patients because he’d stopped OB.”

out

“Dr. Roark, one more question, if I may. In retrospect, knowing what you know, what would you have done differently when you were called about Vivian that day?” “Mr. Farrow, you know, of course, I didn’t know what was happening, but if I had known, I would have hopped in my pickup truck and driven like a madman as fast as I could to the hospital. I would have whipped out my cell phone and personally called an anesthesiologist and a surgeon. I would have told them to come in immediately and demanded OB set up immediately for an emergency cesarean section.

I

would have done everything I could. I would have literally kicked ass to get it done, and I would have tried to save Vivian’s baby and her uterus. and I know Dr. Atwell would have done the exact same thing.” “Thank you, Dr. Roark. That’s all the questions.” “Mr. Gallagher, you may cross-examine the witness,” said the judge. “Dr. Roark, were you the Andrewses’ family physician?” “Yes. I saw Steve, Vivian, and the kids for whatever they needed, plus all the kids’ shots.” “Did Steve Andrews ever mention Vivian wanting VBAC?”

“He came in to see me for headaches one day. I told him they sounded like tension headaches. He said he and Vivian were arguing . . . he was worried he might lose her. He knew the VBAC thing was risky. He thought Vivian had gotten in with some real loonies—those were his words.” “Your Honor, I have no more questions of the witness.” There was nothing phony or wishy-washy about Josh’s testimony, and the jury got his message.

He raised quarter

horses like Quincy, lived on a farm, and had been Vivian and Steve Andrews’s family doctor for years. Near the end of his testimony, Josh had turned his head toward Jay and winked. As he left the witness stand, he walked straight toward Jay, smiled, and said in a quiet, raspy voice, “Don’t worry, old buddy.” He left the courtroom.

Chapter Thirty-seven Surprise Witness In a final act of desperation, Collin approached the judge’s bench and requested a conference. Danny jumped up and approached the bench, demanding to know what kind of mischief Collin was up to.

The judge denied Collin’s

request but agreed to a side bar. “Your Honor,” Collin insisted, “may I remind you of your previous ruling. You denied me permission to admit into evidence anything related to cesareans because you

said I had no evidence that Vivian Andrews had ever actually requested a cesarean.” “That was my ruling,” replied the judge. “Your Honor, I admit that allowing a new witness to testify this late in a trial is an unusual break in court procedure.” “It certainly is. I object,” said Danny. “It’s not without precedent, Your Honor,” said Collin. “I have a new and unexpected witness. She just agreed to testify to the facts in this case. My new witness will testify that Vivian Andrews did indeed repeatedly request a cesarean section be performed during her admission at Clarkesville Memorial Hospital and that she made these repeated requests known to the head nurse on duty at Clarkesville Memorial Hospital.” “Your point is well-taken,” said the judge. After a heated bench conference with numerous objections by Danny, the judge called the court recorder over and agreed to a brief continuance, a delay in the trial, in order to allow the defense sufficient time to depose the new witness before she could take the stand. The judge spoke to the jury, “I will allow limited testimony from an additional

witness with specific stipulations and instructions to the jury. The jury is dismissed for the remainder of the morning. You are instructed to return this afternoon at 1:00

PM

sharp.”

At this point, Jay and his defense team were ushered into a private room along with a court reporter. They met the new witness: Sarah Foley. Jay recognized the name and remembered that she was the same person he had seen at the graveside services for Vivian’s baby—the same person in the photos Claire had shown him. He drew his attorneys aside and briefed them on her history. The deposition lasted two hours. Danny offered no new objections and prepared for the afternoon session. After the continuance, the judge addressed the jury and advised them that in the interest of justice, he would allow an additional witness to be sworn and heard. “After I hear her testimony, I will rule whether her testimony is admissible.” Several members of the jury looked perplexed. “Bailiff, the next witness,” piped the judge.

The new witness entered from the back. She walked

quietly past Jay on her way to the witness box. The courtroom was silent. Jay glanced toward the rear of the courtroom and saw Claire and Brad Foley sitting next to Ann. Seated next to Claire was Ellen Jones. They made eye contact. Her blue eyes still sparkled. She acknowledged him with a big smile. He smiled and nodded. He hadn’t seen her in over twentyfive years. She still looked great. Good times flashed through his mind. The new witness was sworn as Ms. Sarah Foley. She wore a solid light blue ankle-length dress with long sleeves fastened with straight pins, black hose, and black flat shoes; and her hair was in a bun covered by a black prayer cloth. “Your witness, Mr. Farrow,” said the judge. “Ms. Foley, you are here to tell the truth, the whole truth, and nothing but the truth?” “Yes, of course. It would be against my religion not to tell the truth.” “And what is your religion, Sarah?” “I was brought up Plain...I’m Mennonite.” Jay knew there were large settlements of Mennonites in

Indiana. The jurors would understand. “Sarah, at the day and time in question . . . that day at Clarkesville Memorial Hospital, you were a nursing student at the Clarkesville Junior College. Is that correct?” “Yes, sir, that is correct.” “Are you an RN, a registered nurse?” “Oh no, sir.

I’m only an LPN, a licensed practical

nurse.” She offered a faint smile. “Where were you on the day in question . . . the day Vivian Andrews was admitted to Clarkesville Memorial Hospital?” “My nursing supervisor, from the junior college, she did all the assignments. She assigned me to labor and delivery at the Clarkesville Memorial Hospital. I was a student nurse.” “And what kind of duties were you assigned?” asked Colllin. “My assignment was to observe . . . observe new labor patients . . . take notes.” “Did you examine any patients?” “Oh no, sir. Our duties were strictly limited to

observing patients in labor.” “And did you observe Vivian Andrews that day at Clarkesville Memorial Hospital when she was in labor on the maternity floor?” “Yes, sir, I did.” “Would you tell the jury what you observed, any conversation you overheard. Specifically, tell the jury what you heard the plaintiff tell the head OB nurse that day?” She glanced toward the jury. “I was standing in the doorway of the labor room. I tried to stay out of the way. Mrs. Andrews, she was in hard labor, talking how she couldn’t take it anymore . . . she pleaded . . . she begged the head nurse . . . to please schedule her for a cesarean, to please set up and take the baby. She asked the head nurse several times.” She looked downward and waited, unsure what to say next. “So you heard Vivian Andrews ask repeatedly for a cesarean section?” “Yes, sir. That’s correct” “Vivian Andrews asked the head nurse to set her up for

a cesarean section?” “Yes, she did. That’s correct,” answered Sarah. “And how did the head nurse respond?” The head nurse told Mrs. Andrews, “An emergency cesarean can’t be done.” “Did she say why it couldn’t be done?” asked Collin. “Yes, she did. She said, ‘We can’t do an emergency cesarean because it usually takes too long to set up, especially on a weekend. You could make it to Indianapolis before they could get set up.’” The jury listened to every word. “What else did Mrs. Andrews say to the head nurse?” asked Collin. “I heard Mrs. Andrews tell the head nurse that Dr. Atwell had told her there had been classes to train OB nurses to set up for emergency cesareans and that it could be done.” “And what did the head nurse say?” “The head nurse said, ‘There were training classes, but the program never got implemented.” “So Mrs. Andrews thought an emergency cesarean could be set up quickly and performed, right?”

“Yes, that’s correct,” answered Sarah. “Mrs. Andrews said she thought the local OB department could set up quickly for emergency cesareans.” “What happened then, Ms. Foley?” “The head nurse left the room and walked back to the nursing station.” “About how far away was that?” “The nurses’ station was about fifty feet down the hall from Mrs. Andrews’s room.” “So in summary, Vivian Andrews did indeed make a specific request for a cesarean section and that she specifically requested that they start to set up for a cesarean section, and she also told the head nurse it was her understanding that the local OB department could do an emergency cesarean.” “Yes, that’s correct.” “Thank you, Ms. Foley. That will be all,” said Collin. “Your witness, Mr. Gallagher,” said the judge. Danny rose and slowly approached Sarah Foley. “Ms. Foley, why is it that at this late date you decided to call the court, the plaintiff’s counsel, and inform them of your testimony?”

“It’s rather complicated,” she replied. “Would you share it with us . . . see if we can understand why you’re here today?” “Well, to start with, our family is real close. We keep in contact with each other. I’m also close to some retired navy people, friends of my mother and father. My father—he retired from the navy after thirty years—he worked for JAG, the legal branch of the navy.” “Go on,” said Danny. “I didn’t get the letter from Mr. Farrow right away. That’s because for six months, I was working as a nurse, assisting the county health nurse with immunizations out in the Mennonite farm community.

The clinics are held in the

homes of different families. My mail was held for me by one of my relatives.

When they saw I had a letter from a law

firm, it was put aside.” “Why was it put aside, Sarah?” asked Danny. “Because Mennonites believe they can solve most internal disputes through faith in God and prayer. There is a distrust of the outside world, but we abide by the laws of the land as long as they are not in conflict with God’s laws.” “Go on, Sarah,” said Danny. “When I finally got the letter and opened it, I

wasn’t sure what it meant. Our family prayed together each night for a solid week that I wouldn’t be involved with any outside legal problems.” “Then what happened?” “I finally showed the letter to Commander Ellen Jones, a retired navy nurse.

She was on duty the night I was

born; we’ve kept in touch throughout the years. important person in my life.

She’s an

We talked last week, and she

told me of the trial. I told her what I knew, that I was a student nurse at the hospital the day Vivian Andrews was a patient.” “And?” “Then I told my father and mother about the letter, the trial.

They said it sounded important and that in this

case I had a moral obligation to tell the court what I knew, so I did what the letter told me to do—I called Mr. Farrow’s office.” “Well, then, Ms. Foley, I think that the jury fully understands the reason why there was a delay. Was there anything else, any other conversations that you heard, any other observations you recall from that day, besides the ones you’ve testified to, so that you might at this late date enlighten our jury?”

Sarah paused and tightened her lips as if to seal them. Then she took a deep breath and slowly told her story, “Yes, sir, there was.

I’ve kept them all, written

down in my nursing notes.” Collin looked surprised. “And what else did you hear or observe that day?” Danny asked. Sarah pulled out her notepad and placed it in view of the public but didn’t read from it. “I saw and overheard another conversation between Mrs. Andrews and her husband.” She looked down at her lap for a moment and then slowly raised her head. “And was that conversation before or after the head nurse had left the room?” “It was after the nurse left the room; she couldn’t have heard it.” “What was said?” asked Danny. “After the head nurse walked to the nursing station, I heard Mrs. Andrews and her husband argue. Mr. Andrews said, ‘Vivian, you have just told a really big lie. You knew darn well Dr. Atwell warned you about the problems here in the

hospital. You know very well he told you they can’t set up quick enough for emergency cesareans.’” “Go on, Ms. Foley,” said Danny. “Mr. Andrews said, ‘If we lose this baby because of that damn VBAC group, there’ll be hell to pay.’” The entire courtroom was on the edge of their seats. Sarah dropped her head into her hands for a moment. “He said that . . . to his wife? There’ll be hell to pay? You heard him say that?” Sarah slowly raised her head. “Yes. Those were his very words. They both used some words that I can’t use. I can’t repeat them. They’re sinful words.” “Anything else you heard?” “Yes.” “What was that?” asked Danny. “Mr. Andrews, he asked his wife a question.” “What did he ask?” “Whose name did you give as your attending doctor?” “She said, ‘I gave Dr. Atwell’s name.’” “He said, ‘Vivian, you know he’s not your attending doctor.’” “The clerk needed a name, a local doctor. So I gave his.”

“Is there anything else that you can remember?” asked Danny. “Mr. Andrews said, ‘I wished you’d never gotten involved with that damn VBAC group.’ He screamed at her. It was horrible, and Mrs. Andrews . . . she was in a lot of pain. I can still hear her screaming.” “Thank you, Sarah. No more questions, Your honor.” “Your witness, Mr. Farrow,” the judge declared. Collin stood up and approached Sarah. one question, Sarah.

“I have only

Do you know the defendant, Dr.

Atwell?” “Yes, sir, I do,” answered Sarah. “And are you related to Dr. Atwell?” “No, sir.” “So what is your relationship?” “Dr. Atwell is a friend of my family, and he’s the main reason I’m even alive . . . he saved my life.” She started to cry. The jury gasped. The bailiff handed a box of Kleenex

to Sarah. A female juror began to cry. “Sarah, how did it happen that Dr. Atwell saved your life?” Collin asked. “Dr. Atwell was the obstetrician on call the night I was born . . . the night my mother’s uterus ruptured. Dr. Atwell performed an emergency cesarean on my mother. He delivered me just in time. Otherwise, I would have died.” “Thank you, Sarah. You may step down. thanks you for your testimony.

The court

No more questions, Your

Honor.” Sarah sat motionless, then finally spoke, “God has punished her enough. Please forgive me.” The jury sat motionless, riveted by her testimony. “Bailiff, please help the witness down,” said the judge. The bailiff took Sarah’s hand and helped her down from the witness stand and led her out of the courtroom. Her sobbing continued through the courtroom doors. Brad, Claire, and Ellen followed her out from the courtroom. Jay hoped he could say hello to them. Collin waited until Sarah left the courtroom, then turned toward the judge. “Your Honor, I’d like to state that some of Ms. Foley’s testimony qualifies as hearsay and is prejudicial for the defendant.”

“Your request is noted, Counselor,” said the judge. The judge called a short recess. By the time Jay entered the hallway, his old navy friends had disappeared. His past had slipped away.

Chapter Thirty-eight Time to Testify “Your next witness, Mr. Farrow,” said the judge. “I call Dr. Jay Atwell to the stand.” Jay raised his right hand, swore to tell the truth, and sat down. He knew it was important to sit up straight, on the edge of the chair, with both hands in front, visible to the jury. TV newscasters called it the network lean. Collin walked slowly toward the witness stand. Then he paraded in front of the jurors. He moved back and forth

like an entertainer ready to work the audience. When Collin came close, Jay saw the moisture under Collin’s nose and on his forehead. His neck veins protruded. Until then, Collin had kept his emotions buttoned. He wore a sneer, his speech a bit contrived, overly controlled. He looked like a rumbling volcano about to explode. “By now, we all know who you are, Dr. Atwell. Let’s dispense with preliminaries.

We know you are an

obstetrician gynecologist. We know you’re board certified, right?” The corner of Collin’s mouth and nose curled upward. The disdain in his voice was obvious. “We know you were Vivian’s doctor, right? We know you said you’d be available to take care of her, right?” Collin paused a moment to wipe the perspiration that trickled down his brow. His slender fingers showed his nervousness, enough to make the papers he was holding vibrate. His voice turned raspy. Jay had spotted him taking some over-the-counter medicine during the last break. The judge interrupted. “Mr. Collin, which one of those questions would you like Dr. Atwell to answer?” “None of them, Your Honor. They’re background.” He walked back to the witness stand and restarted. “Dr. Atwell, do you attend many out-of-town medical meetings?”

“I did when I was in private practice,” answered Jay. “Aren’t these meetings held in expensive, plush resorts?” “The ones I attended were usually at convention centers, in large cities. The hotels are expensive, even for a very small room.” “Isn’t it true, Doctor, that at these meetings, you cut loose, party a lot?

Aren’t you and your colleagues

wined and dined by companies?” “Mr. Farrow, when I went to medical meetings, I was usually in classes from seven thirty in the morning until four thirty in the afternoon.” “You mean to tell me while you were in Boston, at your annual meeting, you didn’t go to some expensive restaurants? Really, Dr. Atwell?” “Mr. Farrow, of course, my wife and I ate out. Hotels don’t allow cooking in the rooms.” The jury smiled. “Were there a lot of parties?” “We went to free cocktail parties sponsored by drug companies like Mead Johnson, Ortho . . . They promote their

products . . . They want us to prescribe their brand of birth-control pills. We all know that.” “No out-on-the-town parties, Dr. Atwell?

All medical

courses? No playtime?” At that moment, he knew Collin had thrown him a slow curve ball, and he would try to hit it out of the park. “Yes, Mr. Farrow. You’re right. We did go out on the town, in Boston.

I bought two tickets. My wife and I went

out to see Larry Bird play basketball at the Boston Garden. I wanted just one time, to see our local Hoosier hero before he retired.

I’d never seen him in person.

And I

can tell you, Mr. Farrow, seeing Larry Bird play basketball was the thrill of a lifetime.

He’s sure done us Hoosiers

proud, hasn’t he?” Jay glanced over at the men on the jury. They all smiled and nodded affirmative. “And how much were those tickets to see Mr. Larry Bird? And did you charge them off as business expenses, Doctor?” “It cost the same in Boston as it costs here in Indianapolis at the Conseco Center if you want to see Reggie Miller and the Indiana Pacers.

I paid one hundred

dollars each for two tickets, cold cash. It was worth every penny.

I’m so proud of Larry bird, as are most people

sitting in this courtroom.” Collin dug in, retraced prior testimony, and hammered Jay with repeated questions about why Jay hadn’t warned the Andrewses that the hospital had so many problems in the obstetrical department and why he didn’t inform the Andrewses with a simple phone call that he was going out of town. Jay started each of his answers with “Vivian Andrews wasn’t my patient, but if she had been, I would . . .” Collin lectured the jury about how Jay had a responsibility as her doctor to uphold the hippocratic oath.

He kept after Jay for a full half hour. Collin asked

the same question fifteen different ways to test Jay, to see if he would change his testimony. He wanted to push Dr. Jay’s button. Jay finally flared. “Mr. Farrow, I’m really tired of this grilling. You’ve asked me the same question fifteen different ways, and I’ve given you the exact same answer fifteen times, and I’m not about to change my testimony.” The judge rapped his gavel. “Both of you stop it right now.” Again and again, Jay looked directly at the jury and

started each answer with the phrase “Mr. Farrow, I simply wasn’t Mrs. Andrews’s doctor for this pregnancy, but if I had been, I would have done as much as I could to save her womb and her baby.” Collin became more desperate.

A large vein on the top

of his forehead bulged purple. “Dr. Atwell, isn’t it true you thought of Vivian as your own daughter?” “Certainly not. Mrs. Andrews had been my patient for many years, but I never thought of her as my daughter.” “But, Dr. Atwell, didn’t you testify you thought of Steve Andrews as your son?” “Certainly not. What I said was that when I talked to him at his office, I talked to him as a father would talk to a son, but I have never thought of him as my son. There’s a big difference.” Collin then got into the high section rates at Clarkesville Memorial Hospital. “Dr. Atwell, weren’t your personal cesarean-section rates abnormally high?” “Cesarean-section rates are high nationwide . . . mine . . .”

“Answer yes or no, Doctor,” snapped Collin. “Counselor, let the doctor speak,” the judge intervened. “You may continue, Doctor.” “My rates were high enough but not abnormally high.” “What rate would be abnormally high?” “I don’t know, Mr. Farrow.” “You don’t know why your rates were high?” “One of the reasons my rates were high is because I was the only board-certified obstetrician in town.” “Why would that make your rates high?” “Physicians referred difficult cases to me.

My

practice consisted of complicated cases nobody else would touch—pregnant women with diabetes, high blood pressure, older women who had delayed their pregnancies due to their education or their careers.” Collin started to sneer. “Any other reasons why your rates are high, Doctor?” “I’ve lived long enough to see the issue of cesareansection rates swing through a full circle. When I started practice, it was ‘once a cesarean always a cesarean.’ Then women protested and demanded VBAC to reduce the rates. Our parent organization actively encouraged VBAC births in an attempt to reduce rates. Unfortunately, the outcome of that attempt is that women like Vivian have paid the ultimate

penalty. Enthusiasm for VBAC has waned. Organizations like the Cesarean Prevention Movement tried to candy-coat the real risks and the dangers of VBAC. Now, the pendulum is swinging back to ‘once a cesarean nearly always a cesarean.’ Even our national organization has changed its official position. They’ve seen the error of their ways, and they now recommend that most women have repeat cesareans instead of VBAC.” “Then why are the rates in Canada and England much lower than here in the United States? Why the difference?” “Part of the reason is that the women there haven’t pushed for VBAC, and there aren’t as many lawyers to initiate lawsuits.” The judge smiled; the jury grinned. “Anything else you want to tell us, Doctor?” “In Brazil, the opposite is true. In Brazil, the cesarean rates are much higher there than here in the States.” “Why is that, Doctor?” “In Brazil and other areas of South America, the cesarean-section rates are as much as 50 percent higher. The reason is partly cultural. In Hispanic cultures, the men want their women to preserve the virginal structure of their vagina; the men want a tight vagina. The Hispanic

women understand the sexual needs of their men and accommodate them. In order to preserve faithfulness, many of the women have cesareans for all of their births. Here in the States, we have labeled it ‘cesarean on demand.’ The Brazilian women report fewer bladder problems such as incontinence or need for surgical repair in later years. In China, where one birth is permissible and two births are punishable, the cesarean-section rate is 47 percent. There are very few malpractice suits in South America or China.” “Thank you for the educational lecture, Doctor, but didn’t your hospital call in a team of experts to investigate the high rates of cesareans at your hospital?” “Yes, they did. The board of directors at our hospital hired a group of obstetricians to look at the whole department of obstetrics. I wasn’t practicing obstetrics when that happened, and I was never privy to the results of the study.

I do know that no physicians were ever

disciplined or sanctioned.” “You were good at doing cesareans, weren’t you?” asked Collin. “Yes, Mr. Farrow, I was good at performing cesarean sections.” “Weren’t your personal cesarean-section rates

excessively high by any standards?” “No, that’s not true. Who’s to say what’s too high? I can honestly say that I have never regretted any cesarean I performed in order to get a good baby, but I can also say there were times when once it was all over, I wished I had done a cesarean instead of a vaginal birth.” “So, Dr. Atwell, are you saying cesarean-section rates don’t matter?” “No. I’m saying there is a difference of opinion on how high the rates should be.” “So no one knows what’s high. Is that right, Doctor?” Jay paused a moment, then quietly answered. “In our profession, Mr. Farrow—” “Yes or no, Doctor!” snapped Collin. “Counselor, stop badgering the witness. Let Dr. Atwell speak,” said the judge. “When we make a decision to perform a cesarean section, we’re not treating a cesarean-section rate; we’re treating human beings. We’re not treating charts. We’re not treating some statistic. The objective in obstetrics is to deliver a healthy baby. First and foremost, Mr. Farrow, we treat expectant mothers and their unborn babies. We don’t treat some theoretical norm established by some committee

in New York City or Washington DC.” “Since you’re so good at cesareans, it’s too bad you weren’t available that day, isn’t it, Dr. Atwell?” The jury scowled at his question. “If I’d been there, I would have done what I could to help Mrs. Andrews and her baby, but I wasn’t her doctor, and I wasn’t there.” “You could have saved her baby, couldn’t you, Dr. Atwell?” “I certainly would have tried,” answered Jay. Testimony between the two was beginning to boil. The judge rapped his gavel and took a recess.

Chapter Thirty-nine Those Two Imposters After the recess, Danny assumed Collin would continue his grilling of Jay. Collin surprised everyone by announcing to the judge that his cross-examination of Dr. Atwell was complete. It was the first hint that Collin had given up. Danny rose up quickly. “Your Honor, the defense moves for judgment based on the evidence.” “Motion denied, Counselor. The court will file your

motion,” said the judge. “What was that all about?” asked Jay. His cocounsel leaned over and explained that it was a routine but necessary motion. “Occasionally, a judge will make a judgment in favor of the defendant if he feels there was lack of evidence or if the jury ever became deadlocked, like a ‘hung jury.’ Then the judge could rule on the evidence as he saw fit. Danny may do the same thing again,” said the cocounsel. “The defense calls Dr. Atwell to the stand,” said the judge. Jay walked to the witness stand. Danny approached. “Dr. Atwell, did you have any professional relationship with Vivian Andrews during her last pregnancy?” “No, sir, I did not,” answered Jay. “If you had been her doctor, would you have helped Vivian Andrews?” “Yes, sir, of course, I would.” “No more questions,” announced Danny.

“You may cross-examine the witness, Mr. Farrow,” said the judge. “I have no questions,” said Collin. Danny stood up again and faced the judge. “Your Honor, the defense moves for judgment based on the evidence.” “Motion is denied, Counselor. Your motion is recorded,” said the judge. It was time for both attorneys to do their summations. Collin was first. Collin had the jury’s attention. He retraced the whole tragic event and emphasized how Dr. Atwell had promised to help Vivian but wasn’t available when she needed him.

He

made Jay appear as an unreliable scoundrel, who couldn’t be trusted. He told the jury that if he were in a war, he sure wouldn’t want to be in a foxhole with Dr. Atwell, and he was sure no one in the jury would want to be in a foxhole with Dr. Atwell either. He went on to say nobody should rely on Dr. Atwell to come and help in a time of need. lecture continued, and Collin was on a roll. savvy showed and Jay worried. Then it was Danny’s turn.

The

His courtroom

During his summation, Danny seemed physically and mentally tired.

His rhetoric was sluggish. He acted unsure

of himself, and Jay was not impressed. disjointed. He rambled on.

His speech sounded

He had told Jay the night

before he was living on coffee and didn’t get much sleep. Danny didn’t look in sync. Then it was time for Collin’s final summation. Collin appeared extremely tired; the notes he was holding in his hand shook as if he had palsy. It had been obvious from the start of the trial that Collin had an upper respiratory infection and took over-the-counter decongestants from a bottle he pulled from his coat pocket. Collin completed his final summation sitting next to Vivian.

In a soft and nearly inaudible voice, he rambled

on. He read assorted religious scriptures to the jury. The last sentence sounded like a Catholic phrase. “Blessed be the fruits of the womb.” The judge addressed the jury as to their duties and responsibilities. He read their instructions from a small notebook computer. Several jurors nodded off asleep during his singsongy instructions. He finally snapped the computer closed and dismissed the jury to deliberate. They paraded out.

The trial was over. Jay’s guts were still in knots. He wanted to get out, look at something other than courtroom walls, and needed a washroom break, some space devoid of legals. He headed across the hall to the men’s washroom. He’d had enough medical jurisprudence to last a lifetime. He knew he’d think long and hard before he ever wrote a note again on a patient’s chart, which a lawyer could intentionally misinterpret or creatively spin. No more Good Samaritan. He’d had his chance to settle the case during mediation but decided against it. Even before he was finished washing his hands, his cocounsel had rushed in and stood beside him. “The judge wants you back in the courtroom. He wants you to take a look at Mr. Farrow. He’s sick.” Jay looked him straight in the eye. “Mr. Farrow is sick?” “Yes, he looks real sick. The judge wants you to take a look at him.” “Why don’t you go back in the courtroom and tell the judge that he should just let the little son of a bitch die,” said Jay.

“Sorry, I won’t tell him that.” “I’m sure you don’t have the balls. Tell ’em I’ll be there in a minute,” said Jay. The whole eight-year ordeal was nearly over, and Jay would never deny helping somebody really sick, not even a slimy little blemish like Collin Farrow. Jay walked into the courtroom. The judge had stepped down from his bench, his face emotionless, his arms crossed. He stood over Collin, who sat slumped in his chair with a cold washrag across his brow. Collin looked pale, his body limp. He looked sick. Jay took Collins’ pulse; it was weak, thready, and difficult to find. Collin whispered, “I got a pounding headache, like a migraine.” “Are you on any meds?” Jay asked. “No, not any prescription medicines, but I’ve had a cold and been taking some over-the-counter cold tablets.” “I saw you popping pills,” said Jay. Collin’s color was sallow. Jay told the judge, “Mr. Farrow should be taken to a

hospital as soon as possible.

Have your staff call 9-1-1

immediately, then make certain the EMTs know which courtroom and to be certain the front doors are unlocked.” The emergency medical technicians arrived and took Collins’ pressure. It was above 190 systolic. Jay helped the EMTs lift him onto the gurney. “Your Honor, if you’d like, I’d be happy to accompany Mr. Farrow to the hospital.” “Thank you for offering. I don’t think it will be necessary. University Hospital is only a few blocks from here, said the judge.” The EMTs raised the gurney to eye level. Mr. Farrow turned his head toward Jay and spoke to him, “I’m so very sorry, so sorry for dragging you through this messy trial.” That was all he said. The EMTs covered him with a sheet and buckled him in for the ride. They passed Vivian on the way out. She motioned them to stop.

She took Collins’ hand, bent over

him, and gently kissed him on the cheek. Then she said, “I hope you have a better ambulance ride than I did.” The Indiana University Medical Center was only five

blocks away. They were taking Collin to the same hospital as Vivian had gone to on her fateful day. Vivian’s ride had been a disaster. The thought was scary. Jay wondered if anyone remembered. Jay’s cocounsel gave his cell number to the bailiff, announcing that they would be at the Beehive Restaurant. Ann and Jay followed, along with the rest of the Friday crowd. The jury appeared anxious, ready to go home, see their family, and light the grill. Jay wondered how long they would take to decide his fate.

The Beehive Restaurant was a watering hole for legals; it was dark, crowded, and already shoulder to shoulder with the Friday-night crowd.

After their eyes adjusted, they

placed their drink orders. The lawyers monologued postmortems. The instant Danny speared his first bite of tuna salad, Steve’s cell phone rang. “It’s the bailiff; the jury’s in.”

Jay took his chair at the end of the row. The jury filed in, unaware of Collins’ absence. Everyone rose as the judge entered; they sat after he had.

“Mr. Foreman, has the jury reached a verdict?” “Yes, Your Honor, we have.” “Please give your verdict to the bailiff.” The bailiff handed the paper to the judge, who read it and handed it back to the bailiff. “Read your verdict.” “We, the jury in the above-entitled action, find the defendant, Dr. Jay Atwell, not guilty of any of the charges of malpractice.” “Is this your verdict, so say you all?” Each juror nodded in agreement. “The court thanks you, and the jury is dismissed,” announced the judge. The judge turned toward Jay and said, “The defendant is free to go.” Jay smiled at Ann. She remained tense.

The lawsuit

had complicated their lives for eight years. It had whittled away at their psyche and their protective veneer, and it exposed rough edges of their marriage.

Ann stayed

in the back of the courtroom. Jay remembered the warning he had received from the

alcoholic navy commander: once you have a malpractice case filed against you, people view you as guilty until proven innocent. Jay could have settled the case for pocket change and gone back home, but the instant gratification would only have validated Collin and encouraged him to file more frivolous lawsuits. It would have been like shoving candy or a pacifier into the mouth of a whiny infant. Besides, Jay had wanted to see how it would play out. Rudyard Kipling summed it up: If you can meet with triumph and disaster and treat those two imposters just the same. If you can walk with kings, nor lose the common touch. Jay had met those two imposters many times during his obstetrical career until those two imposters fused together. They were like twins, but not identical. The legal system was more about wining and losing than justice. Vivian wanted triumph but found disaster and death. “Your Honor, any news on Collin Farrow’s condition?” Jay asked. “Yes. The bailiff told me that Mr. Farrow lost consciousness on the way to the hospital, and the ER physicians had ordered a CAT scan.” Jay kept his mouth shut, but he knew what the CAT scan

would show. Collin had probably ruptured a blood vessel in his brain or had a stroke. He approached Vivian. “Vivian, I’m so sorry you lost your baby,” said Jay. “I don’t know if Steve will ever forgive me,” she replied. “I don’t know if she’ll ever forgive herself,” said Steve. Jay and Ann walked back to the hotel. “I’ve had enough reality. Let’s invite the grandchildren to Disney, have some fantasy. It’ll be our treat.” Jay smiled. “We’ll take turns pushing the stroller,” said Ann. The front desk called, “We have an envelope addressed to Dr. Jay Atwell. May we bring it up?” Jay opened the envelope. I was a picture of Sarah working in a Mennonite immunization clinic. Inscribed on the back: “You are always in our prayers. God bless you. Stay in touch.” Signed Claire and Brad Foley. Jay cried and handed the picture to Ann. “Claire introduced me to Ellen. Was she my competition?” “Not for long. She taught me how to love again,” admitted Jay.

“She did a good job.” “You’re the one who stole my heart.”

Their return flight touched down on schedule. Jay looked out on Sarasota Bay and saw seagulls circling, waiting for the fishing boats, looking for a free handout. He pushed the playback button for his messages: “It’s Alexis and your three grandchildren . . . We’re packing, ready for the Magic Kingdom. My six year old said, ‘Oh Mom, Disney is the place where dreams really do come true and Pappy said he’d buy me gelato every day.’ I called Kate and Tom. Kate’s bringing her two, and Tom said he’s bringing the whole family, plus your two great grandchildren. We’ll meet as planned, behind Cinderella’s Castle, next to the Golden Carousel.” He heard the children shouting, “Let the magic begin.” The second message was from his cocounsel: “I wanted you to know the results of the CAT scan . . . It showed Collin ruptured a large artery at the base of his brain. He died today. They ‘pulled the plug’ on his life-support system. His wife donated his organs.” Triumph and disaster still lurked in the background.