Doctors

Her panic was increasing.

  ‘It shows fetal distress – our baby’s in trouble!’

  ‘Now, just a minute,’ Muhradi interceded, ‘let’s not all play doctor here. I am in charge of Mrs Livingston.’

  ‘You are? Where the hell is Bercovici?’ Barney demanded.

  ‘To hell with Bercovici,’ Laura shouted hoarsely. ‘This printout shows the baby’s heart is slowing. There’s a problem. Somebody’s got to do a caesar stat.’

  At this point, Muhradi took a good look at the monitor and realized that his patient was all too correct.

  ‘All right,’ he ordered, ‘everybody out. And that means everybody.’

  He turned to a nurse. ‘Strap some oxygen to her face and take her to the O.R. stat. I’ll scrub up.’

  Before anybody could move, Laura cried helplessly, ‘Barney, help me, help me.’

  He rushed up to her. ‘What – what do you want me to do?’

  ‘Help me turn over. I’m so drugged I can’t do it by myself. Help me get on my knees. It takes the pressure off the baby – helps it get blood.’

  ‘You heard her,’ Barney yelled to the nurses. ‘Help me turn her over, dammit, I’m a doctor too!’

  Laura had gotten very heavy during pregnancy. It took all of Barney’s strength – with the help of the single nurse who understood what he was doing – to turn Laura over so she could rest on her elbows and knees. The doors flew open and two other nurses rushed in to roll the bed to the delivery room.

  ‘Barney, stay with me,’ she pleaded.

  ‘Don’t worry, Castellano, I’ll be right there in a second.’

  He ran into the surgeon’s dressing room. Muhradi, panic on his face, was putting on his greens.

  ‘Where’re the gowns?’ snapped Barney.

  ‘I’m sorry,’ the Iranian replied, ‘this is no time for husbands. She needs a Caesarian.’

  ‘And who the hell is competent to do one around here? The coffee boy? How many have you done? Fewer than me, I’ll bet.’

  The young doctor lost his temper.

  ‘Listen, Dr Livingston, she’s my patient and you will stay outside and wait or else I’ll call Security and have you tied to a chair. Every minute that we spend arguing is taking time from your baby in distress. So sit down, shut up, and let me go.’

  Barney slammed the heel of his fist against one of the lockers.

  You little prick, you’re treating me as if it’s my fault that you didn’t read the fetal monitor. If Laura hadn’t been a doctor, God knows how much longer you would have waited.

  But he did not speak any of his thoughts aloud. For what little rational capacity he had left said, This guy’s scared enough, don’t shake him any more.

  ‘I’m sorry I flew off the handle, Doctor. Go on and do the job. I know it’ll be fine.’

  Muhradi did not reply. He merely turned and disappeared into the scrub room.

  Barney sat outside the operating room doors, trying to eavesdrop. He heard just two things: Laura crying, ‘Where’s my husband? Barney! Where’s my hus …’ And after that the words of the anesthesiologist stating, ‘This’ll shut you up.’

  Thereafter total silence.

  He kept looking at his watch. A nurse approached – to comfort him, he thought. Instead she said, ‘I’m afraid you’re blocking the operating room door, sir. You could cause an accident. I’ll have to ask you to move.’

  ‘I’m a doctor,’ Barney retorted, ‘I should be in there.’

  ‘Well, clearly Dr Muhradi didn’t want you in there.’

  Barney went out into the empty, darkened lobby and, alone with his anguish, shouted out, ‘Fuck you, Dr Hastings – is this what you call your all-star team?’

  For he had scrutinized the operating personnel as they went in. Ball, Muhradi – and two interns who looked as if they were in long pants for the first time.

  He looked at his watch. Thirty-five minutes. No normal C-section can – or should – take that long. Something had happened and it couldn’t be anything good.

  ‘Good news,’ called out a voice in the darkness. It was Muhradi.

  Barney whirled around. ‘Quick, tell me.’

  ‘Everything is fine. You have a lovely, handsome son.’

  Barney nearly fainted with relief. The Iranian came up amicably, put his arm around Barney’s shoulder, and asked, ‘What are you going to call him?’

  ‘I don’t remember,’ Barney muttered, then immediately gathered his wits and asked, ‘How’s Laura?’

  ‘She’ll be asleep for some time in the recovery room. Dr Ball had to administer a pretty hefty general.’

  I know, thought Barney, I could hear it through the door.

  ‘I’m going to see Laura and the baby,’ Barney said. ‘Where are they?’

  ‘In the recovery room,’ said Muhradi. And then he added uneasily, ‘That is, your wife’s in there. The baby is upstairs.’

  ‘What do you mean, upstairs? He should be with his mother. She’ll be frightened if she wakes up and he isn’t there.’

  ‘Look,’ said Muhradi, in his best attempt at a paternal voice, ‘there was a little problem with the baby’s breathing and we thought it best to put him in the ICU at least till morning. I am sure your wife will understand.’

  In an instant Barney was at her bedside. The women in the room were separated merely by a curtain and so the voices of the new mothers and their husbands – and their babies – were all audible.

  Laura was comatose and fighting for lucidity so she could find out how bad the situation was. Because she knew that if her baby wasn’t with her, he must be in trouble.

  ‘Barney, Barney,’ she was muttering.

  ‘I’m here, kiddo,’ he whispered. ‘And we’ve got our little Harry.’

  ‘Where’s my baby, Barney? Is he dead?’

  ‘No, Laura. Please believe me, Harry’s fine. They just had a little problem with his breathing, so he’s upstairs.’

  ‘That sounds bad, Barn. What were his Apgars?’

  ‘I don’t think they’ll let me see the scores, Laura.’

  ‘You’re a doctor, dammit,’ Laura moaned.

  ‘Not tonight, it seems,’ he answered bitterly.

  ‘Barney … everybody else has got her baby. Do you swear he isn’t dead?’

  ‘I swear.’

  ‘Go up and look. Make sure he really is alive. And please find out the numbers. I want to know how long it took to get him breathing.’

  He nodded. Both of them realized that when doctors withhold information, they are never suppressing good news. Neither of them had to admit they were afraid there was brain damage.

  Too impatient to wait for the elevator, Barney sprinted up the stairs and down a long corridor to the Neonatal Intensive Care Unit.

  ‘I’m sorry, you’re not sterile, sir.’

  It was an officious nurse guarding the door. ‘You have to scrub and put on a gown to go inside.’

  ‘Okay, okay.’

  As Barney walked to the sink in the anteroom, he noticed Muhradi in whispered conversation with the ICU resident in charge.

  Barney called out, ‘Take me to him, Doctor – take me to him now!’

  Unruffled, Muhradi smiled. ‘Come right this way.’

  The young doctor led them down a row of tiny doll-like premature infants, their lives wholly dependent on technology. Finally they reached a baby boy, much bigger than the rest.

  ‘Isn’t he a beauty?’ the Iranian said, smiling.

  Barney stared at the infant in the isolette and felt half on the verge of tears. All he could utter was a muffled, ‘Hello, Harry, I’m your dad.’ And then he meekly asked the resident, ‘Can I touch him?’

  ‘Sure, go on.’

  Barney caressed the chest of his young son. Then he took his hand, marveling at the perfection of those little fingers. But he couldn’t help noticing there were traces – barely perceptible, but definitely there – of blue at the fingertips. He stood up and asked the resident, ‘Where are his Apgar numb
ers?’

  ‘I don’t know, sir. I was too busy assisting Dr Ball with intubation.’

  ‘Well, if you two helped the baby, then Muhradi had to be the one who took the Apgars.’

  Barney once again locked the Iranian in his glance.

  ‘Well, Doctor? What were his numbers for color, heart rate, respiration, reflex, and tone?’

  Muhradi shrugged. ‘I don’t recall the exact figures but I know they were on the low side at first.’

  ‘That’s vague enough,’ Barney snarled. And persevered.

  ‘And the score at five minutes? What was my son’s Apgar at five?’

  Muhradi hesitated. ‘Actually, we didn’t do the second test till a little later.’

  ‘How much later?’

  ‘Six or seven minutes.’

  ‘Cut this damn evasion, buddy. Obviously you mean seven. Or are you saying seven because you really mean eight? Come on – you know damn well we’re talking about potential brain damage.’

  At this point the Neonatal resident interposed. ‘Your baby’s fine, sir. He should be out of this ICU and back down with your wife in forty-eight hours.’

  Barney no longer suspected that something had gone wrong with the baby. He knew it. And the awesome thought occurred to him that something might also be wrong with Laura.

  ‘Is there a phone around here?’

  ‘Certainly, certainly. In the head nurse’s office. You can call your family and tell them the good news.’

  Barney stared angrily.

  ‘I’m not about to give anybody any “good news” until I’m sure I really can. I want to call Dr Hastings and tell him to get his ass right back.’

  ‘Oh, there’s no need for you to do that,’ Muhradi said with a satisfied grin. ‘I have already done so. He is chartering a plane.’

  The ‘unsuccessful’ patient – as the doctor construes one with whom he has not succeeded – is the loneliest person in the hospital.

  No one visited Barney and Laura. Even the ladies who brought the food darted in and out so swiftly it was as though they believed that Laura’s anger was contagious. For she was furious after her first reading of the fetal monitor printout.

  Their son had obviously been in trouble for the better part of an hour, and Muhradi, alleged brilliant virtuoso at this wonderful new instrument, had not paid enough attention to notice it. For the simple reason that he had not been conscientious enough to look.

  And they lacked the most important piece of information: How much time had really elapsed between the taking of the first and second Apgar scores?

  For this would be the crucial determinant of how long the baby had been without oxygen. Had it been not seven minutes but rather nine – or maybe ten – the chances for the baby’s viability would surely have been compromised. He might even be seriously brain-damaged.

  Barney had of course reported the disturbing observation he had made – that there were still clear traces of blue on the baby’s fingertips. This alone would cast doubt on the doctor’s passing score for ‘color.’

  ‘I’ve gotta look at him,’ Laura insisted, ‘I’ve gotta check him out myself.’

  ‘Relax,’ said Barney. ‘You’ve just had major surgery. They promised I could take you up there this afternoon.’

  There was a knock at the door, followed by the cheery words:

  ‘Good morning. Have you handed out the cigars yet?’ It was Sidney Hastings.

  Laura answered sternly, ‘Come in and close the door.’

  ‘I’ve been up to see the baby,’ Hastings went on, in an attempt to create a verbal smoke screen between them. ‘He looks like a real super-star. And with his mother’s—’

  Barney cut him off. ‘Don’t waste your breath, Sidney. You know damn well that sooner or later Laura’s gonna go upstairs and find out what’s really going on. So why not have the decency to tell us the truth?’

  ‘I don’t know what you mean—’

  ‘Come on, Sidney,’ Laura interrupted.

  ‘How long did they really take to make him breathe?’

  ‘I haven’t had the chance to look at his report …’

  ‘You’re lying,’ snapped Barney, ‘you’ve probably been studying it for an hour.’

  ‘Look, Livingston,’ Hastings replied, in calm but clearly angry tones. ‘I won’t be talked to like that. I wasn’t here, so I can’t be held responsible for any screw-ups that might have occurred.’

  ‘Aha,’ said Laura, ‘so you do admit that somebody screwed up!’

  ‘Excuse me Laura, I know what a night it’s been for you. But I still refuse to be treated like a criminal in the witness box.’

  Barney made a titanic effort to appear calm. ‘Sidney, please, all we want is the truth. We know accidents can happen. Christ knows, most of us – at one time or other in our careers – have been …’

  He was about to say ‘negligent,’ but stopped himself.

  ‘Listen, we’ve all encountered misfortunes. And from my experience I’ve always found that patients take it best if they’re told the truth, even if it’s the “sorry-we-screwed-up” truth.’

  And then they waited. The ball was in Dr Hastings’s court.

  Uneasy at the silence, the older doctor spoke as if reading from notes.

  ‘Doctor Muhradi and Doctor Ball are both men of probity. And if they wrote down that respiration was restored at seven minutes, I would take them at their word. Now if you insist on behaving in this way, I suggest you find another doctor.’ He turned and walked out.

  ‘What a sonovabitch,’ Barney said.

  Laura reached out and touched his shoulder.

  ‘Barney, get me a wheelchair right now!’

  They lowered the isolette so she could examine her son without having to stand. She checked his fingers and toes for color; she listened to his chest for what seemed like several minutes; she took a pin and scratched it on the bottom of his little feet.

  Barney, watching all this, said to himself, Thank God. The kid’s got some reflexes.

  The final test was the most crucial. Would he suck? For if he was so damaged that he could not, then his chances of a normal life were absolutely nil.

  She took him and put him to her breast. After a moment she looked up at Barney and wept with joy. ‘He’s all right. He’s going to be all right.’

  They left the hospital as soon as possible. All three of them.

  ‘Well, Castellano,’ Barney said, trying to generate some joy. ‘We’ve had a lousy time. They’ve treated us more shabbily than anybody could imagine. But the bottom line is in your arms – weighing in at eight-point-two pounds. Harry Livingston, the future champion of the world.’

  But they knew better.

  For they were both physicians. They knew that although their lovely Harry would grow, smile, and frolic in the sandbox, it was still possible he might never have the mental prowess to write his own name. Only time would tell. Not even doctors held all the answers.

  Meanwhile they would have to live in purgatory.

  55

  Who could have predicted that the failed Jesuit priest, who was socially self-conscious, insecure – and innocent – would ultimately become one of the most respected (and the richest) men in Hawaii?

  But such was indeed the happy fate of Hank Dwyer, M.D.

  Moreover, he not only did well, he did good. The number of people who blessed him, remembered him in their prayers, named their children after him, were legion.

  And wisely he decided to remain unmarried in the future. While still, of course, remaining uncelibate.

  Everything seemed to come to him as easily as a coconut from a palm tree – right into his hand, opened and ready to enjoy.

  His wife, Cheryl, had not been blind to her husband’s diminished affection. And from the time Hank had signed up for yet another tour of duty in Vietnam, she had sought priestly counsel. Indeed, since she faithfully attended mass at the Cathedral of the Holy Cross, the cardinal of Boston himself became her spiritual
advisor.

  His Eminence felt that a pure soul like Cheryl Dwyer should not be forced to live in limbo and would better raise her Catholic children if she could be free of Hank and marry someone worthy of her goodness. And though the Vatican does not countenance divorce, there still were other measures to alleviate the situation. Perhaps there could be a Church annulment of the marriage.

  And thus Hank had not had to bestir himself; he had not missed a single Sunday on the beach at Maui. The papers simply came to him to sign, which he did expeditiously and unemotionally. Actually, the only thing he felt was gratitude for His Eminence’s intervention.

  On July twenty-sixth, 1978, a miracle occurred. In England a child named Louise Brown was born. It was an uncomplicated birth and she was normal in every possible way – except for one thing. She had been conceived not in her own mother’s womb, but in a laboratory jar.

  Because of tubal blockage in the baby’s mother, the pioneering doctors Patrick Steptoe and Robert Edwards had introduced the father’s sperm to the mother’s egg inside a small glass dish. Only when the union had grown into a healthy blastocyst did they return it to its normal habitat, where it implanted happily in Mrs Brown’s womb – and nine months later emerged a healthy baby.

  Procreation was one of the few things for which Hank could claim more than average competence, and it seemed only logical to him that if the prizewinning doctors would allow it, he should go to England and work (unpaid) as their assistant merely to acquire the necessary expertise.

  The innovating scientists looked at his records. Hank’s mediocre grades in Med School were more than counterbalanced by his medals for bravery in Southeast Asia.

  Such a doctor merited a chance to learn the new technique and be one of the first to bring in vitro fertilization to America.

  When Hank returned a full year later, word got out swiftly that he was setting up a clinic on the lines of those he’d seen in England. And, although he never sought publicity, the journalists went after him. Suddenly he was a household word in the fiftieth state.

  In fact, when the governor of Hawaii was apprised of Hank’s plans to establish a new institute, the likes of which even California had not yet established, he arranged for a low-cost state loan for Hank to expedite his project.