By cardiodoug
| Author Notes | Please look for following chapters to be posted every five days. |
By cardiodoug
CASSANDRA
Her problem was genetic, an abnormal DNA code. Her illness began at conception, progressed as she developed in utero and was well established by the time she was born. Nothing was outwardly apparent. She was a beautiful, seemingly healthy baby. Nonetheless, despite her normal appearance, her affliction relentlessly worsened as she grew.
Cassandra awoke bright and early, jumped out of bed and ran to her bedroom window. Falling snowflakes had created a light covering on the ground. She was so excited about the snow that she nearly forgot what day it was. Cassie was a Baby Boomer, born December 1,1947. Today was her fifth birthday. She looked down the street and saw some children playing in the snow. It was Saturday; no kindergarten today.
Her ponytail bobbed around as she ran down the hall to her parent’s bedroom. “Mommy, it’s snowing!”
Cassandra hopped up on the end of the bed, landing on her father’s feet, hidden under the covers.
“Hey, be careful, kiddo.”
“Oh, I’m sorry. It’s snowing, Daddy!”
Carlo raised his head to look out the window. “Why, so it is.”
Cassie jumped up, scurried around to the other side of the bed, and gave her mother a hug around the neck. “Mommy, let’s go outside right now. Okay?”
“Cassie, you’ve got to settle down. You’re so thrilled about this snow, I bet you forgot what day it is?”
“No. I know. It’s my birthday.”
Carlo sat up, swept dark hair from his forehead and said “Your birthday? It’s not.”
“Oh, you know it’s my birthday!”
“Is it really?” Let’s see then, hmmm.You must be four years old today. Is that right?”
“No. I’m a big girl! I’m five-years old!”
“Five-years old? I can’t believe it!”
“Yeah. Five-years old and I’m having a party.”
“Well, you’re a lucky girl, Cassie. New snow and a birthday party on the same day.”
“I am a lucky girl, huh, Mama?”
“Sure you are, honey. Listen, I want you to relax. You look a little out of breath. Are you feeling okay?”
“I’m okay. My chest don’t have hurt in it. Not for a long time.”
Carlo sat up straight. “That’s great, Cassie!”
“Daddy, no hurt for a week, I bet.”
Marie spoke quietly. “That’s very good, honey. But please be careful today. I don’t want you to get too tired playing in the snow, especially before your party.”
“Okay. Let’s go!”
Cassandra took her mother’s wrist and pulled. Marie stood and walked hand in hand with her daughter to go downstairs for breakfast. As they left, she looked back at her husband and smiled. “I guess we’re goin’ outside, Carlo. You coming with us?”
“Sure, I’ll be along in a minute.” As Carlo watched them leave, he pondered the beauty of his wife and daughter. Marie had light brown hair, nearly blonde, and was young enough to wear it long, past her shoulders. She was a very attractive woman with fine facial features and a sensuous figure. Cassandra, an unusually pretty child, had dark brown hair, large brown eyes, and prominent dimples.
After they left, Carlo’s attention turned to his concern over his daughter’s well being. He worried incessantly about Cassie’s health, and was often consumed by fear and anger, fear that his child may have a serious illness and anger toward the doctors who were unable to help her.
Cassie suffered from inexplicable bouts of shortness of breath associated with pain in her chest, under her breastbone. Marie noticed this just after Cassie turned three. Her daughter’s breathing seemed to be labored after playing, especially if she had been running. A few months later these symptoms became worse.
Marie had Cassie examined by their family doctor, Dr. Williams. He couldn’t identify any reason for her breathing problem. She seemed perfectly fine, with a totally normal physical examination.
By the age of four, Cassie frequently told her mother that her chest hurt and she couldn’t breathe right. She said her friends made fun of her for being such a slow poke.
Carlo laid back in bed and recalled one of Cassie’s worst episodes from last summer. She and a playmate had raced down the sidewalk on their tricycles. Carlo, while working in the yard, heard a child’s cries for help. He ran down the street to find his daughter lying on the sidewalk, under her tricycle, gasping for air. Her lips and fingers were blue and she was barely conscious. He scooped her up in his arms and ran back to Marie at the house.
Cassie slowly recovered over a few minutes. Her breathing improved and her discoloration cleared. She cried. She told her parents that her chest hurt and her arms felt funny. She said she wanted to play the way her friends did, and she wanted the hurt in her chest to go away.
After that event, Carlo was horribly frightened and very enraged. He was furious with Dr. Williams for telling them that Cassie was normal. They had taken her to see him three times and his response was always the same.“She seems fine to me. Try not to worry so much.”
Carlo, laden with frustration, resentment, and anger, thought Williams was a condescending jerk for treating Marie and him as overly anxious parents who were exaggerating a minor problem.
As he rose from bed, Carlo took a deep breath, sighed and walked to the window to look outside. Boughs of a pine tree were sagging under the weight of wet snow, as Carlo's shoulders now sagged under the burden of worry. As he watched the snow fall, his thoughts returned to Cassandra and their last visit to Dr. Williams.
The doctor finally admitted that he had no explanation for Cassie’s symptoms, and reluctantly, upon Carlo’s insistence, agreed to refer her to a pediatric specialist at Henry Ford Hospital in downtown Detroit.
Dr. Robert Schmidt, a pediatrician at Ford Hospital, was likewise unable to find any trace of a medical problem to account for Cassie’s shortness of breath and chest pain. He did a thorough physical examination. Her blood pressure and pulse were normal, as was his examination of her heart and lungs. She had no evidence of infection, and no evidence of asthma or lung disease. Everything seemed to be in order.
All of the appropriate tests were done: a chest x-ray, a blood test for hemoglobin and white cells, and a urinalysis. All were normal.
The pediatrician went so far as to order a newly developed test to measure blood oxygen levels, a blood gas. This required a painful needle stick in Cassie’s radial artery.
Carlo recalled how stoic his little girl was; she barely whimpered when the technician stuck her wrist with a needle. The blood gas was normal.
His daydream was interrupted by a call from the kitchen. “Daddy, come down for breakfast, you silly.”
Carlo turned toward the door and he called back. “I’ll be down in a minute.”
“Okay.”
He put on his bathrobe and headed downstairs. As he descended the steps he paused, looking at the front foyer below. His thoughts again drifted back in time.
Cassie’s worst spell had occurred just a few weeks ago when Marie went to buy groceries, leaving Cassie with Carlo in the front yard to rake leaves. Cassie had a toy rake that she used to help her father. Carlo walked back to the garage for a minute and when he returned, Cassie was no where in sight. He found her on the floor of the foyer, desperately struggling for breath, blue in color, and barely conscious. When he knelt to pick her up her eyes rolled back and her breathing stopped.
Carlo panicked! He shook Cassie, and yelled at her to breathe. He screamed at her to breathe as he vigorously rubbed her arms, legs and back.Cassie finally responded with shallow breaths. Within seconds her color returned and she began to cry. Carlo held her in his arms and caressed her until she quietly fell asleep.
“Daddy,come in the kitchen. We’ll eat breakfast and go out to play in the
snow.”
“Okay, I’m coming. I’m coming.”
The pediatric department at Henry Ford Hospital concluded that there was nothing organically wrong with Cassandra. Dr. Schmidt felt her symptoms were possibly a means of getting more attention from her parents, and he recommended she be evaluated by the psychiatry department.
Carlo was furious. He knew damn well that Cassie had a real problem—she got a lot of attention, felt loved, and was not faking these spells. It took some coaxing from Marie to eventually get her husband to consent to a psychologist’s, but not a psychiatrist’s, evaluation.
As Carlo had anticipated, the psychologist, Dr. Thomas Conner, concluded that Cassie simply needed more coddling. She was an only child, and the doctor, after hearing of the leaf raking episode, surmised that she was reacting to her mother’s absence and her father’s brief disappearance from the yard. He even suggested that Cassie was purposely holding her breath, to the point of turning blue, to frighten her parents.
Marie was skeptical, Carlo was incensed. He thought the psychologist was an idiot, that his assessment was ludicrous, and he told him so. Dr. Connor stood his ground and reassured the Conti’s that their daughter would benefit from more devoted care, and would likely “grow out of” this problem in a short time.
At their last visit to the psychology department, Carlo told Dr. Connor that his conclusions were a “bunch of shit” and that he’d never bring Cassandra back. That had been three weeks ago.
After breakfast the Conti family went out to play in the snow. They built a family of snow people with a father, mother and little girl. Cassie made faces on all three with stones from the garden. She used twigs to make arms on the little girl snowman, placing her mittens on the end of each.
Carlo watched his daughter at work and felt relieved to see her playing without difficulty. He thought about her comment earlier that morning, “I'm okay. My chest don't have hurt in it. Not for a long time."
Over the past few weeks, he and Marie, despite their opinion of Dr. Conner, had been giving Cassie extra attention, and it seemed to be making adifference. Carlo thought that he may have been wrong to discount the psychologist, and he felt a bit of remorse for being so rude to him.
Certainly, Carlo hoped he had been wrong about the doctor. The prospect of Cassie’s problem being emotional, rather than physical, was comforting. However, his feelings for Cassie were so intense that the idea of giving her more love and assurance seemed nearly impossible.
At times, Carlo felt he loved Cassie more than he loved his wife. He worried so much about his daughter’s health that he occasionally contemplated how he would feel if it were Marie who were sick instead of Cassie. He knew that he would surely trade places with Cassie, if he could. Better him than her, but possibly, better Marie than her. Such thoughts were disconcerting and of no help, but nonetheless recurrent.
Carlo watched as Cassie completed making faces on her snowmen. She walked back to the large daddy snowman, and using her fingertip, drew a heart on the snowman’s chest. She drew a heart on the mommy snowman, and finally walked to the little Cassie snowman. She stared at her snowman, hesitated for a moment, pushed her finger into its chest and quickly pulled it back.
“What’s wrong?” said Marie. “Go ahead and draw a heart.”
“I don’t want to!”
“Why not, Cassie? You have a great big heart. Go ahead and draw the
biggest heart of all.”
“I don’t like my heart, Mommy. My heart makes my chest hurt.”
Carlo responded, “Why do you say that, baby?”
“Cause. My heart is bad. It makes the hurt in my chest.”
Marie was irritated. “Cassie, your heart is fine. All of the doctors have said so.” She walked to the snow representation of her daughter. “Here, I’ll draw your heart for you.”
Cassie watched as her mother knelt down with her finger pointed toward the snowman. Just as she started to draw a heart shape, she slipped in the snow. Her finger gouged the snow deeply and a large chunk fell from the center of the Cassie snowman’s chest.
“See, Mommy, I told you! My snowman doesn’t want a heart; my snowman knows that hearts hurt too much!”
Marie’s frustration grew, “Oh, Cassie, stop it! Come on now, let’s go in the house to warm up.”
As Carlo walked with them to the house, he looked back at the little girl
snowman. The sight of the hole in its chest gave him an uneasy feeling.
| Author Notes | Chapter Three to be posted soon. |
By cardiodoug
| Author Note: | Chapter 2 details young Cassie's recurrent bouts of chest pain and shortness of breath. Doctors are at a loss to explain--believe it's a ploy to get more attention from parents. |
THE PARTY
Marie planned to bake Cassie’s birthday cake in the morning while Carlo went out for party supplies. She wanted to make the cake a surprise for her daughter, but knew it would be difficult. Cassie loved helping her mom in the kitchen. She liked getting the utensils out, mixing batter and icing and dipping her finger in to taste the results.
Cassie, a precocious child at the age of five, could already read most of the words on the flour and sugar bags. She liked reading recipes to her mother.
Carlo left the house and drove to Kresge’s dime store near their home on the north side of Detroit. He bought balloons, crepe paper ribbon, party favors and a game of pin the tail on the donkey. He thought he might secretly decorate the basement to surprise Cassie, however, like Marie, he knew it would be hard to keep his daughter from seeing him at work. In truth, he looked forward to having her help him. He loved being with Cassandra.
Returning home, Carlo found Marie and Cassie in the kitchen. Cassie was covered with flour over both arms, the front of her dress and the tip of her nose. She and Marie were giggling when he walked in.
“You two seem to be having fun.”
"We’re having lots of fun. We’re baking a big cake for my birthday!”
Carlo chuckled, “Cassie, I think there’s more flour on you then there is in the cake.”
“Did you find everything alright?” asked Marie.
“Yep, pretty sure we’re all set.”
“You wrap her present yet?”
"Well, actually I think it is too big to wrap. Maybe just a ribbon on top would work.”
“My present is too big to wrap! What is it, Daddy?”
Marie spoke up, “Honey, you can’t see it now. It‘s a surprise. You’ll get to see it at your party.”
Carlo had worked for months, building a doll house for Cassie. He left the kitchen as Marie put the finishing touches on the cake.
“Cassie, you should go upstairs and take a nap before your party.”
“I’m not tired, Mommy.”
"I know you don’t think you’re tired, but I bet you’ll fall asleep in a minute.”
“Okay, I’m going to ask Daddy to take me upstairs.”
Cassie left to find her father sitting in the living room, reading the paper. They walked upstairs together with Cassie holding his thumb. Carlo looked at his daughter’s tiny hands. Her fingernails were painted red with most of the polish chipped off at the ends. She liked to wear nail polish and often played dress-up with Marie’s old clothes, make-up and lip stick. Carlo tucked her into bed for a nap and went down to the basement to decorate. Cassie wouldn’t be helping him after all.
Cassie awoke around two o’clock, took a bath, and had her mother do her hair with curled ringlets hanging over each cheek. She wore a new dress, white with lace trim and a blue ribbon around the waist.
Children started arriving for the party at three. Marie helped them remove their winter coats and boots on the landing above the basement steps and directed them downstairs.
Normally, the basement was sparse, with a plain concrete floor and white-washed cement block walls. Carlo had done his best to prepare the room for the party with balloons hanging from the floor joists in the ceiling, and crepe paper ribbon wrapped around the stair railings and iron pole ceiling supports. A picnic table in the center of the room, covered with a paper tablecloth, had settings of paper plates, cups and plastic ware, a new item that most of the children had never seen. A single, bare light bulb hung over the table.
Cassie was ecstatic. She ran down the steps, being greeted by screams of “Happy Birthday”. Presents, stacked in the corner, were to be opened after having cake and ice cream. Marie and Carlo supervised the children in a game of musical chairs, followed by pin the tail on the donkey.
Marie brought Cassie’s cake down and set it on the picnic table. Carlo lit the candles, turned out the light and led the group in a very off-key rendition of happy birthday. Cassie’s rosy cheeks beamed as her eyes sparkled in the candlelight.
“Make a wish and blow out the candles.” said Marie.
Cassie paused, thought for a moment, and made her secret wish. She blew out all five candles with a single puff. The children clapped and giggled. Marie and Carlo served cake and ice cream as the children ran to retrieve their presents.
The birthday girl opened her gifts while the children ate and watched. She politely, as her mother reminded her, thanked her friends for each gift: a coloring book and crayons, a ball and jack set, a Chinese checkers game, a story book, an emerald-green yo-yo, and others. Cassie was having a great time. She finished her ice cream, and joined her friends in a sort of free for all that had been started by some of the boys.
Children were running around the basement with balloons on strings and streamers of crepe ribbon. Marie watched, noticing that her daughter was getting out of breath. Cassie’s ringlets were drooping, damp with perspiration and her face was flushed. She was having such fun that her mother was, at first, reluctant to interrupt. However, Marie did eventually decide to ask all of the children to settle down.
Cassie picked up her new yo-yo and asked her father how it worked. Carlo looped the string around his finger to demonstrate. He showed her all he knew: make it sleep, walk the dog, rock the cradle and around the world. Cassie and the children looked on with amusement.
“Can I try it, Daddy.”
“Sure you can, honey. Here you go.”
Carlo gently placed a loop of string around his daughter's tiny finger. He wrapped the string around the yo-yo and showed Cassie how to throw it. She tossed it downward. The yo-yo hit the floor and bounced.
“Uh oh, I’m not good with this.”
“It’s ok. The string’s too long for a shorty like you. I’ll fix it later."
“Daddy, when I grow up, I want to be a good yo-yo’er like you.”
“As smart as you are, I’m sure you will be, probably better than me.”
Carlo reminded Cassie that she still had one more present coming.
“Oh yea, my present from you and Mommy! Where is it?”
Carlo picked up his daughter and held her. “Its upstairs, Cassie. I’ll get it out, and then you and your friends can come up and see it.”
Cassandra looked directly into her father’s eyes, “I love you, Daddy.”
Carlo paused a moment. “I love you too, honey.”
She leaned forward to whisper in his ear. “Daddy, I want to tell you my wish. Is that okay?”
“You’re not supposed to, but I guess it’s okay. I’ll keep it a secret.”
Cassie whispered, “I wished the hurt in my chest would go away forever and ever. Then you wouldn’t worry no more, huh, Daddy.”
Carlo was silent, overwhelmed with emotion. He gave his daughter a loving hug, put her down, and blinked his tears away. “I’ll call you when you can come up to see your present.”
He went upstairs while Marie busied herself cleaning up and the children continued playing. A few minutes later he called out, “Okay, Cassie, you can come up.”
Cassie immediately ran for the stairs with her friends right behind. When she reached the top landing she came to a halt, and stood very still. She put her hand to her chest and slowly climbed the last two steps to the kitchen floor. The children behind her yelled, “Get moving, Cassie!”
She was too short of breath to talk. A gurgling sound came from her throat as she fell to her knees. Her face and hands turned blue. One of the children called out, “Mr. Conti, Cassie’s sick!”
Cassandra fell forward and hit the linoleum floor with a thud. Marie and Carl both heard the sound, followed by screams from two little girls. One of the boys yelled, “Cassie, get up!”
Marie ran up from the basement as her husband bolted to the kitchen. He pushed through the crowd of children and picked his daughter up from the floor. Her body was limp. Her head fell forward with her chin coming to rest on her father’s shoulder. Carlo heard a faint “Daddy, help me.” Then silence. His daughter's face turned ashen, with a deep blue discoloration around her mouth. She stopped breathing.
Carlo ran to the kitchen table and sat with his child on his lap. Marie knelt at their side.They were terrified, frantic. Cassie’s eyes rolled back in her head, her body began to twitch as the sickening discoloration spread to her neck. Her legs became mottled and cold.
Marie screamed, “Oh my God, Carlo, do something! Do something!”
Carlo shook Cassie to stimulate her breathing, there was no change. He sat her straight up on his lap, slapped her between the shoulder blades, shook her again, and screamed, “Breathe, Cassie, please breathe, baby.”
“Oh, God, Oh my God, Carlo, we’re losing her, we’re losing her! God help us, please! Carlo, my God!"
He stood with Cassie in his arms. He wanted to run away with her to get help, but there was nowhere to go. He paced the kitchen floor, holding his beautiful girl tightly to his chest, shrieking at her to breathe while feeling utterly helpless. Marie ran to the phone and dialed the operator. She pleaded to be put through to the fire department as quickly as possible. An ambulance would be sent.
Pacing, Carlo cried out for his daughter to wake up. Marie ran outside and returned with two handfuls of snow. She rubbed snow on Cassie’s face and pushed some down the back of her dress. No response.
Two minutes had passed since Cassandra had fallen to the floor. Two minutes of horror which seemed like hours to Carlo.
The twitching stopped. Cassie was motionless. Her blue color turned an awful gray as her entire body became cold. Marie was crying hysterically. Carlo sat down, holding Cassie to his chest. He abruptly jumped up, holding his daughter around her waist, he raised her high above his head, and prayed out loud for God’s help, for divine intervention.
Marie, becoming irrational, started grabbing and pulling at Cassie’s dress, pulling her down into her husband’s arms.
Everything stopped. Carlo stopped shaking his child, stopped screaming, and stopped praying. He buried his face in his daughter’s curls, held her close and sobbed. He cried with long moans of agonizing heartache emanating from deep in his soul. His beautiful Cassandra was gone.
Twelve frightened children helplessly stood by as Cassandra Conti died. Some of them cried, some stood mute, some were too young to understand what they had witnessed. Cassie was not going to wake up this time.
Carlo Conti sat down again, moaning, and rocking back and forth with Cassandra held against his chest, his face still buried in her hair. He was oblivious to his surroundings. He could barely hear Marie’s hopeless sobs and screams, which seemed to him like the faint, distant laughter of children. He didn’t hear the screeching siren of the approaching ambulance. His head was filled with a deafening noise--the thunderous roar of abject horror. He was in the throes of an acute mental collapse, absolute devastation. He could not hear, could not see and could not think.
In contrast to her father, Cassandra, at that moment, was overwhelmed with joy. Her pale, cold body belied the warmth she felt. She was bathed in a soothing yellow glow--a glow that pleasantly stimulated all of her senses. She was happier than ever before.
By cardiodoug
Michael
On the evening of December 31, 1959, Carlo and Marie Conti attended a New Years Eve party in Grosse Pointe Shores, Michigan. The acting president of Ford Motor, Henry Ford II, had invited his top executives and plant managers to a celebration to be held at his deceased father's home, the Edsel B. Ford Estate, on the shores of Lake St. Claire, Michigan.
Edsel Ford, the only son of the Henry and Clara Ford, had, at his father's request, assumed presidency of Ford Motor in 1919. Henry Ford, "The Old Man", as he was known, was an austere, irrascible, ocassionally dictatorial leader who had shown little respect for his son's capability as a designer or businessman. He often overruled Edsel's plans for the future of the company, sometimes to the point of humilating him in public.
In 1927 Edsel and Eleanor Ford relocated to a new home at "Gaukler point" on the shores of Lake St. Claire. Edsel's father, Henry Ford, had rejected the pompous, high society nature of The Pointes, populated by those he referred to as, “phony people”. Mr. Ford preferred to remain at Fairlane, near his original home and birthplace in Dearborn, Michigan. In contrast to the lake shore area, Dearborn was middle class America, and to a great degree, a farming community.
Edsel Ford's estate was a palatial, Cotswold style, twenty-thousand square foot mansion. The home's interior was decorated with imported European woodwork, along with a huge art collection containing two original Cezanne's and many exsquisite reproductions of works by Renoir, Van Gogh and Degas. The grounds were highlighted by a rose garden, lagoon, swimming pool and eletrically powered gatehouse designed by Thomas Edison.
Edsel ford was president of Ford Motor from 1919 until his untimely death from post-operative undulant fever in 1943. He died at the age of forty-nine.
Henry Ford senior was born during the Civil War. At the time of his son's death, he was an elderly, frail man, suffering from waning mentation, memory loss and suspicious ideation. To the chagrin of the company's directors, Henry turned a deaf ear to their concerns and admonitions regarding his intention to resume presidency of his company. Despite his failing abilities as a leader and decision maker, Henry, in his typical defiant manner, resumed presidency of Ford Motor in 1943.
It was around this time that Henry Ford ll, returned home from naval service. His grandfather immediately stepped down as company president and the man known as HF2 moved in. Henry Ford ll was an aggressive company manager who in 1960 transformed Ford Motor into a publically held corporation. Hank the Deuce, as he was often called, remained as CEO of The Ford Motor Corporation and Chairman of the Board until 1979 and 1980 respectively.
HF2's home in Grosse Pointe, at ten thousand square feet, was relatively small as compared to his parents' mansion. After Edsel's death, Eleanor continued living in their home at Gaukler Point until her death decades later.
In view of the large number of guests invited to his New Years Eve affair, Henry ll, with his mother's permission, arranged to have his massive celebration at his childhood home, The Edsel B. Ford Estate.
After the War, Carlo Conti went through vocational training as a tool and dye maker, subsequently taking a job at Ford Motor, where he was assigned to work in the carburetor division of the massive Ford Rouge Plant.
Carlo, an intelligent and ambitious young man, found his work as a tool maker monotonous-- at times unbearable. He strived for a more stimulating position. By 1949 he excelled as a dye maker, having developed innovative design ideas, most of which he shared with his supervisors. His suggestions, welcomed and often utilized by the company, were not financially rewarded. Ford Motor felt that Carlo’s ideas were their property, and he, although praised for his ingenuity, had to continue as an hourly wage earner.
At that time, Carlo, being a young man, was still a bit introverted and shy, as he'd been as an adolescent. Consequently, he had diffulculty speaking his mind and was often taken advantage of. Despite feeling that the company was stealing his ideas, he never complained, as always, reluctant to stand-up for himself.
That all changed in December of 1952. After Cassandra’s death, Carlo went through a dramatic personality change--a change that was evident to all who knew him. He took life more seriously, with a more determined, aggressive demeanor that made him less approachable, less amiable. Over time, he became isolated as the majority of his friendships dwindled and faded away. Ironically, despite his solitude, he felt more and more content with life.
Marie, saddened by her husband’s personality transformation, still stood by him, continuing to support him in every way possible. The new Carlo was driven to succeed; he was dedicated to achieving financial independence for his wife and him. However, the more her husband strived for success, the more deserted and lonely Marie felt. Despite this, she bolstered herself, doing her utmost to remain undeterred by her plight-- her plight from the death of a child and the drastic change in her husband’s personality. She remained strong and devoted to Carlo.
On the manufacturing line, Carlo was establishing a reputation as a responsible, no nonsense employee. He was acclaimed for his novel ideas and superior work ethic. Accordingly, he was quickly promoted through the ranks, and by 1959 had advanced to the position of assistant manager of the carburetor manufacturing division. His promotion made him one of the top one hundred salaried employees at the Rouge Plant. Along with a significant pay increase, Carlo’s promotions garnered him one very special bonus, an invitation to attend Henry Ford II’s annual New Year’s Eve celebration.
Carlo felt restless as he and Marie drove down Jefferson Avenue in Detroit. In all his thirty- two years he had never worn a tuxedo. He felt awkward in the tux and anxious about the upcoming evening. He had never been to any formal event, let alone a formal party at the Ford Estate. Carlo squirmed as he struggled to adjust his cummerbund.
“Are you nervous?” asked Marie.
“A little, I guess. I’ll be okay.”
“Of course you will. It’s going to be great party. I can’t wait to see his house.”
Carlo knew Marie would be fine. She had been excited ever since hearing of the invitation, and couldn’t wait to go to the party. They had gone together to buy her an evening gown--black, with spaghetti straps, silver sequins on the bodice and a lacy skirt, split to just above the knee. She looked especially sexy in her new attire, with her blonde hair pulled back and her face highlighted by sparkling gems, dangling from each ear. In her high heels, with her hair up, she stood about five feet seven inches.
Carlo looked at his wife, reveling in her beauty. Her presence always reinforced his self-confidence. He knew, even though he wouldn’t be the most educated or sophisticated guy at the party, he would be the one with the most beautiful wife. He took a deep breath and tried to relax.
As the couple drove up Jefferson Ave, into the city of Grosse Pointe, Marie took the invitation and directions from her purse. A few minutes later they passed through a gatehouse, and pulled into the long circular drive of the Edsel Ford Estate. A valet parked their car as they walked to the entrance of the imposing home.
Marie spoke, “You look absolutely dapper in your tux, Mr. Conti. You must be a very important man.”
“And you look incredibly dazzling in your black gown, my dear. I’m quite proud to be your escort this evening. And yes, Mrs. Conti, I am a very important man.”
They both chuckled. Their silly banter helped to alleviate Carlo’s tension as they entered the stately mansion.
As Marie had predicted, the evening was pleasurable and exciting. The congregation, although sometimes stuffy, was, for the most part, friendly and congenial, and the setting was magnificent. Marie thoroughly enjoyed the experience: the food, the champagne, the music, the spacious rooms with imported furniture and the European art. It was all so new to her and all very elegant.
Carlo and Marie arrived at their home on the north side of Detroit at about two o’clock in the morning on New Year’s Day, 1960.
“Well, Carlo, it wasn’t so bad after all, was it?”
“No, it wasn’t. I actually had a good time. It turned out to be a very productive evening.”
“What do you mean by that?” asked Marie.
“Well, I met quite a few men who work outside the company.”
“How is that? How are they outside?”
“They own their own businesses. They’re suppliers--parts suppliers. Talking with them has helped me make a critical decision.”
“Carlo, I’m not so sure I want to hear this.”
“I’ve got to do it, Marie. I can’t stand giving away my ideas to the company. I need my own business.”
“Honey, look how far you’ve come already. Just look where we were tonight.”
“It’s not enough. Listen, it’s late. Let’s not talk about it now. Let’s go to bed.”
Marie agreed. She was in a good mood and didn’t want to ruin it. She winked at her husband and said, “Okay, let’s go!”
Marie hurriedly got ready for bed and slipped under the covers. Carlo finished up in the bathroom and returned to the bedroom wearing his usual sleep attire, a T-shirt and boxer shorts. Marie had the room dimly lit and was waiting for him with the bedspread pulled up to her shoulders. She was passionately aroused, stimulated by the romantic evening, the excitement of the party and the time spent with her husband. The formal attire, the champagne, the posh elegance of the whole affair had been wonderful. She wanted to make love.
Carlo, gazing beneath the bed covers, was immediately aroused by the beauty of his wife’s bare body. Her skin was pleasantly highlighted by the faint, yellow glow of the bedside lamp. Marie’s body was immaculate. The sight of her smooth skin, her small shoulders, the contour of her neck, the curve of her breasts, her total femininity stole her husband’s breath away. He sensed a pleasurable heaviness in his chest as he felt his heart race. Carlo quickly removed his clothes and joined Marie in bed.
“My God, you’re a sexy woman!"
“Well, I’m glad you think so, Mr. Conti. You’re not so bad yourself.”
Carlo gently passed his hand over his wife’s breasts, abdomen and thighs. She sighed and her breath quickened as Carlo’s strong but soothing hands explored her body. Her husband's head was filled with the pleasant scent of her skin, her hair and the aroma of her cologne. His hand lingered for a moment as he gently stroked her inner thighs. Marie’s body responded with subtle motion of her hips. Carlo kissed her shoulders and neck, pulled her to him and kissed her deeply on the mouth.
Marie felt a deep love for her husband. She passionately returned his kiss and embraced him. They were consumed by ardor and their love making was unusually sensual and erotic, culminating in powerful, mutual satisfaction and intense love.
Carlo smouched Marie on the cheek and told her he loved her. He fell asleep with his arms wrapped around her waist. Marie remained awake, staring up at the ceiling. Her thoughts drifted back to Cassandra and her desire to have more children. Cassie had been gone for just over seven years. Carlo was so damaged by her death that he swore he would never have another child. He was too afraid of the pain--too afraid it could happen again.
As Marie lay awake, she wondered if she might become pregnant that very night. The intoxicating romance of the night was so exciting, so unusual. The whole evening had been so wonderful and their love making so intense.
Ever since Cassandra’s death, Carlo had been cautious and careful about avoiding another pregnancy. Tonight had been different. He hadn’t asked if it were safe.
Marie reached toward the bedside table and turned off the light.. As she lay in the dark, she prayed for another baby and prayed that Carlo would understand.
At that moment, millions of Carlo’s sperm were traveling toward Marie’s cervix, following a chemical pathway supplied by the vaginal mucosa. This chemotactic roadmap directed the spermatozoa through the cervical opening or os, into Marie’s uterine cavity. Millions of sperm were engaged in a race to find an ovum. By three-thirty a.m., a large portion of Carlo's sperm had died; now lying motionless on Marie’s uterine lining, the endometrium. The hardier cells continued to swim inward. Further stimulation from chemotactic hormones would direct the surviving sperm toward the opening of each fallopian tube emanating from either side of Marie’s uterus.
Two weeks prior, on December 16th, Marie marked the calendar hanging on the bathroom door, as she had done for the past seven years, ever since Cassandra’s death. This was to designate the first day of her period.
Carlo, besides blaming the doctors for Cassie’s death, had also blamed himself. He felt guilt for not following the laws of the Catholic Church, believing his daughter’s death may have been punishment from God--punishment for having left the church. He suffered horribly from shame. He had been raised in a strict Catholic household and strayed from the church after leaving home for the military. After Cassie’s death, his guilt and fear brought him back to the church.
Now he closely adhered to the rules and dogma of Catholicism. The Church had deemed "rhythm" as the only acceptable, sinless method of birth control. Consequently, Carlo and Marie had used rhythm ever since Cassandra’s death. Carlo’s obsession with following this dictum, with its unreliability as a means of birth control, created a strange paradox between his fear of disobeying God and his fear of having another child.
On December 16th, the day that Marie had marked her calendar, a single cell within her left ovary started to transform. This ovum, or egg cell, was to become the sole product of that month’s menstrual cycle. Stimulated by reproductive hormones, the cell began to enlarge and migrate to the surface of the ovary. On December 30th, 14 days and 6 hours later, the ovum emerged through the surface of the ovary and broke free on its journey to the adjacent left fallopian tube.
Chemotactic stimulants helped guide the egg to the mouth of the tube, which it entered on the morning of December 31st. Rythmic, peristaltic waves of muscle contraction gently pushed the ovum toward Marie’s uterus.
As Marie lay quietly in bed, she thought of her calendar and did a quick calculation. It had been fifteen days since the beginning of her last period. She recalled the twinge of pelvic pain she’d felt yesterday; her Mittlelschmerz, or middle pain, was a common occurrence on her day of ovulation, and she knew that this night had not been a safe night for making love. A content feeling came over her as she realized her fertile state.
Their love making had been careless and Marie felt hopeful. She was thrilled at the prospect of becoming pregnant, and she hoped that Carlo could get over his fear of having children. As she lay silently in bed, praying for another child, she drifted off to sleep.
As she slept, Marie's ovum continued its journey down the fallopian tube. Egg cells, also known as gametes or germ cells, contain a single set of chromosomes, as opposed to the double set of paired chromosomes present in all remaining cells of the human body. Despite numbering in the thousands, each egg cell, or ovum is distinct in its chromosomal DNA content.
Marie, of German and Northern Italian descent, had very light brown hair, blue eyes and fair skin. Her delicate facial features, small bone structure,and above average intelligence all added to her allure. The ovum now moving toward Marie’s uterus was chosen purely by chance from the thousands of ovarian egg cells available. This particular ovum contained DNA coding to produce a child with blonde hair, blue eyes, light skin tone, average skeletal build and a lean body with above average intelligence. If fertilization were to occur, the single X chromosome present in this ovum would play a neutral role in determining the sex of the child.
A human cell contains twenty-six chromosomes, thirteen from each parent. One of the chromosomes present in this particular ovum carried a rare DNA sequence, an aberrant code, on a portion of chromosome number twelve. This mutant DNA chain, present in less than one in five hundred humans, was present in an ovum produced by Marie nearly thirteen years ago. It was this chromosomal abnormality that was responsible for the premature death of Cassandra. An identical, abnormal DNA sequence was now heading toward fertilization in Marie’s uterus.
By five-fifteen a.m., millions of Carlo’s sperm cells had succumbed on their search for an ovum. Viable cells now numbered in the hundreds of thousands, rather than millions. Every one of these sperm was unique, as distinct from one another as each of Marie’s ovarian cells. Their chromosomal makeup, containing either an X or Y chromosome would, in the event of fertilization, determine the gender of the embryo. The varied chromosomal makeup of the sperm cells present in Marie’s uterus had the potential to produce thousands of different human beings, all of which would have similarities to, and differences from their parents.
Carlo Conti, born Carlos Antonio Conti, was of pure Italian descent. His father, a Northern Italian, had light hair and skin. His mother, from central Italy ,had jet black hair, dark eyes, and olive skin. Carlo had a strong resemblance to his mother, but of course, had inherited some characteristics from both parents. He was very handsome, with a striking combination of black hair, brown eyes, and fair skin. Regardless of his resemblance to his mother, his cells carried an equal number of DNA messages from both parents.
By five-thirty a.m., the number of viable sperm in Marie’s uterus had dropped to the thousands. A few hundred of these were far ahead in their trek across her uterine lining. Over the past three hours they had traversed a distance analogous to a man swimming the English Channel. Many sperm would survive their journey to the awaiting ovum. However, only one sperm cell would be able to enter the ovum’s nucleus; only one cell would be allowed to penetrate the outer lining of the egg.
The relatively small number of surviving sperm could, remarkably, code for thousands of genetic combinations, thus determining hair color, eye color, skin tone, intelligence, skeletal size, muscle size, body mass and facial features of an embryo. The countless sperm and oocyte (ovum) DNA code combinations present in Marie's ovaries and her husband's
testicles had been passed along through generations of Carlo’s and Marie’s ancestors.
If fertilization were to occur, all of the characteristics of the conceived child would depend upon which sperm prevailed. The DNA of the ovum, combined with that of the sperm, would produce a singularly unique being.
At six-ten a.m., hundreds of sperm arrived at target in the very end of Marie's left fallopian tube. They eagerly surrounded the ovum, massive in size compared to the very tiny sperm. The first two sperm to make contact arrived simultaneously, and were followed in seconds by hundreds more. Sperm head contact with the ovum’s outer wall set off a chemical reaction which quickly spread over the surface of the egg. This reaction made it impossible for the late comers to interact with surface receptors on the ovum. The late arrivers were immediately rejected. The two sperm who had attached to the egg cell were now in competition to enter the ovum.
One of these spermatocytes carried an X chromosome with DNA coding to produce a baby girl with light hair, dark eyes and olive skin, destined for a petite build and above average intelligence. The other sperm, in addition to its Y chromosome, possessed a defective DNA sequence on chromosome number twelve, along with DNA coding for a brown haired, brown eyed, light skinned baby boy destined for average height and average intelligence.
At 6:12 a.m., the sperm carrying the Y chromosome dominated, was instantly engulfed, and pulled internally by the invaginating exterior lining of the ovum. The competing X chromosome sperm was immediately rejected.
Within minutes the fertilized egg emerged through the tiny opening of Marie’s left fallopian tube, sliding onto a soft uterine lining, where it was caressed by the engorged, blood rich endometrium.
The dye was cast. At 6:17 a.m., New Year’s Day, 1960, Marie Conti conceived. Marie and Carlo would have a baby boy with brown hair, brown eyes, light skin, and average intelligence. Michael Carlos Conti was born on October 2, 1960, two-hundred-seventy-six days after his conception. Every cell in his body carried a rare DNA sequence on chromosome number twelve, the same sequence that had taken the life of his sister, Cassandra.
By cardiodoug
DAVID
James and Dorothy Barnett lived in the downriver suburbs of Detroit. In sharp contrast to the sophistication of Grosse Pointe, the Downriver area was a stronghold of blue-collar, middle-class families. Fueled by the demand for autoworkers, this densely populated area grew rapidly after the War. Rows and rows of small bungalows lined the streets of neighborhoods such as Melvindale, Lincoln Park, Ecorse and Wyandotte.
The Barnetts had known each other as children, both having grown up in the small, highly industrialized city of River Rouge. This city, originally founded by French explorers in the 17th century, was located on the Rouge River, so named because of its muddy, red color. The Detroit River and its tributary the Rouge, provided a source of water for industries that developed along their shores. In the early 20th century, River rouge, Michigan became home to The Great Lakes Steel complex. Farther inland, on the Rouge River, the massive Ford Motor Company Rouge Plant was to become the world's largest self-contained manufacturing complex.
Jim and Dorothy married during the War, and in 1951, moved from River Rouge to a new home in the growing community of Lincoln Park. This was the golden age of the Motor City. Detroit and its suburbs were experiencing a population boom as an influx of workers from the south ventured north to find assembly line jobs in automobile factories. By the mid-1950's, Detroit had become the fifth largest city in the United States.
Having served as a naval pilot during the war, James, later attended night school at the University of Detroit, taking advantage of the G.I. bill to cover his tuition. During the day, he worked as a foreman at the Chrysler Corporation Jefferson assembly plant in Hamtramyck Michigan. In 1951, Jim received a business degree and was subsequently able to
advance to a white collar position at Chrysler. He was one of the very few white collar
executives living in the very blue collar neighborhood of Lincoln Park.
Dorothy Barnett's maiden name was MacNeil. She was of Scottish descent, with great grandparents who emigrated from Scotland to New Brunswick, Canada, making their new home along the shores of the St. Lawrence Seaway. Dorothy's father, in search of employment as a skilled machinist, moved his family to Detroit in the mid-1920's. They made their home in the city of River Rouge, where Dorothy and Jim eventually met.
By 1959, the Barnetts had one child, a son, Douglas, who was six years old. Over the past four years, they had been trying, unsuccessfully, to have a second child. Dorothy's physician had difficulty in determining why she was unable to conceive again, postulating that it may be related to her previous bout of appendicitis in childhood.
Her appendectomy, in 1931, at the age of twelve, had been performed urgently, just minutes after her appendix ruptured. At the time, there were no antibiotics and the mortality of a ruptured appendix was high. She became critically ill with peritonitis, an abdominal infection, but eventually recovered. The doctor proposed that her remote episode of peritonitis may have scarred her ovaries and fallopian tubes, now making it difficult, but obviously, in light of her her prior preganacy, not impossible to conceive.
On New Year’s Eve,1959, the Barnetts stayed home and enjoyed a quiet evening together.Jim did not drink alcohol, and he and Dorothy rarely went out on New Years. As a point of fact, Jim Barnett despised alcohol. Memories of horrible beatings at the hands of his inebriated father led him to a life of abstinence. In the past, in his late teens, he had tried alcohol, but found that he became so easily intoxicated that just two or three drinks could make him reckless, obnoxious and mean. At the age of twenty-two, he swore off alcohol altogether.
Jim's paternal grandfather had been a vicious, belligerent alcoholic, and his father, who died from alcoholic cirrhosis at the age of forty-eight, was no different--a heavy, daily drinker who was abusive and violent when intoxicated. His father's and grandfather's behavior, along with Jim's own sensitivity to alcohol, suggested that the Barnett men suffered from an hereditary disposition to chronic alcoholism. James was terrified by the prospect of being like his father.
Dorothy Barnett had been a social drinker without any adverse consequences, but in support of her husband, had decided to abstain from alcohol. She was sympathetic to her husband's predisposition to alcoholism, and very aware of the abuse Jim's mother had suffered at the hands of her drunken husband. Dorothy, to say the least, was grateful that her husband had the desire and willpower to not drink.
The Barnett's New Year's Eve celebration was serene and sober. They enjoyed appetizers and finger food while watching watching Guy Lombardo on television. Their son, Douglas, fell asleep on the couch long before midnight. Just a few minutes before 12:00, after tucking his son in to bed, Jim and his wife stepped outside to observe the neighborhood celebration.
When the clock struck midnight, a jarring cacophony rang through the air. People were yelling and screaming out as they beat on pots and pans. The explosions of fireworks near and far, along with the occasional report of a rifle or shotgun discharged into the sky, resonated and reverberated through the cold night air. It was all over in a matter of minutes.
Shortly after the New Year, the couple retired for the evening. Hoping for another child, the Barnetts had been having sex frequently. Tonight was no exception. They made love, and, having stayed up later than usual, quickly fell asleep.
Despite having unprotected sex for years, Dorothy had not become pregnant. The reason, exactly as her physician had proposed, was her prior bout of appendicitis. The infection had caused damage to her right fallopian tube, which was severely scarred and blocked off by adhesions. Her left fallopian tube remained unharmed, however, by chance, the majority of her ovulations over the years had originated from her right ovary. The ovum subsequently released was never able to pass through the abnormal right fallopian. Therefore, she never conceived.
On December 17th,1959, Dorothy's ovulation began. Hormonal stimulation of her ovaries resulted in the growth of a corpus callosum that contained a single ovum. Unlike most of her prior ovulations, this developing egg was located in her left ovary.
At 2:00 a.m., New Year's Day, millions of James Barnett’s sperm were swimming across the lush, cellular lining of his wife’s uterus, as an ovum descended down her left fallopian. At 4:15 a.m., successful fertilization took place with the union of a sperm and ovum in the mid-portion of Dorothy’s left fallopian tube. Minutes later, the fertilized ovum slid onto an engorged, blood rich uterine lining. Uterine implantation of the fertilized egg took place immediately.
At 4:25 a.m., New Year's Day, 1960, Dorothy Barnett conceived. David Paul Barnett was born on September 28, 1960. Every cell in his body carried an abnormal DNA sequence that had been passed on through generations of his father’s ancestors. This aberrant DNA code, present in many hard-core alcoholics, is responsible for the cellular metabolism of ethanol, ethyl alcohol. Past owners of this code have destroyed families, ruined lives and often succumbed to their inherited disease.
By cardiodoug
MOUNIR
Fareed Arafa, his wife, Zaynab, and their two-year old daughter, Basima were Orthodox Christian Arabs who left Lebanon in 1947 and emmigrated to the United States. After spending a short time in New York City, they moved to Dearborn, Michigan, to stay with Fareed’s brother, Assad, who had previously found work as an unskilled laborer in a Detroit auto plant. Fareed, Zaynab, and Basima, would live with Uncle Assad and his wife; all of them crammed into a grossly inadequate, small, two bedroom apartment in East Dearborn.
Displaced, post-war Middle Eastern Arabs seeking refuge in the United States were attracted to Detroit by high paying positions in the auto industry. Arabic Christians and Muslims from Lebanon, Syria, Jordon, Palestine and the North African countries of Oman and Yemen, filtered into the US from 1945 through the 1950’s. During this time, the lower income, east side of Dearborn, became home to thousands of Arabic immigrants.
Dearborn, birthplace of Henry Ford, was the proud home of the Ford Motor Company. Ford Motor, the largest employer in metropolitan Detroit, drew thousands of Middle Easterners to the area. This migration added dramatically to Dearborn’s population, which by the early 1960's, had grown to a population of more than one-hundred-thousand residents.
East Dearborn became a unique entity, conspicuously Arabic, noticeably blue collar and relatively poor as compared to the remainder of Dearborn to the west. This arabic enclave was distinctly separate from the surrounding Anglo-Saxon communities of Dearborn and Detroit. Ford Motor, in particular, welcomed these foreign employees who, accustomed to living in a hot, arid climate, were able to tolerate the extreme heat of the company’s foundries.
By the 1970’s, East Dearborn had the world’s largest population of Arabic people outside the Middle East. Lebanese and Syrian restaurants and bakeries lined Michigan Avenue east of Greenfield Road in Dearborn. The Dearborn phone directory was filled with odd sounding Arabic names, all of which were remote and strange to the surrounding Christian community.
This Arabic population was shunned by the native population of Dearborn. Consequently, the Arab community became ingrained, isolated and over populated; resulting in crowded living quarters and a substandard lifestyle. Many men from Arabic countries, especially those from Yemen, would migrate by themselves to Detroit. Their initial home was often a small apartment, which housed numerous men who slept on mattresses spread around the floor. Once having saved enough money, these fornlorn husbands would send for their families. Husband, wife and children were often forced to live in multi-family dwellings, sharing their home with relatives and friends who were seeking refuge. Two to three families were often forced to live in single family apartments, and tiny, one and two bedroom homes.
Dearborn's influx of Middle Easterner’s lead to an inevitable out lash from the surrounding Christian community. Most of the blue collar Protestants who had migrated to Detroit from the South had never seen an Arab or a Muslim. Downriver Catholics and Protestants alike, became fearful of the Arabic foreigners, many of whom, as the Arafa’s, were Christian, but were assumed to be Muslim.
Fareed Assad's attempts at finding a better paying job in the auto industry were repeatedly foiled by mounting , anti-Arab discrimination. He was therefore forced to take employment in a Lebanese bakery.
By 1955 the United Auto Worker’s Union and its plethora of Southern-Bible-Belt immigrants, had made work for anyone of Arabic descent difficult. Fareed’s brother had endured taunts, threats, ridicule and harassment from fellow auto workers for many years. It wouldn’t be long before he too was working at a bakery.
In the fall of1954, Fareed Arafa, having saved enough money to rent his own apartment moved his wife and daughter into a one-bedroom apartment down the street from his brother, Assad. Life for the Arafa’s was slowly improving. Fareed and Zaynab were planning a large family, however, they were reluctant to bring more children into their current environment, and consequently postponed pregnancy for many years.
On the evening of December 31, 1959, the Arafas, having no interest in celebrating the New Year, retired early. They made love on New Year’s Eve. At 1:15 a.m., a single sperm from Fareed made contact with an ovum in Zaynab’s right fallopian. At 1:35 a.m., January 1, 1960, Zaynab Arafa conceived.
Mounir Assad Arafa was born on September 30, 1960. He possessed no pathologic DNA sequences and his molecular make up was flawless. From a biochemical standpoint, he was perfect. The impeccable cellular content of Mounir’s brain would produce genius. With proper nurturing, his destiny could be greatness.
By cardiodoug
TAMAYO--Part One
Ray Tamayo (tuh-my-o) walked into the cardiac catheterization lab at Toledo Hospital and greeted the nursing staff. “Buenos dias, my lovely Senora and Senorita.”
The head nurse, Linda Arnold, groaned back with a long, “Goood moorning, Dr. Tamayo. Aren’t you full of yourself today?”
“Si, Senora, I am full of myself on this most beautiful day. A great day for the cardiac catheterizations, don’t you agree?”
“Whatever you say, Doc.”
“Yes, Leenda, that is what I say, and it’s time to begin!”
Scrub nurse, Mary Simmons, broke in. “Hold your horses, Doc. Your first patient isn’t even down from the floor yet.”
“Well, could you pleese call and ask them to hurry? I’m a busy man and I need to make the money to pay for my new Mercedes coupe!”
“You’re shameless, Tamayo!”
“Maybe so, Leenda, but at least I am honest.”
The doctor chuckled as he left to change into scrubs.
Just two weeks ago, Dr. Tamayo had completed his five year training in Internal Medicine and Cardiology. He was now a Board Certified cardiologist and staff member at Toledo General Hospital. He looked different today, his first day at work as a staff physician. The change, most noticeable to the nurses, was the expensive looking pinstriped suit, crisp white shirt and silk tie he wore in place of his usual white lab coat. His attire was complemented by a pair of snazzy black leather shoes, not broken in, and obviously new. A plastic caduceus pin adorned his lapel.
The doctor walked past the cath lab secretary, Kathy, seated at the nurse’s station.
“Well, how does it feel to be a full-fledged physician, Dr. Tamayo?”
He bristled at the question raised by a mere secretary. “Kathy, my dear, I have been a full-fledged physician from the time you first met me four years ago”
His anger was brief and his charm quickly returned with a disarming smile. “The only difference now, my chiquita, is that I get to make the big money!”
Kathy took a risk, asking one more question that she’d soon regret. “Dr. T, what’s that pin on your lapel?”
“My dear, working in a medical facility, as you do, I’m quite surprised that you don’t recognize my caduceus.”
Kathy sarcastically responded, “Oh, I’m so sorry, Dr. Tamayo. Please forgive my ignorance, but what is a caduceus?”
“A caduceus, the ancient Greek medical symbol with a winged staff and twin serpents, represents the power to heal. I wear it as a sign of my dedication to the healing power of physicians.”
Tamayo stood, staring at Kathy, with a smug, satisfied look. Kathy, relatively young but familiar with former interns and resident physicians, was not to be intimidated. She glared back. “Gee whiz, that’s very interesting doctor. Thank you so very much for explaining!”
The doctor, oblivious to her sarcasm, gave her a wink as he walked to the cath lab locker room.
. . .
Raymando Tamayo was born in Mexico in 1945. His father was a prominent, well respected physician in Mexico City, and his mother, with the support of three servants, ran their household. Ray was the youngest of three boys, raised in the wealthy, aristocratic lifestyle of upper class Latin America.
As a child it was clear that Ray wasn’t the brightest of the family, but he was the most gregarious and outgoing. He was the family’s charmer, entertainer and comedian. Ray loved to amuse his family, relatives and servants with crazy behavior, stories and jokes. As years passed, his affable extroversion became a liability. Friends and family, especially his father, grew weary of his antics, his garrulous nature and lack of discipline. In some circumstances he came across as a buffoon, to carefree to be taken seriously and likely to be a failure in life.
Through adolescence, Ray became increasingly irritated by his family’s ridicule, growing to despise those who dared question his abilities. He used his charming exterior as a facade, disguising an underlying resentment of his family, especially of his brothers who had followed in their father’s footsteps, becoming physicians, residing in ritzy suburban areas of Mexico City. Ray’s resentment and anger intensified when his father and brothers challenged him to become a doctor, suggesting that he didn’t have “what it takes.”
In 1963, after graduation from high school, Raymondo enrolled at the University of Mexico in Mexico City, hoping to later enter medical school, any school that would have him. Knowing that he couldn’t compete intellectually with his father and siblings, he plotted to someday show them up monetarily. He entered the premedical program at the University of Mexico, and performed well enough to gain entry to the Medical College of Guadalajara.
Ray wasn’t surprised when his father voiced disappointment over his son’s inability to enroll at a more prestigious school, such as the College of Medicine at Mexico City. This further fueled his determination to outshine his father and siblings any way he could. Ray matured into a good-looking young man, charismatic in all respects. After admission to medical school he loosened up academically, relying on his amiable personality and charm to carry him through.
The Tamayo’s ancestors, of Spanish descent, had not mingled with the native population of Central America, and maintained a nearly pure European blood line. Ray had black hair with light skin tone. He was tall and slight of build, with sharp facial features giving him a European look. His teeth were impeccably straight, enhancing his broad smile, which was always present.
During his final year of medical school he developed a plan to out do his father and brothers. He’d studied English for two years, and immediately prior to graduation, made his move, applying for an internship at more than thirty hospitals throughout the United States. He was bewildered, dejected, and angry when he was turned down by every program. His grades in medical school were marginal and he wasn’t granted a single interview. He couldn’t charm his way into an internship position if he weren’t allowed a personal appearance. His hope was fading as he contemplated having to stay in Mexico.
One week after Ray's medical school graduation, a letter came from Ohio. The internship and residency program at Toledo General Hospital was in urgent need of one more intern. They offered an interview to Raymando Tamayo, MD. Ray was elated.
As anticipated, Ray's personality prevailed, and on July 1,1971, Dr. Raymondo Tamayo began his post-graduate training at Toledo General Hospital in Toledo, Ohio. He had never informed his family, or anyone else, of his intention to move to the United States. He had no attachments, no wife, no fiancée, not even a steady girlfriend. His parents were shocked when a post card arrived from their son in Ohio.
. . .
Tamayo returned to the cath lab dressed in blue scrubs. “Mary, where’s my patient?”
“He’ll be here in a minute. I just called the floor. He’s on his way down.”
Mary and Linda had gotten to know Tamayo over his years of internship and residency. The doctor had dedicated an extra, fourth year of training to the practice of cardiology. Linda, having worked as a nurse in the coronary care unit, was familiar with Tamayo’s dubious abilities as a cardiologist. She was also well aware of his quirky personality. She and Mary knew that hiding behind his pleasant, humorous exterior, was a potentially vicious, sarcastic man with a cruel, vindictive temper.
Actually, most of the hospital nurses knew of Tamayo’s Jekyll and Hyde behavior, and did their best to avoid confrontations with him. His appealing, often self-deprecating persona, belied an underlying propensity to bite back with savage defense mechanisms. He was incredibly sensitive to criticism.
Despite that, Mary, Linda, and the remaining cath lab staff generally enjoyed working with Dr. T, as they called him. They carefully avoided any derogatory remarks regarding his medical skills, knowing you could safely joke with him about almost anything, but never question his medical knowledge, or his treatment of a patient. If anything went awry with one of Tamayo’s patients, he would immediately disperse blame upon the nursing staff or any other hospital personnel available. It was impossible for him to accept responsibility for even the most minor professional error.
Bi-fold doors to the cardiac catheterization prep room swung open as the first cardiac patient arrived on a stretcher from the coronary care unit. Mr. Thomas Krider, age 38, had presented to the emergency room the prior night with symptoms of chest pain. Dr. Tamayo, on call that night, had returned to the hospital to examine his new patient.
Krider's only risk factor for premature heart disease was a remote family history of coronary disease. Tamayo, regardless of his patient's atypical chest pain symptoms and the low likelihood of him having coronary artery disease, decided that it would be best to proceed directly with a cardiac catheterization, rather than a cardiac stress test-- there was more money in a cath.
Mr. Krider’s chest pain occurred only once, and he was understandably reluctant to undergo any procedure that entailed risk. He and his wife questioned Dr. Tamayo’s decision to perform a heart angiogram. Ray, with his usual charm, convincingly reassured the patient that the procedure was quite safe, and indeed necessary to exclude the possibility of an impending heart attack. Tom Krider, against his wife’s wishes, agreed to undergo a catheterization the following morning.
Following behind the stretcher was Mrs. Krider, Sandra, an attractive 36 year-old brunette, neatly dressed in a skirt, blazer, and heels. She was walking hand-in-hand with her six-year-old daughter, and carrying her two-year-old son. Mary introduced the Krider family to the recovery area and prepared Tom Krider for his cath. A consent form, explaining the potential risk of the procedure, was read by Mr. and Mrs. Krider, signed by the patient, and cosigned by Mary as a witness. Tom promised his wife that everything would be all right and kissed her on the cheek. He waved to his wife and children as they left the recovery area for the waiting room.
“Good morning, Senor Krider,” said Tamayo as his patient’s stretcher rolled into the cardiac lab.
Tom Krider responded with an anxious voice, “Oh, hello. . .hello, Doctor.”
“You sound nervous, Meester Krider. Please do not worry. You’re in good hands, these hands.” Tamayo held his hands up as Krider forced a smile.
“Have you had any more chest pain, Senor?”
“No, just that spell yesterday. How did my test results come out, Dr. Tamayo?”
“Good news!” Tamayo gestured, making Okay signs with both hands. “Everything is completely normal. Your electrocardiogram and blood work are fine.”
“Really, then should I still have this cath test?”
“Of course. The normal EKG and blood tests prove nothing. We must take the pictures to be completely sure. You need not worry, Meester Krider.”
Linda and Mary transferred Krider from the stretcher to the cath table, and positioned him under the fluoroscope. Tamayo left the room as the nurses prepared their patient for the procedure. They shaved his right groin, cleaned it with iodine solution and covered him with sterile drapes. An IV was inserted in his right arm as a route for administration of intravenous drugs, given for pain relief and sedation. Linda gave 5 mg of morphine sulfate through Krider’s IV line.
Cardiac catheterization, developed in the early 1960’s, entails the insertion of a narrow diameter plastic tube, or catheter, into the heart, via the right femoral artery. The study was initially used to investigate valvular disease of the heart, usually due to rheumatic fever or congenital cardiac disease. In the mid-60’s, it was discovered that one could safely inject x-ray contrast fluid directly into the coronary arteries to visualize narrowings, blockages, in those vessels.
One of the main risks of this procedure is the inadvertent induction of potentially fatal heart rhythms. Furthermore, movement of catheters through the aorta carries the hazard of scraping material off the inner lining of an atherosclerotic, hardened vessel. Cholesterol plaque and calcium deposits, on rare occasions, can break loose into the bloodstream, flow upward, and embolize into the cerebral circulation, thereby causing a stroke. Tearing a vessel with a catheter tip, especially the openings of the coronary arteries, is another deadly, but rare occurrence.
One catastrophic, but readily preventable complication of cardiac catheterization is the accidental injection of air into the bloodstream. Cath lab nurses take extra precautions to adequately flush IV lines and catheters to eliminate air bubbles.
The IV bolus of morphine given to Mr. Krider had taken effect. He was relaxed, on the verge of dozing off, as he lay on the cath table, covered from head to toe with a long, sterile, blue drape. The cylindrical chamber of the x-ray tube, the fluoroscope, was positioned over his chest. A small circular opening in the drape, over his right groin, would provide access to his femoral artery.
Tamayo returned to the cath lab wearing a lead apron to shield him from radiation. He walked quickly into the room, as always, in a hurry. With his best attempt to impersonate an old west cowboy, he exclaimed, “Move along there, cowgirls. Keep them doggies rollin’!”
Linda laughed, thinking how bizarre Tamayo was. Tamayo scrubbed in at the sink, and with Mary’s assistance, donned his sterile gown, mask and gloves. Mary put on her sterile garb and joined him at Mr. Krider’s side.
The scrub nurse at the cath table is responsible for hanging all IV equipment, and flushing all IV lines to assure that no air bubbles are present. For safety reasons, many physicians prefer to attach the contrast syringe themselves, instead of relying on the nurse for this important safety check. This final syringe check by nurse or cardiologist, is at the doctor’s discretion.
Linda and Mary carefully set-up the IV lines for the procedure. Tamayo, to save time, preferred to not fiddle with the syringe hook-up, and always had the scrub nurse complete that safety check. Mary was aware of this, and tried to have all lines cleared, with a syringe full of contrast attached before Tamayo entered the lab. However, the physician performing the procedure is ultimately responsible for checking all equipment to guarantee a safe study.
Tamayo started by injecting lidocaine anesthetic into the skin overlying Krider’s femoral artery, followed by insertion of a large bore needle into the vessel. A brisk stream of blood shot from the needle as it entered the artery. A long guide wire was inserted through the needle and passed all the way up, from groin to chest, through Mr. Krider’s aorta. The coronary catheter, a narrow, three foot long, hollow plastic tube, was advanced over the guide wire and positioned with its tip in Mr. Krider’s aorta, just above his heart. The guide wire was removed, the catheter was left in position, and with the use of a syringe, blood was drawn back, aspirated, through the catheter to remove any remnants of air.
The doctor attached a stopcock and a saline filled IV line to the end of the catheter. This would be used to flush the catheter with saline without risk of introducing air bubbles. A second IV line containing contrast solution was attached to a 10 cc glass syringe used for injection of contrast, through the stopcock, into the coronary catheter, and subsequently into the coronary blood vessel.
The object of the procedure is to position the catheter tip at the opening of each coronary artery, allowing injection of x-ray contrast directly into the coronary blood vessel. An X-ray taken during the three to four second injection of contrast, photographs the coronary arteries. The cine movie produced is viewed later to check for the presence of blockage.
Tom Krider, sedated by morphine, was asleep.
“Senor, how are you do-eeng? Mr. Krider, are you sleeping? I’m about to start taking the pictures of your heart.”
Krider aroused slightly and opened his eyes. He mumbled with a groggy, “I’m ready. Go. . .go ahead, Dr. Tomato.”
Linda and Mary broke out in laughter. Tamayo rolled his eyes, “You are quite the comedian, Meester Krider.”
During his training, Ray had performed over two hundred cardiac caths without a single mishap. He considered the procedure to be simple, and was not overly concerned about safety. As he picked up the glass syringe to begin injecting contrast, his mind drifted off to something he found much more interesting -- his new Mercedes. He’d bought the car the day before, and couldn’t wait to finish work, hopefully before dark, to go cruising around the city.
Mary, standing at Tamayo’s side, turned away to face the equipment table behind her. She was preparing another catheter, needed to visualize the right coronary artery. Tamayo stepped on the floor pedal, activating the x-ray scope, and repositioned the tip of the catheter. He would perform a test injection at this location, prior to advancing the catheter into the left coronary opening.
As Tamayo started the injection his thoughts again drifted back to his Mercedes. He was thinking about the car’s interior, wondering if he would have preferred tan leather to the black he had ordered. As he pushed the glass plunger his daydream was interrupted. The syringe didn’t feel right.
Mary, remembering what she had meant to tell the doctor, turned from the work table to face Tamayo. “Dr. Tamayo, did you fill the. . . ”
Tamayo, continuing the injection, noticed an odd, spongy feeling as he depressed the plunger.
By cardiodoug
Mary yelled, “Wait!”
The doctor watched the X-ray image on the monitor as he completed emptying the syringe. To Mary’s horror and Tamayo’s surprise, a stream of air shot from the catheter tip and coalesced into three large bubbles, which rapidly ascended through Mr. Krider’s aorta.
The first bubble, following the course of the aorta, traveled down to Krider’s lower extremities, where it would shatter into harmless micro-bubbles, absorbed into the bloodstream. However, as Tamayo watched helplessly, the second and third bubbles ascended upward in the left Carotid artery toward Krider’s brain.
Mary quickly repositioned the table, placing the fluoroscope over her patient’s head just in time to see a large bubble wedge in the carotid, creating a vapor lock blockade that slowly advanced up the artery with each heart beat. The bubble popped, showering air into Krider’s left cerebral circulation.
Tamayo turned and glared into Mary’s eyes. She took a small step back. Despite the mask covering most of his face, she could see the rage in his eyes and she knew what was coming. Mr. Hyde emerged from Tamayo’s depths and screamed, “You idiot! You stupid bitch!”
Mary cowered back farther, trembling as tears welled in her eyes.
“You careless, worthless piece of shit! You just killed this man!”
Krider let out a soft groan. His eyes opened wide as he awakened from sedation and mumbled incomprehensibly. Linda, unaware of what had happened, wasn’t surprised by Tamayo’s outburst. She’d seen it happen numerous times for events of little consequence.
She bent down to hear what her patient saying.
With garbled speech, Krider said, “There sum-thin-wron, somethin wrong, Doctor. There something wrong my eye.” His voice strengthened, “Doctor, I can’t. . . I can not, I can’t see of my eye!”
Tamayo knew what had happened; a bubble had gone into Krider’s left retinal artery, causing immediate blindness in that eye.
“You’re going to be okay, Mr. Krider,” responded Tamayo. His voice had a serious tone, lacking its usual jovial nature--no more Spanish banter.
Hundreds of micro-bubbles passed deep into Krider’s cerebral circulation, down to the midbrain and primitive structures at the base of the skull. This area controls basic bodily functions, including respiration and heart rate. The resulting decrease of blood flow and oxygen to Krider’s brain caused a sudden drop in his heart rate and blood pressure, along with a marked slowing of his respiratory rate. The pressure monitor in front of Tamayo showed Krider’s blood pressure to be falling rapidly.
Linda, realizing her patient was in trouble, didn’t know exactly what had happened. She fired a question at Tamayo. “Dr. Tamayo, what’s going on?”
Tamayo quickly turned and shot her an angry look as he screamed, “This man is dying from an air embolization because of this bitch friend of yours!”
Mary was crying, cowering at the end of the table. Linda, not easily intimidated, not even by Tamayo, yelled back. “Look, he’s not dead yet. Let’s do something to save him! His blood pressure’s dropping, Doctor. What do you want me to do?”
Tamayo was trapped, unable to respond, as he stood facing Linda with a blank stare, his mind paralyzed by fear. The possibility that his very first cath patient as a new staff physician was going to die from a complication was too much for him to bear. He’d never be able to concede to the accusations that would follow. He had to escape, but there was nowhere to go.
"Dr. Tamayo! We have to do something! I’m calling a code!”
Tamayo remained unresponsive. In his head he could hear snickers and rumors echoing through the hospital.
Linda yelled again, “Tamayo!”
Ray snapped out of his trance. “No, do not call a code! I can handle this!” Defense mechanisms came into play as Tamayo thought of a scheme to shield himself from blame.
Linda continued. “Do you want me to hang some dopamine?”
“Yes, do that immediately! Mr. Krider, can you hear me?”
Krider’s mental status was failing fast. He was barely conscious, mumbling with slurred speech, “I go in bline.”
As Tamayo looked to the head of the table, he could see that Krider had a right facial droop, indicating further progression of his stroke. The cardiac monitor showed a blood pressure of only eighty millimeters of mercury with a heart rate of forty beats per minute. Air bubbles blocking flow to Krider’s midbrain were causing rapid deterioration of his vital signs. His respiratory rate was dangerously low, his breathing barely detectable.
Linda was angry, “Dr. Tamayo, why don’t you want me to call a code? We need help right now!"
“No we don’t! I’ll handle this. All we need is a respiratory therapist!”
Tamayo knew if the cardiac arrest team were to come down and witness this event, news of his blatant irresponsibiltiy in the cath lab would run rampant, he would never be able to avoid accusation and his fragile ego would be crushed.
Linda called in a stat page for respiratory. She had dopamine, a vasopressor agent, running wide open in an attempt to elevate Krider’s blood pressure. She placed an oxygen cannula on his nose and inserted a second, larger IV needle in his arm to give more fluids.
Mary, recovering from Tamayo’s diatribe, was assisting Linda with the IV line. Tamayo stood back with his arms folded across his chest, shouting orders as the nursing staff worked hard to save his patient.
“Linda, give an amp of atropine IV push. Mary, mix up an Isuprel drip to hang in addition to the dopamine and hang a full liter bag of normal saline to run wide open.”
The doctor walked to the head of the table and spoke, “Mr. Krider, are you still with us?” Krider was silent, unresponsive--his right face drooping at the corner of his mouth, his right eye shut and left eye partially open. He made gurgling sounds as he tried to breathe.
A respiratory therapist ran into the room, “What’s going on?”
Mary and Linda expected an outburst from Tamayo in response to the therapist’s question. They were shocked when he politely responded, “We need your help, my friend. Mr. Krider here is having a heart attack!”
Linda looked at Tamayo with astonishment. She knew Krider wasn’t having a heart attack. He was dying from an air embolism stroke. It was Tamayo’s fault and it had nothing to do with his heart. Tamayo was starting his cover up by lying to the therapist, who responded, “Heart attack? It must be a big one, Dr. Tamayo. This guy doesn’t look so good, does he?”
“That’s right! Unfortunately, we got him to the lab just a bit too late. He’s suffering through a massive heart attack that started just as I began the procedure.”
The nurses were incredulous over Tamayo’s egregious lying. However, they knew better than to raise any questions or make comments. Linda, at least had the nerve to look into Tamayo’s face and stare him down.
The respiratory therapist inserted an endotracheal tube into Krider’s airway, and started pumping oxygen into his lungs. Krider’s chest rose and fell with each compression of the respiratory bag. The atropine given by Linda had minimally improved Krider’s heart rate, which was up to sixty beats per minute. However, despite a massive infusion of IV vasopressor drugs and IV fluid, Krider’s blood pressure remained dangerously low, in the range of seventy millimeters of mercury.
Eight minutes had passed from the moment Tamayo pumped air into his patient’s brain. Large portions of Tom Krider’s left cerebrum, limbic system and midbrain were dying; undergoing necrosis due to lack of oxygen. Krider was comatose, unresponsive to all stimuli. His blood pressure continued to fall as the nursing team worked frantically to save his life.
It was obvious to Tamayo that Krider had already sustained a critical injury to his brain, severe enough to cause extreme debilitation if he were to survive. The doctor decided that his patient would rather die than live a brain damaged life. He reconciled his decision as being what Mr. Krider would want, knowing deep inside it was self-preservation, a reality he tried to force from his mind.
He pondered the thought, I don’t have to save this patient. Krider wouldn’t want me to.
Tamayo kept playing mind games, trying to rationalize his decision, knowing all along it was part of his cover-up scheme to avoid being exposed--to avoid being laughed at.
Tom Krider was no longer on the table. He was watching the whole event from somewhere high above the room, above the ceiling, maybe even above the building--he wasn’t sure. He seemed to be looking right through the floors of the hospital with a crystal-clear view of his body below. He could see his face, his chest, his entire body, just as though he were looking directly through the sterile drapes and overlying equipment. Despite the chaos in the room, and the lifeless look of his body, he felt wonderfully content and detached from the whole event.
Tamayo knew he had to get Linda out of the room before executing his plan to withdraw life support from Krider. “Linda, please go out and speak with Mrs. Krider. Let her know that her husband has taken a turn for the worse. Tell her were working very hard to correct the situation.”
Linda stood back from the table, placed both hands on her hips and sarcastically answered, “Whatever you say, Doctor!”
“And Linda, don’t go into any details. Just tell Mrs. Krider there’s a problem. I’ll take it from there.”
Linda threw a disapproving look at Tamayo as she grudgingly left the cath lab to speak with the family.
Tamayo walked around the table to Mary, standing at the IV poles. He lowered the IV rates without speaking to her. He was slowing the rate of drug infusion to withdraw blood pressure support. Mary didn’t say a word--she was frightened. The respiratory therapist, busy attending to Krider’s airway, didn’t notice the adjustments made by the doctor. Linda returned to the room a minute later.
More than sixteen minutes had passed since the injection of air into Krider's brain. The majority of cerebral cells were coalescing, as hypoxia, lack of oxygen, progressed. Cellular walls stiffened, vital intracellular proteins coalesced and liquefied as nucleoli expanded-- exploding under the stress. Despite this devastating process, Mr. Krider remained aware. Clinically, he was near death, pupils sluggish, body motionless, blood pressure nearly absent. However, he was still cognizant. His mind was dissociated, seemingly in two places, as he observed himself from high above the room, while at the same time, his body and brain below, experienced an incredible joy.
The disintegration of Tom Krider’s left cerebrum produced a spectacular event. Brilliant hues of red and violet shot through his head. He was overwhelmed with the scent of plastic. He knew exactly what it was. He smelled the plastic of a new toy train, a gift given to him by his mother when he was a child. He vividly remembered the train. He could see it, he could touch it, he could smell it. He more than remembered the day-- he relived it as he felt the joy of the unexpected gift.
The intensity of the scent grew as his olfactory lobe slowly disintegrated. Hypoxia of the sensory portion of his brain, the parietal lobe, generated the sensation of being caressed--enveloped by the soft, rubbery texture of the red caboose, purple boxcar and green toy engine. Injury to his occipital lobe, the visual center, created magnificent bursts of light, suspending him in dazzling shades of red, purple and green.
Tom Krider, reliving one of the happiest days of his life, a day thirty years past, became aware of an incredible love for his mother, a degree of love he’d never known.
The scent of plastic started to fade as Krider’s olfactory lobe suffered full blown necrosis. Cellular nucleoli and mitochondria were obliterated as Tom’s brain cells swelled, bursting at an incredible rate. The brilliant colors flashing through his head vanished as his occipital lobe died. The smell of the plastic toy was gone. The sensation of rubbery plastic caressing his body was gone. The memory of his mother was gone. Tom Krider was dead.
Tamayo looked at the monitor as Krider’s heart rhythm went flat line. The respiratory therapist broke in. “Should someone start chest compressions?”
The doctor stepped to Krider’s side, starting half-hearted CPR compressions. He was so nervous that he started speaking in Spanish, quickly caught himself, and resumed in English. “You keep bagging him. I’ll do the compressions.”
Linda quickly rolled the electro-cardioverter toward the table, as Tamayo, without looking up, barked, “Linda, get the defibrillator!”
She responded with more sarcasm, “Right away, sir!”, and handed the paddles across Krider’s chest to Tamayo. The doctor held the paddles up as Linda coated the metal surface of each with conductive gel. He placed a paddle low on Krider’s left chest, with the other up high, near the right clavicle.
Electrical cardioversion works by passing a brief burst of direct current through the chest and heart. This shock eliminates, or overpowers, any abnormal electrical activity present in the heart muscle. If successful, the cardioversion allows the heart’s own natural pacemaker to resume beating.
However, once asystole, flat line develops, the DC shock is virtually worthless. Tamayo was well aware of that, and was simply going through the motions to make it look good.
Tom Krider remained high above the room, watching with curious detachment. He could hear Tamayo and the nurses talking just as if he were lying on the table, right next to them.
“Clear”, yelled Tamayo. He pressed the button on each paddle. A “click” came from the machine, followed by a low level thud as a jolt of DC current discharged between the paddles. Krider’s body jerked, and rose off the table as all of the skeletal muscles in his chest and back contracted violently.
Tom, watching from above, oblivious to the defibrillator’s shock, didn’t feel a thing. In contrast, he felt wonderful. He was acutely aware of his death below, but wasn’t afraid, not even concerned.
As Tamayo anticipated, the DC shock was of no benefit. Krider’s heart remained motionless--no heart beat, no blood pressure, flat line on the monitor.
“Mary, give one amp of epi IV push and an amp of sodium bicarb. Linda, recharge the paddles. We’ll try once more.”
“Clear!” Click, thud--Krider’s body jerked--no change, no rhythm.
Tamayo looked at the respiratory therapist. He wanted to reinforce the diagnosis of myocardial infarction as an unavoidable event, and most importantly, wanted to impress this sham upon the therapist. “He’s not going to survive this heart attack.”
Mary looked down at her feet, overwhelmed with guilt. Linda glared intently at Tamayo with a disapproving sneer. Neither said a word.
Tom Krider still hovered above, now basking in a warm, all-encompassing glow. He heard Tamayo ask Linda to continue with CPR until he had spoken with the patient’s wife. Linda placed her hands, one on top of the other, on Krider’s chest and started rhythmic compressions in synchrony with the airway bagging from the therapist. Krider’s body felt cold, skin mottled, eyes wide open with a blank stare, body motionless.
Linda knew her patient was dead. She recognized this charade for exactly what it was, a show being put on by Tamayo--a charade to protect the doctor from the criticism, the peer review and the potential malpractice suit that would ensue if the truth were to come out. Linda and Mary knew that any attempt to expose the doctor’s incompetence would backfire. He would attack Mary as the culprit, while he would come-off unscathed.
There was another issue. Despite her assertive nature, Linda, had a deep seated fear of Tamayo. She had seen his evil side too many times, and knew that he could be truly malicious, perhaps even dangerous, if pushed too far.
Tamayo removed his gown, mask and lead apron and left the cath lab. He went to the locker room before going to talk with Mrs. Krider. He wanted to make sure he had the proper look for his presentation. He ran his fingers through his hair to give it a bit of tossle, rinsed his hands in warm water and patted his forehead and neck to mimic perspiration. He looked in the mirror. “Perfect,” he whispered. “Exhausted, sad, but still devastatingly handsome.”
As Ray readied himself for his talk with Mrs. Krider, her husband peered down with fascination at his pale, lifeless body. He knew he was dead. He knew Tamayo was about to tell his wife that. Despite it all, he felt ecstatic; he was relaxing in a state of suspension like nothing he’d ever known. He was aware of an incredible love for his wife, but was not concerned about the pain she would soon have to bear; knowing she would someday feel as he did at that moment.
Tom Krider noticed a pleasant taste in his mouth, followed by a unique, pleasant sensation over his skin. He could hear sounds like none before; unbelievably moving sounds--nothing to compare to man-made music. He visualized patterns of light of all shapes and sizes, more beautiful than anything earthly. In short, all of his senses were hyper-stimulated with overwhelming pleasure.
Tamayo entered the waiting room. The receptionist directed him to the adjoining conference room where Linda had previously spoken with Sandra Krider. He hung a look of profound sadness on his face and entered the room.
Sandra was sitting bolt upright on the edge of her seat. After speaking with Linda, she sent her children home with her sister. She was alone, wringing her hands in her lap. Her look was one of extreme anxiety, if not terror. She jumped as the door opened, and looked up at Tamayo. “Doctor, what’s going on? I’m scared! Is Tom alright?”
Tamayo took a seat directly in front of her, and remained silent.
“Oh, my God! Doctor! I can tell from your face. You have bad news, don’t you? Please tell me!”
Tamayo responded in a soft, but firm voice, “Yes, my dear. I do have bad news for you.”
“Oh please don’t do this to me! My husband, my Tommy, my children! What have you done to him?”
“Mrs. Krider, let me explain precisely what happened.”
“Is he alive? Is my husband alive?”
“Yes, Tamayo lied, as we speak he is, and we are doing our utmost to save him. However, I must tell you that I do not expect him to live through this.”
“Why? What went wrong?”
“My dear, nothing went wrong! Your husband had a very extensive myocardial infarction, a heart attack. His chest pain prior to coming to the hospital was indeed from his heart. He was on the verge of a massive heart attack before he got here and it finally occurred this morning. Mrs. Krider, this all happened before I even started the catheterization procedure. It is a very horrible and unfortunate situation. Your husband suffered this heart attack before we could help him. I was not even able to get any pictures of his arteries.”
“Oh, my God! Poor Tom! I can’t believe this is happening. Doctor, he’s only thirty-eight years old. Why would he have a heart attack?”
Tamayo’s expression of sadness changed to a one of exasperation. He was getting irritated by Sandra Krider’s incessant questions, but knew he had to be careful. He couldn’t lose control.
“I’m very sorry, Mrs. Krider, but you don’t seem to understand. I often see heart attacks in men your husband’s age, even younger. It’s quite a common occurrence.”
“But Tom’s healthy, Doctor! He didn’t smoke. He watched his diet. Why would this happen to him?”
Tamayo’s aggravation escalated. A silent, non-verbalized response to her question raced through his mind. Why doesn’t this dumb bitch leave me alone? I should tell her that her fucking husband is dying because that stupid-shit Mary shot bubbles into his brain!
Sandra detected the doctor’s change in demeanor. He seemed distant, as in a trance. She waited for a response. Tamayo regained his composure as a look of dire concern draped his face.
“Mrs. Krider, I’m so very, very sorry. It’s going to take a lot of discussion to explain all of this to you. Right now, I must return to care for your husband as best I can.”
Tamayo stood and left the room. As he walked back to the lab he mentally rehearsed his next conversation with Mrs. Krider. He had no intention of indulging her with long discussions regarding her husband’s heart attack; having neither the patience, nor the inclination to bother with it. He would pronounce Mr. Krider dead, dispense with his wife as discreetly as possible, and write a lengthy note in the medical chart, describing exactly what took place. Certainly, he wasn’t going to let this interfere with his schedule for the rest of the day. He would simply move on.
The doctor entered the lab and found Linda still doing chest compressions, with Mary standing at her side. Tom Krider looked as dead as anyone ever did. His cardiac monitor showed a persistent flat line.
“Linda, you can stop now,” said Tamayo. He looked at the respiratory therapist and said, “You can stop bagging him. We're going to quit. Thank you, all of you, for your gallant efforts. I’m going back out to talk with his wife.”
Before returning to talk with Sandra, Ray went to his desk to write a note in Tom Krider’s chart. He didn’t want Sandra Krider to think they’d given up too quickly; he would wait a while before returning to the conference room. He wrote a long, eloquent note explaining how Mr. Krider had entered the hospital with symptoms suggestive of angina pectoris, and that this patient had unfortunately suffered a massive heart attack before the doctor could perform coronary angiography. He went into great detail outlining the heroic efforts made at resuscitation by himself, the nursing staff, and the respiratory therapist; ending on a note of sadness regarding the unfortunate death of this young man.
Tamayo walked to the conference room. Sandra was gone. He found her down the hall on the telephone. She was crying, sobbing as she spoke to her sister. Ray placed his hand on her shoulder, and she quickly ended the call. They walked back to the conference room in silence.
Sandra took a seat and continued crying. The front of her blouse and blazer were soaked with tears. She looked at Tamayo with eyes full of fear.
“I’m very sorry, Mrs. Krider.”
“Oh, God, please don’t. Please don’t say it!”
Tamayo paused, took a seat next to Sandra, and placed his hand on her arm. “I’m sorry. We had to stop. There was just nothing more we could do.”
Sandra’s sobs grew louder--tears showered down her face, hands trembled. She didn’t speak. Tamayo gently rubbed her shoulder, and placed his other hand over hers on her lap. He concentrated, thinking hard about his past; taking himself back to the ridicule and pain he felt as a child. At a young age, Ray learned how to manipulate his emotions for his benefit, converting angry rage into heart rending tears, at will. He was good at it.
Tamayo focused for a pensive moment. It happened. His eyes welled up. He waited until a tear rolled down his cheek, then turned to face Sandra Krider.
“I can’t tell you how sorry I am, Mrs. Krider.” As he had hoped, Sandra turned to him just in time to see his tear stained face. He gently closed his eyes to squeeze out a few more.
Then, something amazing happened. Sandra Krider actually put her arm around him, leaned her head against his chest, and wept. It was better than he had ever anticipated. Tamayo was elated and self satisfied with his performance, knowing it was all going to be okay--he was home free.
He held Sandra for a moment, waiting for her sobs to subside before cautiously releasing her. The doctor stood, extended further condolences, and told Sandra that the nurse would be in to help her with the details of the situation. As he reached for the door, Mrs. Krider looked up and asked with a hesitant, distraught voice, “Should we have an autopsy?”
It was the question Tamayo hated to hear. He turned back to face her. “My dear, Mrs. Krider, I’m quite sure of what we would find.”
“But you said you didn’t get any pictures of his blood vessels, didn’t you?”
“That’s true, but your husband’s clinical presentation yesterday, and the events of today, truly confirm a heart attack as the cause of his death.”
Sandra persisted, her voice cracking at times. “I remember hearing . . . that . . . that it’s very important to know how severe someone’s problem is, how much blockage there is. I was told it may help protect our children if they inherit the same thing. Isn’t that true?"
Tamayo felt his anger building. He wasn’t home free after all, not yet. An autopsy showing normal coronaries would be a disaster. I have to convince this bitch to drop it, he thought.
“My dear, what you say is absolutely true. However, I intend to help protect your children as much as possible. We can have their cholesterol checked, and have your family doctor educate them on the risks of heart disease in the future. We should do that regardless of what an autopsy shows. Besides, it’s difficult for me to say this, but I'm suspect you've never seen an autopsy? I’m quite sure you wouldn’t want to subject your husband to that.”
“I suppose not. I guess you’re right, Doctor. Thanks for your concern, especially your concern for my children. I appreciate that.”
“You’re very welcome, Mrs. Krider.”
Tamayo hurriedly left the room before she could change her mind. He returned to the cath lab to add additional comments to Krider’s chart, explaining how this unfortunate patient expired from a massive heart attack, totally unrelated to the cath procedure. He described pushing for an autopsy, which Sandra Krider flatly refused.
The doctor finished his day with successful completion of four more cardiac caths. Despite his recurrent daydreams about his Mercedes, there were no complications. He left the hospital late that afternoon, looking forward to a pleasant evening in his car.
Mary Simmons spent the remainder of the day, and many subsequent days feeling overwhelmed with guilt. Linda Arnold had to deal with ongoing frustration and anger. Sandra Krider lingered for months, grieving over the loss of her husband; her children repeatedly asking when daddy was coming home.
Tom Krider was in a state of ecstasy he never could have imagined.
Raymando Tamayo M.D., had an enjoyable day, pleased with himself, reveling in self-satisfaction, content with his abilities as a physician. That evening, as he rode around in his new car, he pondered his future, his career and his anticipated wealth.
By cardiodoug
Dale’s Bar
“Hello, David.”
Barnett looked up from the pool table. “Oh, hi.”
He couldn't believe his eyes. She was standing right next to the table, talking to him. Why was she there? Was it to see him? Impossible!
A rush of adrenaline shot through his blood. He was nervous, shaky, unable to steady his hand on the cue stick.
“Nine ball in the corner pocket.” Oh, shit, he thought as he miscued. The ball skimmed off the side of the stick and didn't even touch the nine. He looked up to Susan. She was still standing there smiling. “Hi, Sue. What are you doing here? I mean . . . I didn't know you came to Dale’s. I've never seen you here before.”
“Well, I thought I'd stop by tonight. Cindy and I came. She's over at the bar getting us
beer.”
“Beer? Do you drink?”
“Once in a while.” She paused. “I thought you might be here tonight.”
“You did?” He felt foolish, too excited. “Well, yeah. Sometimes I think I come in here too much.”
David thought about how pissed off his father would be if he knew his son were drinking. He enjoyed beer and didn’t think there was any danger in it, having convinced himself he would never follow in his alcoholic grandfather’s footsteps. “Did you use a fake ID to get in?”
“No, I don't need one. I turned eighteen last month.”
“Really, well happy belated birthday. I'm still seventeen. I won’t be legal in here ‘til my birthday in August.”
David was awestruck and panic stricken. It sounded like she had come to see him. He couldn't believe it. Sue Jamieson was the best looking, smartest, most sophisticated girl in the school. People said she only dated college guys. She and Barnett shared two classes, where he spent a lot of time just staring at her. She was gorgeous. She also intimidated the hell out of him, and he never said more than an uneasy “Hello” when he had the chance.
“Can I buy you a beer?”
“Cindy's getting me one.”
“Oh, yeah, you said that, didn't you?” Another dumb question, he thought.
“We have a booth over by the jukebox. You're welcome to sit with us if you'd like.”
David's pulse raced. His legs felt weak. “Sure, great. Let me finish this game and I'll be right there.”
Dale’s bar was a favorite hangout for underage guys from Maumee High School. Most got in with fake identification. The place, a long, dimly lit room, attracted a young crowd with most clientele being between sixteen and twenty. There were two pool tables in the back, and a bar running the full length of the front. The wall opposite the bar was lined with booths and a juke box. As usual, on Friday night, the room was smoke filled and noisy. Neil Young was playing on the juke.
Sue left to join Cindy. David walked back behind the tables where his buddies Dan, Pat and Bill were waiting. They each had a beer, and Bill Fox was smoking a cigarette.
“Hey Barnett, what's goin’ on? She come in here to see you?” said Pat Ramsey.
“I don't know, maybe.”
“You're dreamin’ pal! She only goes with older guys.”
“Yeah, that’s what I've heard. Have you ever seen her in here before?”
Danny spoke, “You kiddin’, never. Girls like Sue Jamieson don't hang out in shit holes like Dale’s.”
“What do ya think she’s doin’ here?” asked Barnett.
Bill Fox, the smart ass of the group, added, “Maybe she’s here to see you, lover boy.”
“I doubt it. I hardly know her.”
“Yeah,” Dan Myers responded, “But I bet you'd like to know her!”
“Sure I would, who wouldn't. I better have another beer first.” They all laughed.
“You better have a whole pitcher, Dave!” said Fox.
Barnett looked back at the pool table. “Who's up?”
“Your shot, Barnett,” said Myers.
Even though many stripes and solids remained on the table, David took dead aim at the eight ball and slammed it in the side pocket.
Fox yelled out, “Hey, what the hell ya doin’? You just lost.”
“I can’t play now. Gotta get up front before she leaves.”
“See you later,” said Dan.
Bill Fox chuckled. “Good luck, Romeo! We'll put a quarter up for your next game. You won't be long.” They all laughed again.
Barnett, stood five feet-ten inches with full, dark brown hair and a neatly trimmed mustache-- he was very handsome and very naïve about his good looks. Attractive girls made him nervous and he hadn’t dated much. He walked up front and set his empty glass on the bar top. “Joe, I'll take another.” The bar tender filled the glass as David slid two quarters across the counter. What are we going to talk about? he thought. Where should I sit-- next to Susan or Cindy? He took a long drink from his beer and turned to face the booth behind him.
“Hi, Cindy.”
“Hello, Dave.”
He took another gulp of beer and slid into the booth next to Susan. She was wearing a yellow cashmere sweater, blue jeans, and platform sandals. Her long blonde hair was draped over the back of the seat.
“I'm surprised to see the two of you here.”
“Well, we like to have fun too, you know,” said Cindy.
“Yeah, this place is a good time.” David’s response was followed by brief silence. What next?
Sue spoke up. “Are you a good pool player?”
“I sure didn't look so hot just now, did I?” Susan smiled and softly laughed. Her laugh is so cute, thought Barnett. She’s so beautiful.
David felt a bit more relaxed. The alcohol was kicking in. “Actually, I am pretty good, but not nearly as good as some of the older guys in here.” He paused. Now what? Should I keep talking? “What do you think of Mr. Rapp?”
Charlie Rapp, as his students affectionately called him, taught the physics class Susan and David shared. He was very conservative and years behind the times, but his students appreciated his dedication.
Susan laughed. “He's really a nerd, isn't he?”
Cindy broke in. “Come on you guys. You two brains aren’t gonna sit here and talk physics are you?”
Barnett responded, “What do you mean, ‘you two brains’?” Susan’s the one with straight A's, not me. She's the up-coming valedictorian.”
“Yeah, but she told me how smart you are.”
“She did?” David was shocked to hear they had been talking about him.
Susan defended her remarks. “Oh, come on, Dave. You practically sleep through all the classes and still ace all the tests.”
“No I don't. I got a B on one, just last week.”
“Sure, and I heard you didn't even know there was a test scheduled that day. You didn't study for it, did you?”
“Well, that’s true, but science subjects are easy for me.” Barnett caught himself staring at Susan. He couldn't believe how much she knew about him, astonished that she even knew who he was. He spoke up, “I bet you're getting an A in Rapp’s class, aren't you?”
“I might, but I think it's really tough. I have to study like crazy.”
Cindy broke in again. “Okay, that's enough. I've never been in a physics class and I never will be. Time to change the subject!”
“You're right,” said Barnett. “Where’s Eric tonight, Cindy?”
“Oh, you haven't heard? Eric, that creep, decided to go out with Sharon Keiller last week. He and I broke up.”
“No, I hadn't heard. Sorry.”
“It's okay with me. Like they say, plenty of fish in the sea.”
Barnett paused and thought about asking Susan if she were going with anyone. He was afraid he would sound obviously interested, feeling foolish if she said she were attached to someone. Even worse, if she did have a boyfriend, all of his fantasies over the past fifteen minutes would be shattered.
He took a sip of beer and cautiously asked, “Sue, how ‘bout you? Are you seeing any one, I mean, you know, on a steady basis?” As anticipated, he felt like a fool, sensing warmth in his face as he blushed.
Susan looked right in his eyes and smiled. “No, I'm not!”
Barnett's heart soared. The look on her face was unquestionably flirtatious. Susan Jamieson was pursuing him. He could feel his face getting hotter. He started to perspire, but he didn't care.
Bill Fox walked up to the booth. “Dave, you're up for the next game.” He slid into the booth next to Cindy. “Well, how are you two beautiful girls tonight?”
“Hi, Billy boy,” said Cindy.
Susan smiled, “Hello, Mr. Fox.”
“Hey, Dave. Your quarter’s up. You go play pool and I'll stay here to keep your friends company.”
“No thanks, Fox. I'll pass on the game. I better stay here and protect these girls from you. You know I can’t trust you with these women, you lecher!” Fox smirked as the girls laughed.
Bill yelled to the back of the bar. “Hey, Myers, Barnett wants you to play his quarter. He won't leave Jamieson’s side.” David blushed again, but was glad to have Fox break the ice for him. He didn’t want to leave her side, and he wanted her to know it. He looked at Susan, surprised to see her face flushed as well. Her face was wonderful.
Barnett was envious of Bill’s cool demeanor with girls. He wished he weren’t so shy around women, not knowing they found his reserved nature appealing and Bill’s arrogance obnoxious. David bought another round of beer, and the four of them sat and talked for awhile.
Fox pulled a Camel from his pocket and lit up. “Hey ladies, watch this!” Using his tongue, he flipped the cigarette backwards into his mouth, blew smoke out of the filtered end, and flipped it back again.
Cindy laughed. “Bill, do that again, but try swallowing it this time!” Sue and David burst out laughing.
Dan Myers approached. “Hey, I gotta get goin’. You guys comin’?”
Cindy put her arm around Fox and facetiously said, “Oh, God, don't leave me, Billy!”
“Sorry babe. Me and Barnett rode with Dan. Guess we'll have to go.”
Sue turned to face David and smiled. “Cindy and I both have cars. We can take you guys home.”
Barnett couldn't believe it. She wanted to drive him home. Fox practically jumped out of his seat and yelled, “Sounds like a great idea to me!”
“Me too,” said David, as he returned Susan’s smile. Myers said goodbye and left.
Fox and Barnett stepped from the booth and the girls followed.
David Barnett was a senior at Maumee High School in Maumee, Ohio, a suburb of Toledo. His family moved there from Detroit in 1974, when his father was transferred to an executive position at a new Chrysler plant in Toledo.
Maumee, a well established community with a long history, is located on the Maumee River, the waterway linking the port of Toledo to Lake Erie and the Great Lakes. Many of the wealthier residents of the area lived on River Road, in large homes along the shores of the river. David and Susan lived in modest homes, in less affluent areas of the city.
It was the night of May 8, 1977, the end of Barnett’s senior year, when Sue, Cindy, Bill and David left Dale’s Bar. They paired off as they crossed the parking lot. The weather in Toledo was unseasonably warm. Susan was driving her father's red, Mercury Montego convertible. She had the top down. David, after opening the driver’s door for Sue, walked to the passenger side and jumped in.
“Well, where are we going, Sue?”
“I thought I was giving you a ride home?”
“Do you know where I live?”
“Sure, I do!”
“You do! I'm surprised at how much you know about me.”
“Well, David, I’m pretty smart, you know. Maybe I've been checking you out.”
Barnett didn't know what to say. She was admitting she'd been interested in him prior to tonight. This was definitely not a chance meeting. He felt a pleasant, heavy feeling in his chest. “Okay, let's go.”
Susan drove north in the general direction of David's home. The warm-night air rushed over their heads as Fleetwood Mac played on the radio. David felt wonderful. He was mildly intoxicated from alcohol, and more so from the site of Sue Jamieson. As she drove, looking straight ahead, he turned in his seat to look at her. She was mesmerizing.
“David, you're staring at me!”
“I know. I can’t help it.”
Her blonde hair was blowing back, revealing the beauty of her profile. Her face was illuminated by a soft, yellow glow from the instrument panel. Paradise by the Dashboard Light, thought Barnett. When they reached Garden Road, instead of turning left toward David's home, Sue drove straight ahead toward a rural area on the edge of town.
“Sue, I think you missed a turn.”
“No, I didn't.”
Barnett didn't know what to think, wondering if she knew where she was going. Then it came to him. She was going to park at the Shadow Lake tennis club. The new club was under construction. The parking lot was completed, but lighting had not yet been installed. It was a favorite make-out spot for Maumee students.
David was beyond surprise, shock or disbelieve. He was ecstatic. They drove through the countryside as the lights of the city faded away and the blackness of night enveloped them.
The car slowed as Sue turned into a dark corner of the tennis club's lot. Three or four other cars were there, some with dimmed parking lights still on. She turned off the radio. The faint sound of music could be heard from a distant car. The couple sat silently in the dark for a moment. David felt a rush of anxiety. What should I do?
Sue turned the key to kill the engine, leaving the interior lights illuminated. David slid across the seat, just a bit, and said, “Well, now what?”
“David, I've already been too bold tonight. Now it's your turn.”
Barnett leaned across the seat, gently pushed blond hair from her cheek, and slid his arm behind her. “You're right.”
Leaning farther, he gently placed his lips on hers as she closed her eyes. The sensation was incredible. He loved the soft, fullness of her lips, and the natural, clean scent of her mouth. He detected a hint of strawberry in her lipstick. David slowly pulled back and whispered, “You’re wonderful!”
Susan took a deep breath and sighed. “So are you.” They kissed long and passionately. David embraced her as they lay down on the seat, her face still highlighted by the interior lights. They caressed and talked softly. Barnett's hands explored her breasts through her sweater. She sighed again. He slid his hands over her thighs, but dared not go any further. Her kisses, the soft skin of her neck, the scent of her cologne, the whole experience was much more than he had expected. It was all he needed.
After a number of minutes they sat up for a final kiss. They spoke a bit about school and Susan's anxiety over her upcoming valedictorian address. David kindly assured her she would be spectacular.
The Montego pulled away, heading for David’s house. Minutes later, Sue pulled in the Barnett family's driveway. David gave her one more, long kiss and asked the question he pondered during the drive home. “Sue, would you like to go out with me and Dan tomorrow night?”
“With you and Dan?”
“No, I’m sorry. You and me, with Dan and Kathy Marshall. They’ve been dating for a few weeks.”
“I'd love to, David.”
“Great! Can I pick you up at seven? Is that alright?”
“It's perfect.”
David got out of the car, walked to the driver side and gave her one last kiss. “I'll see you tomorrow.”
“I’ll be ready.”
He watched until the Montego's tail lights disappeared around the corner. Barnett entered his house, feeling a euphoria he'd never known. Minutes later he was kneeling at his bedside, something he rarely did. “Dear God, please let this last forever.”
| Author Notes | Thanks to all reviewers---much appreciated----Doug |
By cardiodoug
Omar's
Mounir(moo-near)Arafa and Salim Nahhed walked through the rear entrance to Omar's. They liked to stand in the back and scan the room before choosing a table; most were already taken, mainly by Arabic guys from the neighborhood. Munie knew nearly all of them, at least casually. There was a fairly even mix of Arabic Christians and Muslims. Most of the Christians,including Mounir and Salim, drank alcohol, as did some of the westernized,second generation American Muslims--those who didn't strictly adhere to Islam. The combination kept Omar's bar business thriving.
In the far corner of the room, near the front door, Mounir noticed a big, blonde-haired guy shooting by himself. A young woman was sitting nearby, drinking a beer. The adjacent table was vacant.
"What do you think?" said Mounir,as he pointed across the room.
"Looks good to me, Munie. We can take that table right next to 'im."
Omar's,the biggest pool hall in the area, was located on Michigan Avenue in the heart of East Dearborn. It was known for its serious players and high stakes. Few women ever ventured in. Years ago, the building had been a restaurant.
Omar Khouri bought the restaurant in the early seventies and converted it to a pool hall. The room's ceiling was high,fifteen feet or more,covered with black tin panels. The floor still had its original maroon linoleum, which was worn through to bare wood at numerous spots. It creaked as Mounir and Salim walked toward the bar. Lamps, with translucent green, glass shades, were suspended from the ceiling, with one centered over each table. The shades were hung below eye level, leaving the remainder of the room dimly lit by a faint, green glow. Led Zeppelin was playing on the jukebox--the song's heavy base vibrating through the floor.
The pair walked past Omar, who was standing behind the bar. He was a short, round man with a face framed by a neatly trimmed salt and pepper beard. His moustache was thick and heavy; his head sparsely covered with thinning,black hair. He had a rotund belly, always covered by a white apron, which by this time of night was soiled with food and beer. Mounir loved this fat old man like a father.
"Hey, Munie."
"Omar, my man. How are you tonight?"
"Another day, another night. I'm happy. Things are good."
"Good evening, chief," said Sal. "Kind of quiet in here for a Friday night?"
"It's still early, Salli. You know it'll liven up--just give it time. You two want the usual?"
"Sure. We'll be at that table up front," said Sal.
Omar facetiously responded. "No kidding. I never woulda' guessed!"
Munie and Sal didn't drink while shooting. Omar prepared a tonic on the rocks with a deceptive lemon twist for Mounir, and a Coke with a slice of lime for Sal. Their drinks gave the appearance of cocktails, but contained no alcohol. This came in handy if they wanted to feign intoxication.
As Mounir walked past the end of the bar, Omar spoke up. "Munie, you want your stick now or later?"
"I better take it now."
Mounir walked around the end of the bar and met Omar in his office. The small room reeked of stale beer from stacks of cased empties lining one wall. A small desk on the opposite wall was cluttered with piles of invoices, dirty coffee cups, and an ashtray full of butts. On the wall above the desk was a locked steel case. Omar took out his keys, opened the case, and pulled out Mounir's personal cue--two pieces of dead-straight maple locked together with a bright-brass coupling. Its total weight--nineteen ounces-- no carvings, no designs, nothing pretentious. Mounir liked a stick that didn't draw attention, something inconspicuous.
He thanked Omar, walked back to the bar and handed his stick to Sal. Munie wouldn't need it for awhile. They took their drinks and walked to the vacant table at the front of the room.
. . .
Mounir had been shooting pool at Omar's since he was fourteen. His parent's apartment was a block away from the hall. At the time, Mounir was under age, and Omar would only let him come in early, after school and on Saturday mornings. Mounir would run errands and help clean up in exchange for free use of the tables. Omar had taken an instant liking to his young helper. He was attracted to Munie's intelligence, precocious maturity and dependability. He also recognized Mounir's potential as a pool player. Even as a youngster, the kid had an incredible eye and an uncanny ability to position shots.
Through Munie's high school years, he and Omar became close friends. Mounir was an A student, but had no interest in pursuing academics, and no intention of going to college. Omar often tried, unsuccessfully, to push him toward a higher education.
Testing in the Dearborn School system had shown Mounir to be a true prodigy. In the second grade, his Stanford-Binet IQ was measured at one-hundred-eighty-four. He was at the top of the genius range with scores higher then ninety-nine percent of the population.
Schoolwork was a bore to Munie. Despite expending minimal effort in school, he easily maintained a straight A record. In high school, he had no interest in extra-curricular activities and was felt to be a loner. Salim was his only friend. They had lived in the same apartment building as children and became good friends in early childhood. Mounir had known Sal as far back as he could remember. Salim's family moved to a newer building when Munie was twelve, but he and Sal maintained a close relationship as high school classmates. Sal was truly his only friend.
Munie shunned people and notoriety, and did his best to remain invisible at school. As the pair approached graduation, Mounir was informed that he was the most likely candidate for valedictorian of the class of nineteen-seventy-seven.
Mounir's grade point average was a perfect four point zero. He was flatly against receiving the valedictorian honor and had no intention of giving an address at graduation. His solution to this dilemma was simple. At the end of his senior year, he failed to show up for a final examination. He was given an F, and his grade point average dropped to three-point-nine A female classmate with a three-nine-five average received became valedictorian.
After graduation Mounir and Salim became even closer friends. They moved into an apartment together and often worked the same jobs. However, Munie abhorred the thought of working for a living, especially at manual labor. He couldn't tolerate being controlled by a supervisor and his employment was generally short lived. Over time, he became determined to survive on income from games. He would be a gambler, and he convinced Sal to join him. They would avoid high-risk games of chance; those with unfavorable odds, and instead, concentrate on honing their skills at blackjack, poker, and Mounir's favorite, billiards.
Munie had a photographic memory and was adept at counting cards in blackjack. He developed a system of signals to tell Sal when to draw or stay. They could play multiple hands and always came out ahead. The pair took frequent trips to Vegas and routinely came home with two to three thousand dollars in winnings. At the age of twenty-four, they had successfully remained unemployed for over two years. They were independent, care free and financially secure. By his twenty-fifth birthday, Mounir had over twenty thousand dollars in savings.
The pair dated women frequently, but rarely had relationships lasting more than a few months. Sal was impressed by his friend's kind treatment of women. Mounir was always a gentleman; never made promises he wouldn't keep and always treated his girlfriends with respect. It was a standard that Sal found hard to emulate.
. . .
Munie and Sal arrived at the vacant table next to the big,blonde guy. Munie set the first rack for eight ball and Sal broke using Mounir's cue. The six ball fell into the side pocket. Sal sank his next shot and scratched on his third. Mounir took one of Omar's house sticks off the wall, chalked it, and called his pocket. "Fifteen in the corner." There was a lot of green and he missed. The fifteen came to rest on the lip of the pocket.
As they played, Mounir discretely kept an eye on their neighbor. The big guy was pretty good. He also had an air of self-confidence that pleased Mounir. His stroke and body language were cocky. Mounir could tell he was impressed with himself, and was showing off for his girlfriend. Munie glanced toward the girl and saw three empty beer bottles on the table in front of her.
Mounir and Sal had three balls left: the eight ball, one solid, one stripe. Sal called the solid in the corner and sank it. He tried to bank the eight into the side pocket and missed.
As Munie scanned the table, he noticed their neighbor looking their way. Mounir lined up a shot--a tough shot, at an acute angle. When he was sure the blonde was watching, he made his play, leaving the ball hanging a good six inches from the pocket, as the cue ball scratched in the side. "I'm just not with it tonight, Sal."
"Too bad, Munie. I guess I'll have to kick your butt."
"Ah, a challenge. I like that. Your shot, wise ass!"
Sal pulled the cue ball from the pocket and took a dead-straight aim on the eight. He cautiously set it up as the big man looked on.
"Eight ball in the corner." Sal timidly stroked the cue ball, barely sinking the eight.
"You lucked out, Sal."
"No luck involved, Munie--just skill my man, pure skill."
The stranger next to them went back to his game and set a new rack. He was wearing a red-flannel shirt and jeans. His sleeves were rolled up on large forearms, covered with thick-blonde hair. He stood about six feet, two inches, with a very muscular upper body and narrow waist. Mounir figured he was an autoworker, probably got paid today, Friday. As he leaned forward to break, his left bicep bulged through his flannel. He took a powerful stroke, followed by a loud crack. The break was tremendous, with balls scattered over the entire tabletop. Two solids fell in.
Mounir recognized an opportunity, figuring the man was showing off for him. "Nice break!" said Munie, as he took a step toward the adjacent table.
The big guy glanced up with a quizzical look. "Thanks."
Mounir took another step and extended his hand. "My name's Munie."
The guy hesitated, finally took Mounir's hand, gave it a firm squeeze.
"I'm Rick."
Mounir detected reluctance in the greeting--either prejudice toward Arabs, or suspicion of his motives. He preferred prejudice. It made the game more fun. "Nice to meet you. This guy over here's Sal."
Rick acknowledged Sal with a nod. Mounir walked back to his table and set another rack. Sal broke. Rick's girlfriend got up and headed toward the restroom.
"Cindy, get me two more beers." Rick's request sounded like a harsh demand. He pulled a wad of bills from his pocket and tossed some money at his girl. She returned a few minutes later with three beers. "Cindy, I want you to play," said Rick.
"Oh, come on, Rick. Please! You never like it when I play!"
Rick responded with an order, "Yes I do. Your shot. Shoot the stripes."
Munie listened in on their conversation. Cindy couldn't shoot. She was petite with small hands. She set her tiny fist on the table and tried to rest the cue between her knuckles. There was no stability and she missed nearly every shot. Her inability aggravated Rick. He criticized her after each missed shot, and remained silent when she occasionally sank one. "Cindy, you can't shoot for shit! Why don't you hold the stick right?"
"My hands are too small. I told you that before. I knew you'd get mad!"
"You're an embarrassment, girl."
"I can't help it if I can't play this game."
"You're uncoordinated, like all women!"
"Okay, Rick! Forget it! I'm not playing! You go ahead and play by yourself."
"Hey, playing against you is like playing by myself."
Mounir seized the moment. He looked at Sal and gave him a nod. Sal took a few steps toward Rick's table. "I'll play you if you want. I'm getting bored. Munie here isn't much competition."
Rick again hesitated with a suspicious look. After a few seconds he spoke. "Alright, I'll play you. Eight ball, I break."
"Sounds good to me," said Sal. As Sal racked, Rick glared down the table at him.
"How 'bout five bucks?"
"Five bucks? Sure, why not?"
Rick delivered the same crushing break with balls strewn everywhere. The eight ball bounced gently off the back rail and returned close to its original position. The fifteen and six fell in. Rick chose stripes and sank two more. As the game proceeded, Sal played to his best ability and eventually won, with Rick leaving only one ball on the table. Rick reached for his wallet with a mixed look of embarrassment and disgust. "Don't worry about it now," said Sal. "Another game?"
Rick stared at him for a second. "Okay, ten bucks this time."
"Fine with me, my break." Sal's break was adequate, but nothing compared to his opponent's. He lost the game, with four balls remaining. Rick was up by five dollars. "You want me to pay you now, or keep playing?" asked Sal.
Rick looked encouraged, feeling he could beat the Arab. "We'll play. How about twenty-five?"
"Twenty-five?" Sal pulled out his wallet as if to count his money. He fingered through some bills, paused, and said, "Alright, your break."
Sal backed off on his game to assure Rick's win, not wanting to scare him off. Rick eventually sank the eight ball on a long bank off the end rail to the corner pocket. Mounir, who had been silently standing back, spoke up. "Nice shot!" Rick grinned and said nothing.
Munie, who had been assessing Rick's attitude, gave another subtle nod to Sal. This was Sal's signal to pull out his wallet and pay Rick the thirty dollars owed. He laid a twenty and two fives on the table. Rick picked it up and said, "Want to keep going?"
"I guess I'll play one more, but if I lose, that's it. How about giving me a chance to win my money back. Can we go for fifty bucks?"
Rick hesitated. "You got fifty on you?"
"Yep." Sal set two twenties and a ten on the rail, securing them with a cube of chalk. "That good enough?"
Rick stared at him. "My break."
It was apparent that Rick was feeling powerful--self-assured. Sal knew this was a crucial game. If Rick won, he may be tempted to leave with his eighty dollar winnings. Sal had to win. As usual, Rick produced a staggering break, pocketing one stripe and one solid. Sal scanned the table. Overall, the stripes were in best position. There were two solids in tempting, gimme, spots--one at the mouth of a corner, the other at a side pocket. However, there were two more solids just off the end rail, buried behind a stripe. They would be tough to free up. Sal watched his adversary set up for his next shot and thought,Come on, go for the solids, you sucker.
Rick took the solids and sank the six. Mounir grinned, winking at Sal. Rick shot the second gimme, sank another solid and ended up stranded with a bad leave. It was just what they had hoped for. Sal sank five of the remaining six stripes and, knowing Rick could never catch up, intentionally missed the final ball, the twelve. Rick missed his next shot. Sal sank the twelve and finished off his opponent by banking the eight ball into the side pocket. Rick glared at Sal with an odd, sheepish look, mixed with anger. He went for his wallet.
Sal quickly said, "Hey, no problem man. I'm only up by twenty dollars. I trust you."
Rick gave him a hard look. "Then I guess you wanna keep playin'?"
"It's your call, pal."
"Don't call me pal!" The muscles in Rick's neck bulged as he grabbed the rack, firmly set it to the table and announced, "Fifty bucks! Nine ball!"
"Nine ball? I haven't played it much," said Sal.
"Nine ball or nothin''!"
"Okay, whatever you say. Nine ball it is."
Cindy remained silent. Her boy friend had already downed the two beers she'd bought and he sent her off for two more. For the next two games Sal backed off. He and Munie wanted to restore Rick's confidence. Rick won two games of nine ball, fifty-bucks each, putting him up by eighty dollars. Sal paid him the eighty.
"Munie, this guy's killin' me. I'm down eighty bucks. You play him!"
Rick looked across the table with a grin and sarcastically said, "I guess you're up, Mooney!"
Mounir loved it. He thought, This shit head is actually challenging me. Munie responded with intentional hesitation. "Okay, I guess I'll play." He turned to Sal. "Sal, if I lose much money we can forget about Acapulco!"
Cindy returned from the bar. Rick's growing confidence, and the four or five beers he'd had, were making him irritatingly talkative. "You guys are goin' to Mexico?"
"Yeah, we plan to."
"I've been to Acapulco. It's a blast. Plenty of wild women."
Cindy looked up and rolled her eyes.
"Yeah, that's what we've heard. Can't wait to go. We've been savin'' up for weeks."
"You'll have a good time. Take my word for it."
Mounir thought, I wouldn't take this assholes word for anything. He asked, "Still want nine ball?"
"Yep!" said Rick.
"Fifty bucks?" asked Munie.
"Yep!"
"I'll rack. It's your break, Rick." Mounir lost the game outright--sinking only two of nine balls.
"Sal, why don't you get us two more drinks. I need another one to straighten me out."
Rick chuckled and taunted Mounir. "Think more booze will help?"
Munie remained silent, stared at Rick and smiled. Sal said he'd be right back. Mounir walked to the end of the table and racked another set for nine ball. "Hey, you mind if we drop the stakes to twenty-five dollars?"
Rick laughed again. "No problem. I'd hate to have you guys miss out on Acapulco."
Rick sank the nine and won the game just as Sal returned from the bar. Munie pulled seventy-five dollars from his wallet and laid it on the table. Rick scooped up the cash and said, "You two losers ready to call it quits?"
Munie was astounded by the guy's arrogance. He ignored the comment. He and Sal stepped over to their original table, as if to confer on the issue of continuing. They pulled out their wallets, counting their money as Rick looked on. Munie finally returned and said, "We'd like to keep playing. Winner names the stakes."
Rick beamed and let out a derogatory laugh. "No problem! I won! Next game's for a hundred bucks, if you can cover it?"
Mounir noticed the big guy slurring his words, having had at least six beers by Munie's count. Cindy shouted, "Rick, are you crazy?" You're gonna lose all your money!"
Rick turned, firing an angry look at his girlfriend. "Shut the fuck up, Cindy! These guys are the ones loosin' money!"
"Rick, you're drunk!"
"I said shut it, Cindy. You're welcome to leave any time."
"Yeah, right. What should I do, walk home?"
"Listen, just sit there on your pretty little ass and watch me in action!"
Mounir felt an unexpected hatred toward Rick. I'm really gonna put this piece of shit in his place. Money was no longer the issue. This son-of-a-bitch needs a lesson in humility!
Munie had him right where he wanted him. Rick was cocky, sarcastic and bragging to his girlfriend. He'd never be able to back down now. To top it off, he was drunk. Rick stepped to the head of the table and repeated the stakes. "Nine-ball. One-hundred bucks. My break!"
Mounir nodded and racked balls one-thru-nine in a diamond pattern at the far end of the table. The one ball was positioned at the head of the diamond with the nine ball centered. The remaining balls were placed numerically. Munie had surmised that his opponent didn't understand the strategy in nine ball. Rick delivered his usual power break as if he were playing eight ball. This could easily set up a run of the table by any decent player.
. . .
The rules of nine ball require the cue ball to first strike the lowest number ball on the table. The low number ball may be pocketed directly, or used to pocket a higher number ball through a combination shot. Sinking the nine ball in proper, numeric sequence, wins the game. A hard break could dangerously expose the nine to a combination shot, which could end the game early.
. . .
Rick sank the five and seven on the break. The nine was frozen on the far rail. He sank the one, ending up with a bad leave, with no chance of hitting the remaining lowest ball, the two. Mounir's strategy was to keep the game as close as possible without losing. He banked the cue ball into the two; it careened into the six, which fell in a corner pocket. He hit the two again, appearing to bank it into the side pocket, purposely producing a near miss.
The two and three balls wee pocketed and Rick inadvertently freed up the nine, which had been lying hard on the rail. Three balls remained: the four, eight and nine. Mounir was concerned. He couldn't safely give Rick any more room. Rick attempted a four-nine combination and missed.
Munie stepped to the table, hesitating to create the appearance of uncertainty. He cautiously chose his next shot. The four ball fell into the corner, leaving the cue ball positioned for an easy shot on the eight. There was no chance for an eight-nine combination.
He changed his approach, feeling he could safely back off once more. He sank the eight and purposely positioned the cue ball for a tough leave on the nine. He hesitated again before calling a bank shot to put the nine in the far corner. Mounir skillfully missed the shot, leaving the cue ball hanging just off the head rail, with the nine resting at the far end of the table.
Rick looked at Mounir, surprised that he had missed the bank shot by so much. He approached the table, pausing for close to a minute as he considered his options. There really were none. There was too much green. He couldn't sink the nine and he knew it. He gently tapped the cue ball causing it to roll only a few inches. This was an illegal move, a foul.
Mounir remained silent and didn't object. He approached the table and cautiously aligned his next shot. He called the corner pocket and beautifully banked the cue ball off the rail with reverse English. It struck the nine, which quietly fell into the leather pouch of the far corner.
Rick stared at Munie with disbelief. Mounir responded with a very matter-of-fact, "My game. That'll be a hundred bucks." He wanted to make Rick pay him now as Cindy watched. He wanted to piss him off.
Rick took a wad of bills from his pocket and tossed two fifties on the table. Mounir took the money, carefully folded the bills and put them in his shirt pocket. "Thanks. By my calculation you're still up fifty-five bucks. Nothing lost so far. We'll go again. Nine ball, one hundred dollars. I break."
Munie hadn't asked him to play--he had declared they would play. The blonde was taking the bait, getting enraged. His muscles tensed as he slammed the rack on the table and murmured under his breath. Cindy looked down without a word.
It was close to midnight and the room was packed with players and bystanders. All the tables were taken. Cigarette smoke filled the air, creating cones of light under each green lamp. The room vibrated from the beat of music, the crack of billiard balls and the din of conversation and laughter. Omar busied himself, serving drinks behind the bar and entertaining customers.
Mounir approached the table to break. He stroked the cue ball with moderate force, driving five balls into the cushions. As he had planned, the nine ball remained motionless at its center position. He looked up to Rick. "Your shot."
As the game proceeded, Munie loosened up, showing off just enough to get the muscle man riled.
Four balls remained on the table when Rick looked across to Cindy. "Don't just sit there lookin'stupid. Go get me a beer!" Mounir figured that Rick didn't want her watching as he lost another game. Cindy returned just in time to see Munie sink the nine with a double bank shot.
"Rick, you lost again, honey. This guy's really good. He's a better player than you. You've got to stop!" Her comment was music to Munie's ears.
"Just give me the God-damn beer, sit down, and keep your fuckin' mouth shut!"
Munie felt the hair on his neck bristle. Rick looked back at Mounir and saw an audience gathering behind him. Two Arabic guys, staring at Rick in response to his outburst, occupied the adjacent table. Four or five more were milling around the area. They all knew Munie, and they had all seen him in action. They knew he was moving in for the kill and they wanted to see the show.
Mounir stared hard at Rick with an expressionless face. "That'll be one- hundred dollars!"
The veins in Rick's neck bulged as he reached in his pocket, peeled off two more fifties and threw them on the table. Mounir picked up his money, folded it neatly and placed it in his shirt pocket. He stared at Rick and delivered the coup de grace. "Maybe you should listen to your girlfriend, pal. She's right, you know. I am better than you."
Rick looked like he was going to explode. He grabbed the rack from the wall and smashed it down on the table.
Mounir responded, "Okay, it's your money. Two-hundred dollars this time."
"Two-hundred dollars my ass!"
"Hey, I won. Winner names the stakes, remember? To make it fair we'll lag for break and you can name your game."
"Eight ball! We go back to eight ball."
"Whatever you say, pal."
"I'm not your pal!" Mounir smiled and said nothing.
. . .
To lag for break, each player banks a ball off the far rail, back toward the head rail. The one who gets closest to the head rail without hitting it wins the lag. Rick went first. The ball stopped about eight inches from the head rail. Mounir wanted Rick to break. He intentionally brought his lag up short, a full foot from the rail. Rick stepped to the table. "My break! Rack 'em for eight ball, pal!"
The crowd was building. Mounir loved it. He was ready to shut this red neck down and he wanted to do it with an audience. As anticipated, Rick delivered an awesome, shattering break. Mounir tensed slightly as he watched the eight ball hit the back cushion, careen off the twelve and come precariously close to falling in the corner pocket, stopping just at its lip. Two balls fell in--one stripe, one solid.
Sal walked over to Mounir and handed him his personal stick. Rick didn't notice the exchange. He was preoccupied, transfixed by the balls on the table and assessing possible shots. Mounir saw Rick stagger as he rounded the table's corner. He's really drunk.
Rick chose solids, sank the five ball and missed an easy play on the two. He was too drunk to make the simplest shots.
Mounir stepped to the table. He checked the position of the remaining six stripes, envisioning every shot he would make and every leave he would need to clear the board. He would do it with a flair for the crowd.
He banked his first four shots, barely hesitating between each. All four balls hit the pockets dead center. Two stripes remained. He sank the first with a triple combination shot, stripe to solid to stripe. For the last two balls, the stripe and the eight ball, he would really put on a show.
Mounir sank the stripe with a triple bank shot, cue ball off the far cushion, stripe off two cushions into the far corner. The crowd applauded and let out a yell. The cue ball came to rest about ten inches from the eight, which still sat at the lip of the corner pocket. A solid, number six, was resting midway between the cue ball and the eight, obstructing any clear shot. Mounir could easily sink the eight with a straight bank off the side rail. Instead he decided to use a masse'.
. . .
A masse' shot applies extreme English to the cue ball. The shot looks strange due to the position of the stick--butt end held high, tip pointed nearly perpendicular to the tabletop. A masse' requires skill and a steady hand. The cue tip strikes down hard, on top of the cue ball at an eccentric point, creating incredible spin, which causes the ball to move in a curved, semicircular course. The shot is used to curve around an obstructing ball, into the object ball.
. . .
Mounir glanced up to the crowd and saw Omar standing a few feet from the table. He smiled and winked at Munie. The commotion at the front of the hall had attracted more players, with fifteen to twenty people gathered around the table.
Mounir raised the butt of his stick high over the table with the tip angled at seventy to eighty degrees. The fingers of his left hand were fanned out--pressed hard to the felt. He struck down with a firm, sharp stroke. The cue ball shot forward, suddenly curving a full one-hundred-eighty degrees around the six. It struck the eight dead center and stopped. The eight ball slowly rolled over the lip of the corner and quietly fell to the pouch. The crowd roared with wild approval.
"Nice shot, Munie!"
"Way to kick his ass, Munie!"
Mounir looked up from the table, staring directly into the eyes of his prey. "Two-hundred dollars, Rick"
The enraged victim glared back! His body was stiff, tense. He squeezed his stick with a tight, white knuckled grip and bulging forearms. Speechless, he turned to scan the crowd. He knew he had been set up and he wanted revenge.
"Fuck you!"
"Excuse me, what did you say?" responded Mounir.
"You heard me. I said, fuck you!"
Munie laid his stick on the table and stepped toward Rick, stopping a few feet away. "I don't think you're in any position to be telling me what to do, friend!" Three of the guys in the crowd stepped closer to emphasize the point.
Rick leaned his stick against the wall and turned to face his girlfriend. "Cindy, give me some money!"
"Damn it, Rick. I told you this would happen!"
Rick walked to Cindy, grabbed her arm and yanked her around in her chair. His fingers dug into the skin of her forearm as she winced in pain. Mounir was caught off guard by his response to this physical abuse. He was infuriated, but sensed a feeling of sadness, which he didn't understand. Something deep inside him, something he couldn't identify, made Rick's behavior frightening.
"I only got a hundred and sixty dollars, Cindy. Give me some fuckin' money. Give me forty dollars so we can get the hell outta this shit hole."
Tears rolled down Cindy's face as she opened her purse and handed Rick the money. Rick pulled the remaining cash from his pocket and walked back to the table. Mounir's eyes were on Cindy, who was quietly crying as she rubbed her arm. His emotions were consolidating into pure rage. The fear and sadness were gone. Rick threw two-hundred dollars on the table. Mounir ignored the money, took one step toward the big man and stared into his eyes. "You're a real asshole, pal--an asshole who abuses women."
Rick placed his hands on his hips. His shoulders and arms bulged as his flannel shirt tightened on an expanded chest. "Who the hell are you to tell me how to treat women, you fuckin'grease ball?"
The last thing Mounir remembered was Rick moving toward him. The last thing Rick saw was the flash of a maple cue. With uncanny speed, Mounir grabbed his stick from the table and swung. The thick, butt end of the cue crashed into the blonde's face as he lunged for Mounir. The blow made a loud crack as the stick smashed squarely into Rick's mouth. The cue snapped in half at its brass coupling just as Rick's front teeth snapped off at the gum line. He crashed to the floor, spewing blood and chips of enamel as he fell. Mounir pounced on him, one knee on his chest, one hand at his throat. He squeezed Rick's windpipe hard between his thumb and forefinger and spoke. "You need to die you big piece of shit?"
Rick was choking on the blood pouring from his lacerated lips and gums. Sal yelled out, "Munie, stop it! You're gonna kill the guy!" Cindy was crying hysterically as she tried to pull Mounir off her boyfriend. Omar stepped in, attempting to console Cindy as Sal pulled Mounir's hand from Rick's throat. "Munie, you gotta stop!"
Mounir finally let go and stood up. He looked as though he were in a trance, confused, not really aware of what he had done. Omar let go of Cindy and grabbed Mounir by both shoulders. "Munie, are you okay?" What are you doin'? I've never seen you this way!"
"Yeah . . . yeah, sure, I'm Okay . . . I'm sorry, Omar."
"You and Sal better go. The police may be coming. You two go out the back. I'll take care of this mess. Don't worry, we'll cover for you. It'll be alright."
Mounir glanced back at the two hundred dollars lying on the table. He picked it up, pulled the rest of his winnings from his shirt pocket and turned to Cindy, who was kneeling at Rick's side. Bending over, he gently helped her to her feet.
"You don't have to put up with that treatment, you know. You seem like a nice person and you deserve much better. Why don't you find a new boyfriend?"
He handed Cindy all of the money, two hundred-fifty dollars. She was speechless, simply staring in awe as she took the cash. Salim was not the least surprised by his friend's kind gesture. He put his arm around Munie's shoulder as the pair exited through the back of the hall.
"Munie, you're really something. You never cease to amaze me, my friend."
The pair left Omar's, entering the darkness and safety of East Dearborn.
| Author Notes | This is a long chapter----thanks to all reviewers with the patience to read it. |
By cardiodoug
Michael and Laura
Michael Conti graduated from Hillsdale College, Hillsdale, Michigan, in nineteen-eighty-two. Hillsdale, an expensive private school in southern Michigan is nationally known as a bastion of conservative thought. Michael's father chose the school, and his son's course of study, Business Administration. In truth, Michael had no interest in business, but that didn't matter. He always did what Carlo told him. Years of domination by his father left him shy, introverted, and insecure. Carlo relished his son's obedience, oblivious to his adverse effect on Michael's self-esteem.
In the mid-sixties, Carlo Conti left the Ford Motor Company to start his own business in carburetor manufacturing; utilizing many of the innovative ideas he had developed while at Ford. His products were unique and appealing to auto manufacturers. His relationship with Ford Motor deteriorated, but he established lucrative contracts with General Motors and Chrysler. By nineteen-seventy his factory was booming, supplying a third of the carburetors used by Chrysler and GM. Within a few years he was a wealthy man--a very wealthy man.
Michael did not date much in college--not until he met Laura. Laura Hanley grew up in Ann Arbor, raised by adoptive parents. Her father was a professor at the University of Michigan, and her mother worked in the Ann Arbor Library.
Adopted as an infant, Laura was the Hanley's only child--an attractive, intelligent, brunette--well educated and sophisticated. She was self-confident, but reserved, not bossy. Laura and Michael were a good fit.
The couple married the summer after college graduation. Their wedding present from Carlo and Marie was a new home in Birmingham, Michigan, north of Detroit. Birmingham, a charming, affluent community with tree lined streets, swanky shops and an abundance of good restaurants, was also home to Carlo and Marie. Michael and Laura's new house was only a few blocks from the Conti's.
Marie objected to her husband's interference in their son's life. It didn't matter. Carlo got what Carlo wanted. He had a position waiting for Michael at his company. After selecting a new home for Michael and Laura, he told Michael where he would work. Michael never said a word. It was what he expected. He never had a choice in life, his father made all the decisions, as he did for Michael's mother, Marie. Michael would have preferred to find his own employment, but that was not an option. Carlo Conti ruled--Marie and Michael obeyed.
Michael began work at his father's factory immediately following marriage to Laura. He wasn't invited to join the front office; a small, tightly knit, highly productive administrative staff.
Carlo thought his son was too timid--too gullible to function as an administrative manager. Instead, Michael was placed in plant production. He worked as an assembly-line foreman to learn the ropes; later being promoted to production manager.
Carlo loved his son dearly, however, he was well aware of the the vast personality differences between Michael and himself; he was leary of Michael's capabilities in the business world. Carlo was surprised when Michael performed better than expected. His son was well liked by foremen and assembly-line workers, who regarded him as a fair manager and diligent worker--willing to help out whenever he could.
Conti Carburetor was approaching its ten year anniversary. Carlo was concerned that the recent introduction of fuel injection would soon make standard carburetor tors obsolete. New technological advances were appearing at a rapid pace, a frightening pace for Carlo. He knew he hadwould have to renovate his plant to accommodate the demand for fuel injection, and he had to do it soon. The health of the automobile industry and progress into fuel injection would determine the future of Conti Carburetor. Carlo had to either rev-up fast to remain competitive in the industries new computer age, or stagnate and go out of business.new industry or close his company.
He pondered whether to bother with the arduous,costly task of modernizing. having been a shrewd investor, he was a millionaire many times over and certainly didn't need the business for himself. From a financial standpoint, he and Marie were set for life. However, his concern for Michael and Laura encouraged him to provide his son with a stable,lucrative position within his business or somewhere similar.
For the present, Michael Conti's job was secure. His father's goal was to guarantee rewarding employment for Michael the rest of his life.
By cardiodoug
FAIRLANE EMERGENCY
An ambulance careened into the emergency room drive. Its rear doors flew open as it screeched to a halt. Two sweaty, tired looking paramedics jumped to the pavement and quickly turned to yank a stretcher out. A third medic clumsily tried to maintain chest compressions on a moving target. The victim was ashen in color, very obese, and motionless except for rhythmic jostling from CPR. His eyes were wide open. He looked dead.
In their haste to enter the emergency room, the medics slammed the head of the stretcher into the partially opened automatic doors.
"Where's Barnett?" yelled the charge nurse.
An orderly replied. "I'll get him. I think he's in the call room."
"Tell him the arrest from East Dearborn just arrived."
David Barnett entered room one at the Henry Ford Hospital satellite clinic, the Fairlane Clinic in Dearborn, Michigan. He was dressed in blue scrubs and a neatly pressed white lab coat. A stethoscope hung from his neck.
He had dark-brown hair, a mustache, and tanned skin. Standing 5'10" at 175 pounds with broad shoulders and a slim waist, Dr. Barnett was very good looking. He had a confident demeanor with an underlying vulnerability making him appealing to nursing staff and patients alike. David possessed a wonderful sense of humor with a disarming, self-deprecating twist. He was intelligent and compassionate, and the nurses loved him. Of all the moonlighting internal medicine residents at Fairlane Emergency, Dr. Barnett was their favorite.
. . .
David's prayer, years earlier, on the night he met Susan Jamieson had, been answered. Sue and he attended college together in Ohio. David excelled in a the pre-med program and was accepted to the University of Cincinnati College of Medicine. The couple moved to Cincinnati and married the summer following Barnett's first year of medical school. Sue and he now lived in Detroit, where David continued his post medical graduate training as a resident in Internal Medicine.
. . .
Barnett quickly assessed his patient. "This doesn't look good."
"No, it doesn't, Doc," responded a paramedic.
"How old is he?"
"We were told he's sixty-four."
"How long's he been down?"
"It's been at least twenty minutes, Doctor, probably more. We got a call from a bakery on Michigan Avenue in East Dearborn at nine-seventeen p.m. When we arrived, his brother and nephew were trying to revive him with chest compressions. I don't think they did any respirations."
"Were you able to intubate at the scene?" asked Barnett.
A paramedic, bagging oxygen into the patient's airway, answered. "It was real tough, Doc. By the time we got to him he'd vomited and had an obstructed airway. He was in v-fib and responded to the first shock with sinus rhythm, but his airway was a real mess. It took us a good three minutes to intubate."
"That's too bad. He probably has brain damage. Are his relatives here?"
The charge nurse, Jamie, spoke up. "Dr. Barnett, his brother and nephew are in the waiting room."
"Good. I'll go and talk to them after we assess the situation. What do we have right now?"
Another medic answered. "He's in a sinus tach with a blood pressure of ninety systolic. He's unresponsive and his pupils appear to be fixed."
David grimaced. "He must have gone a long time without oxygen. We'll hope for the best. Jamie, hang some dopamine at ten micrograms, give one liter of normal saline wide open and keep a close eye on his rhythm."
A respiratory therapist entered the room to relieve the medic bagging the airway. A nurse called out. "Doctor, I can't get any pressure."
Barnett glanced up at the EKG monitor. The victim's heart rate had slowed to forty beats per minute, but his rhythm was otherwise regular and normal. The diagnosis was apparent to David. "He's in EMD. This really is hopeless."
Jim Ross, a medical student from the University of Michigan, was working on his emergency room rotation at the Fairlane satellite. Dr. Barnett was his supervising physician. Jim asked, "Dr. Barnett, what's EMD?"
"Jim, I'll explain it in a minute."
David addressed a male nurse. "Mike, we've lost pressure. You'd better resume chest compressions."
The doctor placed his stethoscope on the patient's chest. There were no heart sounds, no muscle activity to produce blood flow through the heart, no cardiac valve motion and therefore, no cardiac sounds.
Barnett checked the IV line inserted by the paramedics at the scene. "We can't do anything with this little IV. Jim, do you want to do a central line?"
"Sure!"
. . .
Medical students often requested rotations with David Barnett as their supervisor. They knew he liked to teach, letting students perform procedures other residents kept for themselves. David knew it was important for students to learn emergency room procedures, like central IV line placement and cardiac needle aspiration. He frequently let students practice procedures on obviously terminal patients, such as this one. Since the situation for the patient was hopeless, there was no risk of harm, and much experience to be gained by the student--experience that could later save a life.
. . .
Jim Ross anxiously scrambled around the room gathering the necessary equipment for insertion of a subclavian venous line. Barnett walked to the head of the stretcher and pressed his finger to the patient's neck, feeling for a carotid pulse. With each chest compression he felt a brisk pulse of blood flowing through the victim's right carotid artery.
"Stop CPR for a second, Mike."
The nurse doing chest compressions stopped. The carotid pulse under Barnett's finger disappeared.
"Okay, keep going for now. Jim, are you ready to insert that line?"
"Yes, sir. All set."
"I'll show you the landmarks I use to locate the subclavian vein, then you take over. While you're inserting the line, I'll explain EMD."
The doctor showed his student where to place the needle to access the large, subclavian vein under the patient's clavicle. Jim opened a central line kit and sterilized the skin overlying the right clavicle by scrubbing the area with Betadine. He attached a large bore needle to a syringe and started the procedure as David observed.
"Jim, EMD stands for electro-mechanical-dissociation. It means the electrical impulse through the heart is normal, but, since the heart muscle has been severely damaged, the electrical discharge can't produce cardiac contraction. The diagnosis is simple. If you have normal electrical activity on your EKG, or cardiac monitor, but no heart contraction, as evidenced by absent heart sounds and no blood pressure, it's usually EMD, a universally fatal condition."
Jim looked surprised. "It's always fatal?"
"Always--one-hundred percent. If your patient survives, it wasn't EMD. That's why you should never accept the diagnosis until you've excluded any treatable condition that can mimic EMD.
Jim Ross was curious. "What could impersonate EMD?"
Barnett smiled. "Think about it while you work on the subclavian line. I'm going to review his twelve lead EKG and lab results."
David returned a short minutes later. Jim was doing well with the IV. He had entered the vein and was inserting a large-bore, Teflon catheter.
. . .
The subclavian vein flows directly into a larger vessel just above the heart. A central line catheter allows administration of IV drugs directly into the heart's chambers, where they are most effective.
. . .
"Good job, Jim. Now secure the catheter by suturing it to his skin."
There were now four nurses in the room, Karen and Barb in addition to Jamie and Mike. "Jamie, we've got a central line. Give an amp of epi,one amp of atropine and follow with one amp of bicarb. Karen, please transfer the dopamine and saline lines to the subclavian IV."
Jamie went to work as Barnett finished his discussion with Jim Ross. "So, Jim, have you come up with any condition that could masquerade as EMD?"
Barnett knew his student was bright, one of the best he had ever supervised, and wasn't surprised when Ross came up with two plausible answers--tension pneumothorax and cardiac tamponade.
. . .
Pneumothorax is the medical term for the presence of free air in the chest cavity. Trauma to the chest, such as from an auto accident, or in this case, from CPR chest compressions, may lacerate the lining of the lung, producing a leak of air from the lung to the space between it and the inner lining of the chest cage. Such a leak works as a one way valve, allowing air out of the lung on inspiration, but not allowing it back into the lung on expiration.
With each breath, air passes into the chest cavity producing a growing pocket of air under pressure, or tension. An enlarging pneumo compresses the lung and all other organs on that side of the chest.
If a tension pneumothorax occurs on the left side of the chest, the pressurized air can compress, or squash, the heart to such a degree that it cannot fill with blood. The reduced volume of ejected blood produces a low, or absent, pulse and blood pressure.
. . .
The med student responded. "In my thinking, anything compressing the heart could look like EMD."
"Excellent. So, what could do that?"
"How about a tension pneumothorax or cardiac tamponade?"
"Very good! You're a smart guy, Ross. I'm impressed." David saw Jim's face redden as his student blushed at the compliment. "Go on, tell me about a tension pneumo."
Jim accurately described a tension pneumothorax.
"How would you diagnose and treat a pneumo?"
"You diagnose it with a chest x-ray or by listening over both lungs with a stethoscope. If a pneumothorax is present, the lung sounds will be diminished on the of injured side of the chest."
"Correct. So, if you confirm a pneumothorax, what do you do?"
David's student paused a pensive moment. "Well, I suppose you have to remove the air to alleviate the pressure. I've read you insert a large needle into the chest wall to release the compressed air. Right?"
"You've got it. How do we know this patient doesn't have a pneumo?"
"When the therapist bags him his chest rises evenly and his breath sounds are equal on both sides."
"Right, again. Hey Ross, you're the man! I have to talk to the family. When I get back we'll discuss tamponade."
As Barnett walked to the door, he had to move through a room full of bystanders. Three paramedics, two orderlies, another medical student and four nurses were present. When he reached the door, he realized he didn't know the patient's name. He turned to the paramedics and asked, "What's this gentleman's name?"
Frank, one of the medics responded. "You can't even pronounce it. He's some fat camel jockey from East Dearborn."
Barnett shot an angry look at the ambulance driver.
"You need to grow up, Frank. Grow up or shut up!"
The driver winced and blushed, but said nothing. David left the room.
"Man," said Frank. "He can be a real asshole, can't he?"
"No, Frank. You're the asshole," said Jamie. The room erupted with
laughter.
Mounir's uncle, Asad Arafa, saw Barnett leave the room. He was watching
from high above, terrified, uncertain of where he was. Asad was cold--surrounded by darkness. He could see his lifeless body lying on the stretcher below.
Dr. Barnett walked to the nursing desk to check the patient's name on the admission memo. It read, Asad Arafa, age 64, cardiac arrest. He went to the ER waiting room to talk with Mr.. Arafa's family. Two Arabic men were sitting together--the older of the two looked distraught.
"Excuse me. Are you with Mr.. Arafa?"
"Yes, we are," responded the younger man.
The older gentleman looked up as a series of questions shot from his mouth. "Who you are? What you can tell us? He is okay?"
Arabic is the first language spoken in the homes and shops of East Dearborn. For older generation immigrants, English is a distant second. Fareed Arafa spoke broken English with a heavy Arabic accent. His son, Mounir, spoke impeccable English
"Mr.. Arafa, I'm Dr. Barnett, the physician in charge. Could you please come with me to a private area where we can talk?"
The supervising nurse directed the men to a conference room adjacent to the main lobby. David and the relatives sat around a small table.
"Asad is my brother. I am Fareed. This is my son, Mounir."
"Is your brother married?" asked Barnett.
"Yes, but she not here. She got crazy when we call her. My wife with her."
David asked, "Can you tell me what happened?"
"He fall, he turn blue. I don't know what happen. He is okay now, yes?"
"What was he doing when this happened, Mr. Arafa?"
"We move case at bakery. You know, glass case--very heavy. I think he push too hard. Please tell me, he is better now?"
"Your brother is very sick, Mr. Arafa. I'm afraid he's ..."
Fareed interrupted. "But now he is better, yes?"
"Please, Papa. You've got to settle down. Let the doctor talk."
"Okay, okay. He is okay. It is okay."
"No, Mr. Arafa. I'm sorry, but your brother is not okay. He's had a severe heart attack. His heart stopped beating for a long time. We got it going again, but now he has no blood pressure. We're doing everything we can, Mr. Arafa, but he is very sick. I'm afraid he may not survive."
"Big heart attack? You give the clot medicine? You know, I read in Free Press. The clot breaker to stop heart attacks. You did that?"
I'm sorry, Mr. Arafa. The clot medicine you read about would be dangerous in your brother's case. It can't be used in a cardiac arrest patient who has received CPR with chest compressions. Do you understand?"
Fareed looked puzzled.
"Mr. Arafa, your brother's had a lot of pushing on his chest to try and save him. The clot dissolving medicine could make him bleed inside his chest, only adding to his problems. Besides, it's too late to give the clot medicine. It was too late when he arrived here. Do you understand, Sir?"
"Yes, understand. He will be alive, yes?"
"No, I'm sorry. You need to know we've done, and are doing, all that's possible. I'm afraid you're brother is beyond help now."
"Do not tell me! This not true!"
"Mr. Arafa, I understand how you feel. I'm going back to check on your brother now. I promise to do everything I can to save him. I'll be back to talk with you, but please, you need to know this is nearly a hopeless situation."
Mounir welcomed the news of his uncle's impending demise. He had an inner hatred of the old man--emotions he never understood. The source of his anger and contempt were buried somewhere deep within his genius brain.
As David got up to leave, he noticed a strange look on the younger man's face. Mounir was leaning back in his chair, out of his father's view. He was smiling. He had a smug grin, as if he found all of this humorous. David was puzzled. How bizarre is that? This guy looks amused by all of this.
Barnett entered room one to find Mike still working at chest compressions. The respiratory therapist was delivering one-hundred percent oxygen to Asad's lungs. Massive doses of vasopressor drugs and saline were running through the central IV in a desperate attempt to elevate Asad's blood pressure. The cardiac monitor showed a normal rhythm, just as it had when David left the room.
"Let's stop CPR and check his blood pressure," said Barnett.
Jamie inflated the cuff on Asad's right arm. "I can't get any reading at all, Doctor."
Barnett stepped up to the stretcher, placing his hand on Asad's right
groin. "There's no femoral pulse. Jim, check his carotids."
"I can't feel any pulse either, doctor."
Asad Arafa remained in electro-mechanical-dissociation. It had been forty-five minutes from the time the paramedics received the 911 call. It was time to quit. As a last-ditch attempt to turn things around, Barnett decided to have Jim Ross do a pericardial needle aspiration. He knew this was a long shot, not likely to help his patient, but wanted his student to learn the procedure.
"Jim, you were gonna tell me about cardiac tamponade."
Ross paused for thought. "The heart is enclosed by a sack of tissue, the pericardium. If fluid leaks into the pericardium it may develop enough pressure to squash the heart. It can compress the heart so much the cardiac chambers can't fill with blood--similar to a tension pneumo. I think that could mimic EMD. Am I right?"
"Very good,Ross. What fluid would we be concerned about in Mr.. Arafa's case?"
"Blood, I think. Just like a pneumothorax, the pericardium may have
been injured by chest compressions from CPR."
"Correct. So, how would you alleviate pressure around the heart?"
"I'm not sure, Dr. Barnett. I guess you'd use a needle."
"Right again. As you've said, this could have occurred during chest
compressions. He's not responding to medical treatment, and for all practical purposes he's already dead. Jim, I'm going to have you aspirate his heart with a needle to exclude a pericardial hemorrhage with tamponade."
Jim Ross was shocked. "You want me to stick his heart with a needle!"
"Sure. Hey, there's a first time for everything. Right now's as good a time as any. You've gotta learn this stuff."
Barnett looked over to the charge nurse. "Jamie, we need a 14 guage needle, a 30 cc syringe, sterile gloves and drapes, and some Betadine. We're going to do a pericardial aspiration."
"I'll get it right away, Dr. Barnett."
David explained the process to his student. A five inch long, large bore needle on a syringe would be inserted at the bottom of the sternum and directed toward the heart. If there is a hemorrhage into the pericardium, causing compression of the heart, it will be relieved as the compressed blood is removed by the needle.
Jim Ross asked, "How will I know when I'm in the pericardium? What if I go too far and puncture the guy's heart muscle?"
That's a good question. Exactly why it's invaluable to practice this procedure whenever you can. Especially on a patient such as this, in whose case you won't do any harm."
Barnett explained how to guide the needle to the correct position. "We attach an alligator clip to the end of the needle and have the electrode attached to the EKG monitor. If the needle strikes the heart muscle you'll see an injury pattern on the EKG. The ST segments will go up, as they would if the patient were having a heart attack. If you see that happen, you immediately pull back on the needle.
Another safety measure is to continually apply suction on the syringe as you insert. If there's blood in the pericardium it will be under pressure, and the instant you hit the space the syringe will fill. There are other techniques we can discuss later.
The student proceeded with the needle aspiration as Asad Arafa watched from above. He didn't feel a thing as the needle punctured his chest. As Barnett expected, there was no blood present and the procedure was uneventful.
David walked to the head of the stretcher, pulling a pen light from his pocket. He checked Asad's pupils for reaction to light, any sign of life. "Pupils fixed and dilated." He checked his patient's neck for a carotid pulse. "No pulse palpable." Using his stethoscope, Barnett listened over Mr. Arafa's heart. "No heart sounds."
"We're gonna stop. Thanks to all for or a good effort. List the time of death as ten-thirty-three p.m. I'll go talk with the family."
As he watched the doctor pronounce him dead, Asad Arafa detected a foul taste in his mouth. The worst taste ever. Horrible screaming sounds filled his head as he floated away into blackness, writhing in agony as he went.
Dr. Barnett returned to the conference room and sat with Mr. Arafa and his son. "I'm very sorry, Mr. Arafa. We had to stop. You're brother didn't survive."
Fareed looked up, wide-eyed, as though he had just been slapped across the face. "What you mean? No, no, no!"
He broke into a long verbal tirade in Arabic. Barnett was at a loss to console him and simply sat back and waited. Once again, to David's amazement, Mounir was leaning back with a grin on his face. It was very odd.
Within minutes, Fareed Arafa was silent. Barnett extended his condolences as best he could and asked the supervising nurse to stay with Mr. Arafa for awhile. He told Mounir he and his father could come in to see their relative shortly. David added, "Please, call anytime you like if you have questions." He stood and returned to room one.
"Okay, let's clean this place up. The family will be coming in and we could get another arrest in here at any moment. This room's a disaster."
Room one was a mess. The area around the stretcher was cluttered with blood-stained drapes, empty IV bags and dangling IV lines. Betadine disinfectant, with its brown-iodine color, was smeared over sheets and towels. There was a puddle of blood on the stretcher from Jim Ross's central line insertion. Blood and Betadine had spilled to the tile floor. The room reeked of sweat,dirty chlothes, vomit, Betadine and blood, a smell all too familiar to the emergency room staff.
As usual, David pitched in to help. He joined the nurses and orderlies in cleaning up blood soaked drapes, dirty towels, and sweaty EKG electrodes. All were thrown in the trash. Contaminated needles and IV lines were properly disposed of in safe containers. Barnett helped with all of it.
Jamie placed a clean white sheet over the body in preparation for the family's visit. As David left the room, Jamie thanked him for his help. David Barnett was definitely their favorite emergency room doctor.
Numerous patients had accumulated in the ER waiting room while Barnett was tied up with the cardiac arrest. It was approaching midnight, but his call room, and a chance to get some sleep would have to wait until he examined and treated the backlog of patients.
The ER visitors included, among others: a baby with an ear ache, an alcoholic man vomiting blood, a man with a fractured right arm from a motorcycle accident, a young woman with a migraine headache, an older gentleman with uncontrolled hypertension and a teenager strung out on some type of hallucinogen.
Fortunately, Barnett could utilize his med student to appease some of the patients who were angry about the long wait.
At four a.m., Doctor Barnett was finally greeted by a clean slate on the admissions board. All the clipboards were empty. He and Jim had successfully cleared the backlog and were now thankful for a lull in activity.David could escape to the solace of his call room, hopefully getting a few hours of sleep before starting his usual workday at Ford Hospital.
. . .
Moonlighting residents were thought to be crazy for torturing themselves with sleep deprivation. Barnett needed the money, it made Sue happy, and he was willing to risk being up all night, even knowing he would have to start work all over again at seven a.m.
. . .
As Barnett walked to his room, he thought of how wonderful sleep would be. He also had a brief, disturbing craving for a drink. David had long since high school quit drinking beer, having advanced to more potent intoxicants. He thought a Manhattan or Martini would be good right now. He quickly forced the thought from his mind. In the call room, he removed his lab coat, slipped off his shoes and went to bed in his scrubs.
When his head hit the pillow, his last conscious thought was of Mounir Arafa's face with its smug smile and look of contentment in response to the news of his uncle's death. The whole thing seemed ludicrous. As David drifted off, he envisioned Mounir, a vision in which the young Arab's expression morphed from a grin to a sinister sneer.
By cardiodoug
David's Practice
After completing his cardiology fellowship at Henry Ford Hospital, David Barnett, his wife, and child moved back to Toledo, Ohio. Both Sue’s and his parents still resided there. David was offered an attractive position as an invasive cardiologist at the Toledo Clinic, a large, incorporated group of medical specialists. He would be the third member of the cardiology group. In July, 1991, at he age of thirty-one, Dr. Barnett started his new career.
His two senior partners, having been there a number of years, had developed a huge practice comprised of hospital inpatients and office outpatients. They were undermanned and swamped with work. David was welcomed with open arms.
Dr. Barnett jumped in with both feet and soon had a sizeable, thriving practice. He was well respected by his colleagues, both his partners and other sub-specialists.
Office staff and hospital personnel quickly developed high respect for Barnett’s abilities. They enjoyed his humor and pragmatic demeanor. David later learned, through conversation with his senior partner, that the director of the cardiology department at Ford Hospital had described him as the best cardiology fellow he had ever trained.
Despite these accolades, he remained humble and cautious in his approach to medicine. Having known many arrogant medical residents and cardiology fellows who were cut down to size and put in their place following a misdiagnosis or disastrous outcome; David was careful in his approach to medicine.
His popularity and capabilities were an odd contradiction to his insecurity as a physician. A deep internal anxiety induced him to compulsively check and re-check patient therapy plans. He obsessively reconsidered every move regarding patient diagnosis and treatment--strongly adhering to the physician’s motto to do no harm.
This was time consuming, and for the most part, unnecessary. David recognized his compulsive approach to medicine as self-defeating behavior that interfered with his family’s well being. They suffered from his absence.
During Barnett's training at Ford Hospital, Susan and he had a child. Their four-year-old daughter, Elizabeth, was the delight of their life: precocious, cute as a button, clever as could be. Their son, Paul, intelligent and all boy, was born in the fall of Barnett’s first year of practice. A daughter, Marilyn, would follow in two years.
Eight months after joining the Toledo Clinic, Dr. Barnett suffered an emotional set back when one of his patients died from an unusual cardiac condition. In reality, the patient’s death was not David’s fault, but due to his insecure nature, he blamed himself. He was plagued by depression and guilt for many weeks. Fortunately, over time, as he gained more experience, his self-doubt slowly healed. Over the ensuing years he matured into a confident, efficient cardiologist, who maintained high practice standards.
David had an uncanny knack for making difficult diagnoses. His clinical acumen and bedside skills were superlative, and he prided himself on using his stethoscope and intelligence, rather than expensive testing, to make a diagnosis. His partners were pleased to have him as a member of their group. Cardiologists across the country were being criticized for excessive utilization. David’s group did its best to limit expense--being gratified with their ability to maintain low test utilization. The group was recognized by insurers for their cost-conscious approach, especially when compared to other cardiologists in the community.
Dr. Raymando Tamayo, for example, was notorious for his inordinate, unnecessary, potentially harmful and incredibly expensive use of cardiology tests. His referring physicians were frequently disturbed by the plethora of expensive studies to which Tamayo subjected their patients--their anger compounded by the large number of normal test results, an indication that most of these evaluations were never indicated in the first place.
Consequently, over the years, Tamayo’s referral base dwindled, along with his patient population. To compensate, Ray resorted to distasteful advertising on billboards, phone book covers, and radio programs.
He became the laughing stock of the medical community, but didn’t care. Through years of practice, Tamayo’s ego had hardened enough to withstand virtually any criticism: derision from other professionals, anger and disgust from abused patients, even widespread snickers and jokes about his lousy patient care and blatant greed. At David’s office, if a physician were thought to have done an unnecessary test he was jokingly said to have “Pulled a Tamayo.” For Ray Tamayo, money came first, vacation time second, patient care a distant third.
Three years into his career, Dr. Barnett was routinely working twelve to fourteen hours a day. The toll on Susan was mounting. In addition, fatigue caused by his abusive work schedule compromised his ability to remain sober. In the evening, after an arduous day, he would obsess over having a drink or two at home.
Near nightly drinking soon became his norm, only abstaining, with difficulty, every third day and weekend when he was on call at the hospital. Susan loved David, but hated having their brief time together ruined by his intoxication. He was usually so exhausted that after a couple of drinks he would fall asleep, not helping her with childcare and routine chores around the house.
His ever growing patient load added more and more work to his day. Within another year he was struggling through eighty to one-hundred hour weeks, often going to his office on his weekend-off to catch up on paper-work and test dictation. His relationship with Susan was on a downhill spiral.
Through it all, through all his years of work, saving lives and depriving his family of his presence, he continued to drink. David's urge to soothe his fatigue with alcohol was uncontrollable.
He often arrived home as late as eleven or midnight, missing nearly all family meals and many gatherings with relatives. As his oppressive schedule advanced, so did his alcohol use. He wondered what his partners would think if they knew their junior associate was a frequent drinker. Dr. Barnett would carefully abstain in the presence of other physicians, when attending medical social events or hospital functions. Drinking at home was his secret—a secret he kept from colleagues, and most importantly, his father.
David never drank in front of his parents. His reasons were twofold: not wanting to hear his father’s criticism, and not wanting either of his parents to worry. Susan saw this as her husband’s concern for the well being of his parents, over that of his family. It compounded her anger. She considered blowing the whistle on David by telling his father, asking him to intervene. Not wanting to destroy the last bit of trust shared with her husband, she held back on calling, but kept it in mind as an option for the future.
Barnett used long work hours to justify his drinking, despite knowing of many doctors who worked just as hard without using alcohol for relief. His guilt and shame grew as his drinking increased, occasionally having one or two when on call, which eventually escalated to a nightly event. Being on call was no longer a deterrent.
Despite this, David's' popularity and prestige in the medical community remained solid, as did adoration from his patients. His esteemed reputation only amplified his guilt and remorse. David’s self-respect and sense of integrity deteriorated as shame over his secret grew.
The Barnett’s were wealthy. Their children attended private school and David took his family on many expensive, exotic vacations. He knew private school and vacations were no substitute for an attentive father and husband, but he was stuck. His career was what it was. He couldn’t change that.
Susan’s tolerance approached the breaking point as the children became more distant from their father. What David knew to be the most important thing in his life, his family and their love, was fading away.
In response to her husband’s absence, Susan resolved to find a career of her own. This conflicted with her dedication to her children and her refusal to use daycare facilities. She abhorred the thought of her children becoming latchkey kids. As an alternative, she decided to work out of her home as an interior designer. Part of that plan entailed a new house to be designed and lavishly furnished by Sue as a showcase for her decorating talents.
The home she envisioned, and its furnishings, would be expensive. If her husband could not fulfill her life with the attention she craved, she would try to find happiness from the wealth his career created. David, willing to do anything to improve his marriage, readily agreed to the construction of a new home. As Susan’s plans grew, so did the size of the house. What started out as a fairly modest, three to four-hundred-thousand dollar home, turned into an extravagant, seven-thousand square foot monster, with a million dollar price tag.
Despite that, Barnett, committed to pleasing his wife and keeping his family intact, never said a word. He never complained about design changes made by Susan, and willingly agreed to nearly any construction costs. The mounting expense and anticipated mortgage only compounded David’s travails, demanding that he continue working long and hard to satisfy new financial obligations. As his fatigue increased, so did his drinking.
Near the end, Susan and David became sadly aware that a house is just a house, money is just money, and neither can replace love. They were caught in a heartbreaking dilemma with no solution in sight. David saw his life racing toward a head on collision with divorce. In desperation, he did his best to reduce his work schedule and spend more time with his wife and children.
Dr. David Barnett had practiced cardiology for slightly less than six years. Over that relatively short time, his career had taken a severe toll on his family. Attempts at working fewer hours were seen by his wife as too little, too late. Before long, the foundation of his marriage would crack, and David’s life would come tumbling down.
By cardiodoug
The Child
The black BMW cruised down Oakwood Boulevard heading north toward Michigan Avenue. The car was spotless, glistening in the afternoon sun. Mounir drove past a tall, concrete wall running to his right. The eight-foot barrier hid the Ford Motor proving grounds from view. He passed the entrance to Greenfield Village and the Henry Ford Museum.
Mounir approached Michigan Avenue, stopping at a red light. Across the street he saw a well-dressed man and young boy exit a restaurant. The child appeared to be six or seven-years-old. The man, presumably his father, was dressed in business attire with a dark suit and top coat.
The boy looked up and spoke to his father. Munie jerked with a start as he saw the man smack his son in the back of the head with a closed fist. The child’s head snapped forward as he fell to the ground on outstretched hands. His father reached down and yanked him to his feet. The youngster kept his head down, staring at the sidewalk, as he was dragged along by the arm.
Demons surfaced from hiding deep within Mounir’s brain—demons he didn’t understand but often encountered. His pulse raced. His head was swimming. He was disoriented. He looked around the intersection with confusion, not knowing where he was. His vision blurred as his mind was barraged with fleeting images, splotches of red and white. Overwhelmed with fear, he cried out as everything went gray.
His foot slipped off the break and the car slowly rolled into the intersection. The blare of a horn, followed by screeching tires startled him out of his trance. He slammed the brake pedal just as a car swerved past the front of his Beamer.
Mounir, drenched with cold sweat, had a strangle hold on the steering wheel. He was jarred by another horn blast from an impatient driver behind him. The light was green. Munie cautiously moved forward, turned left and drove past the restaurant. He caught a glimpse of the man and child just as they disappeared around the corner on a side street.
Father and son walked across a parking lot to the rear of shops and restaurants on Michigan Avenue. They stopped at a Lincoln Mark IV. The boy’s father jerked the passenger door wide, viscously shoved his son in and slammed the door. As he walked around the car he encountered a young, dark-haired man in a black-leather jacket and jeans, standing at the rear of the Lincoln.
Mounir assessed the boy’s father with a hard stare. He looks wealthy--expensive clothes and a luxury car. Probably a Ford executive, thought Mounir. A well to do asshole who likes beating his children. The executive shot a quick look at Mounir and ignored him. Munie took a step forward, blocking his path around the car.
“May I help you?” The inquiry rang of sarcastic arrogance. Mounir said nothing.
“What do you want?”
Now there was fear in the man’s voice. He looked through the Lincoln’s rear window. The young boy was hidden from view by the seat and head rest. After assuring the child was not watching, Mounir approached his frightened foe.
The guy tried to push his way past. With obvious terror in his voice, he exclaimed, “Leave us alone! I have my little boy with me. Please, my son’s in the car!”
Mounir grabbed him firmly by the arm and flung him to one side. He fell hard with arms extended, cutting his palms on the asphalt pavement. His knee struck the ground, tearing a hole in his dress pants. He peered up at Mounir and slowly rose to his feet. He was visibly trembling.
“Here, take my wallet. I have alot of money. Please!” He pulled his wallet from his pocket and held it out.
Mounir didn’t move. “Your license, give me your driver’s license.”
As the man fumbled through his wallet for the license, Mounir looked back to the car. The child was still out of sight. He imagined the boy sitting there, crying, fearfully awaiting his father’s return. Rage surged through his body. He snatched the driver’s license with his left hand and delivered a crushing blow to the man’s chest with his right fist. The executive fell back, sprawled on the pavement. He looked pathetic, pale and terrified--on the verge of tears.
Munie glanced at the driver’s license, entering the data into his cerebral archives. He could retrieve the information at will, any time it was needed. He knelt next to the helpless, broken man sitting on the pavement, tossed the license at his feet and grinned. “I’ve seen you before,” lied Mounir. “Now I know who you are and I know where you live.”
“Who are you? What do you want?”
“I’ll be watching you. I’ll come to your house at night. You’ll never see me, but I’ll be there. You won’t know when I’m around.”
“Why? Watching what? I don’t know what you mean!”
“Your son--I’ve been sent to protect your son. How many children do you have?”
“I have three. Who sent you? Please, for God's sake, I don’t understand.”
“I’ve been assigned to protect them--to protect your children from you. It is for God's sake, just as you've said. If I have to visit you again it will be worse, much worse. You’ll be sorry.”
The man, still on the ground, looked up at Mounir with a contorted, horrified face. He was speechless.
“If you hurt your children again you’ll pay. It will be regrettable. Don’t ever forget this. Do you understand?”
A mumbled stutter came from a bone dry mouth. “Yes. . .I. . .I under-st-st-and”.
The man grabbed his license from the ground and stood to walk to his car. He opened the driver’s door of the Lincoln and looked back at the parking lot. Mounir was gone.
By cardiodoug
The Separation
“David, I hate your drinking! I hate it, and I hate you!”
“Sue, please don’t say that.”
“It’s true. You make me so angry! You’re ruining our lives. You’re ruining our family and I hate you for it.”
David’s head was pounding from last nights’ binge. “I’ll quit Sue, I promise.”
“You’ve said that a thousand times. It’s always the same with you. You’re a liar. You can’t quit.”
Deep inside he knew she was right and he despised himself for it.
Susan, still in her night gown, walked to the adjoining bath area of their new home, the huge house David had agreed to build in hope of appeasing his wife’s anger and disappointment with their marriage.
The bath was an opulent room with an Italian marble floor, gold fixtures, French windows with custom drapery and original art work. It was one of the highlights of the house. Sue stood at the basin and turned on the water as David appeared at the door.
“I’m really am sorry, Sue.”
She glared at him. “You’re sorry alright! You’re a sorry excuse for a husband and a father!”
Her shouts cut through his hangover like an electric shock.
“You were playing the stereo so loud last night the children couldn’t sleep. You were drunk. You don’t care about me and you don’t care about the kids. You’re a selfish, son of a bitch, David.”
His self-loathing grew with each of her outbursts. He retreated to the walk-in closet and grabbed a suit for work.
“Don’t run and hide, David. I’m telling you, if it doesn’t change I'm going to leave you. I’ll divorce you! I mean it.”
That dreaded word, divorce, terrified him. His pulse rose. He felt weak and nauseated. She'll never leave me, it's impossible. We've been together for nearly twenty years. Dave and Sue, the great couple with the beautiful kids, the beautiful family.
“I mean it. I’ve already talked with an attorney.”
He felt sick, sick inside and sick of what he had become--disgusted with his drinking and himself. However, with each of Sue’s accusations his denial grew. She has faults of her own. She acts like she’s perfect.
He was angry. David stepped from the closet, buttoning a white shirt. A tie was draped around his neck. He raised his voice with an accusatory tone. “What are you talking about, Susan? An attorney? You’ve spoken with an attorney?”
“Yes, I have. Do you think I'm going to put up with this shit forever? Yeah, I saw an attorney weeks ago.”
The reality of it struck him hard. He took a step toward his wife and gently touched her arm. “Sue, I’ll get help. I’ll do it.”
“I’ve heard it all before, David. It’s all lies. All you do is work and drink. You ignore me and you ignore the kids. I can’t stand it anymore.” Sue pulled her arm away and turned to the basin.
“Susie, come on. I'm very sorry."
“Don’t call me Susie.” She dipped her hands in the water, turned toward her husband and flicked water in his face. “You’re not sorry. You’re never sorry. If you were you’d quit drinking.”
A second splash of water hit him in the face. His anger was coming back. He moved closer and shouted, “Stop it!”
“Get away from me!” A third splash hit him in the face. “Go away. I want you to leave.”
“Stop it, Sue. We need to talk.”
“I’m through talking.”
A fourth splash flew from her fingertips, just inches from his face. Water hit him directly in the eyes, his anger peaked. He slapped her across the face.
“David! Now you’ve done it. You’re crazy! I want you out of my house!”
He couldn’t believe he'd hit her--instantly apologized, moved away, and sat on the side of the bath, their Jacuzzi. Sue stepped to the doorway, pointed down the hall and screamed, “Get out!”
As she started down the hall, David ran toward her, pleading, “Please let me talk to you, Sue.” He grabbed her arm to keep her from leaving. She lost her balance and fell to the floor, shrieking.
“Leave me alone!” She got up and started crying, yelling even louder. “Get out of my house. I want you to leave and never come back!”
Her house, her dream house, had been her project. For years she had been planning a house, drawing hundreds of floor plans, reviewing interior design magazines, searching through shops for the right appointments. After construction began she often appeared at the work site to supervise her project.
David had not wanted a new house, content with where they had been living. The home his wife planned wasn’t his style. He saw it as ostentatious, unnecessary and too expensive. Despite that, he never objected. He knew how Susan obsessed over her dream house. Telling her his true feelings would have been a disaster.
She was determined to have her showcase home, convinced her new career in interior design required it—convinced it would make her happy. David prayed their new home would bring them happiness. Instead, it brought more misery. Despite his sizeable income, they became house poor, barely able to afford a summer vacation. The financial pressure put a huge strain on their relationship.
Their youngest daughter was awakened by her mother’s screams. Six-year-old, Madeline, ran into the bedroom, “Mommy, why are you crying?”
“It’s okay, honey. I’m alright. Why don’t you go downstairs, Maddie? I’ll come down and get you some breakfast.”
As Maddie was leaving the bedroom she saw her father standing silently, starring out the window. “Hi, Daddy.”
“Hi, Mad. I’ll see you downstairs, honey.”
Madeline left and ran down the steps. David heard some noise in the dressing closet. Susan was pulling his clothes off hangers and throwing them on the floor. The sight of it filled him with fear--fear and heatbreak. “I’ll take care of that, Sue. I’ll leave today.”
“Good!” She left to go downstairs.
Their older children, Erin and Peter, were still asleep. When David walked out of the bedroom he peaked into each of their rooms for one last look before leaving.
Maddie saw her father walking through the kitchen toward the garage. He was carrying a suitcase and had clothing on hangers slung over one shoulder.
“Daddy, where are you going?”
“I’m going to work, honey.” He opened the hallway door to the garage. Madeline jumped up and ran to him, her eyes filled with tears.
“Why do you have those clothes?”
“It’s alright, Maddie. Don’t worry.”
David walked to his car with his little girl following right behind. He opened the car’s trunk and placed his suitcase inside, laying his loose clothing on top. Maddie tugged at the suitcase, trying to pull it out of the trunk.
“Please, Daddy. Don’t take your clothes. Let me take them back in the house!”
“Maddie, it’s okay. Everything’s fine.”
“No, you’re leaving. I don’t want you to leave. Please don’t go. I’ll carry your suitcase back in the house, okay.”
He knelt down and brushed the hair back from his little girl’s forehead. “Honey, your mom and I had an argument. I’m just going away for a few days. I‘ll be back before you know it.”
“Daddy, I don’t want you to leave. Let me take your clothes in the house.”
David smiled at his daughter. “Maddie, you sweetheart, everything will be fine. I have to go now, baby. You don’t want me to be late for work.”
He pulled his car out of the garage as his daughter watched, standing in the drive with tears rolling down her face. He opened the car window.
She called out. “I love you, Daddy.”
“I love you, baby. You know that. I promise to be back soon. Now go in the house and finish your breakfast.”
He waited in the drive until his daughter went back inside. As he drove away his eyes welled with tears. Did I lie to Maddie? Will I be back soon, in a week or two? A sinking feeling in the pit of his stomach told him otherwise.
By cardiodoug
The Police
David, living in a motel, was doing his best to maintain his medical practice and daily routine. It was difficult. He was heartbroken and scared--afraid of a lonely future without Sue; simply terrified of being alone. He called Susan every day, sometimes twice a day. She usually refused to talk and hung up, and when she would talk, she was aloof--untouched by her husband’s pleas for understanding.
As days passed, David's despondency grew. His wife’s attitude shocked him--her defiance left him sad, listless and depressed, to the point that he could barely get through the day; after which he would retreat to bed. Sleep was his only escape from the horrible reality of his life. He worked, slept, and worried. He ate little, and within weeks lost over ten pounds. He looked distraught, thin and pale. His patients commented on his distance and lack of attention. They loved their doctor and many voiced concerns about his well being. He wasn’t the Dr. Barnett they knew and trusted.
David drove past his home, without fail, every night, hoping for a glimpse of Susan or the children. On occasion, only after dark, he would park down the street and walk back to the house to look through the windows, doing just about anything to see his family.
Sneaking around in the dark, fantasizing about being back home, made him feel whole again, as well as humiliated and pathetic. He would hide in the bushes around his house, the gigantic house that was supposed to have made his wife happy and save their marriage. It’s an Albatross, he thought. The straw that broke the camels back along with our bank account and our marriage.
The money the Barnett's had saved over David's six-year career, all went toward building the house; the ostentatious, seven-thousand square foot nightmare he had come to hate. He was,
while living in a motel, paying a huge monthly mortgage for a house he wasn't permitted to enter.
Three weeks after moving out, he was there in the dark, peering through the window of their family room. Sue and the children were gathered around the television. He could hear their laughter; life seemed to be going normally for them. They looked happy. The sight made him miserable and angry. This situation is absurd. He wanted back in with is wife and children--back in his house.
His mounting anger made him impulsive--irrational. He ran from the back yard to the front door and pounded. A light came on in the foyer. The door barely opened as Susan peeked out.
“David, are you nuts? You’re not allowed to be here.”
“Why not? It’s my house, my family.”
“No it isn’t. You’ve lost your privileges. You don’t belong here anymore.”
Susan’s words made his anger soar. He pushed the door wide open.
“David, get out! I’m calling the police!” Sue ran to the kitchen.
He was about to step inside when his son ,Peter, appeared in the foyer. “Hi, Dad. Are you okay?”
“Peter, I'm so glad to see you. I’m okay. How you doin’, Pete? Haven’t seen ya for awhile.”
“I miss you, Dad.”
Peter’s words drained the anger from his body; he feared he would start crying. Not wanting his son to witness his grief, he composed himself. “I miss you, too, Pete. I love you.”
Sue reappeared. “Peter, go back to the family room.”
“I better go, Dad. See ya later.”
“Bye, Pete. Hope to see you soon. Love you.”
Susan spoke in an irritating, matter-of-fact tone. “The police are coming. You better leave right now.”
“Why? What can the police do? I haven’t done anything.”
“David, you idiot. I’ve seen you on your nightly drives by the house. I’ve seen you snooping around the windows. What’s wrong with you? I called my attorney and he’s issued a restraining order. You’re not allowed on the property.”
A police cruiser pulled in the driveway, no lights, no siren. Two officers walked across the lawn toward David.
“Dr. Barnett?”
“Yes, sir.”
“Doctor, do you know you’re not allowed to be here at your house?”
“No, officer. I wasn’t aware of that.”
The second officer spoke. “Mrs. Barnett, are you okay?”
“Yes, I’m fine. I don’t want him here. He scares me.”
“Okay, Ma’am. Why don’t you go back inside and lock up. We’ll talk with your husband.”
“Thank you. Please make him understand.” Susan closed the door. David heard a click as the door locked.
“Doctor, lets go back to our car and talk.”
David responded politely. “Sure, no problem.”
“Doctor, didn’t you receive notice of a restraining order in the mail?”
“No, sir. I haven’t received most of my mail. I’m staying at a motel on Reynolds Road."
The officers looked at each other, surprised that this wealthy cardiologist was holed up in a motel. “Dr. Barnett, we sympathize with your situation. Since you were unaware of the restraining order, we’re gonna give you a break this time. But you’ve gotta stay away from your wife’s house, understand?”
David resented the statement. “It’s not my wife’s house. I’m paying for it.”
“We know that, sir. Believe me, we'’ve seen many similar situations. Unfortunately, we've also seen things like this get out of hand. People get hurt. We don’t want that and I’m sure you don’t either.”
“No, I don’t. I love my family. I’m both heart broken and pissed off .”
“Doctor, you’re obviously an intelligent man and I wouldn’t think I’d have to tell you how to deal with this. However, in my experience, it’s always best to stay away and let emotions cool down.”
“Yeah, I know that. I also know it’s easier said than done.”
The policeman's demeanor became more serious. “Listen, I have to warn you. We’ve seen you driving through the neighborhood many times. The next time you’ll go to jail. Do you understand that?”
David hesitated. The two men had been professional and polite. Despite that, he was feeling abused. He answered with a terse, “Yes, sir.”
“Doctor, you can go now. Good luck. We really wish the best for you."
The second policeman, who had been silent, spoke. “Be careful, Barnett.” He stepped out of the cruiser and opened the rear door. David slid out and said thank you. The officer smirked and said. We'll be watchin' you, pal." David resented the younger policemans cavalier attitude. He didn't respond. The policeman added, "You're drunk. I wouldn't let you touch me if you were my doctor." Barnett was shocked. The commanding officer yelled, "Leave him alone, White! Get the hell in the car."
The police waited in the drive until David drove away.
Fifteen minutes later he arrived at his motel. It was well after midnight and he was exhausted. He had a seven a.m. cardiac catheterization scheduled at Toledo Hospital. David hoped for at least four to five hours sleep.
By cardiodoug
The Elevator
David slept poorly on the evening of his encounter with the police. His sleep was fitful, interrupted by numerous dreams, mostly nightmares. He arrived at the Toledo Hospital cath lab a few minutes after seven. The procedure went without complication, revealing three vessel coronary disease. Dr. Barnett spent a half-hour discussing the findings, and drawing explanatory pictures for the family, before calling his friend, Drew Montgomery, a cardiovascular surgeon. They reviewed the case and scheduled the patient for a three-vessel bypass for the following day.
David spent the remainder of the morning making rounds on hospital inpatients, finishing a little after twelve noon. He went to the hospital cafeteria to grab a quick lunch before heading across town to his office. While eating, he wondered about his afternoon schedule. He would likely have twenty-five to thirty patients to see, and would not finish until six or seven. He still had to make rounds at Christ Hospital later that evening. It’s gonna be a long day. Probably won’t get home ‘til ten or later. Home, he thought, some home, a lousy motel.
After lunch, rather than taking the stairs, he headed for an elevator to descend to the first floor. His legs were leaden from emotion and a chance to relax in elevator was inviting. He was exhausted and the day wasn't event half over.
He entered the elevator, barely noticing its occupants. A child’s giggle caught his attention. A family of five was heading down with him: husband and wife and three young girls. One of the two youngest, vying for the right to push the “close door” button, mistakenly hit the “open" button. The partially closed elevator doors jerked to a stop and opened wide.
“Maddie, honey, you pushed the wrong one.” Said her mother. She sheepishly glanced toward David.
“I’m sorry about that, doctor.”
“It’s okay. I’m in no hurry.”
Barnett looked across the elevator to her husband, who had scooped up his little girl, holding her firmly cradled in his arms. He turned back toward the woman. “I have three children. My youngest is, Maddie. Is yours a Madeline?”
“No, her name is Madison.”
"That’s different--don't think I've heard that before."
"We hadn't either. We were sure it would be a unique name, but soon after she was born, as always seems to be the case, 'Madisons were coming outta the woodwork--now they're everywhere.
"Yeah, that's how it seems to go, doesn't it. Same thing happened when we named Madeline." David turned back to the husband and daughter. "She's pretty and she looks quite smart."
Madison stared at him. Her father smiled to acknowledge the compliment as his daughter turned to hide her face in his chest. She quietly giggled.
The elevator started its descent. Nothing more was said.
Barnett moved to the back of the elevator and watched the young family; noting that the mother--attractive with dark hair pulled back in a clip--was slender with a delicate figure. Her husband had a rugged look, sandy hair, mustache and a muscular build. Both parents were in blue jeans. The father wore a pull-over shirt with the sleeves pushed up over his forearms. His wife's sleeveless white cotton top nicely outlined her breasts and narrow waist. David admired her neat, clean look, complimented by white canvas deck shoes. Sue often wears those, he thought.
David loved the way Susan looked in casual clothes, especially when wearing sleeveless tops. The woman in the elevator had small shoulders and slender arms, similar to Sue’s. David felt a fullness in his chest and a lump in his throat as he reminisced about his wife.
The doctor looked down at the older sisters, huddled in the corner by their mother. He guessed they were around five and eight years old. Both were dressed in jeans, T-shirts and pastel colored sneakers. The youngest child, still in her father’s arms, appeared to be two or three-years-old. She was wearing a light-blue sundress and white anklets and sandals. She snuck a peak at David from the corner of one eye.
The elevator doors opened. The family walked out and turned left, toward the hospital lobby. Madison, looking over her dad’s shoulder, waved goodbye to David. He waved back, smiled, and turned to the right, headed toward the physician’s lounge.
As he walked down the hall he thought of his family, imagining Susan, her petite size and her gorgeous figure. He could smell the scent of her skin. The weight in his chest increased. David sighed deeply, his throat tightening as his eyes welled up with tears.
He increased his pace--anxious to reach the refuge of the doctor’s lounge--hoping he wouldn’t encounter a colleague on the way--hoping the lounge would be empty. David wanted to hide in the restroom stall where he could open up in private and release his pain.
Navigating the hallway without incident, he entered the doctor’s lounge and quickly retreated to the restroom, which was thankfully vacant. In the stall he locked the door and sat, fully clothed, on the toilet seat. Holding his sagging head in his hands, he cried as quietly as he could. As he wept, staring down at the floor, his tears dropped in streams, splashing on the ceramic tile below. After a few minutes, he composed himself. I have to get to the office.
Exiting the hospital, he headed for the physicians' parking lot, the only evidence of his despair being the large puddle of tears left on the restroom floor.
By cardiodoug
“Yes, Lisa. What is it?”
“Mr. Conti, Mrs. Conti’s on line three.”
“Okay, thanks.”
“Hi, honey. What’s up?”
“Carlo, you called and left a message this morning, remember?”
“Oh yeah, guess I did. I want to talk about Michael.” Marie remained silent. “I have a new opportunity for him. I wanna tell you about it.”
“What sort of opportunity?”
“You remember when I told you about Chrysler’s intent to buyout American Motors?”
“Yes.”
“Well, I talked to Jim Turner a few days ago. You met Jim at a dinner party awhile back.”
“Yes, I remember.”
Carlo already sensed a terse tone in his wife's voice. “He and I talked about the company’s plans to reorganize the Jeep plant in Toledo. They need an assistant plant manager. I’ve recommended Michael for the job. Jim knows of Mike's abilities as our manager here. He seems enthusiastic.”
Marie nearly shouted, “Toledo, that’s too far away, Carlo!”
Carlo, though expecting resistance on the issue, still cringed at hearing the exasperation in his wife’s voice. “Marie, Toledo’s only seventy miles from Detroit, and the Jeep plant’s very close to the Michigan line. We could drive down I-75 anytime we wanted and be there in a little over an hour. It’s really not far.”
“You know how I feel about this. I have one child and one daughter-in-law, and I love them both dearly. I’m still hoping for grandchildren and I don’t want to be a hundred miles away when one arrives.”
“Marie, you’re exaggerating. It’s not a hundred miles. Besides, I’ve told you of my concerns over Michael’s future. You haven’t forgotten, have you?”
“What concerns?”
Irritated, he took a breath, ignoring her charade. “Marie, I’m talking about my business—the carburetor business and the future of carburetor manufacturing! I’ve already told you--fuel injection is the wave of the future. Conti Carburetor could be shutting down in a year or two. Michael knows that. Toledo's a great opportunity for him, a lot of security, and now's the time to take advantage of it.”
The phone went silent. Marie finally responded in a smug tone. “I’m aware of that. Of course, I remember talking about it. But the future of your company doesn’t change my feelings about having my family nearby.”
“I understand. I know you don’t like the idea, but they all think Michael would be perfect for the job down there and . . . . ”
Marie cut him off. “And what?”
“What do mean—and what?”
“What about his job here?”
Vexed to distraction by his wife’s irrational persistence, he lost control, shouting into the phone. “Are you deaf, Marie? I’ll tell you what! Michael’s gonna take this job. I’m through discussing it!”
Carlo heard a "click" followed by a dial tone. "Goddamit! He shouted as he slammed the receiver down. “Son of a bitch. That woman drives me crazy!”
He sat back in his chair, fuming. A moment later his intercom buzzed. He barked, “What is it, Lisa?”
“I’m sorry, sir. It’s Mrs. Conti again. She’s on line two.”
Carlo took a deep breath, as deep as he could, and let it out slowly. He picked up the phone. “Yes, Marie.”... silence... “I apologize for raising my voice.”
"It's alright. I'm getting used to it."
Carlo pushed on. "You want to discuss this now or later?”
“Now’s alright.”
“Well, as I was saying, Michael may not have employment here in a couple of years. It worries me. As I’ve told you, at least a few times, fuel injection is the future. Carburetors are out. This company could go down in a heart beat and I don’t want Michael to go down with it.”
Marie responded with rapid fire questions. “But, Carlo. Toledo? It sounds terrible. What do they have down there, anyway, besides the Jeep plant? Do they have any nice restaurants? Any good neighborhoods? I don't want Laura raising a baby in some ghetto! And schools--my God--are there any private schools? And besides, I hardly see Michael and Laura as it is, and there practically living nextdoor. I’ll never see them if they’re in Ohio. This is just awful!"
As he listened, Carlo rolled his eyes and mocked Marie's facial expressions, which he could practically see through the telephone. He brought the receiver back to his ear, having held it inches away during his wife's tirade.
“Yes, Marie, you will see them. We can easily visit them on weekends and I'll make sure Michael understands the importance of coming home--often." Carlo, still annoyed, couldn't resist adding a little sarcasm. "And, yes Marie, Toledo has running water, electricity, shelters called homes--even flush toilets. Okay?"
Marie didn't appreciate the humor. Her anger grew as she confronted her husband, something she raely did. “We have plenty of money, Carlo. Michael doesn’t even have to work. You could support him the rest of his life and you know it!”
“Marie, are you out of your mind? Even if we could afford it, I’d never subject him to that.”
“Subject him to what?”
“To living off us--like some helpless school boy. Everyone should work. I don’t want Michael to become some bum, mooching off his parents. Besides, work builds character, integrity and self-confidence—something Michael is sorely lacking.”
“And whose fault is that, Carlo?”
He was stunned, shocked by the accusation. “What the hell do you mean? You’re blaming me!”
“Yes, I’m blaming you.”
Carlo felt like reaching through the phone and grabbing his wife by the neck. He bit his tongue and waited.
Marie spoke. “That’s all I’m going to say.”
“Good! You’ve said too much already.”
“Carlo, it’s obvious you aren’t going to give an inch on this. I’m gonna leave it up to you and Michael.
"Thank you."
"What will you do if Michael refuses?”
“Marie, you know he’s not going to refuse.”
She knew he was right. “Yes, I know. I know how much control you have over our son, and how you intimidate the shit out of him. I suppose you’re proud of it--proud that your thirty-six-year-old son is afraid of you, unable to make any decisions on anything without your direction. It's his life, Carlo. Not yours! ”
Marie's husband was astounded by her defiance and her foul language, which was way out of character. He had to make a choice: either continue pushing, in which case she would hang up....or back off to let tempers cool. He chose the latter, a bit of discretion--distinctly unusual for Carlo, was called for. “Honey, I don’t want to discuss this right now. It’s gonna be okay, Marie, I promise. I’ll let Michael and Laura decide. I’ll offer it to them as an option. He and Laura can do whatever they want.”
“I’m not sure I believe you, Carlo. But it doesn’t matter. I don’t want to be involved. After you decide, you can tell Michael what he's going to do. And, you should be the one to tell Laura, as well. Don’t ask me about this again.”
“Marie, please try to understand the situation here.”
“I understand the situation quite well. As always, Carlo gets what Carlo wants.”
“Damn it, Marie. You’re being unreason . . . .”
He was cut off by a loud click. She hung up again.
Carlo, irritated, frustrated, simply pissed off, slouched back in his chair and mumured to himself. He glanced at a framed photograph on the corner of his desk. It was a picture of Cassandra, wearing a white party dress with a blue ribbon, on her fifth-birthday. Over the past years, Carlo had moved between numerous office locations. Throughout that time, there was one constant--Cassandra’s photograph was always there, on his desk, in plain view.
He leaned forward in his chair, hands going to his face to wipe his eyes and push his hair back. He tapped the intercom button. “Lisa.”
“Yes, sir.”
“Page Michael for me. Have him come up to my office.”
“Yes, sir, right away.”
Michael was on the main floor of the factory, where he'd spent most of the day discussing quality control issues with departmental foremen. A loud page from overhead speakers echoed through the plant. “Michael Conti, please report to the main office.”
Michael, who never kept his father waiting, abruptly ended his conversation with a foreman, and briskly walked to administration. On the way, he passed production lines with large stamping machines, steam washers for removal of industrial oil, and conveyor belts lined on either side by workers assembling carburetor parts as they moved down the line. Hooks on moving overhead tracks, circulated throughout the plant, transporting carburetor housings to their assembly destination.
Michael reached the stairway leading to his father’s office on the second floor. Out of breath from his walk, he paused before climbing the steps. As he ascended, a tightness developed in his chest and he became short of breath. The chest pain caught him off guard. He’d had shortness of breath recently, but never any chest discomfort. It must be a strained muscle, maybe indigestion.
He stopped at the top landing to recover, feeling a mild ache in his left arm. It quickly passed as he entered the office.
“Hi, Lisa. Did you page me?”
“Hi, Mr. Conti. Your father asked me to call you. He wants to see you.”
Michael walked through the heavily paneled doors of his father’s office.
The room, plush and opulent, had a coffered ceiling crisscrossed with mahogany beams. The ceiling’s periphery was enclosed by an elegantly papered soffit with recessed lights creating a golden glow on the walnut paneling below. The floor was covered with thick, hunter green carpeting, highlighted with yellow insets of fleurs-de-lis. Behind Carlo’s desk, were beautiful, floor length brocade curtains with a matching valence, framing two French windows with oak muntins.
The office overlooked downtown Detroit, the Renaissance Center on the shore of the Detroit River, and portions of downtown Windsor across the river. The view after dark was impressive, with the illuminated Renaissance Towers and the colorful lights on the Canadian shoreline shimmering off the surface of the water.
“Hey, Dad. What’s goin’ on?”
“Mike, how are things downstairs?”
“Fine. I was just reviewing some quality standards with Charlie Curtis. You know Charlie, he’s the foreman for Section Five.”
“Sure I do. Charlie’s been here for ages.”
“So anyway, Lisa said you wanted to talk to me.”
“Yes, we need to talk about some ideas I have, Michael. Take a seat.”
A pair of French Provincial chairs with satin upholstery were positioned in front of Carlo’s massive walnut desk. The desk was gorgeous, with multi-colored wood inlays and a satiny hand-rubbed finish. A beautiful brass lamp, crystal paper weight, some of Carlo’s business achievement awards, and the ever present photograph of Cassandra, were strategically placed on the desk. A large oak chest, filled with old books, sat on the floor at one end of the desk. Michael was about to take a seat in an upholstered chair when his father’s hand shot up. “Stop! You have grease on your pants. Don’t sit there.”
Michael jerked to a halt, looking embarrassed.
Carlo pointed to the oak chest. “Here, Mike. Pull this out a bit and use it as a seat.”
Michael positioned himself on the low, makeshift chair, feeling ridiculous, with his knees up to his waist and his head barely rising above the desktop. Carlo, sitting tall in his leather armchair, had to look down to speak to his son, like a teacher addressing a grade school child.
“Michael, I spoke with Jim Turner the other day. We talked about you and Chrysler’s plans in Toledo.”
“The Jeep plant?”
“That’s right. They have a great opportunity for you down there.”
Michael felt his heart sink. He didn’t want to leave Detroit. He and Laura loved their home in Birmingham--the neighborhood and the friends they had made. “Yeah, Dad, what about it? What’s the opportunity?”
“Mike, they’re offering you a job as assistant plant manager. It’s an outstanding position.”
A subtle, nearly imperceptible tremor made Michael's left eyelid twitch. He felt weak and nervous--a common sensation when in the presence of his father. He didn’t want to move to Toledo, but knew he couldn’t refuse. It was simply impossible for him to disagree with the old man.
“Mike, you know how concerned I am about our future here at the factory. You know business is down. The situation here is precarious. You need more security. This job in Toledo would be perfect for you.”
“Michael swallowed hard. “Whatever you say. You always know what’s best, Dad”.
“I wish you didn't sound so disappointed. Toledo’s a nice town, and it’s not far from here."
Michael felt paralyzed. He looked down at his feet. His foot tapped the floor. “Like I said, I’ll do whatever you think is best.”
“Good. I’m glad you agree, son. It’s the right move. I’ll call Jim Turner and let him know. Mike, you should be proud. This decision came right from the top—from Lee himself. He wants you there.”
“Really! That's something, insn't it?"
“It sure is, Mike."
"Dad, I’m sorry if I seem disappointed. I’m really not. I’ll be fine. I appreciate you lookin' out for me and Laura.
Michael stood-up from his oak perch and gazed around the room, up to the ceiling, down to the floor and out the window. He stared out at the skyline for a long moment and addressed his father without turning to face him. “So when is this gonna happen?”
“Soon, Mike. Why don’t you tell Laura tonight. Maybe the two of you can go down to Toledo this weekend to look it over--get an idea of where you want to live, check out the town. Does that sound alright, Mikey?”
“Sure, it sounds good. I’ll tell Laura when I see her tonight. Dad, I should get back downstairs. Is that okay?”
"Of course it is. We’ll talk again tomorrow."
Michael left the room, gently closing the door. Carlo sat back in his chair in a pensive state. He knew his son was disappointed, but remained convinced this would be best for him in the long run. Michael and Laura will eventually thank me for this. I’m sure of it.
He leaned forward, opened the top drawer of his desk and took out a small wooden box. Gently lifting its lid, he stared at the contents. His eyes shifted briefly to the photograph of Cassie on the desk, then returned to the precious items in the tiny box. He welled up with tears as he examined the green yo-yo and blue satin ribbon he had saved from nearly forty-five years ago. A small black and white photo of Cassie, at about age three, was pasted to the inside bottom of the box. He raised the ribbon to his nose, searching for any lingering scent of his baby girl. He spoke to himself in a whisper. “Cassie's gone. Michael is leaving. Marie and I will be alone again.”
Carlo Conti returned his daughter's yo-yo and ribbon to their hiding place, slid the box to the back of the drawer, fell back in his chair, and cried.
By cardiodoug
David Meets His Attorney
"David, I hope you've learned your lesson."
Barnett's mother was standing at the foot of the bed.
"Mom, what are you doing here?"
"What am I doing here? Why are you here, David?"
His eyes darted around the room. I'm in the hospital! An IV was running in his right arm. He had a crushing headache and felt nauseated.
David's father entered with a glaring look of disgust. "Well, Dr. Barnett, you've really screwed up this time, haven't you?"
David was dumbfounded. What are they talking about? "What do you mean, Dad? How'd I screw up?"
"I warned you about the booze, didn't I. I told you a thousand times, but you wouldn't listen. Hot-shot doctor, too smart for the rest of us, right? Now look at you, no wife, no family, no job. All you have is your alcohol. I hope you enjoy the rest of your decadent life, you scum!"
"David, how could you do this?" His mother asked as she looked toward the far side of the bed. "Look what you've done to poor Susan. She's terrified!"
He shot a glance to his right, shocked to find Sue standing inches away.
"Your parents are right. You've destroyed everything we had, David. You and your drinking. I hate you! The children hate you! And now you're dying!"
Dying? "What are you saying? I'm not dying, am I?"
His father, red faced with buldging neck veins, bellowed, "Damn right you're dying! The doctor says your liver's a wreck, ruined by alcohol. You're a dead man."
David was stunned. My liver?
His father screamed even louder. "You're a piece of shit, David. We all hate you. We all hate you."
His mother and Sue joined in. "We all hate you. We all hate you. We all . . . ."
Overwhelmed with shame, he rolled over, burying his face in his pillow. The pillow was hard, smelling of plastic. The bed was as hard as a board. He turned back to his family.
Susan and his parents were gone. Bright light bathed him with warmth. He was a young boy, lying on a hard, concrete driveway, watching clouds float by on a sunny day. He was happy, having escaped the shame of his adult life. A bell rang.
David awoke and opened his eyes, staring directly into brilliant fluorescent lights.
"Time for breakfast, gentleman. Rise and shine."
He shot upright. A police officer was standing at a gate, passing plastic trays of food through an opening in steel bars.
"Oh, my God. I'm in jail."
A cell mate, no more than a teenager, was sitting on the floor next to him. "Course, you in jail, Bro. What ya think, you was home in bed?" Two others laughed.
David's head was pounding from a hangover. Jail, I can't believe it. What happened? He felt like a piece of shit, just as he had dreamed. He was on the floor, sitting on a thin, plastic mattress--his bed for the night. Dressed in a suit, he stood out in a room full of derelicts. His shoes, tie, belt, wallet, and wrist watch were missing--confiscated by the night supervisors.
The cell, standing room only, was packed with men: whites, blacks and Hispanics, jammed into an overnight holding area, the bull pen. Most looked disheveled and hardcore--many still sleeping on mats scattered around the room. Nearly all appeared younger than Barnett. The bull pen smelled of sweat, body odor, booze, and bad breath. David sighed and breathed deeply to clear his head--trying to remember what he had done.
I phoned Dad in Detroit. But why? Why did I call my father? His memory slowly returned. Last night the police at Lucas County Jail told him he was allowed one call. They advised calling an attorney. He didn't have an attorney. He called his father. David raised his hands to bury his face. His finger tips were stained black. I was finger printed! He lay down on his mat, trying hard to recall the prior evening's events.
Ten-minutes later, he sat up. A clock outside the cell read six-thirty a.m. It was Saturday morning. Time passed slowly, excruciatingly slowly. After what seemed like hours, he checked the clock again. It was seven-fifteen. Impossible, it's got to be at least nine or later.
Every twenty-minutes or so, an officer would call the name of an inmate to be released. At ten-forty-five, a guard yelled out, "Barnett. I need David Barnett."
Thank God! He stood and walked to the gate.
"Barnett?"
"Yes, sir."
"Your attorney's here. Come on out."
He was escorted to an interview room with a small table and two chairs. A short, stout ,bearded man in a three-piece suit was seated at the table. "Doctor, I'm attorney Jacobs, Allen Jacobs. Your father called me last night."
They shook hands. David took a seat.
"Doctor, your father couldn't tell me much. I got most of the details from the police report. Sounds like you had a bad night. Why don't you tell me about it? I'll see if I can get you outta here this morning."
The comment caught David off guard. "Mr. Jacobs, are you saying I might not be released today?"
"No, no. Don't worry about that. The Sylvania judge, Larry Scott, and I are friends. I'll call him. You'll be ok."
David felt relieved. "That sounds good."
"Okay, tell me what went on."
"I'll do the best I can. I have to admit I had way too much to drink, but I think I remember most of it. You know I have a restraining order against me, right?"
"Yep, I know."
"My wife and I separated six weeks ago. It was her idea, not mine. I've been despondent ever since. Frankly, I'm heartbroken and scared. My whole world's changed."
"I've been there myself. Your whole world has changed. It's frightening, isn't it?"
"Very. Much worse than I would have imagined."
"How long have you and your wife been together?"
"We met at seventeen--been a couple ever since--almost twenty years."
"Twenty years. That is rough. I feel for ya. Any children?"
"Three--two girls and a boy."
"That adds a lot, doesn't it?"
"It's terrible. I haven't seen them for weeks."
"I interrupted your story. Please go on."
"As I said, I've been a mess. I can barely get through a day at work. My patients can tell I'm distracted. It makes them nervous. My office staff is freaked out. Worst of all, I've been drinking more. I've always been a drinker, more so than most. But now it worries me. I'm out of control."
"Doctor, are you drinking during the day, at work?"
"No. I've never done that. It's always in the evening, usually late. I'm alone. I can't sleep. I'm not doing well, Mr. Jacobs."
"Please call me Allen. And if it's alright with you, I'll call you David?"
"Sure, that's fine."
"David, we'll work together on the drinking problem. For now, let's stick to what happened last night."
"I've been going to the house. I drive by every night. Sometimes I stop and look in the windows. A week ago, the police warned me to stay away--said they know my car and they've seen me in the neighborhood. They told me I'd be arrested if I didn't stop. The restraining order, as you know."
"Yes, go on."
"I know I'll get in trouble, but I can't stop. I miss my wife and children so much. It's killing me. After a few drinks I don't care about the police. I go to the house anyway."
"Have they seen you since the warning?"
"I don't know. I'm pretty careful. Either they haven't seen me or they're being very generous."
"I doubt that, David. They've already given you one warning. Don't count on a second."
"I suppose not. Anyway, two nights ago there was a truck in the driveway, a black pickup, parked behind Sue's car. When I saw it my heart sank. I knew it had to belong to a guy--certainly not one of Sue's girlfriends. Some guy was in my house with my wife and children. I couldn't believe it. It really shook me up."
"I sympathize. I know how that feels--from my own experience."
"It made me sick inside. After seeing the truck my heartbreak turned to anger. You know, what the hell's she doing with some guy in our house with the children? For God's sake, Maddie's only six years old. It really pissed me off!"
Jacobs gave a nod of understanding.
"I parked my car about three blocks away and walked to the backyard, where the police couldn't see me. I went to the family room window. Allen, I couldn't believe it. The guy was wearing boxer shorts and a tank top. The son of a bitch was walkin' around in front of my children in his Goddamn underwear. He has a shaved head, an earring, and his arms are covered with tattoos. I watched him strut around the house like he owned the place. Allen, my wife has gone off the deep end. It was like I was watching a movie. It didn't seem real."
Jacobs frowned and shook his head.
"Then this tattooed son-of-a-bitch went to the kitchen. I was outside hiding in the shrubs like some moron. I scrambled over to the kitchen window. The guy opened the refrigerator, pulled out a gallon of milk, looked back, as if to make sure no one was watching, and took a big swig right out of the bottle--the bottle of milk my children drink! He capped it and slipped it back in the fridge. Allen, I was so fuckin' mad I wanted to crash the door in and strangle the asshole!"
"David, I really feel for you. You're in a bad spot and I understand your anger. Go on with your story, but try to settle down. Take a breath and relax."
"I'm sorry about my language."
"Hey, it's no problem. I'd wanna kill the son-of-a-bitch, too."
"I was about to kick the door in when I heard a car coming down the street. It was a police cruiser. I backed out of sight. The cops slowly drove past and kept going. Seeing them snapped me back to reality. I didn't want to go to jail. So I left."
"I'm confused. You left? How'd you get arrested?"
"Allen, I apologize for dragging this out. This happened two nights ago. I got arrested last night."
"Okay. Go on."
"As I was I leaving, I walked past the truck. Suddenly a dog, a Doberman, lunges at the truck window, barking. It scared the shit out of me. It was the icing on the cake, Allen. We have two little Westies and this guy's got a Doberman."
"Yeah, I know the breed. West Highland Whites--great dogs."
"The dogs are mine. I raised them, trained them, bathed and groomed them. Now they're with Sue and some jerk with a Doberman."
"So you left?"
"Yeah, I drove to my motel. I barely slept and had an exhausting day at work yesterday. Allen, what happened next was unbelievable."
By cardiodoug
“Yeah, Allen I drove to the motel. I couldn’t sleep all night and I'd had an exhausting day at work yesterday. Allen, what happened next was unbelievable.”
“Really? Tell me.”
“I was relaying this story to one of my partners, Chuck Herschel.”
Allen smiled. “I know Chuck. He’s a good guy.”
“He sure is. We’ve been friends for years.”
“So what’s Chuck got to do with this?”
“I was telling him about the guy in my house, the tattoos, the milk incident, so on. When I mentioned the pick-up truck and the Doberman he said, ‘Oh shit, David’.”
“Turns out Chuck knows the guy from the gym. As soon as I mentioned the dog he put it all together. He said his name is Gary Keller--earring, tattoos, pick-up, Doberman, has to be the same guy, who, according to Herschel, he practically lives in the weight room at the gym.”
“Bit of a coincidence, Chuck knowing the guy."
“I know. Here’s the worst part. Chuck says Keller’s a real hot head. Has a big chip on his shoulder. He’s known around Toledo as a trouble-maker. According to Chuck, Keller received a one year suspension from the gym--got kicked out for starting fist fights in basketball games. He apparently beat the shit out of someone a few years ago. Chuck’s heard he’s had his tires slashed more than once.”
“Sounds like a real charmer.”
“In addition, he’s practically unemployed—gets by doin’ part-time construction. Allen, what’s happened to my wife? How could she let a guy like that in our house. For that matter, why is she even involved with him?”
“David, I know it seems preposterous, but I’ve seen it many times. Crazy rebound relationships are pretty common. That’s why it’s important for you to get a grip on this. I’ll help any way I can. You can’t let this escalate into something worse."
“What could be worse?”
“Doctor, come on. You have any idea of the violence this could lead to? People get killed, David. You absolutely have to get control of your emotions. And drinking won’t help. It’s like throwing gasoline on a fire.”
“I know, Allen. I appreciate your offer to help with that.”
“David, I’m very sincere. I mean it. I’ll do all I can.” Jacob pulled a business card from his wallet, wrote his home phone number on the back and slid it across the table to Barnett. “Call me anytime, day or night. I’d rather talk with you on the phone than come down here to pull you outta jail.”
“Thanks. I’ll call if I need to. Allen, you referred to Sue as a woman on the rebound. Rebound from what?”
The attorney frowned, looking stunned by his client’s refusal to accept the obvious. “David, I’ve never met your wife and I don’t want to add to your grief. But, in my opinion, your marriage is over. Your wife’s behavior tells me so.”
Barnett looked down to the floor. His voice weakened. “I know that, but I hate thinking about it. It’s so hard to believe.”
“Has she mentioned divorce? Has she filed?”
David was sullen. “Apparently, she has talked with a lawyer. I don't know if she's filed, I don't think so--not that I know of.”
“All right, that’s good. But, from what you’ve told me, I think you should be prepared for the worst. Situations like this nearly always end in divorce.”
Barnett’s heart sank. His eyes fell again, staring at the table top. He responded in a low voice. “I know that, Allen. But right now it’s impossible to accept. We’ve been together so long. I keep hoping it’ll get better. I want to get back with my family, Susan and my kids. The day I left I promised my little girl that I’d be back soon.”
Both men were silent for a moment. Allen spoke. “I feel you’re pain, David. You’re going to get through this and you’re gonna be happy again. You have to believe that.”
David looked at Jacobs with a half-hearted smile--blinking twice to dry his teary eyes. “I hope you’re right. It‘s hard to imagine--you know, being alone. Sue with someone else. My kids having a some guy in my place.”
Jacobs glanced at his watch. “It’s ten forty-five. Sorry to rush you, but I have a luncheon appointment at noon. Let’s move on with last nights events, okay?”
David sat up straight, responding with a clear voice. “I guess doctors aren’t the only ones working long hours.”
Allen smiled. “Don’t kid yourself. I’m sure my hours aren’t nearly as long as a busy cardiologist’s. After lunch, I’ll be free for the rest of the weekend. Attorneys put in a lot of time, but we're not on call twenty-four hours a day the way you guys are.”
“Well, maybe not. But I’ve gotta tell you, I appreciate you comin’ here on a Saturday morning.”
“No problem at all. We’ll finish up and I’ll call Judge Scott to get you out of here. How's that sound?"
"Sound's good to me."
"Okay, telI me what happened."
"Well, I worked all day as usual, leaving Mercy Hospital at about nine-thirty in the evening. I drove by my house. All the lights were out. No cars in the driveway. My imagination ran wild, thinking Sue was out on a date with Keller, possibly with the children, too. I was consumed. I went to the Cottage Inn to have a few drinks.”
“The place on Salem Road?”
“That’s right.”
“I’ve been there before.”
“I started drinking--had no appetite--didn’t want to eat. I must’ve had five or six glasses of wine on an empty stomach. By eleven I was pretty blasted. It was the usual story. I start the day feeling sad and depressed--then in the evening, alcohol turns my grief to anger.”
Jacobs frowned. “I understand that.”
“I left the Inn and drove back to the house. The lights were on. Sue’s car and Keller’s truck were parked in the driveway. I could see the Doberman’s head sticking up over the seat. Allen, I was enraged. I gave no thought to the restraining order--drove up the drive--went to the door and started pounding. Seconds later the door opened wide."
“I was expecting Susan. It was him, wearing an exercise outfit. He glared at me and shouted, ‘What the hell are you doin’ here?’ I told him to get out of my house, away from my family. Incredibly, he yelled, ‘It’s not your house, asshole. I live here now.’ He slammed the door in my face. I started pounding again, harder this time. He opened the door and yelled to Susan. ‘He’s still here, honey. Call the police’.”
“This shit head was calling my wife honey. I wanted to kill him. I grabbed his arm and yanked him onto the porch. He stumbled down the steps and fell to the sidewalk. He looked scared. He’s a big, muscular guy, but I think my wrath, the look in my eyes, frightened him. As I leaned over him, he jumped to his feet and took a swing. I turned to dodge his punch and his fist hit me in the side of the head.”
David turned, pointing to his right ear. Jacobs took a look. “Yeah, there’s dried blood on your hair.”
Barnett shrugged. “The blow knocked me off balance. I swung a backhanded fist and caught him in the nose. He went down hard, bleeding from his nose and mouth.”
Jacobs shook his head and groaned. “I hope he doesn’t file assault charges. What happened next?”
“Allen, I was shocked, this big guy looked startled, actually scared. I pounced on him, my knee in his chest. It knocked the wind outta him. I was ready to smash his face with my fist when I was grabbed from behind. Before I knew what was happening I was in hand cuffs. Now I’m here.”
“Did they arrest Keller?”
“I don’t think so. Not while I was there. I do remember them talking about him. The guy was crazy! Right after they cuffed me, Keller started berating the police. Said they weren’t doing their job, they weren’t protecting Susan and him. That idiot acts like it’s his family and his house. The cops told him to shut up or go to jail. The last I remember he went in the house and slammed the door.”
“Did your wife come out?”
“No. I didn’t see her or my kids.”
Jacobs looked relieved. “That’s good. Then they brought you down here?”
“Yeah, I barely remember the ride. I thought they’d take me to the Township Station. It’s only two blocks from my house.”
Jacobs smiled, “No jail cell there, David. No accommodations for hardened criminals like you.” They both laughed.
“Right, I’m a real tough guy, Allen." Responded David, sarcastically. "Although, I have been in more than a few fists fights, but that was years ago, in Detroit.
Jacobs smiled. "Guess there's a time for everything. Did the officers say much?”
“It was the same pair of cops who gave me the warning last week.”
“I know. I saw their names on the police report--Bill Hollister and Jimmie White. I know both of ‘em.”
“They weren’t quite as sympathetic as the first time.”
“I’m not surprised.”
“The guy driving, the big guy, heavy mustache, does all the talking.”
Allen responded, “That’s Hollister. He’s a good officer.”
“I know. He was polite. I’m suspect it’s partly due to my being a doctor. He was very professional--seemed to feel sorry for me--especially after meeting Keller.”
Jacob's responded, “Jimmie White’s a little different, isn’t he?”
“Yeah, he seemed pissed off. Said I was a drunk and he’d never let me touch him as a patient.”
“That sounds like White. He’s a bit of a Barney Fife.”
David continued. “So they brought me downtown and threw me in the bull pen.”
“Okay, Dave, that’s all the info I need for now. I’ll go call the judge. Sorry, but you’re gonna have to go back in the cell until I return.”
“That’s fine. I hope you can get me outta here today.”
“I’ll do my best, I promise.”
An officer escorted Barnett to the bull pen as Jacobs went upfront to make the call. David waited, standing at the steel bars of the gate, waiting for his attorney, hoping for good news. Five minutes, ten minutes, fifteen minutes went by. He started to worry. Why is this taking so long? After twenty minutes, Jacobs returned. He didn’t look encouraged. David’s pulse picked up. He and Jacobs returned to the conference room.
“David, I’ve got bad news.”
“I was afraid of that. Your face told me.”
“I’m really sorry. Judge Scott wasn’t very sympathetic. It’s the OJ Case. It’s been two years but the country’s still up in arms over domestic violence. It’s got the legal system paranoid about being lenient in stuff like this. Scott’s not gonna let you out.”
“Not let me out?”
“You’ll have to stay here ‘til Monday morning.”
David was relieved. Only two days. I can handle that. “OJ! What’s that got to do with it? I didn’t touch my wife. It’s Keller. He’s the problem.”
“I know. It doesn’t matter. It’s still considered domestic violence. David, you should be glad it’s only a domestic charge and not assault on Keller. Things could be much worse.”
“Yes. I know. So what happens Monday?”
“Monday morning they’ll transport you to Sylvania Court to appear before Judge Scott.”
“Will you be there, Allen?”
“Absolutely, don’t worry. We’ll get you through this. You’re gonna be okay. Listen, I’m sorry, but I’ve got fifteen minutes to get to my next appointment. I’ve gotta go.”
“Sure, you’ve been great, Allen. I’ll see you Monday.”
Jacobs turned as he stepped to the door. “Hang in there buddy, you’ll survive. I’ve been told the food’s the worst part. I’ll see you Monday.“
A guard took Doctor Barnett back to the bull pen.
David was impressed with his attorney. In the past, he'd bad mouthed lawyers for being so aggressive with medical malpractice. He recalled jokes about them being bottom feeders. I’ll never think that again. When you’re in trouble, an attorney’s worth his weight in gold. Jacobs is sympathetic and polite--very pleasant. I’m glad to have him on my side.
By cardiodoug
WEEKEND IN JAIL
Barnett spent Saturday afternoon in the bull pen, sitting on the floor, mentally reviewing his life. He looked at the clock, it was three-thirty. Moments later a guard called out, "Barnett, David Barnett, front and center. He was escorted to a sixth floor cell block, where a second guard unlocked the bolted door to his new quarters. Inside, David found a sizeable common area, with two, long formica tables and plastic chairs. Six steel doors lined the far side of the room, and an ancient portable television with rabbit ear antennae sat on an old desk near the front windows, which were crisscrossed with steel bars.
The common room had a blue ceramic floor, with concrete walls and ceiling--painted in glossy battleship grey. David's cell mates were sitting at a table, playing cards. The acoustics were horrible. The television was blaring an MTV rap song. The loud music and boisterous jive from the card game bounced around the room. “You’re goin’ in number six, over here.”
Barnett didn't hear the guard.
He spoke again, louder. “Barnett, over here!”
David, having been told he would be in low security, was surprised to find he was in a private cell with a heavy steel door and sliding bar lock.
His cell was small, about eight by five feet. Everything was concrete and stainless steel: a steel bed with a thin, green plastic mat, a steel commode, a steel sink and a framed sheet of shiny stainless to function as a mirror. Barnett noticed a half-used roll of toilet paper lying on the floor next to the toilet. A tiny, heavily-barred, grimy window caught his eye. He turned to the guard and pointed to the window. "Guess I won't be bustin' outta this joint, will I?"
The guard chuckled. "Go ahead and try. You wouldn't be the first." He tossed a jumpsuit and pair of plastic slippers on the bed. “Take everything off but your skivvies and put these on. I‘ll be back.”
A short time later he returned. David was wearing his new outfit: a brilliant orange jumpsuit, zipped from crotch to neckline, and purple slippers which were too large, making his feet look ridiculously big.
The guard grabbed David’s clothes from the bed. “I’ll lock this stuff up with your personals. The cell door stays open all day. We lock it at eleven--evening curfew.”
As the guard turned to leave, Barnett spoke. “Is this considered low security?”
“No. Low security is packed full. This is level one security. Believe me, it could be a lot worse. You’ll live through it.” He left.
Dinner was served at five sharp. Each man received a heavy, plastic tray with molded compartments for each entre, the same trays used in the Bull Pen. David's dinner consisted of a hot dog with no bun, watery scalloped potatoes, a small serving of peas, stale chocolate cake and a carton of warm milk, all placed directly on the tray, which had an odd, chemical odor. There was a plastic fork and spoon, no knife, no dishes.
Jacobs was right, thought David.The food may be the worst part. It’s barely edible. Everything has a strange taste. Probably from being heated in the these old trays soaked with disinfectant. It reminded him of his Veteran's Hospital rotation during medical school. Food at the VA was critically bad. This is worse.
To his amazement, his cell mates seemed to love the cuisine. They scarfed it down. A young black guy across the table, watched Barnett pick at his dinner, take a few small bites and stop.
“Hey man, ain’t you gonna eat that?”
“No, not hungry.”
“I’ll take it if you don’t want it.”
The guy next to him grabbed the edge of Barnett's tray. “You gotta split it with me. I’m starvin.”
David slid his tray across the table and the pair dug in.
After dinner, a card game resumed. The earsplitting noise from the television, along with banter and laughter from the card game reverberated around the room. Barnett was beside himself, disgusted with all the racket. He walked to the television and turned it down.
Frankie, a young, scrawny guy, the only other white in the room, yelled out. "Hey man, what you doin’?”
David didn’t respond. Louis, a huge black guy, six feet plus, gleaming coal-black face, brilliant white teeth, biceps buldging through his suit, came to Barnett's defense. “Leave the old man alone. We’re playin’ cards here. Don’t need no fuckin’ television.”
Barnett smiled to acknowledge the man’s support, and returned to his cell.
At eleven p.m., David's cell door slammed shut with a bang. The guard, who had pushed it shut, peaked through a small opening in the door to insure David was inside. A loud “clank” rang out as he slid a heavy steel bar across the door. Moments later, the lights went out. David, exhausted from having had little sleep for nights, tossed around on his steel bunk with its cardboard like mat, trying desperately to find a comfortable position, using one arm as a pillow.
A screeching buzzer sounded. Barnett, shot upright in bed. The noise came from a box on the ceiling. A moment later someone yelled, “Breakfast.”
The cell door swung open wide. No one was there. David slowly rose from his bed. Wow, I can't believe it, I slept like a log. The clock in the common area read six-ten a.m. David’s cell mates were already lined up to receive their trays. Breakfast was no better than dinner, possibly worse. It’s gonna be a long day. He ate a little and returned to his cell.
Lying on his mat, he considered the potential consequences of his arrest. It's Sunday, I’ll have Peggy pick me up tomorrow when I leave court. I’m scheduled for hospital rounds in the morning. If I’m back early enough, my partners won’t notice a thing. With a little luck, I can pull this off, keeping it from my partners and everyone else.
Lunch arrived at noon. Barnett gave his entire tray to the card players. By mid-afternoon, incredibly bored and lonely, he decided to join the others at a table. They looked surprised when he sat down. In all, there were six men: David, Louis, Frankie, James, Markus and Chico.
The Hispanic, Chico, was sitting at the far end of the table. He had a shaved head, deep black goatee and an earring. His jumpsuit was wide open, showing tufts of curly black hair and a blood red tatoo of MEXICO across his chest. Chico was short, stocky and muscular.
David sensed the Mexican's domination over the two younger men sitting by him: James, a teenage black, and the white boy, Frankie. Markus, a middle age black, seemed to ignore everyone. Louis, the huge black man, was not the least intimated by Chico; he was not to be intimidated by anyone.
Chico spoke at Barnett with an antagonistic growl. “What you doin’ in here man? I seen you come in here wearin’ a suit, lookin' important. You look like a business guy, an attorney or doctor. You think you special?”
David, totallly caught off guard, became nervous--even a bit frightened. "No, I'm not special, but I am a doctor.”
The young black, James, started laughing. “Shit, you a doctor? What the fuck a doctor doin’ in here. What you do?”
Before David could respond, Frankie, interjected, “Fuckin’ doctor, no shit? I can’t believe I’m in the place with an M fuckin' D. What the fuck?”
David finally spoke. “It’s a long story. My wife. . . .”
Chico, interrupted. “I knew it. It’s always the bitch! Fuckin’ bitches. They can really fuck you up. You know that?”
Barnett, only mildly surprised by the language, responded. “I never knew that before, but I think I’m learning.”
“Damn right you learnin’. You learnin’ the hard way, mister doctor."
Louis, the big man who defended David with the television incident, joined in. “That be right, Doc. I got slammed by my old lady. She called the man, and the man sent me here.”
James added, “See what we be sayin’, Doc. Always the bitch. Fuck ‘em all.” Then he asked, “Hey, Doc. How old you?”
Barnett smiled. “I’m thirty-eight.”
“Thirty-eight! You an old man to be in the dog pound. First time?”
"First time--hopefully the last.”
“Don’t count on it, Doc. This my third visit to the Toledo Hilton. We all be in here before.”
Louis added, “He’s right. You best be careful. Those bitches like to send you back.”
Markus, appearing to be the oldest, perhaps early thirties, was tall and thin with light skin tone, a clean shaven face and short cropped hair. "You home boys don’t know shit. Don’t you be tryin’ to tell the doc his business. Ya’ know what I’m sayin’? Leave the man alone!”
David nodded with graditude. Chico gave Markus an angry stare. Barnett noticed a copy of a Grisham novel on the Markus' lap. He must have gotten it from the jail library, thought David. Seems to be the most intelligent of the group. Markus stood and moved to the other table to read.
David continued. “I understand how you all feel, but my wife’s not that bad. She’s been good to me most of the time. We’ve been married close to twenty years.”
The entire group groaned in unison. James shouted. “Twenty years! You a crazy man. You a sucker. Dem women is all alike. You betta’ believe it.”
David paused and changed the subject. “Listen, I hope you all get out of here soon. Hope you all make this your last stay at the Hilton.”
Louis yawned. "Don't count it. Most of us be back. Just the way it is, ya know?" He pushed his chair back. "I gotta catch some sleep." Louis retired to his cell, leaving Chico, James, Frankie and Barnett at the table.
Barnett felt a hard stare from the Mexican. This guy's got a gigantic chip on his shoulder.
After sitting through five minutes of inane conversation, David had an urge to leave. "I think I'll try to get some sleep, too." He stood and walked toward his cell.
James shouted, “Shit, Doc. What you sayin'? You can't get no sleep on that torture rack?”
Barnett answered without turning. “Torture rack. That’s a good description. I’ll see ya later.”
Frankie yelled out, “You be cool, Doc. Be cool.”
As David reached his cell door he heard a terse call from the table. Chico yelled, "Hey, white boy. You too good for the rest of us. That why you leavin? Cause you a doctor?"
Barnett froze, slowly turned, walked back to the table and sat down. "Excuse me!"
"You heard me, man. You think you better than us, don't you?" Chico shot Barnett with a piercing, dark eyed stare.
David looked away as a surge of adrenalin seized his body. Having been in more than a few fist fights on the streets of Detroit, he had long ago found that backing down always left him feeling worthless. Over the years of his youth he learned that he must either show strength in these situations or suffer through painful embarrassment. Threats from big mouth hoods in high school had taught him to defend himself. Backing down was not an option. If you walked away you were left with sickening humilation and shame. Standing you're ground was the only way out.
"You gonna answer me, gringo?"
With muscles tensed, mind racing, adrenalin doing its thing, Barnett returned Chico's stare, remained silent and clenched his jaw, making his facial muscles bulge.
"What you starin' at, boy? You pussy doctor."
Barnett had a dangerously low tolerance for bullies--bullies being one who embarrassed or humiliated him or anyone, even a complete stranger, in public. He knew, when his emotions peaked past threshold, there was no turning back. At that point it became impossible for him to stop. He went on auto pilot.
David's rage was rising. That asshole better not say another word. His thoughts went back to nineteen-seventy-two, when he was in the sixth grade----------Hey Barnett, you egg head. You gonna blush for us now. Hey everybody, David's turnin red---look at him--he's a little sissy. Turn on the juice, turn on the juice--let's all sing before teacher get's back---turn on the juice, make like a hot cake, turn on the juice--look at his face--he looks like a tomato--turn on the juice, turn on the juice, turn on the ju. . . .
Chico laughed. "You gonna say something? You a coward, gringo?"
The dam broke. James and Frankie lurched back as David flew from his seat to the table top. Before Chico could react, Barnett's heel slammed into his tatooed chest, delivering a crushing blow. The Mexican flipped backward, chair and all. David leaped from the table--his knees pinning the bully's arms. Chico was gasping for air as David's right hand went for his windpipe. He knew exactly where to squeeze, the cricothyroid cartilage---his Adam's Apple.
The pressure on Chico's windpipe produced paralyzing pain. He was immobile, totally incapacitated.
Barnett felt a heavy hand on his shoulder, a second later he was yanked to his feet. Louis' shiney black face was staring down at him. Chico remained on the floor, sucking air and gurgling as he rubbed his throat.
"What the hell you doin', Doc. You gonna get yerself in a lotta trouble."
Chico struggled to his feet. "I'm gettin' the fuckin' guard right now. You're white ass is history, doctor."
Louis stepped forward and grabbed Chico's shoulder with a massive hand. "You ain't tellin no one 'bout this. You deserved what you got. I heard what you was sayin'. Heard from my cell. You tell anyone 'bout this and I'll kick your spic ass into next week! You got that?"
Chico grabbed his chair and drug it over to the television. He watched TV, not saying another word.
Louis and David walked away from the table. Frankie and James were whispering to eachother.
"You see that, Frankie? The doc is a bad ass."
"You got that right. That man freaked me out! I never seen nothin like it. One bad ass fucker, he is."
Louis was consoling Barnett. "Don't worry 'bout this. That Mexican is all talk. I be watchin' him. He aint tellin' no one nothin."
"Thanks. I'm glad you came to my rescue."
"You're rescue? I'd be thinkin' I came to that asshole Chico's rescue. Where'd ya learn to fight like that?"
"I've been around, Louis. Had some rough times when I was a kid."
"You must have. I shore wouldn't wanna tangle with ya."
Barnett smiled. "Yeah, right. I'd never be so dumb as to mess with a guy like you. I know my limits."
Louis chuckled. "You be cool now, Doc. Best you stay away from the Chico. Might wanna stay in your cell for rest of the day."
"Sounds like a good idea. Thanks, Louis."
Barnett awoke to the same screeching buzzer at six a.m., Monday morning. After breakfast, he, James, and Chico were taken to a holding area on the first floor. They were to be transferred to the Municipal Court of Sylvania. The remaining men would be arraigned in Toledo or Lucas County courts.
A guard placed David and his cell mates in a small, steel-barred holding room crammed with more men in orange jump suits. All had to stand straight, packed into the elevator sized chamber. Chico found a place in the corner of the cell. He was staring at Barnett. David ignored him. James peered around at faces and noticed an old friend.
“Lavon, you back again?”
“Hey, what ya’ doin’, James. What you in for this time?”
James grinned. "Shit, I didn't do nothin but tap my old lady with a baseball bat."
Lavon laughed. "Yeah, it bet ya just tapped her! You a crazy dude--you know that?"
"Oh Yeah--what you do this time, Lavon? Y'all crazier than I am."
"I got what they be callin' assault with a deadly weapon. My attorney says...."
James, not the least surprised by his friends serious charge, interrupted, "Lavon, where you be stayin?”
“I got a crib on the south side, off Broadway. I be stayin’ with Yolanda. You ‘member Yolanda?”
“Hell yes.You still wit her? What’s wrong with you, nigger? She be a crazy bitch.”
“You got that right. No more her for me, man. The girl is history. Know what I’m sayin’? She the reason I be here right now.”
“How that be?"
"Me and Yolanda be driven down I-75 toward Dayton.
"Dayton? What you be doin' down there?"
"Goin' to see some my homey's, my boys with the connections. So, I see this nice ride by side of the road. It down there by that moon man city. Ya know the man--the city be wopawopa somethin'.?"
James laughed. "Lavon you are one dumb nigger, you know that. The man's name be Neil Armstrong and that city be Wapakoneta."
The insult slid right over Lavon's head. Yolanda tell me she likes that ride and she tell me to stop. So, I stop to help this white boy change his tire. Know what I'm sayin'?"
"Yea, I know what you be sayin' you fool. So what happen?"
"The police tell me the man with the car in some hospital in Dayton. He be in bad shape.
"If he be in Dayton, why you up here?" asked James
"They transfer me. Say Toledo got some standin' warrant for my black ass."
“What you do down there, Lavon? You crazy man."
By cardiodoug
Lavon went on, telling James what he had done. “So, James, that white boy be drivin' a new Lincoln, and like I said, Yolanda want that ride real bad. So, I stop to help--so maybe I take that fine automobile. That boy start givin’ me shit so I whack him in the face with the tire iron. Had to change that fuckin’ tire mysef. Had Yolanda drive my car and I takes off in my new wheels.”
“A Lincoln? That be a sweet ride. Know what I’m sayin’?”
“Real nice ride.”
Barnett, although disgusted by the James' apathetic detachment from Lavon's vicious crime, remained intrigued. He intently listened, oblivious to the hard stare coming from Chico, still standing in the corner of the cell.
"Lavon, what happen to Yolanda?"
"Shit, I don't know. That bitch took my car and I ain't seen her since. She probably be down in Dayton with my homies."
James spoke. "So the man got you in the squeeze, Lavon. That charge you got be some serious shit."
“Very serious shit. I be charged with assault with a deadly weapon and and grand theft auto. I be prayin’ to the Lord that white boy be livin’ or I be in real deep—maybe manslaughter.”
“Manslaughter my ass! You be lookin’ at homicide, James. You best be prayin’ he be okay, nigger!”
David was shocked by their frank conversation, which the other prisoners seemed to ignore. They’ve likely heard it all before--that or worse.
“James, I think I be okay. I spect that boy gonna be fine. Shit, I didn’t whack him hard.”
“Either way, Lavon, you lookin’ at five minimum.”
"Come on, James. You know me. Shit, I do a nickel standin’ on my head.”
“Yeah, I did three when I was fifteen. Low security. It weren’t bad. Played hoops everyday; got work in the laundry. Food weren’t bad neither. But Lavon, doin’ five in the real joint, high security, ain’t gonna be no good, man.”
“I ain’t worried.”
"Why you not in the place in Dayton? Why you up here?"
"The man transfer me here. He say I got an outstandin' warrant in Toledo. I know nothin' 'bout that. But they send me back here."
Barnett couldn’t believe what he was hearing. Lavon is expecting five years in prison and talking like it would be a picnic. Unbelievable.
The gate opened. Two guards, holding long lengths of steel chain, stood in the hall. “Come on out, gentlemen. Line up against the wall. You know the routine.”
Everyone put their back to the wall as the guards bound them. Each man received a chain around his waist, shackles on both wrists, and a short chain linking their ankles. Their wrists were pinned at their sides, locked to their manacled waist. A third guard separated the inmates into groups of six. A long chain was snaked through a steel ring at the front of each man’s waist, making two lines, six men each, joined in sequence.
David was astounded. I don’t get it. We’re bound together like a bunch of murdering psychopaths. This is ridiculous.
The prisoners were directed to a pair of vans parked outside. David had to take quick short steps to keep from tripping over the guy in front of him, while pulling on the one behind. The group looked like two orange caterpillars crawling out of jail.
Arranging six prisoners, chained together, in the back of a minivan was no easy task. Thankfully the ride to Sylvania Court was quick and quiet. Exiting the van was a another challenge. The leg restraints were too short to allow stepping to the pavement. Each man had to jump to the ground without dragging the one behind with him. The last in line lost his balance, falling into the arms of a guard.
The naer-do-wells shuffled across the parking lot and entered the court house. A guard led them into the court room. For convenience, they were seated in the empty jury box. David saw ten to fifteen people scattered around the court’s seating area. Thankfully, he recognized no one. Sylvania court was in his home community. Being seen by a friend or patient would have been disastrous.
He looked to the back of the room, hoping to see Jacobs. Allen was there. He gave a quick wave. David tried to wave back, forgetting his wrists were bound. He smiled.
The bailiff approached, removed the shackles and chain, and returned to his position next to the judge’s desk. Judge Scott appeared. It was a quarter past eight.
“All rise. The Municipal Court of Sylvania is now in session. His honor, Judge Patrick Scott, presiding.”
Jacobs had arranged for David to be called first. The bailiff escorted the doctor to a table in front of the judge’s bench. Jacobs walked forward and took a seat next to Barnett. He placed his hand on David’s shoulder and quietly spoke.
“Everything looks good, Dave. Don’t worry.”
The judge announced the charge. “David Barnett, domestic violence.”
The attorney asked to approach the bench. He and the Judge Scott spoke briefly in private. He returned to the defendant’s table just as the judge addressed Barnett. David stood up.
“Dr. Barnett, I hope your weekend stay has given you time for reflection and cause for restraint.”
A shout came from across the room. “Nail his sorry ass, Judge!” Chico was standing in the jury box.
The judge slammed his gavel down. “Bailiff, have the guards remove that man from this court room!”
Jacobs leaned to David's ear. "Make a new friend in jail, David?"
Barnett smiled and whispered. "I'll tell you about it later. "
Scott looked back to the defendant. “As I was saying, Doctor, I trust you’ve learned something during your time in jail.”
“Yes, your honor, I have.”
“Mr. Jacobs has explained your circumstances. Fortunately for you, I intend to be lenient. The charge of domestic violence is hereby suspended for one year. However, you will be placed on a one year probation with parole requirements. Any further violations, even being near Mrs. Barnett's residence, will result in your arrest and reinstatement of the domestic violence charge. Do you understand?”
“Yes, sir, I do.”
“I sympathetize with your predicament and appreciate the emotional strain you’re under. However, as you may be aware, domestic violence has become a national issue. This court will not be tolerant of repeat DV offenders.”
“I understand, your honor. Thank you.”
The next case was called. As David was escorted back to the jury box, it dawned on him that he wouldn’t be released until all twelve cases were heard. Furthermore, he’d have to be taken back to the jail house to retrieve his belongings. This is gonna take hours. He asked the bailiff for permission to speak with his attorney and turned to Jacobs. "Allen, can we talk for a second?”
“Sure.” Jacob's had the bailiff accompany Barnett to the rear of the room.
“Allen, I’ve got a full schedule in the office today. I’m supposed to be there at nine o’clock.”
Allen glanced at his watch. “It’s ten till nine now. By the time you’re discharged from downtown it will be noon or later.”
“That’s what I figured. Could you make a call for me?”
“Absolutely.”
“Please call my office manager, Peggy, at 555-3543.” Allen wrote the number on his legal pad.
“Do you want me to tell her where you are?”
"You’ll have to. My car’s been impounded. I want her to pick me up at the jail. I’ve known Peggy for years. She’ll keep it in confidence. Please tell her I’ll try to get there by one o’clock or soon after. She’ll have to ask this morning’s patients to wait, come back in the afternoon, or reschedule for later this week.”
“I’ll take care of it.”
“Tell her I’ll call when I need a ride.”
“I will. David, I’m concerned about you. I’m afraid your drinking is gonna get you in trouble again.”
The remark embarrassed Barnett. He blushed. “Yeah, I understand. I know I have to quit.”
Jacobs looked dubious. “What do you think of going to a rehab center for a few weeks? Actually, a month—a twenty-eight day program.”
David was stunned. Rehabilitation, he thought. Am I that bad? He thinks I’m an alcoholic. “Allen, are you serious?”
“Very serious. I think you’ve got a problem.”
Barnett was silent.
“It’s only four weeks, Dave."
“A month! I’d have to take a month off work. It’s impossible. I’ve got hundreds of patients scheduled and my partners would have to pick up the slack. I’d have to explain it to my entire office staff. I can’t do it, Allen.”
The attroney backed off. “Okay. But please keep it in mind. Give it some consideration. It would be great if you quit drinking. I think it would make a tremendous change in your life. But, if you can’t . . . .”
Barnett interjected. “I know, I know. I’ll consider it. I’ll even leave work for awhile if I have to. But I’d rather do it on my own.”
“Alright. Just remember, I’m on your side. I’m here to help any way I can. I want you to call if you need to talk. Anytime, twenty-four hours a day!”
“I’ll call if it's necessary, Allen. I mean it."
“Good luck, David. Stay away from the booze, buddy. Also, stay away from your wife.”
“Definitely.”
“Call me in a few days with a progress report.”
“Okay, Allen. Thanks for your help.”
By cardiodoug
Marie Conti was lonely, painfully lonely. Michael and Laura had been living in Toledo for more than a year. Michael’s job consumed his time, including weekends, and opportunities to visit his parents in Detroit were limited. As usual, Carlo was obsessed with work, struggling to keep his business afloat as the industry changed from carburetion to fuel injection. He and Marie rarely socialized. Marie was alone, unhappy and apprehensive about her future. She worried about everything. The more free time she had the more anxious she was. She worried about Michael and Laura and she worried about her health.
Throughout her life, Marie had been blessed with good health; now, at the age of seventy-two, a few months younger than her husband, she had a problem. She recently suffered from inexplicable fatigue and weakness brought on by the least exertion. She hadn't mentioned it to anyone, most notably, Carlo. She knew he would minimize her symptoms, blow her off and tell her to not think about it. He would never allow her to seek medical attention--never.
For Carlo, doctors were out of the question. He despised physicians. For decades he had blamed greedy, incompetent doctors for Cassandra’s death. His daughter's death left a gigantic hole in his heart—a hole that never mended. He would never forgive the medical community for taking her from him.
When Michael was a baby, Carlo reluctantly permitted Marie to take him to a pediatrician for immunization shots and nothing more--that was it. Neither he, Marie, nor Michael had been to a doctor since.
In secret, Marie tried vitamins and over the counter remedies, an unsuccessful attempt to alleviate her symptoms. Her fatigue improved briefly after taking such pills, but soon returned, worse than before. She was short of breath when walking, especially climbing stairs. Her concern grew to desperation. She had to see a physician, regardless of her husband's wishes. If she asked to see a physician, he would react with anger, she was certain of that. She decided to keep it from him. Marie deeply loved Carlo, and felt ashamed for going behind his back but there was no alternative.
Her plan to see a doctor posed another problem. She had no health insurance. Years past, she had pleaded with her husband to buy a health policy. He reluctantly agreed to major medical coverage only—no insurance for routine care. He was convinced his family would never be seeing a physician for office care; so there was no point in having full insurance coverage. If Marie went to a doctor she would have to pay cash, being careful to not generate any statements--any evidence of her visit to a doctor. Carlo kept tight control of the family’s finances, personally paying all bills. He would find out.
Marie didn’t know a single doctor and decided to sek help from a friend, a retired nurse who had worked in hospitals for years.
“Hello”
“Helen, it’s Marie.”
“Hi, Marie. Nice to hear from you. How things goin’?”
“Helen, I need your help--your advice on finding a good family doctor.
“Sure, I’ll be glad to help.”
“Could we meet tomorrow for lunch? I’d like to discuss my dilemma.”
“Of course. I‘d like that.”
The pair arranged to meet the following day at a local coffee shop in Birmingham.
“Marie, it’s great to see you. So what’s this all about? You seemed a little sullen on the phone. Is everything okay?”
“Oh, sure. I’m okay. I just need a little advice. Let’s take a seat and have some coffee.”
Marie and Helen, one of her few friends, sat at a corner table in the shop.
“Helen, I’ve been feeling lousy for months. I’m really beat, tired and worried. I think I should see a doctor.”
“Of course you should. Who’s your family doctor?”
“I don’t have one.”
“Your kidding?”
“No, I’m not.”
“Marie, you must have a gynecologist? He could refer you to someone.”
“I’ve never seen a gynecologist. I’ve never seen any doctor, Helen.”
“Never? What about when you were pregnant with Michael?”
“Well, yeah. I saw an O.B. at the end of my pregnancy. Carlo refused to let me go for prenatal visits.”
“You can’t be serious! Why would he do that?”
“It’s a long story. Carlo doesn’t trust doctors. He got that way years ago when Cassie died. I’d rather not get into that.”
“That’s okay. If you’re sick, why don’t you just tell Carlo you have a problem and you have to see a physician?”
“I wish I could. Carlo’s a wonderful man, but when it comes to doctors he loses it. He’s irrational. He doesn’t know a single physician. He thinks they’re all incompetent crooks. Helen, I can’t tell him I’m going to see a doctor. I know it sounds crazy, but that’s how it is."
“So, how can I help?”
“I was wondering if I could go to your doctor or one you know from the hospital.”
"I’d be glad to refer you to someone.”
“Helen, I’ll have to pay cash for my visit. That’s not a problem for me, but I need a doctor who’s willing to take patients with no insurance.”
“Marie, my doctor, Dr. Pierce, is a good man, very thorough, but not real personable. I don’t think he’d be a good choice. I’d recommend Dr. Kawalski. I know him from the hospital. He’s a great guy. I’d be happy to talk to him about your situation, if you'd like.”
“That would really be helpful. I feel so foolish about this. The whole thing--no insurance, going behind Carlo’s back--you know.“
“It’s no problem. Kawalski’s a nice guy, an internist with a good reputation. I’m sure he’ll be willing to help you.”
“What should I do? Will you call me after you clear things with Dr. Ka-wal. . . .”
“Mark Kawalski”
“Yes, Mark Kawalski.”
“I’ll call him this afternoon, and try to get you in tomorrow.”
“Thanks, Helen. You’re a good friend. I appreciate it. I feel better already.”
“Come on, Marie. What I’m doing is no big deal. I’m glad to do it. I just want you to find out what’s wrong and take care of it. Marie, this thing with Carlo is crazy. I can’t believe you don’t have a doctor.”
“I realize how it sounds. I just don’t want to talk about it now.”
“That’s fine. We’ll get you taken care of, regardless of your kooky husband.”
Marie wasn’t offended by the comment. She laughed. “He is a nut sometimes, but I couldn’t live without him.”
“Listen, honey, he couldn’t live without you, remember that. He should be glad you’re taking care of yourself.”
The couple made small talk before leaving the shop. Helen promised to call that evening.
Dr. K, as he was known, saw Marie as an added patient on Saturday morning. As Helen had said, he was very personable with a wonderful sense of humor combined with a professional approach.
Marie felt sheepish—embarrassed as she explained her situation: no documented medical history, no prior physicians, no health insurance, not even a medical exam for the past forty years. Kawalski reassured her that the cost of her evaluation would be minimal. He agreed to perform tests without charge whenever possible. Marie thanked him profusely.
The doctor listened intentlyas she described her symptoms of fatigue. He did a complete physical examination, which he reported as entirely normal: normal blood pressure and pulse, unremarkable ear, eye, nose and throat exam, clear lungs, normal heart exam, no abdominal or pelvic masses, normal neurological and vascular status and no lymph node enlargement.
“Mrs. Conti, your physical examination is fine. I find nothing abnormal. However, your symptoms do concern me. My initial impression is that you may have a problem with your heart or lungs. We also need to make sure you're not anemic. A low blood count can cause exhaustion as you’ve described.”
“Doctor, what could be wrong with my heart or lungs?”
“Well, you may have coronary artery disease. Lung problems are less likely.”
“Coronary artery disease! You mean a heart attack?”
“No, I don’t think you’ve had a heart attack. Your EKG will give us more information on that. But I suspect you could have some narrowing in your arteries causing your fatigue. Prior to having a heart attack, a lot of people simply feel tired with exertion, as you’ve described.”
“But I don’t have chest pain."
“Mrs. Conti, that’s a common misunderstanding. Many people with coronary atherosclerosis, hardening of the arteries, don’t have chest pain. Everyone knows about chest tightness and left arm pain from heart disease. Unfortunately, some heart patients simply feel tired, exhausted or short of breath. Since they don’t have chest pressure or pain they may delay medical attention. That can be disastrous. It’s good that you’ve come in today. If it is your heart we can diagnose the problem early and avoid a heart attack. Current treatments for such a problem are magnificent. But first we have to make a diagnosis. I doubt that this is a pulmonary problem. You have no evidence of emphysema, bronchitis or asthma. And you’ve told me you’ve never smoked, correct?”
“That’s right. I don’t think a cigarette has ever touched my lips.”
“Good. Let’s concentrate on your heart first. I’ll also do some blood work to check your hemoglobin to make sure you’re not anemic. And we'll check your cholesterol and thyroid levels."
Marie was silent. Her face drooped with concern.
“I can see that you’re upset Mrs.Conti, but believe me, it’s better to have a coronary blockage than some of the other possibilities I’ve thought of. As I've said, treatment for coronary disease has advanced tremendously over the past few years. You’re actually better off having heart disease than something like emphysema, lung cancer or leukemia. Those conditions could cause your symptoms as well. It may sound strange, but I hope you have a heart problem because it can be treated, and it’s the most treatable condition you could have in view of your complaints of fatigue. You’re gonna be okay, Mrs. Conti.”
“Thanks for the reassurance, Doctor. What do we do now? “
“For starters, we need to do a cardiac stress--a treadmill exercise test. I’m sure you know people who’ve had that done. My technician happens to be here this morning. I think we could squeeze you in the schedule and get the stress test done today if you want. It' ll give us a lot of information about your heart, and possibly, a definite diagnosis. Is that okay with you, Mrs. Conti?”
“Is the test expensive?”
“Please don’t worry about the cost. I can make adjustments. In fact, I’m quite willing to do the test free of charge. I will ask that you pay the fifty dollar charge for the nuclear tracer."
Marie was grateful and wanted to proceed right away. She was directed to the cardiac stress lab. The technician, a young woman, prepared her for the test. After removing her blouse and bra, she had EKG electrodes placed on each arm, across her chest and on her lower abdomen. She was wearing a skirt and high heels. The skirt was no problem, but she wouldn't be able to walk on the treadmill in heels. She removed her shoes and put on a pair of cloth hospital slippers. The technician explained the procedure.
. . .
The purpose of a stress test is to see how the heart reacts to exercise. If a coronary artery narrowing is present, and is severe enough to cause symptoms such as chest pain or shortness of breath, it will nearly always cause changes on the electrocardiogram when the heart muscle is stressed by exercise. Exertion forces the heart to pump more blood and consume more oxygen. If a narrowing, generally greater than an eighty percent reduction in the artery diameter, is present, it will restrict blood flow and oxygen delivery to the point that the patient feels symptoms and the electrocardiogram shows changes of ischemia, the medical term for oxygen starved tissue.
The test is designed to produce a graduated increase in exercise load. The study is broken down into three stages with the speed of the treadmill and degree of incline increasing every three minutes. The study is stopped when the patient becomes exhausted or the electrocardiogram shows evidence of a problem.
Dr. K was there to observe the EKG monitor and watch Marie’s response to exercise. Her resting electrocardiogram was normal. However, this was of no reassurance. A normal resting EKG can only give evidence as to what has happened to the heart in the past—a previous myocardial infarction, for example. It is not useful in predicting future events, or in determining whether or not underlying coronary disease is present. This explains the unfortunate, but frequent phenomenon of a man or woman who suddenly drops dead from a heart attack after being given “a clean bill of health” with a normal, resting EKG. Likewise, a cardiac examination with a stethoscope is of no value in detecting coronary blockages or narrowings.
At rest, a tight narrowing in a coronary vessel can allow passage of enough blood to maintain adequate oxygenation of the relaxed heart muscle. However, during exertion, this same narrowing will often result in inadequate oxygen supply to meet the demand from the exercised, stressed myocardium. Once the threshold of reduced oxygen supply is reached, the continous EKG strip on the stress monitor will show dynamic changes of ischemia. At this point, the patient often experiences typical symptoms of chest pressure, left arm ache, shortness of breath and fatique.
. . .
The technician started the treadmill and Marie walked at the slow pace of stage one exercise. She felt fine. Her electrocardiogram remained normal for the first three minute stage. The pace picked up and the ramp incline increased as the test entered the second stage. Marie told Dr. Kawalski she was getting winded. He reassured her that her electrocardiogram looked fine and encouraged her to continue. As expected, her heart rate gradually increased. The technician took a blood pressure: one-hundred-fifty over eighty. That was no problem. Blood pressure normally increases with exertion.
As she approached the end of stage two, Marie's legs became weak and she was noticeably short of breath. She told Dr. K she couldn’t go much further.
The doctor approached the monitor for a closer look. The EKG strip was showing subtle changes of ischemia.
“Mrs. Conti, I’d like you to hang on for another minute.”
“Okay, I’ll do my best.”
The test entered stage three. Marie’s heart rate was one-hundred-sixty and her blood pressure had increased to one-eighty over ninety. She was puffing hard.
“Mrs. Conti, do you have any chest discomfort? Any pressure or pain?”
Marie gasped, “No, Doctor. I just can’t catch my breath. I have to stop!”
Kawalski instructed his technician to administer the IV nuclear tracer. “Alright, Mrs. Conti, just hang in there for another thirty seconds."
“Thank goodness!”
“Bring her down, Cindy. We’re stopping now, Mrs. Conti.”
By cardiodoug
| Author Note: | part two of Marie's illness |
The stress test ramp’s incline gradually dropped to a flat level as it slowed and stopped. Marie was exhausted. Cindy assisted her off the machine to a nearby stretcher. Dr. Kawalski ran a resting EKG while Marie was lying down. He closely examined the findings. A specific portion of the electrocardiogram, known as the ST segment, had changed. The test was abnormal with definite evidence of myocardial ischemia. After Marie had rested for a few minutes, she was placed on a stretcher, a second EKG was obtained, showing some resolution of ichemia, and the stretcher was positioned with Marie's chest directly beneath a gamma ray scanner. The scanner would anylyze the flow of nuclear, radioactive tracer through her coronaries.
Dr. Kawalski entered the nuclear lab. “Are you okay, Mrs. Conti?”
Marie was already feeling better. Her breathing had returned to normal and her leg weakness was gone. “Sure, Doctor. I’m okay now, but I was really getting weak on that thing!”
“Yes, I could see that. I’m glad we did the test today. I’m pretty sure we have a firm diagnosis.”
“What’s wrong doctor? What did the test show?”
“Well, it is abnormal. It indicates that you likely have a problem with your heart.”
“Oh no! Is it serious?”
“As I said earlier, considering your symptoms, I think it’s better to find a problem like this, a problem we can fix, as opposed to other, more ominous conditions. Mrs. Conti, we discovered the source of your symptoms before anything bad happened. You’ve not had a heart attack and I’m confident we can make you feel better with some medication for now. Next week we can investigate further to determine what intervention may be needed."
She anxiously asked, “What kind of investigation?”
“You’re gonna need a cardiac catheterization, an angiogram, to look at your coronary arteries. That’s the only sure way to see exactly what’s goin’ on and to determine what treatment needs to be done.”
“A cath. What’s that?”
“You probably know someone who’s had a coronary bypass or a coronary balloon treatment?”
“Sure. I know a few people who’ve had a bypass operation and one of my husband’s friends had that balloon thing.”
“Well, all of them had to have a cardiac catheterization to decide what needed to be done.”
Marie looked overtly concerned. ”Will I have to have a bypass?”
Dr. Kawalski could see his patient’s dread over the thought of heart surgery. “You’re getting ahead of yourself, Mrs. Conti. Let’s say there’s a remote possibility that you'll need surgery. It’s much more likely that the problem can be fixed with a balloon treatment and a stent, what we call a coronary angioplasty. You said your husband’s friend had that done. I assume he did well?”
“Yes, he did very well.”
“That’s good. The procedure has become very common and it’s getting safer all the time. The results are generally excellent. However, we’re gettin’ way ahead of ourselves. The first thing we need is an angiogram, a cath. Then the cardiologist can tell us what he recommends.”
Marie was distraught, thinking of the expense, the hospital stay and Carlo.
Mrs. Conti, I really think you'll do fine with this. You can have treatment and live a normal life. I’ll have you see a cardiologist right away. Hopefully, we can have you taken care of next week.”
“That’s not the problem, Doctor. It’s my husband. I’m afraid to tell him. He’ll be very upset.”
“I’ll be happy to talk with him if you'd like. I can reassure him. He’ll be fine.”
“It’s not that he is worried about me. I mean, he will be worried, but that’s not what concerns me. He’ll be angry as well--angry that I came to see you in the first place. It’s a strange situation. It’s embarrassing."
“What situation is that, may I ask? Strange in what way?”
“He hates doctors. It’s a long story. He blames doctors for our daughter’s death.”
“Your daughter? What happened? When did she die?”
“She was only five-years-old. I’d rather not talk about it right now. The problem is that if I need treatment, like one of those balloon things, or worse, bypass surgery, I’m going to have to tell Carlo. He won’t like it.”
“Mrs. Conti, I have no idea of what’s goin’ on with your husband, but we have to put your well being ahead of his emotions. You know that.”
“Yes, I do. I deal with it everyday. I’ll explain it to him this weekend, but I’m not looking forward to it.”
“Please, don’t hesitate to call me if you have trouble with your husband. I’ll be glad to explain everything to him. I’m on call this weekend and I’ll be available if you call the hospital and page me. Here’s the number for the hospital.” He handed Marie a business card with the hospital's number written on the back.
“Thank you. I really hope it's not going to be a problem, with my husband I mean."
"I'm sure he'll be fine once he understands how important this is. How long have you and he been married?"
"It will be fifty-three years this summer."
"That's a long time, Marie. He must love very much. I think he'll be ok with this."
"I'm sure he loves me, doctor. But still. . . . "
Kawalski interrupted. We'll work it out, Marie. Please call if you need to talk."
“I will. I promise.”
“In the mean time, before you see a cardiologist, I' m going to give you some prescriptions. I want you to take one baby aspirin a day. This is very important, Mrs. Conti. Most people don’t think of aspirin as a medication, but it's very effective at preventing heart attacks. One baby aspirin a day is the ideal dose. I’m also writing prescriptions for two medications. You’ll have a medication called Nitrovasc, that I want you to take every morning, and a second prescription for nitroglycerin. You probably know that nitro is used under your tongue if you have chest pain. You don’t need to take this unless you have symptoms of chest pressure or shortness of breath. Marie, my nurse will explain the details to you. She’ll make an appointment for you to see a cardiologist as soon as possible. Until then, I want you to take it easy. No exertion. Just become a couch potato for a few days. Okay? If your symptoms get worse, call me. Call me at anytime, Mrs. Conti, day or night. I always have my beeper. You simply need to call the hospital operator and ask her to page me.”
“I understand, Doctor. I think I’ll be fine. I really want to thank you for being so helpful, Dr. Kawalski.”
“That’s my job Mrs. Conti. It’s no problem. I think you'll do well. We’ll fix you up as soon as we can. I want you to return Monday morning for the resting portion of this test. We compare the resting nuclear scan with the exercise scan. That helps to determine the severity of the problem. Please don't eat anything for breakfast on Monday. We'll do some fasting blood work for cholesterol and a few other things when you come in. I’ll see you then.”
“I’ll be here. Thanks again.”
Marie talked with Kawalski's nurse before leaving the office. On her way home, she stopped at the pharmacy to fill her prescriptions. She was still frightened about telling Carlo of the days events. At least, she thought, I now know what the problem is. That's something good. But Carlo's going to be trouble, I know it. Marie decided to wait a day or so before talking to her husband. She thought it best to relax over the weekend and avoid confrontation. As instructed, she would be a couch potato.
She took a dose of aspirin when she arrived home, waiting, as instructed, to start her other medication in the morning. She would have to hide her new medications from Carlo. She watched television that evening and went to bed early. As usual, Carlo stayed up late, doing paper work while watching the news.
Marie kneeled at her bedside and prayed, as she did every night. “Dear God, please bless and protect Michael, Laura, and Carlo.” Her prayer continued, asking God to protect her loved ones, her sister, her friends. She never asked for personal help. God was busy enough helping others. She would feel guilty asking him to protect her or provide her with personal favors--she was more concerned about her family than herself. After twenty minutes of humble prayer, she ended, as always, for a request of God’s blessing on Cassandra. Asking God to protect her baby, to love her and hold her in His arms.
Marie slipped into bed, pulled the covers up and caressed her pillow. She lie awake for what seemed hours, thinking about Carlo, worrying about him—fretting over his anticipated reaction to her doctor visit and her health. What would he do if I were gone? He’d be alone and lost. She drifted off to sleep. A short while later she was awakened by Carlo as he crawled into bed.
“Hi, honey,” said Marie
Carlo kissed her on the cheek. “Good night.”
Marie quickly returned to slumber. She was walking—strolling through their old neighborhood in North Detroit. A light rain was falling, a warm summer rain. She was wearing a sun dress.
The rain turned cold. Marie felt a chill as she looked around the houses. Nothing was familiar. Where is Cassie? Cassie’s lost. I have to find her!
Marie was lost. The houses were all run down, some were vacant, some boarded-up, some iin shambles. She felt terror. Th cold rain on her shoulders made her shiver. She screamed,
Cassie, where are you?
Her heart pounded, her chest and neck felt full. She screamed again, Cassie, where are you, honey? Please answer me, please baby, tell me where you are.
Marie heard a racing engine. She turned, looking over her shoulder. A car was flying down the street. It was their old Ford Fairlane. She bolted, running down the sidewalk as the Ford swerved and jumped the curb, chasing her down. Horror struck as she shot another glance over her shoulder. No one’s driving. The car is empty!
Looking ahead, she ran as fast as she could--heart racing, skin cold and clammy. She turned again to look at the approaching car. There was a driver after all; it was Carlo. He had a terrifying, wide eyed look and a toothy grin with huge, bizarre teeth. He screamed, I’ll get you. I’ll kill you for this.
The front bumper struck her legs. Marie let out a horrifying shriek as she slid under the car. The Fairlane stopped. An incredible force was crushing her chest. She was pinned against the sidewalk with the full weight of the car on her body. Staring upward, she saw the engine. Grease and oil dripped down on her--her torso was compressed by a hot oil pan. A loud noise filled her head. The engine was roaring. She felt a crushing pain in her upper left arm and shoulder. She was in tortured misery. The pain in her arm and burning pressure in her chest increased. She tried in vain to pull her arm to the side--forcibly turning her head to the left, scraping her jaw against a hot engine block. She could see her arm and shoulder, smashed against the sidewalk by the car's broken left front axle. Her jaw ached from being burned by hot steel. She was trapped in agonizing pain. She thought of Cassie. I have to find her. She cried out, God help me! God help me, please!
To Marie’s amazement, the car disappeared. Her pain was gone: chest pressure, arm pain, shoulder pain, jaw pain, all gone. God is helping me. She was bathed in a glowing warmth--feeling incredibly safe and content. Marie sensed an exquisite taste in her mouth, a wonderful sensation that she had never before known. Her head was filled with beautiful music. All of her senses were pleasantly stimulated. She was caressed by a soft blanket of warmth.
Out of nowhere, came the most beautiful sound she had ever heard. “Hi, Mommy. I’ve been waiting for you. I love you, Mommy.”
The alarm clock went off at seven a.m. Carlo jumped out of bed, wide awake as usual. He went to the master bath to get ready for the day. Marie remained in bed, lying silent, still caressing her pillow.
It was Sunday. Carlo got ready for church as he had done for the past forty-seven years. For him, Sunday was no different from any day with regards to church. He went to mass seven days a week, a ritual he started years ago, shortly after Cassie’s death. Being obedient to the church and God was what he relied upon to spare him from further pain--the dreaded pain of loosing a child. However, despite attending mass every morning, he remained a Catholic recluse. He knew the parish priest superficially, but always left mass early without talking to anyone. For Carlo, it was personal--between him and God.
“Marie, time to get up, honey. We have to get ready for church.”
Carlo shaved, showered and returned to the bedroom with a towel rapped around his waist.
“Come on, Marie. We’ll be late.”
Marie was motionless. Carlo walked to the head of the bed and gave his wife a gentle shake. She didn’t move. He leaned down to kiss her on the cheek. Her face was ice cold. Springing upright, with a sense of horrid urgency, he yanked the blankets off his wife’s cold, lifeless body.
* * *
On Monday morning, the phone rang. Carlo answered.
“Hello, Mr Conti. This is Dr. Kawalski.”
“Doctor who?”
“Dr. Kawalski. I saw your wife Saturday.”
“You what?’’
“I saw Mrs. Conti, Marie. She’s having some trouble.”
“You must be mistaken. My wife never saw you.”
“Actually, she did. I know you don’t approve of doctor’s, but she did see me for assessment of fatigue.”
“You saw Marie two days ago?”
“Yes sir, I did. She was supposed to return to my office today. Since she didn’t show I thought I’d call. How’s she doing?”
Carlo was incensed. “What did you do to my wife?”
“We did a stress test. I’m concerned about her heart. How is she?”
“She’s dead, you asshole. Marie died in her sleep. What did you do to my wife, you son of a bitch?"
Kawalski was shocked. “Mr. Conti, I’m so terribly sorry. What happened?”
“She went to bed and died. You killed her, you goddamn crook!”
“Mr. Conti, please. . . .“
“Please what, you fuckin’ jerk. I hope you die a painful death, you bastard!”
"Mr Conti, I hav. . . ." "Click"
Carlo slammed down the receiver.
By cardiodoug
Barnett jumped, hearing the blare of his alarm clock. Ignoring the alarm, he immediately fell back to sleep. The clocks rhythmic beeping sent him into a dream—dreaming that he was alone, making rounds in the hospital, bombarded with bells and beeps from IV pumps, malfunctioning ventilators, call lights, and code blue alarms. He was frantic, unable to find his patients, certain that one of them was dying--someone he was supposed to save. Running down a hospital hallway, he broke into a sweat, gasping for breath.
As always, in this repetetive dream, he mysteriously wound up in the basement, the bowels of the hospital where large asbestos bound, steam fiiled ducts ran overhead, and huge, shiney, piston driven machines roared in unison as they pumped water, oygen, oil and blood to the upper floors of the hospital. He was terrified, isolated, searching for a way out of the basement. There were no doors, no stairways, no elevators. Just as his desperation brought him close to the threshold of awakening, he translocated.
Once again, as he always drempt, he was standing in front of a group of nurses in the cardiac cath lab. They stared at him, the younger ones giggling. David looked down, noticing that he was wearing only his underware. He was never nude, always in his skivvies.
Embarrassed, standing before six young women, he shyly asked. Where can I get a scrub suit? Jennie Stevens, the one he was most attracted to, always responded. David, sweetheart, you know where the locker room is. It's in the basement, honey. Weren't you just down there? What's wrong with you, lover boy, are you drunk or stupid, drunk or stupid, drunk or stu. . . ? David ran from the catheterization lab to a nearby elevator. He hit the down button. The elevator doors slid open--David started to step forward, froze, and jumped back. Susan and her new boyfriend were inside, in a tight embrace, kissing. They turned and laughed, seeing David standing there in his underware.
David shot upright in bed and slammed his alarm clock. "I hate that damn dream!"
He fell back on his pillow and, amazingly, fell asleep again. Minutes later the alarm went off again. He awoke in a stupor, groping for the alarm on his bedside table. He felt the power cord. As he yanked it from the wall, the clock tumbled to the floor. Hours later he awoke again, struggling to sit up in bed.
Bright sunlight was streaming through his window. What time is it? Sitting on the edge of his bed, he saw the alarm lying on the floor. Its digital screen was blank. He found his wrist watch on the table. Oh shit! It’s two-fifteen. I slept half the day away.
He panicked. I’m supposed to be at work! David lept from bed, ran to the bathroom and flipped on the shower. At the sink, he stared into the mirror. Puffy, red eyes stared back. I look like crap!
In his haste, he failed to see the mess he had made around the toilet the night before. He'd fallen asleep in his dress pants, white shirt, and tie. As he struggled to remove his clothes, he lost his balance, striking his head on the vanity as he crashed to the tile floor. Then he saw it. The area around the toilet was covered with vomit. Appalled, he sat up on the bathroom floor and thought about the prior nights events. He barely remembered a thing. One item did come to mind; he had gone out on a Friday night. Today is saturday. Filled with relief, he sighed and stood up. His urgency vanished. One of his partners was making rounds today--he was off work for the weekend. He walked out of the bathroom and fell into bed--his head pounding from a hangover. He had a tremendous thirst.
Barnett had been banned from his house for nearly three months. His brief stint in jail was two weeks past. After his release, he didn’t drink for two days--only two days. Despite his promise, he never called Jacobs. A week ago, having accepted that he wasn’t going home to his family, at least not sometime soon, he moved from his motel to an apartment. The motel was a lousy place to live, especially at fifty bucks a day, fifteen hundred a month. His apartment was much nicer at half the price.
He got out of bed, walked to the kitchen, and smelled something burning. The oven light was on. Jerking the oven door open, he found a circular chunk of charcoal lying on the oven rack. It was a pizza--totally black--burned out of recognition. He groaned with disgust, barely remembering placing the frozen pizza in the oven last night. That’s just great. I fell asleep with the oven on.
David turned the oven off and opened the refrigerator, hoping to find something to quench his thirst. The fridge was empty. He filled a large tumbler with water and slugged down two full glasses. His head was still pounding and he was nauseated. He returned to the bathroom, cleaned the mess around the toilet and went back to bed. He stayed in bed, staring at the ceiling, thinking. I’m ruining my life. I’m dying. I need help.
The prospect of diving deeper into depression and decadence seemed inevitable. David was terrified. He escaped to his only refuge—more sleep. Within minutes he was dreaming again.
He was in a court room. The judge was pounding his gavel on the bench. He wouldn’t stop. He kept pounding. David awoke. Someone was banging on the door.
Barnett stumbled through his apartment and opened the door. A middle-aged man in a wrinkled sport coat was standing outside.
“Are you David Barnett?”
“Yes.”
“Here.”
The visitor shoved an envelope in David’s hand and quickly walked away. It came from the Lucas County Clerk of Courts. Barnett’s heart sank. What now, another criminal charge?
He sat on the couch and opened his mail. It wasn’t a criminal charge or a warrant. It was a divorce notice. Susan had finally done what he feared most. He was never going home again.
Dr. Barnett leaned back and cried. He really needed help now. I have to call Jacobs.
By cardiodoug
CHAPTER 24
ALCOHOLICS ANONYMOUS
(Addendum: At end of last chapter posted, Dr. Barnett realized alcohol was going to kill him. He spent many months in a physician rehab program in Atlanta. The chapter about rehab is not yet completed. Current Chapter starts with his return home to Toledo. )
David ventured down the steps to the basement of the Presbyterian Church. Hearing activity down the hall, he entered a room to find a number of men and women sitting around a long series of folding tables. The pleasant smell of fresh coffee was hardened by the reek of cigarettes. A gentleman with wild gray hair in dreadlocks, and a long gray beard, was seated close to the door. The attendee, wearing tattered jeans and a T-shirt emblazoned with The Grateful Dead, turned to greet Barnett. He stood and extended his hand.
“Hey man, I've never seen you here before. I’m Franklin. Nice to have you.”
David, caught off guard, hesitated and said, “Glad to meet you. I’m David Barnett. I’m lookin’ for the AA meeting.”
“Well you found it, buddy. This is where you belong. I’m an old timer here. By the way, no need to tell your last name, unless you want to. We're all sworn to anonymity. Why don’t you have a seat next to me?
“Thank you. Think I will.”
Barnett surveyed the room. There were men and women of all ages, appearing by their dress to come from varied social backgrounds. He again noticed the scent of coffee and asked his new friend if it was available.
“Sure it is. Help yourself. The coffee, regular and decaf, sugar and cream, is on the table in the back of the room.”
David poured a cup of coffee. Returning to his seat, he walked past the end of the table and froze--he reconized someone. A doctor he knew, Neil Dewitt, was sitting just a few feet away. His colleague, a neurologist, feeling Barnett's tension, turned and broke the ice.
"Hi Dave, you look a little shocked to see me. Glad you're here. I've been a member of this group for years."
I'm surprised, Neil I had no idea."
"That's good. Shows how effective the anonymity rules are in AA. On the other hand, if you had known, it wouldn't have been a problem for me. It's nothing to be ashamed of. In fact, I'm proud of myself for working so hard for my sobriety. I'm proud of you too, Dave. It's good that you're here. Truth is , I've been expecting to see you, sooner or later."
You have!! "
"Sure, I have. You think I didn't know?'
"Well, yea. Honestly, I thought my drinking was my big secret."
Neil smiled. "I was the same way--thought no one knew. When I finally fessed-up to my partners, they told me me half the medical community of Toledo was talking about me behind my back. I couldn't believe it. Suppose you don't believe it now, do you."
"No, I don't. I mean, I haven't thought anyone knew. But some people, certain nurses and docs, have been rather aloof lately. Guess I've been naive about the whole thing."
"Don't sweat it, David. Important thing is that you're here--and, that you keep coming back."
This is my first meeting in Toledo, Neil. I've been out of town for a few months."
"I know that."
"You do? You seem to know a lot about me."
"Listen, don't get shook up. People with addiction problems can spot another user a mile away. I knew you were having trouble. When you disappeared from work, I assumed you were in treatment. Like I said, don't be embarrassed. You should feel good about yourself. I'm proud of you, I mean it. Their are plenty of docs out there who can't face the reality of their problem. They think it's a secret, just as we did, but it rarely is. Their associates know, other docs and nurses know, but unfortunately most of them don't have the guts to confront the addict. So it goes on and on, ignored until a disaster occurs. By then it's often too late."
"Neil, I'm relieved to see you here. I feel better already."
"Okay, Barnett, the meeting's starting. We can talk more later."
"I'd like that. Thanks." David returned to his seat.
The meeting began with the same ceremonial readings David knew from his recovery program. He was surprised at how uniform and universal they were. He thought, no matter what AA group you attend, anywhere on the planet, the protocol is virtually identical: How it works, The Promises, The Twelve Steps, The Twelve traditions, the remarks about anonymity and “What is said here, stays here.” It was all familiar to David from his time in Atlanta.
After completion of the standard readings, the moderator asked if there were any newcomers or first time visitors. No hands went up. David, unnerved, turned to Franklin, who whispered. “Go ahead. Just give your name and a few words about who you are.”
Barnett raised his hand. “I’m new here. “
The moderator said, “Welcome. Please tell us who you are and a bit about why you’re here.”
He knew the standard intro. "Hello, I'm David. I'm an alcoholic."
The others called out in a loud, uniform response."Hi, David !" echoed through the room.
Barnett went on. "I just returned to Toledo from a recovery program in Atlanta. Been a drinker for a long time.”
The moderator welcomed the new member again and asked the others to introduce themselves. An elderly woman across from David started.
“I’m Margaret. I’m an alcoholic,” was followed by “Hi, Margaret.” Similar intros went around the table, returning to Barnett.
Once again he anounced, “Hello, I’m David. I’m an alcoholic.” He said it without hesitation and felt good about it.
During the meeting, for David’s benefit, there were many comments directed at newcomers. The conclusion was that he likely suffered from shame; ashamed about his drinking, ashamed about his life, ashamed about his divorce and ashamed about who he was. Numerous members of the group told him that he probably didn’t love himself or even like himself. The message was that they would all love him for who he was, and then he would eventually learn to love himself. Then, he would be free.
The comments brought tears to his eyes. This group of pragmatic, realistic people was completely different from the arrogant, staid, uninspired members of the physician groups he had attended in Atlanta. These were real people with real problems, and they all wanted to love him and teach him to love himself. The message was profound.
At meeting’s end, many members approached Barnett to invite him to return; asking him to consider making this his home group, and to contemplate helping with pre-meeting chores, such as making coffee and setting up the room, along with post-meeting clean up. One gentleman explained that these activities go a long way toward maintaining sobriety, in contrast to those who often arrive late and immediately disappear as soon as the meeting ends. He explained, "It's the difference between someone who really wants to be here, in contrast to those who are forced to be here--usually by a court order or an angry spouse."
Some gave David their phone numbers, asking him to call any time, whenever he needed to talk. He was also invited to meet for breakfast or lunch with a group of men who often met outside the formal group. This was a unique experience for Barnett, who had always been a loner. The doctors he had known in Atlanta were not nearly as approachable as these people in Toledo.
David felt he had finally found his niche; a group of sober-minded, matter-of-fact alcoholics, who openly accepted him. Like him, they were all alcoholics, with only a scant number of mixed users with a history of hard drugs. There were doctors, attorneys, executives, truck-drivers, laborers, housewives, secretaries and unemployed men and women--participants of every walk of life, all with a common, unifying trait—they all wanted to be sober, at any cost.
As David walked to his car he sensed a new optimism. When he left Atlanta a week ago, he'd felt revitalized; having learned so much about himself. However, soon after he returned home he was burdened with worry and self-doubt. Would he be able to maintain his new outlook, or would old routines slowly creep back into his life? Would he drink again?
Just as he reached his car, Neil Dewitt aproached. "So, what do ya think of the group, Dave?"
"Oh, hi, Neil. The group was wonderful. Really, I felt comfortable, welcomed by everyone."
"I suppose your recovery program down south recommended you do ninety in ninety, ninety meetings in ninety days?"
"Yeah, they did. And after tonight i feel better about it. It won't be as hard as I thought."
"Be careful, Dr. Barnett. With our insane work schedules, ninety in ninety is no cake walk. I know from experience."
"Neil, I think I can do it. I'll go to meetings at six am or midnight if I have to."
"Yeah, that's easy to say, but I couldn't pull it off when I started, and I was just as determined as you. Here's a word of caution. Don't get down on yourself if you miss a meeting. I know how it feels. Missing a meeting now and then is inevitable. So, don't get discouraged when it happens. However, you should do your best to never, I mean never, miss two or three days in a row. That happens and you'll be off to the races--never to return."
"I won't let that happen. It feels too good being here. I'll never quit!"
Neil grimaced--he'd heard it all before. "Dave, have you ever heard of a pink cloud?"
"Sure, the term was tossed around a lot in Atlanta."
"The pink cloud effect is dangerous, my friend. You seem to be a bit too happy right now, perhaps euphoric about your new sobriety. An alcoholic on a pink cloud is often headed for trouble. I've been there myself. You quit drinking for a few days or weeks, or months in your case, and become overly excited and optimistic about the future. Finding an enjoyable group, as you did tonight, simply adds to the elation."
"I think I understand, Neil. I do feel optimistic--actually elated, as you say. But I'm hell-bent on doing this."
"That's good! Just don't make unrealistic committments. I've been around here for years and I've seen a number of pink clouds drift away from sobriety. Consider it a friendly warning. I'm surely on your side and I'd love to help you get started in the program."
"Thanks, I appreciate your concern and your advice."
"With that in mind, I'd like to invite you to a meeting tomorrow night. It's a closed mens group, non-smoking, fortunately. No stagnate, smoke filled air as we had tonight. The group meets at the Wayne Trail elementary school in Maumee.""Sure, I know where that is. I'd like to go."
"Great. It starts at eight o'clock. Lets meet out front a little before eight?"
"Sounds good, Neil. I'll be there."
"See you tomorrow."
Barnett got in his car, closed the door and sat for awhile, thinking about Neil's comments. He was glad to have found a commrade so quickly, especially one with a career so like his own. He mentally reviewed Neil's warnings. David was most concerned about his genetic predisposition to alcohol abuse; as indicated by his strong family history of the same. Now, after attending his first meeting at home, he felt confident—confident that with the help of others he could beat this thing; he'd beat the demon that had ruined his life, caused his divorce and threatened to take his career. For the first time in many months he was happy—filled with sanguine expectation about his future. Am I too happy, too excited about my new life? Am I on a pink cloud? Only time will tell. I better be careful, cautious optimism is best.
| Author Notes | Thanks to all who have reviewed. Much appreciated. |
By cardiodoug
| Author Note: | Carlo's only child is having problems. |
CHAPTER 25
MICHAEL’S SYMPTOMS
Michael had just returned home from a three mile run. He always warmed down for the last quarter mile and was usually breathing easy by the time he finished.
Laura was in the living room when he entered. “What’s wrong, honey?”
“Oh, nothing. I’m just having a bit of trouble catching my breath. I don’t think it’s anything serious.”
“You really look beat, Michael. You’re pale!”
He did feel beat. He felt horrible, weak and exhausted.
“Michael, talk to me. Why are you so out of breath? You don't look good at all."
“I don’t know. I think I’ve been having some trouble over the past few weeks.”
“You think? What kind of trouble?”
“My chest gets tight when I run. Today my arms felt a little weird--kinda heavy.”
“For God’s sake, why didn’t you tell me this before?”
“I doubt it’s anything to worry about, Laura. I’ll be okay. I’m in great shape.”
“Michael, it doesn’t matter if you’re in shape. Chest tightness, arm pain, you can barely catch your breath. I’m worried!”
“Yeah, I guess you’re right. I’m worried too. I didn’t want to upset you, so I didn’t tell. I’m sorry.”
“I’m calling a doctor. You have to see someone right away!”
“Okay, I suppose so. Alright, whatever you say, Laura.”
Laura and Michael had been living in Toledo for just over a year. Neither of them had been sick. They didn’t have a family physician. “Michael, I’m gonna find a heart doctor in our insurance booklet.”
Laura walked to the kitchen, opened a drawer and pulled out their health insurance information. The Chrysler-Jeep plant in Toledo had enrolled them in an HMO managed by Aetna. Their HMO booklet showed participating physicians listed alphabetically by subspecialty. Laura scanned the list of cardiologists.
“The program requires a referral form a primary care doctor if you need a specialist. We don’t have a primary doctor.”
Michael thought for a second. “Maybe we can find a doctor who does both internal medicine and cardiology. He could be our primary doctor too.”
“That’s a good idea. I’ll check it out. Here’s one listed for both. His name is Tamayo. He could act as our family doc and your cardiologist.”
‘What’s his name again?”
“It’s Tamayo, T-A-M-A-Y-O. Raymondo Tamayo. Maybe he’s Italian, Michael.”
“Sounds Spanish to me. Doesn’t matter.”
“Good, his office is close by, too. He’s near Flower Hospital, right here in Sylvania. I'm goning to make an appointment for you right away--tomorrow if possible.”
“Okay. I’ll see him. I guess it’s the best.”
“Of course it is. Absolutely, Michael. You're mother just died in her sleep, honey. Think about it. You might have some kind of inherited problem."
“I know, I know. But Laura, if you happen to talk to my father, don’t mention this, okay?”
“Michael, you know I’d never do that. I never tell him anything, do I? You know I think it’s really stupid that your dad won’t see doctors."
“Come on, you know the situation.”
“Yes I do. I know how angry he is and I think it's ridiculous. I won't interfere. However, regardless of your dad, you have to see a doctor. Now!”
'Okay, I'll go."
"And for God's sake, quit running until we figure this out."
Michael didn't say a word.
| Author Notes | Thanks to all reviewers---Doug |
By cardiodoug
Raymondo Tamayo had practiced medicine in Toledo for more than thirty years. He had attending priviledges at only two of the six hospitals in Toledo. The remaining four hospitals, because of Tamayo's tendency toward over utilization of tests and his history of performing unneccesary procedures, had refused to grant him staff member status. That didn't bother him. One, lenient hospital was really all he needed.
Over the years, Ray had lost most of his accent, which was now barely perceptible. Despite that, he still had bizarre habit of calling men and women by senor and senora.
Michael wore a suit and tie for his very first visit to a doctor. As he was escorted to an examination room, he noticed a number of Tamayo's framed diplomas, certficates, awards, etc, hung on the hallway wall.
“Senor Conti, very pleased to meet you. I’m Dr. Tamayo.
“Hello, Doctor. Thanks for seeing me on such short notice.”
“It's my pleasure. How old are you, Mr. Conti?"
"I'm thirty-nine. I was born in 1960, on new years day, actually.
The doctor smiled. "Now tell me, what's going on with you?”
As Tamayo spoke, Michael noticed a glistening sparkle from a diamond pin on the lapel of his lab coat. “Dr. Tamayo, you have an attractive pin on your coat. What is that, may I ask?”
"Certainly. The pin is a caduceus. This Greek emblem, a winged staff with two serpents, is centuries old. It represents a physician’s role as a messenger of medical information. I love its history. I’ve had my caduceus made by a prominent jeweler. As you can see, there are diamonds in the serpent’s eyes. The remaining serpent and staff is cast from eighteen karat gold.”
“It’s beautiful,”
“Thank you. The caduceus reminds me of my devotion to mankind and my obligation to care for my patients--to relieve suffering and do no harm.”
Michael responded. “That‘s impressive.”
“Thank you again, Senor. Ray smiled and said, "I take my commitment to heart, so to speak. I’m truly dedicated to my profession—dedicated to knowledge, compassion and honesty in all I do, but, enough about me. Please tell me why you are here.”
Conti was reticent. He had never been to a doctor before, at least not that he could remember. His mother told him he received vaccinations as a baby. He must have seen a doctor at that time. He had a pre-employment examination when he started at Jeep last year, but that was cursory, most of it handled by a nurse.
Michael paused for a moment and stammered. “Doctor, I. . . I’ve been having trouble with my breathing. I get short of breath when I run.”
As he spoke, his anxiety rose, making him more animated. Rapid fire speech and questions flew from his mouth. "I don't understand it-- I exercise all of the time—I’m a runner--my sister died—I’m scared—what’s wrong with me?”
His agitation and angst made an impression on Tamayo, who was already considering a diagnosis of anxiety disorder; suspecting this young man may have nothing more than psychosomatic symptoms.
“Mr. Conti, please relax. Whatever the problem is, if there is a problem, we will deal with it. Now, why don’t you carefully tell me what’s bothering you? It's natural to get winded when you run, correct?"
“Yes it is, but this is different, it's bothersome. Maybe I'm overreacting---I hope I’m overreacting. You see, I exercise often. I’m a runner---three to four miles a day.”
“That’s excellent, senor. Exercise is wonderful. I wish I had the time to workout myself. Of course, I’m much too busy, caring for others. Please go on.”
“I’ve had some minor problems over the past few months, maybe longer. Now I get short of breath simply from walking. Sometimes, just once in awhile, not often, really, I get a tight feeling in my chest, you know. That’s not unusual, is it?”
“No it isn’t. Mild chest discomfort is quite common, but it depends upon the nature of the tightness—location, duration, so on. Please tell me about it.”
Michael’s apprehension blossomed again. “I never though much of it, I mean, how could I be sick? I exercise, watch my diet, don't smoke, take vitamins. What could be wrong?”
Tamayo saw a look of frantic despair on Michael’s face. His suspicion of psychosomatic illness was being reinforced. He laid a hand on his patient’s knee to reassure him. Michael tried to smile, took a deep breath, and went on.
“What else, Doctor. What do you want me to tell you?”
“Mr. Conti, you’re much too worried right now. You must settle down and give me some details. Please allow me to ask a few questions. That may make it easier for you.”
“Okay, okay, let’s do that.”
“Alright then, first tell me when you feel the chest pain. Excuse me, pain is not the right word; it's usually a tight or heavy feeling?”
“Yes, that’s right--a heavy sensation and i'm out of breath at the same time. It's only when I run, you know, at the beggining, before I'm warmed-up. Michael was starting to feel better about the whole thing. He thought, Who wouldn’t get short of breath running three miles. It’s probably nothing.
“And your chest heaviness, how long does it last?"
"Just the first mile or so. Then it's gone."
Michael quickly interjected. “It’s not pain, Doctor. My chest just gets a little tight—heavy, I guess.”
Yes, senor, we've discussed that.
“Any other symptoms?”
Michael smiled, "Nope, that's it!" He thought of the few times he had chest and left arm ache simply from walking. I'm holding back. I should be honest. With more faltering, Michael said, “Yes, well, maybe. I did have a slight . . . a very slight ache in my arm a few times--nothing much.”
“Which arm?”
Dismay returned. Michael knew the significance of the question and dreaded hearing it. “I think it was in my left arm. I’m not sure. Yes, my left arm."
Tamayo, perceiving his patient’s avoidance, smiled, almost chuckled. " Senor,you need not be so worried. What ever the problem is, I will fix it."
Michael sighed with a bit of relief. “My upper arms have been heavy, both of them, doctor. They feel that way when I get the heavy feeling in my chest. It can happen when I'm at rest, just sitting on the couch."
“I see. Anything else? For instance, have you had any pain in your jaw, especially on the left side, or in your upper back?”
A disquieting rush of adrenalin hit. Michael thought to himself. I have had an achy feeling in my jaw. And some upper back pain. My God, it is my heart. I know it! He had ignored these symptoms, thinking they had nothing to do with his heart. Michael spoke nervously. “Doctor, what do my jaw or back have to do with anything?”
Tamayo, not wanting to aggravate things further, downplayed the question. “It’s not important. Rarely, pain in those locations can be associated with your heart, but not often. So tell me, have you had jaw pain or ache or a heavy, tight feeling in your back, perhaps between your shoulder blades.
Michael Conti turned pale and became nauseated. The doctor had just confirmed his worst fears. He was cold and clammy, on the verge of throwing up. “Well, I. . . I suppose I’ve had some weird feelings in my jaw. And maybe . . . maybe my back, too. But I. . . .”
Mr. Conti, are you okay? You look pale and sweaty. Please, let's remove your suit coat and tie and have you lie down on the exam table." Ray Tamayo took his patient's pulse; it was very slow at forty-two beats per minute. Michael's blood pressure was eighty-six over forty. Tamayo picked up a phone from the desk."Marcia, please bring me an emesis basin and a dose of atropine. Don't open the atropine yet.
"Mr. Conti, please take some slow, deep breaths." Ray was trying to calm him, get his mind off his heart. Marcia entered the room. "Try to think about pleasant things. What are you doing the rest of the day, Senor. Maybe spending it with your wife?"
Michael took a few deep breths and tried to relax. "No, unfotunately, I have to go straight back to work when I leave here."
"Oh, Im sorry. A day off would have been nice, yes?" Michael didn't answer. Tamayo placed his index finger on Michael's left radial pulse. His heart rate had increased to seventy-four beats. His color returned. "You must be feeling better now."
"Yes, sir. Much better."
Tamayo had Marcia leave with the basin and atropine which were no longer needed.
"Okay, Mr. Conti, time is flying by. Let's proceed with your exam."
"Sound's good to me."
"Have you ever smoked? Also, do you happen to know what your cholesterol level is?”
Michael thought about the lab work he had done at Jeep on his employment physical last year “No, Doctor. I’ve never smoked and I certainly don’t intend to. I think I did have high cholesterol about a year ago, when I started working here in Toledo. A cholesterol check was part of my employment physical. But I don’t remember the numbers."
Conti was lying. He knew exactly what his cholesterol was. It was sky high. Following his exam at Jeep, he received a letter from the company physician, asking him to return for treatment of very abnormal lipids. Michael never went back. Fear of the unknown, his lack of familiarity with doctors, and most importantly, fear of ridicule from his father, held him back.
“Just one more question. Can you tell me your family history—about your parents and siblings? Earlier, you said something about your sister. Is there any history of heart disease?”
The word sister hit a nerve. Michael paused again, thinking about Cassandra.
“My father’s alive and he seems to be in good health. My mother died in her sleep about a year ago. The cause was never determined. She was seventy-two."
“Was there an autopsy?”
“No. My father would never consent to that.”
“Anything else, Michael?”
He thought about Cassie. He didn’t really know much about her death. His parents never talked about it. All he knew was she died suddenly. “My older sister, she died at age five, in nineteen fifty-two.'
“Really. How very sad. What happened?”
“I’m not sure. My parents never told me much. I guess they couldn’t bear to talk about it. They were devastated, of course. I just know she died, very suddenly, I think. It was on her fifth birthday.”
“Not an accident? Car accident, perhaps?”
“No, apparently not. I can’t really tell you anymore.”
“It must have been a traumatic time for your parents.”
“I suppose so.”
Tamayo mentally reviewed his patient’s symptoms. He found them suggestive of coronary ischemia with exertion. The diagnosis of psychosomatic disorder was now less likely. “Michael, your symptoms are a little bothersome. However, we must do some tests before I can make a firm diagnosis. Please try to remain objective. As I've said, whatever the problem is, I’m sure we can fix it.”
Conti didn’t want to hear anymore. Afraid to ask what the doctor’s concerns were, he remained silent.
Tamayo continued. “So, enough about medicine for now. We should talk about more pleasant things. Don’t you agree?”
Michael’s eyebrows rose with inquisitiveness. Pleasant things? What could that be? “What about the tests you're gonna' do. Can we discuss that?”
“Of course. I’ll review everything before you leave.”
Before I leave? he thought. I’m ready to leave now. “Okay, I guess. What did you want to discuss?”
“Mr. Conti, you seem to be quite intelligent. Your attire suggests success. May I ask what you do at the Jeep Company—a high level executive perhaps?”
He was caught off guard by the inquiry. Why does that matter? He actually blushed at the question, embarrassed by being thought of as an executive. How can the doctor think that? I’m not that intelligent. I work in the plant.
The sad truth was that Michael was intelligent, but never gave himself credit. His position as assistant plant manager was high level, and he deserved to be proud. Unfortunately, his father had stolen his pride and self-esteem decades ago.
Tamayo sensed Michael’s uneasiness. “Senor Conti, please do not be offended by my question. I simply want to know what your lifestyle is. It does make a difference. It could help me pin point the diagnosis.” The truth was, Tamayo was interested in knowing which of his patients were wealthy. He thought of friendships with the rich as a well deserved perk of being a cardiologist.
Michael responded, “I’m not an executive. I’m the assistant plant manager.”
“Ahh, good for you, senior. That is a very important position, especially at such a huge complex as Jeep.”
He blushed again. “I suppose so, but I’m only the assistant.”
“But you have just started. With your obvious intelligence, I think you will someday be head manager.”
Conti was stunned by the remarks, wondering why Tamayo was so inquisitive and so complimentary.
“Senor Conti, transportation is essential. We all need cars. I congratulate you.”
Michael still felt flushed. I don’t deserve the compliment. I didn’t really have anything to with getting this job. It was all my father’s doing. He spoke. “Thank you, doctor.”
Tamayo’s next question caught Conti by complete surprise.
“Michael, would you like to go fishing with me?”
“Excuse me. I don’t think I heard you.”
“I would like to introduce you to the magnificence of the Great Lakes. You may not know this, senor, but you are living near the Walleye capital of the world. In addition, many people consider Put-In-Bay to be the summer party capital for this area. Plenty of fine ladies are to be found there. It’s an island in Lake Erie. Have you heard of it?”
Not sure of what to say, Michael paused and went on. “I think I have. Yes, I’ve heard of Put-In-Bay, in passing. I’m not much of a fisherman though.”
“Senor, I have a wonderful boat. You might consider it a yacht. Fishing is only part of the enjoyment of my cruises. I would love to have you accompany me.”
Michael couldn’t believe it. He had never met this man before and the doctor was inviting him to go on a party cruise on Lake Erie. He couldn’t understand it. “Dr. Tamayo, I’m married. I appreciate your offer, but it sounds like it’s not for me.”
“You can bring your wife. She’ll have an exciting time--fishing--partying."
Wanting to avoid the topic, Conti abruptly changed the subject. “Doctor, can you tell me what you think is wrong with me. What’s causing my shortness of breath?”
The doctor’s invitation had been ignored. Michael thought he discerned a brief look of annoyance on Tamayo’s face. The terse response to his question confirmed that suspicion.
“I think your symptoms are probably due to over exertion and worry. On the other hand, you may very well have heart disease. You’ll have to excuse me now. I’m a very busy man. My physician’s assistant, Jeremy Anderson will explain all of this to you. Goodbye.”
Michael was stunned. Did I offend him? What’s goin’ on? He blurted out, “Please, wait!”
Tamayo stopped, turning from the door with a stern look of animus. He took a deep breath, trying to calm himself. “Yes, what it is it?”
“I’m sorry, Dr. Tamayo, but I have so many questions. I think I’d rather talk with you, instead of your assistant. Would that be okay? I’ll make it quick.”
The doctor had three patients waiting in exam rooms. He saw an opportunity. I’ll quickly dispatch my next patient and return to Conti after Jeremy talks with him. I can offer my invitation again. He regained his composure. “Senor, I understand. Please let Mr. Anderson assist you for now. I’ll return in a few minutes to answer any questions you have. Jeremy is quite good. I’m sure he can answer most of your questions.”
Without waiting for a response, Tamayo yanked the door open and left.
Michael felt abandoned--sitting alone in the exam room, more nervous and worried than ever. At the nurse’s station, the doctor scribbled some notes on a sheet of paper and handed it to his assistant. “Take care of this kook, Jeremy. He’s a neurotic mess.”
A few minutes later, the assistant entered. “Hello, Mr. Conti. I’m Jeremy Anderson. The doctor has given me instructions for your testing and preliminary treatment.”
“Treatment? What treatment? Dr.Tamayo kinda left me hangin’ without fully explaining my condition. He left in a hurry. I think he was upset.”
“Don’t worry about him. He’s often moody. I’ve learned to ignore it. He’s given me instructions for some meds and a few tests. I can answer your questions for you.”
“What did he say about me? Does he think I have a heart problem?”
The assistant smiled, thinking of Tamayo’s comments—a neurotic kook. “The doctor thinks you might just have a case of the nerves. Perhaps you’re too worried about your symptoms. However, he does want to exclude coronary artery disease. You may have angina.”
“Angina, that’s chest pain from blood vessel blockages, isn’t it?”
“Yes. You could have some narrowing in the arteries to your heart. When you exert yourself, such as running, the narrowed spots may not let enough blood through to satisfy the heart's increased demand for oxygen. That can cause shortness of breath and chest heaviness.”
Michael’s face fell. He looked down at the floor, thinking of his trouble breathing, chest tightness, arm pain, jaw pain, and upper back ache, everything Tamayo had pointed out. I do have a heart problem, I’m sure of it. It all fits. An unexpected sense of relief soothed him. At least I know what’s wrong. I’ve caught it early—haven’t had a heart attack. I’m gonna be okay.
“Mr. Anderson. . . .? "
“That’s right. Please call me Jeremy. I’m not an MD. You understand that?”
“Sure. jeremy, what can I do to fix my problem?”
“First of all, we’ll give you a few meds to add some protection while waiting for your test results. Dr. Tamayo wants you to start taking one baby aspirin a day, along with a medication called Nitrovasc. Also, if you have symptoms, he wants you to try some nitroglycerine under your tongue.".”
Michael thought, I need nitroglycerine? That stuff’s for old timers. “Jeremy, why nitroglycerine? I thought that was for old men?”
“It will be useful to know if the nitro helps alleviate chest tightness or shortness of breath. Nitro taken under your tongue is rapidly absorbed and quickly dilates coronary arteries. It’s amazingly fast. If it makes your pain stop, that will suggest a heart problem. On the other hand, if it doesn’t help at all, it could be that your heart is okay. It’s not definite either way, but it helps. Your test results will be more important for confirming a diagnosis.”
Michael smiled. “When I here of someone taking nitro, I always think of dynamite.”
“You’re not far off. Decades ago, the idea of using nitro for angina came from workers in gun powder factories. Some of the workers who had angina, apparently reported that their chest pain disappeared while at work. That’s how nitroglycerine came about as a medication.”
He laughed. Michael actually laughed. “No kidding. Who would’ve guessed?” He was feeling more relieved—impressed with Jeremy's knowledge.
The physician assistant went on to answer all of Michael’s queries. Though well acquainted with Tamayo's routine, Jeremy still revealed a hint of reluctance, or embarrassment, while reviewing the exhaustive number of studies the doctor had requested. The order sheet listed an EKG to be done today, a stress nuclear exam, an echocardiogram, a twenty-four hour Holter recording, a carotid Doppler, an ultrasound of the abdominal aorta, a lower extremity vascular exam, routine blood work to include a cholesterol fractionation, and more exotic blood tests for homocysteine and cardiac C-Reactive protein levels.
“Wow! I need all of that?”
Jeremy knew the testing panel was absurd--he knew of the doctor’s greed and blatant abuse of patients and insurance companies. Jeremy was simply biding his time until a better job, with an honest physician, came along. He hoped to soon find work in a reputable office--leaving Tamayo and his disgraceful practice for good.
Jeremy forced himself to keep a straight face. “That’s what the doctor ordered.”
“Then I guess I need it done. I’m okay with that. My insurance from Jeep is pretty good.”
The assistant thought of the unnecessary thousands that Conti’s insurance would soon be charged. Michael would also get a sizeable bill—twenty percent of the total. Jeremy estimated the final charge to be in the range of five to six thousand dollars. After overhead expenses, Tamayo would net close to four grand for an hour of work. A responsible cardiologist would do an EKG, stress test, and cholesterol. That’s all he’d need. Tamayo’s a greedy jerk.
Tamayo entered the room. “So, Senor Conti, has Jeremy answered your questions satisfactorily?”
Michael smiled and gave Jeremy a nod. “Yes, he has. He’s very thorough.”
“Mr. Anderson is excellent. He's the best assistant I’ve ever had.”
Jeremy smirked and gave a subtle skake of his head toward Michael. He remained silent, thinking, I’m the only assistant dumb enough to stick around as long as I have. Tamayo’s office is like a revolving door for employees; secretaries, nurses and physician’s assistants come and go like crazy.
“You can go now, Jeremy. Please take care of discharging Mr. Rupert in room three.“
Jeremy turned to Michael. Good luck, Mr. Conti. Nice meeting you.”
“Thanks, Jeremy.”
As his assistant left, Tamayo took a seat directly in front of Michael.
“Senor, I’m going on a vacation for two weeks. I will be in Cancun, Mexico. However, Mr. Anderson will be checking all of your test results. If there is anything abnormal he will notify you. Otherwise, I will see you back in few weeks--when I return from vacation. Okay?”
“Sure, I guess so. I’ll try not to worry.”
“Very good. My advice for you is to play it safe. Stop all exercising until we have a diagnosis. Believe me, you’ll be running again before you know it. You are a young man. You are going to be, as they say, A-OK. I guarantee it.”
“I feel much better already, doctor. I’ll hold off on exercising until I see you again.”
“That’s excellent. My nurse will be in shortly to write your scripts and do an EKG. Todd will review your electrocardiogram before you leave.”
“Thank you. Thanks again for squeezing me in for this appointment.”
“No problem. It has been my pleasure to meet a man of your stature. Senor Conti, there is one more thing. I would like you to reconsider my offer—my invitation to you and your wife to take a Great Lake cruise.”
Michael thought it over. He’s the man responsible for my care. I don’t wanna piss him off again. “Sure. I think that would be fun. I’ll discuss it with my wife, Laura.”
“Wonderful! As soon as you are properly treated we will take a pleasure cruise. We’ll do some fishing, and of course, some partying. Who knows, we may become good friends.”
Smiling, Michael acknowledged the comment with a nod. “I’ll look forward to it.”
“Goodbye for now, Senor.”
As the doctor left, Michael caught another sparkling flash from his caduceus. At that moment, he realized that Tamayo hadn’t performed a physical examination on him. With the exception of placing a hand on his knee, he hadn’t touched him. His stethescope never left his pocket. It seemed the doctor was more interested in social activities than thorough patient care. Michael was disconcerted. Then he thought about the numerous diplomas, award certifcates and news articles the doctor had displayed in the hallway. Knowing of Tamayo’s high credentials, he thought he should respect the doctor’s intelligence, opinion and authority. After all, who am I to question an accomplished cardiologist?
| Author Notes | Thanks to all reviewers.---Doug |
By cardiodoug
The phone rang. David Barnett picked up. “Hello?”
“Hi, Daddy.”
“Hi, baby. How are you?”
“I’m great, Dad.”
“Well, I’m glad to hear it, Maddie.”
“I’m gonna be in a musical at school.”
“You are? That’s exciting.”
“I get to sing on stage.”
“Wow, that’s wonderful, isn’t it?”
“It’s tomorrow night. Can you come see me?”
“Maddie, I’d love to. I wouldn’t miss it for anything. Is it at your school?”
“Dad, we don’t have a stage there.”
“Oh, yeah. I forgot.”
“It’s at the Bently building.”
“The old junior high?”
“Yep. We get to use their stage.”
“That’s good. That’s a nice auditorium.”
“Have it you seen it?”
“Yeah, your sister was in a show there once.”
“It’s at seven o’clock, Dad. Mom, Erin and Peter are going.”
“Well, honey, I’ll definitely be there. I can’t wait.”
“Thanks, Dad. I’ll see ya tomorrow. Love ya.”
“Love you, Maddie. See you tomorrow. Bye-bye.”
“Bye, Dad.”
Barnett hung up, feeling a surge of love for his little girl. Over the past year his relationship with his children had gotten better and better. He thought about his schedule tomorrow. I’m on call at the hospital. Barring any critical emergencies, I should make it.
David had been home from Atlanta and back in practice for just over a year. All was going well—incredibly well. He hadn’t had a drink for nearly two years-- one year, ten months and three days to be exact. It made a big difference. Dr. Barnett was back on top of his game--more thorough and more efficient than ever. He loved cardiology again, as he had in the early years. Since returning to Toledo he had mentally reviewed his past patient care, during the bad times—during the heavy drinking surrounding his divorce. David prayed he hadn’t harmed any of his patients. In fact, he hadn’t.
He had self-respect and pride in his work, more than ever. Barnett’s life was good. He was content—he loved his sobriety, loved his career and loved his children—he loved life. Only one thing was missing--mutual love between partners. David’s heartbreak from losing Susan was dissipating, but still lingered in his subconscious. He dreamt of her often. In Atlanta he’d learned the importance of moving on—giving up on Susan and finding a new love. It was important for maintaining sobriety, as well as for finding future happiness. David looked forward to falling in love again. He knew intellectually that he and Susan were through and he tried hard to convince his heart of the same. Eighteen years of marriage was difficult to forget. Over the past few months he had occasionally dated. So far nothing had clicked—no chemistry. He’d bide his time. It’ll happen sooner or later.
The morning following Maddie's call, David started hospital rounds at seven am. He did two cardiac catheterizations, saw numerous patients in the hospital and went to his office to see more patients that afternoon—completing office work at six-thirty. Not having had time for lunch, he grabbed a quick bite to eat at a drive through and headed for the Bently building. As he pulled into the school parking lot, his pager sounded. He answered the page using his car phone.
“Mercy emergency room.”
“Hello, this is Dr. Barnett. I was paged.”
“Yes, doctor. Dr. Goetsh needs to speak to you.”
There was a brief pause as David waited for Goetsh to come to the phone.
“David.”
“Hi, Steve. What’s up?”
“Hey, thanks for calling back so quickly. I’ve got a thirty-nine year old guy here with unstable angina.”
“How’s his EKG?”
“It’s normal, but his symptoms are classic. He’s had heavy chest pressure for about twenty minutes.”
“And his tracing is normal?”
“To my eyes it is.”
“He’s probably got a subtotal coronary occlusion. Thirty-nine you said?”
“Yeah, and no risk factors. In fact the guy looks like a jock. He seems to be in great shape. He’s never smoked and has no family history to speak of. His mother died in her sleep last year but there was no autopsy. He had an older sister who died of some illness at age five--not likely cardiac at that age, and his father is still alive at age seventy- three. No health problems."
“Do you have enzymes yet?”
“I just got his CPK. It’s just a bit elevated at 276, but the cardiac fraction is negative..”
“What about his troponin?”
“It’s not back yet. Blood’s at the lab.”
“So, sounds like you're pretty sure it’s cardiac?”
“Yeah. He’s just got that look. He’s a little pale, diaphoretic, nauseated--you know.”
“How about his pulse and blood pressure?”
“Everything is stable at the moment. His pressure’s one-thirty over seventy. His pulse is regular at eighty.”
“Have you checked his pulse-ox?”
“Yeah. It’s fine. Ninety-two percent on room air.”
“Ninety-two percent, that’s good. Listen, Steve, I’m in a bit of a fix here. My daughter's in a school play tonight and it starts in a few minutes. I promised her I wouldn’t miss it. That may sound trite but I think you know the situation."
Goetsh was aware of most of the details of Barnett’s divorce and was empathetic to his family problems. He understood how important his children were to him, especially now.
“Okay, Dave. How about this? All we have right now is my suspicion of an impending infarct. If his troponin is elevated, or his EKG changes, I’ll call you stat.”
“Very good, but I’d like to add some precautionary treatment. Why don’t you give him one chewable aspirin and start a heparin drip. Have you given him any nitro?”
“Just one tab sub-lingual. It didn’t seem to help. Gave him a wicked headache, though.”
"How about morphine?"
"I just ordered two milligrams IV push."
“Okay. Good. If his pain persists on the heparin you can start a low dose nitro drip.”
“Gotcha.Listen, Dave, you go ahead to your daughter’s show. If anything changes I’ll let you know."
“Steve, I’m only five minutes away. Do serial EKGs and enzymes and definitely call if there's anything suspicious. Call immediately if anything changes. I can come right over and start thrombolytics, or take him to the cath lab if necessary. He’s a young guy, Steve. I’ll do an emergency angioplasty if necessary.”
“Sounds good. I’ll give you a call either way. It may turn out to be nothing. Could be a GI problem, reflux or an ulcer."
"Could be, but we have to exclude a cardiac source first. Please keep a close eye on him. I'll be there ASAP if you call. I appreciate it, Steve. Will talk soon."
“You got it.”
Barnett placed his car phone in its dashboard cradle. It was seven-ten. He walked to the auditorium. The show had already started and the seats were shrouded in darkness while brilliant lights illuminated the stage. He scanned the auditorium for his family. With eyes unadjusted to the darkness, he couldn’t see his kids or Susan. Just as well. Sue probably wouldn’t want to see me anyway.
The stage was packed with fifth graders dressed in red, white, and blue outfits. They were marching in unison. David took a seat toward the back and looked for Maddie in the crowd of children. She wasn’t there. At the end of the first performance, just as Barnett's pager sounded, the audience erupted with roaring applause. The beeping from David's pager was drowned out by the ovation. He never heard a thing.
The stage cleared and three girls dressed in Uncle Sam outfits, top hat and all, walked front and center. Maddie was in the middle. David stood and stepped into the isle and waved to his daughter. She smiled and waved back.
The girls sang a wonderful, mildly off key rendition of the school anthem. David was enthralled. Once more, as the trio ended their song, the crowd broke out with thunderous applause. The girls removed their hats and bowed.
David saw Susan standing just two rows in front of him. Erin and Peter were on their mother's left, and a man was standing on Sue's right. It was his old nemesis, Gary Keller. Barnett’s heart sank. She brought him along! With my children!
David felt a sudden urge to leave. He didn’t want to be seen by them, especially with her boyfriend there. Besides, he had to call Mercy Hospital to check on Goetsh’s patient. He walked out to his car and glanced at his watch. It was seven-thirty five. He checked his pager. The digital screen illuminated with a message, call 555-1444. . . 911. The message had been called in at seven-sixteen, twenty minutes ago.
He checked his watch again. Shit! It’s been nearly half an hour. Why didn’t I hear that page? He jumped in his car and called the hospital.
“Mercy emergency room.”
“This is Barnett. Let me speak with Dr. Goetsh right away, please.”
“Yes, Doctor.”
“Dave, where ya been?”
“I’m sorry, Steve. I never heard the page.”
“This guy’s in trouble, David. His repeat EKG shows big time ST elevation across the precordium. His enzymes are through the roof and his blood pressures dropping!”
“Damnit! What is his pressure?”
“Around eighty systolic, Dave.”
“Hang some dopamine.”
“Already done.”
“Thrombolytics?”
“Already going, buddy. I decided not to wait for your call and went ahead.”
Barnett felt a wave of relief. No harm done by my absence. Goetch took care of it. “That’s good, real good. Listen, Steve, I’ll be there right away. I wanna take him to the cath lab. Have the operator call in the cath team?”
“No problem. I’ll call right now.”
“Steve. Try to keep his pressure over ninety with dopamine. Give him fluid, gingerly, only if you have to.”
“You got it, doc. See ya in a few minutes.
Barnett was upset with himself. He felt a twinge of shame and guilt; his usual reaction when things didn’t go just right. Shit. This guy’s my age, thirty-nine. I’ve gotta save him.
Feeling restrained, he yanked off his tie and sped out of the parking lot. Caught by two red lights, he came to a full stop at each and cautiously drove through. He pulled into the hospital parking lot three minutes later. David jumped out of his car and ran to the emergency room entrance, nearly smashing into the slowly opening automatic doors. Walking quickly past the receptionist, he slapped a wall plate door opener and yelled for Dr. Goetsh.
“Cindy, where’s Goetsh?”
“Hi, Doctor B. He’s with your patient in room one.”
Barnett entered the treament room. Michael Conti was lying on a gurney with I.V. drips running in both arms. He was naked from the waist up and had EKG electrodes pasted to his chest. A nasal oxygen cannula was draped over his face. His eyes were closed. He looked pale and sweaty, just as Goetsh had described.
David looked at the EKG monitor overhead. His heart rates increased to a hundred and ten beats per minute.
Goetsh was standing at the end of the gurney.
“Steve, gimme a quick update.”
“David, glad to see you. He’s not doing so well. His blood pressures hovering in the nineties with dopamine at ten micrograms. His cardiac rhythm is stable, no ectopy, but his heart rate’s climbing. Dave, I think he’s having a big anterior.”
“Have you called the cath team?”
“They’re on their way.”
Barnett reviewed Conti’s EKG tracings. As Goetch said, the first one was completely normal. The second EKG showed subtle changes suggesting coronary disease, nothing remarkable. However, the third EKG was grossly abnormal, showing evidence of a massive heart attack involving the front section of Michael Conti’s heart.
David’s sense of guilt returned. “You’re right, Steve. His last EKG looks like bad news. I’m sorry for not being here earlier.”
“Don’t sweat it. No problem. I don’t think it made any difference. I’ve got him on the proper treatment, don’t I?”
“Yeah, you do. You’ve done a great job. I’m glad you didn’t wait for me to show up.” Barnett appreciated his friend’s reassurance. I guess my absence didn’t matter.
Doctor Barnett pulled his stethoscope from his suit coat pocket and listened to Michael Conti’s heart. He heard what he expected--a loud S-4 gallop. He also heard a systolic murmur. Goetsh interjected.
“David, I think I heard an S-4.”
“Yeah, you’re right. Unfortunately he’s also got a murmur of mitral regurgitation. It may not have been there when you listened. I bet he’s got papillary muscle dysfunction from the MI. We’re gonna have to watch him closely for congestive failure. What’s his pulse-ox doin’, Steve?”
“He’s running in the low nineties, but he’s on six liters of oxygen.”
“We’ve gotta get him to the cath lab as soon as possible.”
Barnett looked into Michael’s face, gently touching his cheek to get his attention. Michael Conti’s eyes opened. “Mr. Conti, I’m Dr. Barnett. I’m a cardiologist. A heart doctor.”
Michael didn’t speak. His eyes were filled with fear. David felt an urge to reassure him.
“Mr. Conti, can you hear me?”
Yes, Doctor, I can. Where’s Laura? My wife, Laura. I wanna see her.”
“Okay, I understand. I’ll have her come in soon. Mr. Conti, you’re having a heart attack.”
“I know. It hurts horrible.”
Barnett turned to Goetsh, who anticipated his question.
“David, we’ve already pounded him with morphine. I had to back off when his pressure dropped.”
“Mr. Conti, you’re going to be alright. But you have to fight this thing. I want you to try and stay awake. You need a heart catheterization. I want to open your blocked artery with a balloon. You’ve heard about balloon angioplasty, haven’t you?”
“Yeah, I have. Do whatever you want. I wanna see my wife. I wanna see Laura.”
“I’m going to talk with your family, Michael. Then she’ll come in to see you. I promise.”
Barnett turned to Karen, the nurse in charge. “Karen, is his wife here?”
“Yes, Doctor B. She and Mr. Conti’s father are in the waiting room.”
“Please have them taken to the conference room. I’ll be there in a sec.”
Karen left to move the Conti’s to a private area. David walked to the nurses' station to review Goetch's notes and the lab results on Conti's clipboard. He noticed Michael's birth date as August 20th, 1960. This guy is exactly a week younger than I am. Barnett perused Steve’s notes. Michael had no past medical problems. Goetch had noted that Dr.Tamayo had seen Michael Conti less than two weeks ago. Barnett returned to room one. “Steve, he saw Tamayo?”
“Yeah, he told me he’d been having some chest and arm complaints. His wife picked Tamayo at random from their insurance booklet. Some bad luck, eh.”
“I’d say so. Did you call the infamous Dr. T?”
“He’s out of town. Down in Mexico on vacation.”
“He should do us all a favor and not come back!”
Goetsh chuckled. “That would be nice.”
David returned to Steve’s notes. As expected, an incredibly complete and expensive cardiovascular work up had been performed at Tamayo’s office. Since Michael hadn’t received a call, he had assumed everything was normal. Barnett wasn’t surprised. He’d seen patients with totally normal stress tests die just a week or so later from a heart attack. It was rare, but it happened. He shook his head, thinking, Cardiac stress tests have pitfalls. Even nuclear exams. They’re just not fool proof. David turned back to the charge nurse. “Karen, let's move him to the cath lab right after his wife visits. I’m gonna talk with his family. I want his wife to see him before he goes.”
“Okay, doctor, I’ll get right on it.”
Barnett left room one for the conference room, an area for confidential discussion of critically ill patients. The Conti’s, Laura and her father-in-law, had been seated at a small, circular table in the center of the room. They anxiously awaited the cardiologist. David walked in and saw an elderly man sitting next to an attractive brunette. He took a seat next to Michael’s father and introduced himself. “Mr. Conti, Mrs. Conti, I’m a cardiologist. I’m David Barnett. I just saw Michael.”
Laura blurted out, “Doctor, is my husband okay?”
Barnett paused as Carlo interjected. “Doctor, we’ve been here for more than an hour. Where the hell have you been? I demand to see my son. I want information and I want the truth. I want the truth.”
David was stunned. Laura looked down at the table as Carlo glared at Barnett. “Yes, sir. I understand your frustration. This is a very critical situation for your son.”
“Then start talking, doctor. I want answers.”
Barnett turned toward Laura. Her eyes were teary. “Please, how is Michael?”
“Michael’s in trouble, Mrs. Conti. He’s having a very serious heart attack.”
Carlo broke in again. “What are you talking about? My daughter in-law tells me my son was given a clean bill of health just two weeks ago. Dr. Tamayo told him his heart was fine. You doctors are all the same. Money’s the bottom line. You don’t give a shit about your patients, do you? Explain it to me! How the hell can this be happening? How sure are you about this and where the hell have you been? We’ve been sitting here waiting--waiting for you.”
Barnett was astounded. He didn't know what to say. “I’m sorry you feel that way, Mr. Conti. All I can tell you is that everything possible has been done to help your son. Despite that, I have serious concerns. I intend to take him to the cardiac catheterization lab right now."
Laura looked into David's eyes. “Please, tell me what’s going on. The other doctor, Gatch, I think. He told us he wasn’t sure this was a heart problem. What happened?”
“Mrs. Conti, you’re husband’s diagnosis wasn’t evident when he arrived here at the hospital. That’s when Dr. Goetsh spoke with you. Since then it’s become apparent that Michael is having a myocardial infarction, a heart attack. I’ve reviewed Goetsh’s treatment. He’s given the appropriate treatment in every respect. The last resort is to take Michael to the cath lab. I hope to help him with a balloon dilatation of his blocked coronary artery. Maybe a stent.”
Laura was frantic. She practically screamed, “Last resort! You mean he could die, here--tonight!"
David responded in a soft voice. ‘’Yes, he could.”
Carlo was leaning back in his chair with a look of bewilderment and disgust, thinking about Cassandra and Marie, oblivious to what was just said. He turned to Barnett. “So, doctor, tell me, what the hell are you going to do to help my son?”
Mr. Conti’s accusatory tone would have made most doctors angry and defiant. Instead, Barnett felt another jolt of guilt for being late to the emergency room. He took a deep breath, kept his cool and answered. “Mr. Conti, Mrs. Conti, I’m going to do everything in my power to help Michael. However, you must understand that he’s in a very serious situat . . .”
Carlo jumped in again. “You’ve told us that, you moron. What are you gonna do about it!”
David was dumbfounded. In his entire career he’d never encountered such a rude, offensive man. He was tempted to walk out. Instead, he again turned to address Laura. “Mrs. Conti, I should go now. I’ll take you to see your husband, but it has to be quick. I want to start his cath as soon as possible.”
He gave Carlo a cross look and delivered a bit of retaliation. “Mr. Conti, you have to stay here. I’ll have a nurse keep you updated during the procedure.”
Carlo defiantly crossed his arms. “I demand to see him!”
Laura gave the doctor a look of despair and a tiny shake of her head, as if to say, Please don’t let him.
Barnett ignored the old curmudgeon, helped Laura to her feet and asked her to wait outside of room one. Carlo stood and grabbed David by the arm. “Listen, my son is everything to me. I expect you to save him.”
David felt the old man’s fingers digging deep into his forearm. “Mr. Conti. I intend to do my job. I’ll be back to speak with you. Now let go of me!”
The doctor pulled his arm loose and left the room, closing the door hard behind him.
By cardiodoug
Barnett entered the cardiac catheterization lab wearing blue scrubs and a lead apron. He handed his cell phone and pager to Nikki, who placed them on a counter. The cath crew, Marsha, Jennifer and Nikki, had come in from home for the emergency procedure. Michael Conti was on the cath table, covered chin to toe with a sterile drape. It had an opening over his right groin where the nurses had shaved and prepped Michael's skin in preparation for needle puncture access to his femoral artery.
"Marsha, what's his BP?"
"Ninety to ninety-five systolic, Dr. Barnett. He's on dopamine at twenty micrograms."
Twenty mics of dopamine is a massive dose, thought Barnett. The cardiac monitor showed a sinus tachycardia at one-hundred-twenty beats per minute. His heart rate was climbing. Michael Conti was in a dire situation.
David put on a mask and head cover, quickly scrubbed in and had his scrub nurse, Marsha, help him don a sterile gown and gloves. It was eight-fifteen p.m.
* * *
In the ER conference room, Carlo Conti was pacing the floor. Laura remained seated at the table, starring down with tear filled eyes--head held in her hands.
"Laura, I can't stand this. I'm goin' out to my car to call my brother."
Laura nodded. She thought of calling her parents.
* * *
David walked to the head of the cath table to speak with his patient.
"Michael, are you okay?"
"I'm still here, doctor. My chest pain's gone."
"Good. We're going to start the procedure now. You'll feel a needle stick in your groin. I have to inject some anesthetic. It's gonna sting."
"I'm ready."
Barnett used his fingers to locate Michael's femoral pulse, injected Lidocaine in the overlying skin, and gently rubbed the area to dispense the anesthetic. He waited a minute to let the numbing effect set in, and inserted a sixteen-gauge needle through the skin toward the femoral pulsation. Michael was thin; hitting the target was easy. A stream of bright red blood shot from the head of the needle. Marsha, standing next to Barnett, called out, "We have arterial." Nikki noted the time of femoral puncture on Michael Conti's chart.
* * *
Carlo Conti was in the parking lot, sitting in his car, using his car phone.
"Hello."
"Tony, It's Carlo."
"Hey, Carlo. What's up?"
"It's Michael. He's in the hospital in Toledo. He's having a heart attack."
"Oh shit! You gotta be kiddin' me. Is he okay?"
"Apparently not. It sounds like he's in trouble. Tony, I'm really scared."
"What the hell happened? Did he collapse? I thought Mikey was in great shape."
"Laura says he's been having chest pain for awhile. He saw some doctor last week. I never knew about it. This afternoon his pain got real bad, so she took him to the emergency room."
"In Toledo?"
"Yeah. I wish I'd never sent him down here to this shit hole. He was better off in Detroit."
"Carlo, I'm sure that has nothing to do with it."
"Probably not."
"My God, Carlo, what else could happen to you? I'll be prayin' for you and Mikey."
"Thanks, Tony. I gotta get back in there to see Laura. She's really shook up."
"Carlo, be sure an' keep in touch. Gimme a call later and let me know how things are goin'."
"I'll call you, Tony."
* * *
Barnett checked the IV lines and injection syringe for evidence of air bubbles. The lines were clear. Marsha presented the tip of a long guide wire to the doctor, who inserted it through the needle into the femoral. The needle was removed and a Teflon sheath was passed over the wire, into Michael's arterial circulation. David removed the wire and inserted a left coronary catheter through the sheath. As he watched under fluoroscopic imaging, Barnett passed the catheter upward through the aorta and around the aortic arch, positioning the tip just above the heart.
* * *
The human heart has four chambers, two atria on top and two ventricles on bottom. The left ventricle (LV) is a strong, muscular chamber responsible for pumping oxygenated blood through the body. The LV receives ninety percent of the coronary arterial blood flow and is the site of nearly all myocardial infarctions. Occasionally, heart attacks occur in the right ventricle--virtually none in the atria.
Myocardial blood supply is derived from three coronary vessels: the left anterior descending (LAD), the circumflex (Circ), and the right coronary (RCA). The LAD and Circ branch off from the short, left main coronary, originating from the left aortic base, immediately above the heart. The origin of the RCA is above the heart at the right aortic base. In most cases, the LAD and RCA deliver a major portion of the blood supplying the left ventricle.
* * *
David cautiously aspirated blood from the catheter, flushed it with saline and made a final check for errant bubbles. The catheter was filled with x-ray contrast and a small test injection was made at the base of the aorta. He carefully positioned the catheter tip in the opening of the left main. His pager sounded.
"I'll get it, said Nikki. She called the number listed on the pager. "Dr. Barnett, you have a consult at Toledo CCU."
"Ask if it's urgent."
"The nurse says it can wait till later if you're tied up."
"Okay, write down the name and room number. Tell 'em I'll be there tonight."
* * *
Laura Conti decided to call her parents. She left the conference room to use a telephone at the receptionist's desk.
"Hello, Mom."
"Hi, honey. How are you?"
"Not so good. It's Michael. He's having a heart attack."
"What! How can that be? He's so healthy."
"I know, Mom. I can't believe it. I'm really worried. Mom, I'm scared!"
"Oh, Laura. I hope he's gonna be okay."
"Mom, what will I do? I can't make it without him."
"You have to be positive, honey. Medical care is miraculous these days. He's gonna be alright."
Laura wept quietly into the phone.
"Your father and I will be praying for you and Michael. Please call back as soon as you know more."
"I will. I gotta go."
"Goodbye, Laura."
* * *
Michael Conti's heart rate had risen to one-hundred-thirty. An intra-arterial blood pressure recording, obtained through the femoral sheath's sidearm, was visible on the hemodynamic monitor. His blood pressure still hovered at ninety millimeters of mercury.
"Mr. Conti, can you hear me?"
"Yeah, doc. I hear you."
"I'm ready to take a picture. You'll need to take a deep breath and hold it when I give the word. You can breathe when you here the camera stop."
"Okay. Tell me when."
* * *
Carlo Conti returned to the conference room to find Laura seated at the table.
"Laura, have you heard anything?"
"No!"
"What the hell's taking so long? Where's that goddamn doctor?"
"Carlo, he's working on Michael. I'm sure he's busy. We just have to wait and pray."
"Wait and pray. Wait and pray. I've been praying my whole life. What good has it done?"
Laura turned to her father-in-law with a look of disgust. Carlo started pacing the floor, muttering to himself. "Pray, pray, pray. Fuck it."
"Carlo! Please stop! Please, I'm terrified enough as it is."
* * *
Barnett stepped on the fluoroscope peddle. "Go ahead, Mr. Conti. Take a deep breath." The x-ray image improved as Michael's diaphragm dropped on inhalation. David quickly moved his foot to the cine peddle to take a permanent, moving picture as he injected contrast. He pushed the plunger on the contrast syringe. Dye flowed into Michael's left coronary system.
Marsha, watching the injection on a video monitor, exclaimed, "Oh, my God!" Her voice hung in the air.
The doctor was stunned by what he saw. He whispered to himself. "Holy shit." The contrast slowly trickled through numerous, tight constrictions in the LAD and Circumflex. Michael's left coronary system was replete with severe atherosclerotic plague. There were high grade narrowings everywhere. His coronaries looked like those of a ninety-year-old man, not a thirty-nine-year-old athlete.
Michael, hearing Marsha's remark, asked,"Is something wrong. Am I Okay?"
"You're fine, Mr. Conti," answered David. "The test is going well."
Wanting no more outbursts frightening his patient, he turned to Marsha, placed his gloved index finger close to his mask, and gave a soft "shh".
Marsha whispered, "I'm sorry."
X-ray contrast is mildly toxic to the heart. Barnett decided to limit his injections to two, instead of the usual five or six. In addition, taking a picture of Michael's left ventricular chamber was out of the question. In his case, the large volume of dye required would likely be fatal. He quietly spoke to his other nurse. "Jenny, we'll only take one more picture. Let's go sixty degrees LAO."
Jennifer moved the x-ray tower to a lateral position.
"Mr. Conti, one more deep breath."
Barnett hit the cine peddle and made a second injection. The left coronary vessels, viewed from a new angle, looked as bad or worse than before. David closely reviewed both pictures on a digital screen. A tight, ninety percent lesion in the proximal (early) portion of the LAD, had a tiny remnant of fresh clot. He pointed to that spot and softly spoke to Marsha. "Here's the culprit. He had a total thrombosis right here. The thrombolytics worked, partially dissolving the clot, but the damage was done. His atherosclerosis is just too severe."
Marsha acknowledged with a nod. David had to do whatever he could to keep the LAD lesion open. A balloon angioplasty would be much too hazardous. The time involved would not be worth the minimal benefit. The safest way to keep Michael's coronaries open would be with increased anticoagulation.
"Jenny, bolus him with another thousand units of heparin and increase his drip to twelve hundred an hour. Marsha, wait about ten minutes for the increased heparin to kick in, then draw some blood for a stat PTT."
David reviewed the coronary pictures again. To make matters worse, there were small collateral blood vessels connecting the distal (end portions) of the LAD to the right coronary artery. Collaterals develop slowly over time, usually years, only when there is demand for blood from an adjacent vessel.
This meant the right coronary had gradually closed off sometime in the past. The collaterals, supplying blood retrograde, backwards from left to right, had protected Michael from an infarction when total blockage of the right coronary occured. He probably had minimal, or no symptoms, at the time. However, when Michael's LAD occluded hours ago, blood supply to his collaterals was cut off. Consequently, he had two simultaneous infarctions--one in the distribution of the LAD, and a second in the distribution of the right coronary. Barnett thought, He's wiped out his anterior wall (front of the heart) and his inferior wall (bottom of the heart) Know wonder he's in shock.
* * *
Shock, in medical terms, occurs when blood pressure is too low to sustain life--usually below eighty systolic. At such pressures, the supply of oxygen to vital organs is inadequate. The kidneys shut down first, liver damage ensues and skeletal muscle starts to necrose. Continued muscle metabolism in the face of poor oxygenation leads to anaerobic breakdown of tissue. Lactic acid, produced by muscle necrosis, is released into the blood stream. Acidosis leads to dangerous electrolyte imbalance. Death follows soon after.
* * *
Barnett, to make sure his suspicions were correct, switched the left coronary catheter for one designed for right coronary cannulation. He injected a small bolus of contrast into the RCA. As anticipated, the artery was totally occluded near its origin.
A cell phone rang. Nikki answered. "Hey, doc, it's your daughter, Maddie. She wants to know if you liked the show?"
David chuckled. What a time for her to call. "Tell her I loved it. She was wonderful."
Nikki relayed the message. "Nikki, tell her I can't come to the phone right now. And remind her that it's past her bedtime."
Nikki laughed. "She said she stays up later now."
"I'm not surprised. Okay. Tell Maddie I'll call tomorrow afternoon."
He turned his attention back to his patient, noting that Michael's breathing was more labored. He checked the pulse-ox reading on the monitor. Michael's oxygenation was suffering the consequences of his extensive infarction. And, despite huge doses of dopamine, his pressure was falling--systolic BP hovering around eighty. His pulse-ox, on maximal nasal oxygen was critically low. David thought, we need an echocardiodgram to asses his left ventricular function and severity of mitral regurgitation. He needs more oyygen.
"Nikki, call for a stat echocardiogram. We'll do it right here in the lab. Jenny, please call respiratory. Start a non-rebreather mask at one-hundred percent oxygen. Barnett said to himself, he's developing pulmonary edema.
* * *
Pulmonary edema is the medical term for wet lungs--congestion in lung tissue. A damaged, failing heart causes increased back pressure, resulting in the accumulation of fluid in lung tissue. Mitral regurgitation adds to the problem. The congestion causes reduced up-take of oxygen in the pulmonary vessels. In Michael's case, it was an ominous sign.
* * *
"Mr. Conti, we've taken two pictures of your heart. How do you feel?"
Michael was fading. His speech was garbled. "I. . .I'm short of breath. I feel. . . dizzy."
"Okay, Michael. We're gonna fix that for you. Jenny, get me a blood gas syringe."
David aspirated arterial blood from the femoral sheath. It was dark red, not as bright in color as it had been. "Nikki, send this for a blood gas. Tell 'em to run it stat. Jenny, he's gotta be getting acidotic. Push one amp of bicarb, give him twenty of Lasix IV push and turn the saline drip down to keep open. He can't handle anymore fluids. And Jenny, please tell respiratory to get here now!"
Jennifer ran to the supply counter for an oxygen mask, Lasix and bicarb. Nikki, after sending the blood gas, returned to the lab. "Nikki, call anesthesia. I want him intubated. Then call cardiac surgery--ask for a pump tech. I need an intra-aortic balloon pump up here pronto.Jenny, please get that oxygen mask in place. We'll use that until he's intubated."
"I'm on it, doc."
"Nikki, I also need someone to talk with the family. We can't afford to have any of you leave. Call Karen in the ER. Ask her to bring the family up to the cath conference room. "
"Okay, right after I call for anesthesia and the pump tech."
Glancing up to the wall clock, David noted the time. It was ten after nine. They had been in the lab for nearly an hour.
Michael's pressure dropped to seventy-five systolic. Jennifer and Nikki were busy, scrambling around the room, giving meds and making phone calls. Barnett, exhausted from the weight of his lead, ripped off his blood smeared gloves, gown, and lead apron--dropping all of it to the floor. His scrubs were soaked with perspiration. "Mr. Conti, we have to put a breathing tube in your airway. It goes in your mouth, down in your trachea. It'll help you breathe."
Michael murmured something through the mask. David couldn't here what he said. He was getting frustrated. His patient was crashing. "Nikki, what's takin' anesthesia? Where are they?"
"Hey, doc, it's only been a minute since I called. They said someone would be right up. I'll call them aga. . ."
"Forget it. Pull the crash cart over here. I'll do it myself."
The doctor pulled Michael's mask off and used an Ambu bag to deliver three good inhalations of oxygen. "This is gonna be uncomfortable, Mr. Conti. I have to put some pressure on your jaw."
Michael Conti opened his mouth wide. David inserted a retractor blade and pulled up, peering down Michael's throat to locate his vocal cords. The tissue in his airway was swollen, edematous from fluid retention. Vocal cords came into view. "Jennie, hand me that number twenty-one ET tube with a wire trochar."
With his free hand, Barnett carefully slid the wire stiffened tube between Michael's vocal cords, removed the retractor and trochar, and immediately attached the Ambu bag to the tube emanating from Michael's mouth. More inhalations were given. "Jennie, secure the tube with tape. You'll have to bag him until anesthesia gets here. Nikki, call respiratory again for assistance with his airway. Marsha, what's his BP?"
"It's down a little more, bouncin' between seventy and seventy-five. His rates up to one-forty, sinus tach."
Barnett's pager went off. " Nikki, please answer that."
"Dr. B, its the CCU upstairs. You have another consult."
"Ask them what's going on with the patient."
"It's a fifty-five year old woman, doctor. She was admitted through the ER by Dr. Goetch. Her attending want's you to assess her chest pain."
"Okay, Nikki.Tell them I'll run up and check her out as soon as I leave the lab."
"Will do, doc."
David turned back to his patient. He walked to the opposite side of the table and increased the dopamine drip to thirty micrograms, an incredibly high dose. He yelled, "Nikki, where are you?"
"I'm right behind you."
"Oh, sorry. Check his Foley bag for me. See how much urine he's made."
Nikki reached under the long drape hanging from the table. "Not a drop of urine in here, doc."
"None?"
"I emptied the bag when we started. None since."
"Marsha, he's in renal shutdown. Draw blood for stat electrolytes, BUN and creatinine. Jenny, I'll take over bagging while you make up an Isuprel drip. Start it at ten mics. Nikki, give him another bolus of Lasix, eighty milligrams IV push."
A moment later the respiratory tech arrived. "Hi, Dr. Barnett. I'll take over for you."
David knew him. "Thanks, Doug. He's hypoxic as hell. Bag him at a good rate--twenty a minute."
"Okay, I got it."
A small Asian woman in scrubs entered the lab. Barnett had never seen her before. "I Dr. Kim, anesthesia. Sorry I late. I tied up in operating room. You need help?"
"No, we've got it under control."
"Okay, I go?
"Sure, thanks." David thought. Thanks for nothing. Get the hell outta here.
David turned to the digital screen to review the arteriograms once more. There's nothing I can do here. His thrombosis is dissolved and there's no need for an angioplasty. A balloon dilatation would be risky. Besides, I wouldn't know where to start. He has too much disease.
The doctor knew Michael's only chance was to support him mechanically, thereby buying time for his infarction to heal. Even then, the extent of his ventricular damage and the diffuse nature of his coronary atherosclerosis would preclude coronary bypass surgery. If, against all odds, he lived through the night, he would have a rough road of healing ahead. His only chance for a long, meaningful life, would be a heart transplant. The hard truth was that Michael's chance of survival, even for a few hours, was nil.
| Author Notes | This chapter contains loads of medical jargon and technical information. Is it too much? Please let me know.-Doug |
By cardiodoug
“Nikki, did Karen bring his family up?”
“They're across the hall. I have some lab results, doc.”
“Okay, shoot.”
“His PTT is 70 seconds. His blood gas shows a PO2 of 73, PCO2 of 64, and a pH of 6.2.”
David shook his head and grimaced. With the exception of the PTT, the numbers were all bad—very bad.
“Jenny, his PTT’s good. Keep the heparin as is. He’s still acidotic, pH down to 6.2. Push another amp of bicarb. Marsha, send another blood gas. We have to see if his numbers improved after intubation.”
"Right away, Doctor B.”
The large, double wide utility doors to the lab swung open as a bypass pump tech, pushing an intra-aortic balloon pump with one hand, and carrying tubes, cords and other pump paraphenalia in the other, hurried into the lab. “Dr. Barnett, I’ll have things ready to go in a couple of minutes.”
“Thanks. I have to talk to the family. We’ll insert the balloon as soon as I get back.”
“Sounds good.”
“Doug, his PCO2 is up to 64. You’ll have to increase your rate. And he’s very hypoxic. You sure he’s gettin’ a hundred percent oxygen?”
“Yeah. Tubing’s hooked up, max O2 running.”
“Marsha, you and Jenny keep a close eye on him. Titrate the Isuprel to keep a pressure of eighty or higher. Watch his rhythm. If he starts throwin’ any PVC’s, I want you to bolus him with a hundred of Lidocaine. Push it slowly, it could drop his pressure. I’ll be back in a minute.”
David removed his blood stained gown and lead apron. After wiping sweat from his face and hair, he entered the conference room. Carlo was sitting next to Laura at a table. He glowered at Barnett with an angry sneer. David turned to face Laura.
“Doctor, please tell me what’s happening. Is Michael okay?”
“Mrs. Conti, I’m very sorry, but your husband isn’t doing well. He has severe narrowings in all three of his coronary arteries and his heart muscle has been extensively damaged by this heart attack. I hate to say this, but you need to know; I don’t think he’s going to survive.”
Carlo shot up from his chair and screamed. “You son of a bitch! Who the fuck do you think you are to tell me my son’s gonna die? You screwed up, didn’t you? Where the hell were you when we needed you?”
David winced, turned away from the old man and took a seat next to Laura. Carlo sat, glaring at the doctor. Laura Conti was crying.
“Oh, my God. I can’t believe it. My poor Michael.”
“I’m sorry, Mrs. Conti. I don’t know what’s going on here, but your husband has extremely severe arterial disease—much more than would be expected in someone his age. It really doesn’t make any sense. I’m concerned that he may have a genetic problem.”
Carlo shouted. “He doesn’t have a genetic problem you asshole. You’re the problem."
Leaning across the table, Carlo grabbed Barnett by both wrists. David yanked free. "Mr. Conti, if you continue to assault me I'll be forced to have security intervene."
Laura reached out, touching her father-in-law on the hand."Please stop. Just stop!" She shook her head with disgust, cried a bit more, then took a moment to compose herself. “Doctor, please excuse his behavior. He’s really distraught. I hope you can understand.”
David was silent as he stepped to the conference room phone and dialed the lab.
“Cath lab, this is Nikki.”
He spoke in a low voice, nearly a whisper. “Nikki, please clean the room as best you can. Place a clean drape over Mr. Conti. I'm going to have his wife and father come in to see him. This may be their last chance."
"Will do, Dr. B."
“Thanks.” David returned to the table. "Mr. Conti, Mrs. Conti, I think you should see Michael now. His condition remains critical, but he's stable at the moment. I believe he'd like to talk with both of you. My nurse, Nikki will be here in a moment to escort you to Michael's side. Please, It's difficult to say this, but I must tell you that this may be the last time you see him alive. Be prepared to say what's important.You don't want lingering regrets. I strongly suspect Michael knows this is the end."
Carlo stood and walked out of the room. David took the opportunity to talk privately with Laura Conti.
"Mrs. Conti, I know your father in law has lost loved ones in the past, and I’m sure this is devastating news for him. But I can’t tolerate his belligerence. He must calm down or I'll have him removed by security."
“I understand. I'll do my best to settle him but it won't be easy. Carlo's had a problem with doctors, even the medical community in general, for many years. He blames doctors for his daughter's death. She was only five, you know. He's been like this for decades--it's an obsession. He actually abhors, really hates physicians. And now, since his wife's death he's worse. He's consumed by loathing and anger and seems to thrive on it. It's all so irrational."
"I empathize with him, having lost his entire family. It's very sad. Doctors are far from perfect, some are simply incompetent, others are just in it for the money. I hope the death of his children and wife weren't due to negligence."
"I have no idea. Michael never talked about his sister's illness; I don't think he was ever told anything. Carlo never permitted Marie and Michael to see a physician. So I can't blame any doctor, only my father-in-law. Doctor Barnett, You know as much about Michael as anyone, with the exception of that doctor Tamayo, where ever he is."
Laura changed the subject. Doctor, you said something about my husband having a genetic condition. What could that be?”
“Michael may have inherited a predisposition to atherosclerosis, hardening of the arteries. We should discuss that later.I have get back to the lab.”
“What more can you do? Does he need one of those balloon treatments or surgery?”
“Neither of those is possible or indicated at the moment. A balloon angioplasty wouldn’t help, and it would be dangerous. Urgent open heart surgery is out of the question. He wouldn’t live through it. I’m going to put him on a machine; it’s called an aortic balloon pump. It has nothing to do with balloon angioplasty. It’s not a treatment, but may help support his blood pressure. Mrs. Conti, I’m not hopeful. You should be prepared for the worst.”
“I don’t know what I’m going to do without him. Please do all you can.” Her head fell—tears dripping to the floor.
“I’ll do my utmost. I promise. I have to go.”
David literally ran to the cath lab, grabbed his lead from the floor and went to the scrub counter for gloves and a fresh gown. “Marsha, what’s goin’ on?”
“Jenny says his pupils are still reactive, but he’s barely responsive.”
“Okay. How’s his rhythm and pressure?”
“Systolic BP still hangin’ in at seventy-five to eighty. Jenny had to up the Isuprel drip to fifteen.”
“And his rhythm?”
“He started throwin’ some PVC’s. We gave him lidocaine as you said. It seems to have settled things down.”
“Good, that’s good.” David came to the table in fresh gloves and gown and addressed the pump tech. “I’m sorry, I don’t know you’re name.”
“Jim, Jim Novak.”
“You ready to go?”
“All set.”
The tech had prepared the pump equipment. "Jim, I see you've started an arterial line in the left radial. Nice work."
David stepped to the far side of the table, next to Michael’s left groin. He pondered some of the possible reasons for Michael’s advanced arterial disease. “Marsha, draw some blood from the right femoral. Nikki, send the specimen for a cholesterol fractionation. Have the lab send the results to my office."
* * *
A cholesterol or lipid fractionation cannot be run stat. The test would take twenty-four to forty-eight hours. David would later review the results at his office.
* * *
Marsha drew the blood and stepped to the opposite side of the table, next to David. "Okay, Marsha, let's do this."
* * *
An intra-aortic balloon pump (IABP) is a temporizing device used to support heart contraction and blood pressure in the face of severe left ventricular failure. It may keep a patient alive long enough for the damaged myocardium to heal--many days, or weeks if necessary. However, without definitive treatment, such as coronary bypass or heart transplant, the patient will usually not survive.
The IABP is placed by inserting a large catheter with a narrow, elongated balloon at its tip. The balloon, roughly an inch in diameter and six inches long, is positioned in the thoracic aorta, above the diaphragm and below the aortic arch. The pump’s timing is determined by the heart’s rhythm on EKG. The machine inflates and deflates the balloon in synchrony with heart contractions. Deflation occurs simultaneously with left ventricular contraction, thereby unloading the ventricle, so to speak. Deflation creates a vacuum effect, making it easier for the left ventricle to squeeze and pump blood to the body. Inflation occurs during the ventricle’s relaxation phase, providing increased back pressure to the upper half of the body, forcing more oxygenated blood to the brain and coronary arteries, as well as producing forward pressure down the aorta to vital organs, especially the kidneys.
* * *
Jenny prepped the area over her patient's left groin and femoral artery. David inserted a needle into Michael's artery. Blood shot from the tip of the needle, splashing on his chest and arms. He passed a long guide wire, through the needle, into the femoral and half way up the abdominal aorta. The needle was removed over the wire,and the plastic dilator, wide in comparison to that used for coronary catheters, was passed over the wire.
Barnett had to push and rotate the dilator to force it through the tiny puncture site in the skin and femoral. As he removed the dilator, the huge hole made in the arterial wall resulted in a massive stream of blood shooting from the femoral, over his gown, on his arms and abdomen, and on Marsha's chest and neck.
“Oooh,” exclaimed Marsha, as droplets of blood hit her face.
David turned toward her. “Sorry about that." He tossed a sterile gauze to the end of the table. “Jim, could you please clean her up?”
Novak carefully dabbed the blood off Marsha’s forehead and cheek.
David added, “So sorry, Marsha. My fault."
"It’s okay—just part of the job. I’ve had worse.”
Marsha handed the doctor the catheter, which he advanced over the wire into the dilated opening of the femoral. All went well until the catheter tip encountered narrowings in the aorta. Using fluoroscopy, David could see that Michael’s abdominal aorta was riddled with plaque. He carefully navigated the catheter through tortuous turns in the vessel, finally positioning the balloon just below the aortic arch. After removing the guidewire, he passed the open end of the catheter to Jim Novak, who attached it to a hose coming from the balloon pump, set the timing in synchrony with Michael's electrocardiogram, and turned on the pump. Within seconds, Michael's pressure increased to a range of ninety to ninety-five systolic.
So far so good, thought David. I need to check his ventricular function again. “Nikki, please call for another stat echocardiogram. And I need those lab results.”
“Right away, Doc.”
Marsha sutured the left femoral catheter to the skin surrounding the puncture site. Nikki returned, holding two lab slips. “I’ve got his blood gas and chemistries.”
She held the slips up for David to read. Michael’s blood gas was no better than before. In spite of intubation and multiple doses of IV bicarb, he remained severely hypoxic and acidotic. His chemistry labs showed a high BUN and creatinine, indicating acute kidney failure. Importantly, his renal shut down and metabolic acidosis had caused a life threatening rise in his potassium level. If Michael survived the night, he would need urgent hemodialysis by morning.
There was nothing more David could do. The marginal increase in Michael's blood pressure, was not nearly enough to keep his heart, lungs and kidneys from failing.
* * *
Carlo Conti was in his car, ruminating. Despite his son’s impending death, he couldn’t face returning to the hospital. He recalled the horror of holding Cassie’s lifeless body in his arms, and the shock of finding his wife’s pale body lying motionless in bed. The thought of another tragic loss, the death of his son, the end of his family, was too much to comprehend. He couldn’t bear another death. Seeing another body, Michael’s body, would put him over the brink. He feared he would lose control, possibly accost Barnett or tangle with security guards. He had to leave immediately. Carlo slowly drove away, having no idea of where he was going—he just had to leave.
* * *
"Nikki, please check his urine output again."
"The Foley bag’s still empty. Just a couple drops of urine, Doc."
Barnett walked to the head of the table. "Mr. Conti, can you open your eyes?"
Michael couldn't speak because of the endotracheal tube. He did manage to slowly open his eyes. He stared at the ceiling without acknowledging Barnett's presence. A young woman rolled the echocardiogram machine into the lab.
"Thanks for coming so quickly. All I need is a quick look at his left ventricular function."
The tech placed the machine at the left side of the table, adjacent to Michael's chest. David pulled the sterile drape from his patient's torso. The technician took a few pictures as Barnett observed the echo screen. Things looked worse as compared to the prior study. Michael's left ventricle was barely moving. His entire heart was enlarged and his mitral valve was leaking severely.
"That's enough. Thanks again."
The technician left.
Barnett returned to the table at Michael's right groin. The monitor showed a heart rate climbing to the one-thirty, one-forty range. In spite of the aortic pump, his blood pressure had fallen back to eighty millimeters of mercury. As David watched the monitor, Michael's cardiac rhythm changed. He threw two separate, aberrant beats--PVC’s, followed by a couplet, followed by a triplet, and finally, a sustained run of ventricular tachycardia, a potentially fatal arrhythmia.
Michael’s blood pressure dropped precipitously: seventy, sixty-five, fifty, forty. "Jenny, get the paddles."
Jenny grabbed the electrocardioverter and quickly rolled it to the head of the table. She smeared conductive gel over Michael's lower left chest heart and his right clavicle. "Turn it to maximum Joules, asynchronous."
"Okay, got it."
"Shock him.”
“Clear!” Jenny depressed the buttons on each paddle. The machine clicked. The patient's upper body lurched from the table.
Michael was barely aware of the electricity coursing through his chest. He was alive, but his brain was suffering the effects of hypoxia, decreased oxygen. He was having a wonderful dream about Laura. His imaginings overwhelmed him with love for his wife. His mother appeared. She was sitting by his side, patting his forehead—telling him what a smart boy he was. Abruptly, his dream changed. He was pointing a gun at his father. “I hate you, Dad. You’ve ruined my life. I’m gonna kill you.”
Carlo, with his back turned, spoke in a deep, inhuman voice. "You aren't going to kill me. You can't kill me. I'm killing you!"
Michael felt weak, worthless and terrified. He let out an earsplitting scream as his father turned to face him. Carlo had become a grotesgue, gargoyle like creature with an evil, unholy appearance. This thing stared at Michael with a wide, toothy grin followed by a roar of laughter. "A frail wimp like you thinks he can kill me? You're a coward.You're couldn't kill anything!"
Michael raised the gun and squeezed the trigger. The creature disappeared, leaving Carlo behind, lying on the ground, dead. Michael began to cry. His dream was over.
The cardioversion worked. Michael’s heart rhythm returned to a sinus tachycardia and his pressure improved. Jenny heard her patient moan over the ET tube. “Mr. Conti, are you awake?”
He didn’t respond. She took a closer look, stunned by what she saw. Michael had tiny tears rolling down his cheeks. He moaned again.
Marsha yelled, “He’s in V-tach again!”
Barnett reacted. “Jenny, push an amp of epi, an amp of bicarb and another bolus of lido, one-hundred milligrams. I’ll take the paddles.”
He shocked Michael again. “Marsha, what’s his rhythm?”
“It didn’t work. He’s still in V-tach.”
Michael’s blood pressure crashed again. David watched as his patient’s rhythm deteriorated further—ventricular tachycardia progressed to ventricular fibrillation. “V-fib,” yelled Marsha. David quickly stepped back to the head of the bed and delivered another cardioversion shock. “Click—thump.”
His patient's body barely moved this time. Michael's chest and back muscles were dying, no longer able to contract. He remained in V-fib for a few seconds and abruptly went flat line.
“Dr. Barnett, he’s flat line.”
Michael Conti was watching from somewhere high above. He could see his body on the cath table below with Dr. Barnett and the nurses working furiously to save his life. Though knowing he was dying, he felt wonderful—enveloped by a warm yellow glow. He had an exquisite taste in his mouth. Captivating sounds, unlike man made music, beautiful sounds, came out of nowhere. He saw Laura sitting at a table, sobbing. He took comfort in knowing she would some day feel as he did at that moment.
Jenny yelled out, “Doctor B., should I start chest compressions?”
David thought it over. CPR was pointless. There was no reason to extend this any further. “No, Jenny, we’re going to stop. Doug, you can stop bagging him.”
Michael watched from above as he died on the table below. For him, his physical death was inconsequential. He had a euphoric sense of love for everyone: the doctors, nurses, technicians--everyone he had ever known, including his father. He could see Carlo’s car slowly wondering down a narrow road. His father was crying. Michael loved him. All of his father’s ridicule was now meaningless.
Nikki left the lab and returned with a pen light. Barnett checked Michael’s pupils. They were fixed—widely dilated. He listened over his patient’s heart with his stethoscope; no heart sounds."Nikki, record the time of death as ten-forty-eight. Jenny, I’m going back to talk to his wife. Please clean him up before she comes in. Marsha, cover him with a fresh gown. I’ll be back in a few minutes."
Michael Conti, still hovering above, slowly floated away in a blanket of joy and love. He saw his mother walking hand in hand with a young girl. His mother was beautiful. He had never met the little girl, but knew who she was.They were coming to take him home.
Barnett entered the conference room. Laura quickly stood. A look of despondence draped her face. “Mrs. Conti, I’m sorry. Your husband didn’t survive. We had to stop. It was a hopeless situation.”
Expecting the worst, she barely reacted. After a short pause, she asked, “What do we do now?”
“First, I need to talk with your father-in-law. Do you know where he is?”
“I’m not sure. I guess he’s down in the emergency room.”
David called the ER.
“Hello, mercy Hospital emergency.”
“Sherry, it’s Dr. Barnett.”
“Yes, Doctor.”
“Could you please check to see if Michael Conti's father is in the conference room?”
“I saw him leave about a half hour ago. He was headed for the parking lot.”
“Okay, thanks.”
David turned to Laura. “He left awhile ago. The receptionist saw him walking out to his car.”
Laura spoke. “I’m sorry. As you’ve seen, Carlo is out of control. He's so bitter. Actually, I’m glad he’s gone. He’s odd and unpredictable. I can’t imagine what he’d do if he were here right now.”
“I’ll call him later if you’d like.”
“No, I don’t think you should do that. I know he’ll be offensive. I’ll talk to him.”
“Alright, but if there’s a problem don’t hesitate to let me help.”
“Thanks. I will.”
David reviewed Michael’s problem in detail with his wife. They discussed the pros and cons of an autopsy. David, in light of Michael’s severe arterial disease at such a young age, thought it may be best to have an autopsy. However, he had no strong feeling either way. Laura, anticipating Carlo’s reaction, decided against it. Barnett had no objection.
The pair walked to the cath lab for one last visit. David wrote a long note in Michael’s chart. It was eleven-thirty when he left the lab. He had three consults waiting for him, one all the way across town at Toledo Hospital.
Carlo Conti, after wandering around the city of Toledo, eventually, practically by accident, found his way bck to Mercy Hospital. He pulled in the emergency room drive, parked, and sat in his car, staring at the hospital. His cell phone rang.
"It's Laura. I have bad news."
"Of course you do and I don't want to hear it!" He hung up. The demise of his family was the end of everything. His will to live wained as his hatred of doctor's and hospitals surfaced. He was both hopeless and enraged.
Over the past years, Carlo, out of a sense of obligation to Ford Motor, had purchased a new Lincoln Continental on an annual basis. He now sat, transfixed, staring out the windshield of his four-thousand-pound luxury sedan. The Continental was pointed directly at the hospital's emergency room entrance. With mechanical, near robotic motion, he slipped the car in drive. The Lincoln slowly rolled forward. Carlo slammed the accelerator to the floor.
By one a.m., David Barnett had completed his two cardiology consultations at Mercy Hospital. He left the CCU, headed for the ER exit and the doctor's parking lot. The main exit of the emergency room was locked and barricaded. He left via the adjacent ambulance entrance and noticed that the main ER entrance was partially collapsed and cordened off with yellow Police tape. David drove across town to see his third consultation at Toledo hospital.
He arrived home at two-fifteen a.m.; hoping to get a few hours of sleep before starting rounds in the morning. Seconds after he climbed into bed, his cell phone rang. He had an urgent consultation at Toledo Emergency. An elderly woman with an acute MI was in need of attention. He rolled out of bed and got dressed.
| Author Notes | Thanks to all reviewers---much appreciated.--Doug |
By cardiodoug
| Author Note: | Carlo Conti suffers after his son's death. Ray Tamayo avoids blame. |
An American Airline flight from Cancun, Mexico, landed at Detroit Metropolitan Airport on Sunday afternoon. Ray Tamayo, his wife, and his two teenage daughters exited the plane. They were all tanned and happy. Dr.Tamayo, in particular, was pleased with his appearance; his dark suntan contrasting nicely with the silver hair at his temples. He arranged a limousine ride to take his family to their home in Toledo. Detroit Metro is located on the south side of Detroit, a mere forty-five miles from Toledo. The limo ride would take just under an hour.
The doctor’s home was mammoth; a ten thousand square foot mansion built in a Spanish motif with white stucco exterior and a bright orange terracotta roof. Entering the home, they were greeted by the scent of fresh flowers, a welcome prepared by their maid, Annalina. She had cleaned the entire house during the family’s absence, and placed bouquets of fresh flowers in the foyer, kitchen, living area and master bedroom. Annalina, an illegal immigrant from Mexico, had separate living quarters in Tamayo's home.
Ray Tamayo felt invigorated and alive after his vacation, but didn’t look forward to returning to work--especially knowing he would be greeted by stacks of charts in need of dictation, along with piles of unanswered telephone messages. The next day, as usual, he arrived at the office early, never later than seven a.m. The doctor knew that time was money, and for him, money was life.
* * *
On Monday morning Carlo Conti drove his new Lincoln Continental to St. Christopher’s Cemetery in Beverly Hills, Michigan. It was exactly ten days from the night of Michael’s death, and ten days since he had rammed his car into the hospital's Emergency Room entrance. He'd driven directly into a thick, concrete column, one of two supporting a concrete slab roof. His intent to kill himself was foiled by an airbag. Something he had forgotten about. He sustained nothing more than bruised knees and walked away from the crash with naer a scratch. He was not cited by the police, who assumed the distraught old man had either passed out or was disoriented. In either case, they felt he was not responsible for his actions.
He stood at his son’s grave, which was covered with freshly laid sod. His entire family was there, Michael, Cassie, and Marie. Next to Marie’s gravesite was one remaining, unused plot. Carlo placed flowers in front of each headstone. He knelt and prayed—praying for the souls of his children and wife. He spoke to God, apologizing for his life of anger, his pursuit of weatlh and the horrible way he had treated his son. Since the funeral, Carlo had resumed attending Mass every day, praying for forgiveness, doing his best to redeem himself and make reparation for what he perceived as a life of unconscionable behavior. After twenty minutes of solemn prayer, he drove back to his empty home.
* * *
As expected, Tamayo found a large pile of charts on his desk, along with numerous messages and test results. A death certificate, lying on top of a stack, caught his eye. He reviewed the certificate: Michael Conti, age thirty-nine. The name didn’t ring a bell. He couldn’t recall who Michael Conti was, and wondered if the certificate had been delivered to the wrong office. A copy of the emergency room memo regarding Michael’s treatment was paper clipped to the death certificate.
As Tamayo read the memo, he felt a rush of anxiety. Michael Conti suddenly came back to him. What the hell happened? he thought. Leafing through the emergency room notes, he discovered that David Barnett had been called in as a consulting cardiologist. Tamayo knew Barnett well enough to know of his capabilities; he held him in high regard. Ray felt some relief in knowing that Mr.Conti had most likely received good care from Barnett, and realized that he, having been on vacation, had no obligation to sign the certificate. Death certificates are a serious matter, and generally have to be signed within forty-eight hours of a patient’s demise. This certificate was already a week late. He took it out to his secretary and asked her to send it immediately, via courier, to Dr. Barnett’s office.
Tamayo returned to his office and fingered through various medical charts on his desk. He located Michael Conti’s chart from his visit two weeks ago. Inside were numerous test results awaiting his review. As with most of his patients, he had tested Michael to the hilt. The chart contained results from an EKG, a Doppler of the carotids and lower extremities, an echocardiogram, an ultrasound of the abdominal aorta, a forty-eight hour Holter monitor, a nuclear stress test and blood work including a complete metabolic profile, complete blood count, cholesterol fractionation, and some esoteric labs, a homocysteine level and C-reactive protein.
Since Michael Conti was dead, and would never be returning to the office, Tamayo decided there was no need to assess the test findings. He would be too busy with his remaining backlog to waste time on a dead man. He had more important things to attend to. Ray threw Conti's chart in the lower drawer of his desk.
* * *
Time had become Carlo Conti’s enemy. Minutes passed at an excruciatingly slow pace. Three weeks after Michael’s funeral, Carlo had not yet returned to work. He no longer cared about his business, his wealth or his life. He was painfully alone and living in misery; he prayed to God frequently throughout the day, begging for relief from his dire agony—none came.
Carlo tried to escape reality with sleep, but suffered through relentless nightmares that forced him to take short naps during the day--remaining awake all night. He went a month or more without leaving his home, becoming disheveled and unkempt. He wore the same clothes for days on end, never showered and refused to answer phone calls, even those from his office. Carlo Conti, the CEO and President of Conti Manufacturing, had become a destitute, abject recluse.
A major change in Carlo's attitude came just in the nick of time; as he was nearing his breaking point, and seriously considering suicide, an emotional transformation came to his defense. Intense, malevolent anger and a craving for revenge became his salvation. The joy of vengence consumed him, giving him something to live for. His depression was surplanted by a thirst for restitution from those who had destroyed his family. For the first time in many weeks, Carlo Conti was happy.
Characteristicly for Carlo, with his past dedication to rhythm birth control when never wanting another child, he remained oblivious to the contradiction between his hunger for vengence and his desire to please God.
Carlo's new found anger, snapped him out of his catatonic state. He began to venture outside and soon returned to work. At his office, he became preoccupied with planning his attack. By any means possible, he would obtain recompense. Any means included assistance from the one person he knew could help. Carlo had to call his cousin Vico.
“Hello.”
“Vico, it’s Carlo.”
“Carlo, I’m really glad to hear from you. Me and Angela have been worried sick about ya since Mikey and all.”
“I appreciate that, Vico.”
"I felt bad about not talkin’ to you at the funeral. You know how it was--so crowded, and we really didn’t know what to say. It was terrible, Carlo.”
“I understand. Give my best to Angela. Listen, I'm callin’ ya for a favor.”
“Anything, you name it.”
“I wanna hire a P.I., an investigator to do some snoopin' for me--to look into someone’s background.”
“No problem. I know a lot of guys like that. Hope you don’t mind me askin’—why do you need a PI?”
“I’m angry, Vico, real angry. It’s the doctors. I know they screwed up. Michael shouldn’t have died. Marie never should have died.” He hesitated, deciding not to mention Cassandra.
“I know how you feel. Those fuckin’ bastards. Fuckin’ doctors are worse than the goddamn attorneys. Mikey and Marie both gone. It’s your whole family.”
Carlo thought, Vico didn’ t mention Cassie. I’m not surpised. She’s a distant memory for everyone but me.
Vico continued.” You’ve lost your whole goddamn family. I feel for ya.”
Carlo was no stranger to curse words; however, when talking to Vico, four letter words seemed to fly out of his mouth, as if they were mandatory. “You’re right, Vico. Those bastards are all a bunch of greedy assholes. They’ve killed my family and I’m gonna make ‘em pay!”
“Son-of-a-bitch. I know exactly what you mean. I’m so angry I could go after those pricks myself. I don’t know how you sleep at night.”
“I don’t.”
“Fuckin’eh. I’m not surprised, Carlo”
“Vico, I appreciate your help. If you could give me the name of someone who can investigate these crooks it would mean a lot to me.”
“Listen, I’m not gonna give you a name now. I have to think about this. I wanna decide who’s the best man for your job. You’ll get a phone call in a couple a days. I guarantee it.”
“Thanks. Remember to tell Angela I said hello. I appreciate her thoughts.”
“I won’t forget. Like I said, we’re both pretty tore up about this. It’s a fuckin’ bad deal. The big guy upstairs really fucked you over.”
Carlo felt an emotional jolt, stunned by hearing the suggestion that it was God’s doing. Since Cassie’s death, he had been consumed by guilt—religious guilt, Catholic guilt. He struggled with it for decades. He thought, Am I to blame. Is God punishing me for my sins?
"Vico why do you say that? What’s God have to do with this?”
“Come on, Carlo. It’s just an expression. How the hell would I know what God thinks? I was only talkin’ ‘bout all the shit you been through. I know you go to church every day. I know you gotta be prayin’. What good has it done ya? Fuckin’ God. I don’t believe in him.”
“Vico, I’m not blaming God for this. I love God. He’s on my side. Without my prayers I’d have been dead long ago.”
“Okay, I’m sorry for what I said. You hang in there buddy. Remember, you’re gonna get a phone call in a couple a days.”
Exactly as promised, a call came two days later. It wasn’t Vico. It was an investigator named Frankie Belletti. Carlo explained that he wanted background information on all of the physicians involved in Michael’s care: Tamayo, Goetsh, and most importantly, Barnett. The PI said it would be a piece of cake. The majority of the information needed was on the internet in the National Physician’s Data Bank. He promised to get all of the dirt he could find—figured it would take no more than a week of poking around. Frankie would report back soon.
A return call came sooner than anticipated,only four days later. The investigator had already dug up some pertinent information.
“Mr. Conti, it’s Frankie Bell. We spoke the other day.”
“I thought your name was Belletti?”
“Yeah, it is. But everybody calls me Frankie Bell. You know how it is with us Italians."
Feeling disappointed, Carlo thought, I hope Vico hasn’t sent me some low life. “Okay, Frankie Bell, I’m surprised you called back so soon.”
“Yeah, me too. I got some good dope on one a your doctors. Didn’t wanna wait to tell ya ‘bout it."
“Great, what did you find?”
“This David Barnett guy.”
“Yeah, what about him?”
“Fuckin’ guy’s a lush. He’s a boozer. The state board suspended his license. They made him go to treatment, some place down south. He was down there forever, then they let the son-of-a-bitch go back to work.”
Carlo wasn’t impressed with the news. It was interesting information, but likely wouldn’t amount to much. “I’m not sure that’s gonna help. I was with Barnett at the hospital. He certainly didn’t seem to be drunk. Is that all you’ve found?”
“Is that all? I was pretty excited about it myself. But if that ain’t enough, I’ll just keep on diggin’.”
“I’d appreciate it, Frankie. I’d like you to do that. This alcohol stuff may be useful, but I’m hoping for more.” Carlo reinforced his point. “Listen Belletti, check out all of those fuckin’ doctors, not just Barnett. Understand?”
“Okay, okay, I will. I’m on it, Mr. Conti. Call ya again in a few days.”
“I’ll be waiting.”
Three days later he received his return call. “Mr. Conti, it’s Frankie Bell.”
"I hope you have more news for me.”
“I don’t think we’re gonna do any better. I been lookin' around in the background of the docs: Goetsh, Tamayo, Barnett, even the emergency room nurses. Everybody seems clean. This boozer Barnett is the only thing I got for you.”
“I’m disappointed. Tamayo, you sure looked hard at Tamayo?”
“Yea, I looked real hard. Everybody I talked to said the guy’s an arrogant asshole, but that’s about it. He’s squeaky clean. Never been successfully sued, no drugs, no booze, no sex issues, no nothin’. He’s a real greedy bastard, but that’s it.”
“So, you think this is all you’re gonna get?”
“I’m afraid so. I’ll keep my ears open and keep lookin’ a little more, but I don’t think we’re gonna get more than we got.”
Carlo was frustrated. “How much do I owe you?”
“Mr. Conti, I know I told you ten grand when we first talked, but since I feel like I’m lettin’ you down a bit, let’s call it an even eight big ones. That sound alright?”
The money was of little concern for Carlo. He was more interested in the results. “Frankie, tell you what, I’m going to give you the full ten thousand, but I want you to keep your eyes and ears open. Any other information provided will be greatly appreciated and financially rewarding.”
“I understand. And thanks for the ten grand. I don’t feel like I deserve it, but I ain’t gonna turn it down. I’ll be talkin’ to you later, sir.”
“Good bye, Mr. Bell. Keep looking.”
Carlo spent the following week ruminating over his situation. His anger and desire for revenge were as strong as ever. Frankie Balletti had called back without new information. All Carlo had to go on was Barnett’s history of alcoholism. After thinking long and hard about it, he decided he would have to make that work. Now he needed an attorney. Another call to cousin Vico was in order.
* * *
Ray Tamayo, having been home from Cancun for over a month, had long ago finished his backlog of dictations. He said goodbye to his last patient of the day and walked to his office to dictate a note. He pulled his stethoscope from his neck to store it in the bottom drawer of his desk. Opening the drawer, he noticed one last chart needing dictation—Michael Conti’s chart. Shit, I forgot that was in there. Might as well get it over with now. He sat to review its contents.
Conti's chart was jammed with test results waiting for Tamayo's review. Ray started dictating.
The first test in the pile, a normal resting electrocardiogram, was followed by a Doppler study to review the carotid arteries for evidence of plaque. The Doppler was mildly abnormal and was dictated as such. The following test, an echocardiogram, done to review cardiac muscle and valve function, was normal. Michael’s lower extremity Doppler study showed minimal narrowing in the vessels to his legs—nothing serious. An ultrasound of Michael’s abdominal aorta revealed extensive atherosclerosis, unusually advanced for a thirty-nine-year-old, but not life threatening. Since none of these studies had any serious abnormalities, Tamayo dictated them accurately.
The three remaining tests in the pile really caught his attention. He perused the Holter recording’s numerous pages of EKG rhythym strips, stopping short on page five. The EKG showed a short burst of a life threatening arrhythmia--ventricular tachycardia. The doctor quickly leafed through the accompanying diary of symptoms to see what Michael was doing when the V-Tach occurred. He had been jogging, and reported a sensation of skipped heart beats at the exact time of the arrhythmia. Tamayo was in a jam. The serious nature of this arrhythmia would have warranted rapid follow up. Since a Holter requires forty-eight hours of recording, Tamayo could not have reviewed it prior to leaving on vacation.
Furthermore, Michael’s nuclear cardiac stress was markedly abnormal with severe electrocardiograph changes during exercise, indicating that he indeed had significant coronary artery disease. While reviewing the stress nuclear, Tamayo felt a sinking feeling in his chest and a brief wave of guilt—both quickly passed. No need to cry over split milk, he thought. His major concern was the possibility of this test getting into the hands of an attorney. Certainly, Michael should have received urgent attention on that Monday, two days after Tamayo’s departure. It was the doctor’s responsibility to have adequate coverage by another professional, a cardiologist, not merely his medical assistant.
The last test in the pile was a sheet of laboratory results. Most of the results were normal with one major exception When the doctor saw Michael’s cholesterol level his eyes shot open wide as he uttered, Dios Mio! Michael Conti’s cholesterol was a staggering twelve-hundred-eighty-six. Tamayo was stupified; he had never seen a cholesterol level any where near that level
Had Michael’s tests been reviewed in a timely manner, Tamayo could have saved his life—he was sure of it. An angioplasty or coronary bypass would have saved him. However, at this point the test results were moot; the patient was dead. Tamayo's neglect of Michael Conti's cardiac work-up was blatant, egregious negligence that Ray Tamayo could never face publicly. The doctor decided there was no need for further dictation, further thought or further remorse. It was time to move on to more pleasant things.
Tamayo placed Conti’s chart in a special cabinet containing his collection of past mistakes--a secret, padlocked cabinet. The doctor removed the tape from the dictation machine and tossed it in the trash. It’s been more than a month and I haven’t heard a word from Conti’s widow or relatives. Things should be fine--things will be fine, I'll see to it. I’m not gonna worry about attorneys and law suits. Besides, I’ve never been sued in over thirty years of practice. I’m charmed!
* * *
“Hello.”
“Vico, it's Carlo.”
“Hey, Carlo. Did my man call you?”
“Yep. He came up with something I can use.”
“I'm not surprised. Frankie’s a good guy.”
Carlo bit his tongue, thinking Frankie was a louse. “Yeah, he’s alright.”
“What can I do for you now?”
“Vico, I need an attorney. Someone experienced in malpractice. Someone who’s really good.”
“I know just the guy. He’s a fuckin’ bulldog. This guy eats doctors for lunch. But Carlo, he’s a bit pricey.”
“Money’s not an issue. He sounds like the right kinda guy—an aggressive blood sucker?”
“You got it, Carlo. Like I said, he’s a Goddamn bulldog. And this guy’s experienced. I’ve known him for a long time, and from what I hear, he never loses. He's even done some work for me. As you can imagine, if he takes care of my shit, he ain’t no stickler about the law—breaks a few rules now and then, but get’s the job done. Know what I mean?”
Carlo hated attorneys almost as much as he hated doctors, but in this case, the right attorney could be his salvation. “He sounds perfect. However, there’s a potential problem. This case is gonna be in Ohio, in Toledo. I need a guy that’s licensed outside of Michigan.”
“I don’t know ‘bout that. I’ll give him a call and find out if he can work in Ohio, I’ll have him call you directly. I think those guys can get temporoay privelidges outta state. If not, I’ll call ya back and come up with some more names. I know a lotta councelors, Carlo. Like the consiglieres of the old days. They were the best. Most of these new guys are asshole-- greedy bastards, just like the doctors, but some of ‘em are good guys; there willing to give ya an honest day’s work for a few bucks.”
“Sounds like a plan, Vico. I appreciate it. “
“Hey, Carlo. It’s the least I can do. Like I said, me and Angela, we’re really shook up about this whole thing. You deserve some gratification, a little sweet revenge for Christ’s sake, Carlo, you’ve earned it.”
“Vico, what’s this attorney’s name.”
“His name? It’s John Gallagher.”
"He's not Italian?
"Fuck no. Guy's Irish or a Scot--I don't know. But I can tell ya, I know some world history. I study that shit. Those people are fuckin' barbarians, especially the Scots. Gallagher takes no prisoners. He'll do the job for ya, Carlo."
| Author Notes | Thanks to all reviewers for their input. |
By cardiodoug
Carlo Conti pushed the heavy oak doors open, stopped, and gazed around the courtroom. David Barnett was seated next to his attorney at the defendant's table. Carlo hadn't seen Barnett since the day of Michael's death, well over a year ago. He was struck by how different the doctor looked; he was smiling--he looked charming. Carlo's memory of Barnett was of a foreboding, sinister man. This contradiction gave him a brief surge of guilt. Should I be doing this? Am I wrong to seek revenge? As he walked toward the front of the room his thoughts went back to Cassie, Marie and Michael. All gone. All dead because of incompetent doctors. He was sure of it. Older memories from his adolescence remained deeply barried for the present. He looked back at Barnett and saw the evil man he remembered. Now his emotion was anger, not guilt. I'm doing the right thing. The Old Testament says, an eye for eye. I deserve vengeance.
The image of David Barnett, lying on Carlo's retinae, stimulated the visual center of his occipital lobe. A micro second later an electric impulse shot down his spine, terminating at his adrenal glands, initiating the release of adrenalin into his circulation. Within seconds a cascade of neurohumoral events took place in Carlo's body. Catecholamines from his adrenals produced an increase in heart rate and blood pressure. His face flushed as veins in his cheeks dilated. His elevated pulse and pressure forced his myocardium to work harder. As blood raced through his coronary arteries, his heart's demand for oxygen increased. Adrenalin activated his sweat glands. Carlo began to perspire.
Unknown to the old man, there were numerous atherosclerotic plaques in his coronary circulation, the worst of these being an eighty-percent narrowing in his left anterior descending artery, a major vessel supplying the front wall of his heart. As his myocardial workload surged, this partial blockage became a critical impedance to blood flow, causing insufficient oxygen supply to a large portion of his left ventricle. Carlo felt uneasy. He had heaviness in the center of his chest and was short of breath. His perspiration turned to a cold sweat. This sequence of events, from his anger to the onset of chest pain, took less than ten seconds.
Approaching the plaintiff's table, Carlo noticed an ache in his left arm. He took a seat. His attorney, John Gallagher, was yet to arrive. Carlo pulled a small cylindrical bottle from his suit pocket and discretely slipped a tiny pill under his tongue. The medication, rapidly absorbed by the soft, moist tissue of his mouth, dilated his blood vessels. Seconds later his chest heaviness was gone. His left arm pain resolved and his blood pressure and heart rate returned toward normal.
A huge black man, a sheriff's deputy, entered from the far side of the courtroom and escorted the jury to their seats. Carlo, hearing activity behind him, turned to see people, five or six, taking seats in the gallery. He didn't recognize anyone; they were all strangers, street people who liked to attend court, mostly to escape to an air conditioned room during the sweltering months of summer or to seek warmth and shelter from snowy, frigid days in the dead of winter.
As Carlo was about to turn from the gallery, his daughter-in-law entered through the rear of the room. Laura walked to the plaintiff's table to say hello. Seeing only two chairs at the table gave her a sense of relief, offering an excuse to sit behind Carlo, rather than next to him. Laura stepped back to the first bench of the gallery, taking a seat directly behind Carlo. A moment later, John Gallagher appeared.
"Hello, Mr. Conti." Carlo turned to greet the attorney. They shook hands as Gallagher took the seat next to him, then turned to say hello to Laura. She silently responded with a smile. After some small talk, the counselor addressed more pertinent issues. "Carlo, I've been pondereing our approach. I think we should put you on the stand first, before your daughter-in-law. "Are you okay with that?"
"Why does it matter?"
Before Gallagher could respond, Judge Franklin Richardson entered the courtroom. "All rise," the bailiff announced. "The Lucas County Court of Common Pleas is now in session, The Honorable Judge Franklin A. Richardson presiding."
The Judge took a seat in the high backed leather chair behind his desk. "The plaintiff's in this case are the survivors of Mr. Michael Conti vs the defendants, doctors Raymondo Tamayo, Thomas Goetsh and David Barnett." He asked Mr. Gallagher whether a medical facility was involved in the suit.
"No, Your Honor. My clients have excused the hospital."
Richardson was surprised. Nearly every malpractice suit he'd presided over involved a hospital. What he didn't know was that Carlo Conti wasn't interested in money--he was out for personal revenge. In his mind, the hospital had nothing to do with his son's death. John Gallagher, on the other hand, being interested in his share of a large financial reward, had tried to convince Carlo to include allegations against Mercy Hospital. Carlo flatly refused. He wanted to get David Barnett, and that was it.
His Honor spoke again, "Gentlemen, I see we have a visitor from Detroit, Mr. John Gallagher, representing the plaintiffs, Mr. Carlo Conti. and Mrs. Laura Conti. Mr. Theodore Atkins is legal representative for Dr. Raymondo Tamayo, and Mr. Lawrence Burkhardt is representing doctors Stephen Goetch and David Barnett. Is that correct?"
All three attorney's responded with a, "Yes, Your Honor."
"Mr. Gallagher, Attorney Atkins has asked that his client be crossed examined first, with the intent of possible dismissal. Do you have an objection?"
John Gallagher turned to Carlo and quietly explained what the judge was requesting. Carlo was indifferent. He'd never met either Tamayo or Goetch. "It doesn't matter. I really don't give a shit as long as we nail that bastard Barnett."
Encouraged by his client's vehemence, John Gallagher smiled. "We have no objection, Your Honor."
"You may proceed, Mr. Gallagher."
"Your Honor, I call Dr. Raymondo Tamayo to the stand."
Tamayo, seated next to Atkins, stood and walked to the stand. The doctor was dressed for success: expensive looking charcoal suit, powder blue dress shirt with a white collar, and a beautiful, deep-blue silk tie. His light brown skin contrasted nicely with the silver hair at his temples. As Tamayo took his seat at the witness stand, Barnett saw a bright sparkle from a diamond studded caduceus pin on the doctor's lapel. He was sworn in by the bailiff.
John Gallagher approached. "Dr. Tamayo, you are a cardiologist, is that correct?"
"Yes, it is."
"How long have you been in practice, Doctor?"
"Just over thirty years. All here in Toledo."
"Are you board certified in cardiology?"
"Yes, I am. I'm certified in both internal medicine and cardiovascular disease."
Gallagher continued, "You're familiar with the medical history of Mr. Michael Conti, the deceased, are you not?"
"Somewhat."
"You saw Michael Conti as a patient, didn't you?"
"Yes, I did."
"So, you did know him?"
"A little. I saw him once as a new patient in September 200---------?."
"Why did he consult you?"
"He was having shortness of breath and chest discomfort."
"Did you find these symptoms worrisome?"
"Yes, they were suggestive of coronary artery disease but not diagnostic. There were other diagnosis to consider as well."
"What might those be? What other diagnosis?"
"His cheat pain could have been musculoskeletal pain, inflamation of chest cartilage for instance. Mitral valve prolapse would be another consideration. A pulmonary emblism could cause both pain and shortness of breath, as could pneumonia. And, as I've noted in his records, he seemed anxious. Anxiety itself can sometimes mimic angina, coronary pain."
That's quite a list, Doctor. How did you investigate these possible diagnosis?"
"My greatest concern was to exclude pulmonary embolism and coronary artery disease, two life threatening conditions. His resting heart rate was low at fifty-eight beats per minute. That virtually excludes an acute pulmonary embolism. Furthermore, he had no evidence of clotting in his veins, called DVT, deep vein thrombosis, a common source of an embolic clot, a clot that travels through leg veins up to the lungs, which is very dangerous. Coronary disease with angina pectoris cannot be excluded by a physical exam. If I may, I'll dicuss my approach to that diagnosis last."
"Yes, please continue."
Michael Conti's physical examination did not suggest chest wall pain, cartilage pain. His denial of cough or fever made pneumonia unlikely. Ausculatation of his chest was normal, without evidence of infection or mitral valve condition. I ordered a chest x-ray and a white blood cell count, a CBC, to further exclude pneomnia, and an echocardiogram, an ultrasound of the heart, was ordered to exclude mitral valve prolapse, a relatively benign but often bothersome condition."
"Dr. Tamayo, it sounds as though you were quite thorough in your evaluation of these alternative diagnosis. Could you please explain how you investigated Mr. Conti's heart. How did you asses the possibility of his symptoms being cardiac in origin?"
Barnett whispered to his attorney. "Very thorough is an understatement. Tamayo's practice habits are a travesty. A money making machine." Burckhardt nodded to acknowledge.
Tamayo esoterically continued. "New onset angina pectoris in a young man with no risk factors for CAD, coronary artery disease, would be an unexpected finding, however, that is exactly the diagnosis I investigated most intensely. Mr. Conti had an electrocardiogram, commonly called an EKG, and, as I've previously mentioned, an echocardiodgram, a forty-eight-hour Holter recording, a stress nuclear exam, complete blood work, including a cholesterol fractionation, and, for the sake of completeness, an assessment of his arterial vasculature via a carotid artery Doppler, an ultrasound of his abdominal aorta, and a peripheral arterial exam of his lower extremities.Tamayo, seemingly proud of his testing acumen, finished with a smile. A second later, realizing what he'd said, he regretted mentionining the additional vascular studies. He'd fix that later.
Larry Burckhardt turned to Barnett. "Is that standard practice? Sounds excessive." David nearly laughed outloud. "Are you kidding. Tamayo's a jerk, a charlatan. I'd guess he billed Conti for at least four-thousand-dollars for his 'thorough exam', it's ludicrous." Burkhardt skook his head with disgust.
Gallagher, like Barnett, incredulous over the extensive testing ordered by "The Doctor", facetiously commented. "Dr. Tamayo, thats an exhaustive list." Turning to the jury, he smirked, and added, "You surely are dedicted to the cause."
A few chuckles emanated from the the gallery. David Barnett loved it. Gallagher's subtle sarcasm flew right past Ted Atkins' meager mind.
John Gallagher's sarcasm continued. "Dr. Tamayo, certainly this extensive, thourough testing of your patient, wasn't completed on the day of MIchael Conti's office visit, was it?"
Ray Tamayo, arrogantly oblivious to the attorney's sarcasm, replied, "No, that would be impossible. These examinations were peformed over a period of days."
"I see. So, Mr. Conti returned to see you soon after his initial visit. Yes?"
Tamayo cringed inside. Realizing he was being set up for a fall, he tersely replied, "Yes, he returned to undergo the studies I've described."
"I see. So you saw Michael Conti again, soon after his first visit?"
Tamayo's mind raced. I'd like to to strangle this prick. Expecting, hoping for an objection, he turned to his attorney with a look of anticipation. Atkins, still seated at the defendants table, head hanging down, chin resting on his chest, had nodded off. (Add description of Atkins age, early dementia, etc at beggining.)
Gallagher quickly jumped back in befor the judge could addreess the sleeping attorney. "Doctor, did you see Mr. Conti when he returned for testing?"
John Gallagher, Carlo Conti, Laura Conti, Steve Goetsch, David Barnett and Larry Burckhardt all knew that Tamayo had left for Cancun the day after Michael Conti's office visit. Despite that knowledge, Ray Tamayo, rather than admitting the obvious, a reasonable occurance for any doctor, wanting to defy gallagher at evry single turn, He foolishly replied, with out explanation, "No. I did not see see Mr. Conti again." He could hear Atkins snoring.
barnett thinks--maybe ray's not a shrude as I thought--or he's letting his defiance get the the best of him.
"Really! I don't understand, Doctor. If Michael Conti, a young man with symptoms of heart disease, had to return to your office to undergo the extensive testing you've so eloquently outlined, why did you not see him for at least a brief followup visit? Barnett whispered to his attorney."Larry, I love this guy. What a smart ass." Burkhardt replied, "Don't love him too much. He'll be after you pretty soon."
Tamayo, struggling to maintain a professional demeanor"I saw Mr. Conti on a Friday afternoon. He returned to my office, to undergo the testing I've described. I did not see him because I was on vacation. I was in cancun Mexico. I work long hours and I need.... Gallagher not letting him excuse himself, interupted. Thank you sir. We understand everyones right to take a vacation. on Monday, three days after I saw him."
"And Michael died of an acute myocardial infarction, a heart attack, just one week after your evaluation. Correct?"
"That's correct."
"Do you agree with the diagnosis of myocardial infarction as the cause of death?"
"Yes, after my review of Dr. Barnett's findings, I concured."
"Why didn't you ask Mr. Conti to see you again, for follow up?"
"I performed the necessary tests and told Mr. Conti that I would contact him immediately if there were any abnormalities. Otherwise he was to return to my office in one month."
"Were there any abnormal test results, Doctor?"
Tamayo responded emphatically, "No, there were not."
Gallagher pushed harder, "None!"
The attorney's persistence worried Tamayo. Could Gallagher possibly know about the trashed lab tests? Ray began to sweat. After a brief pause, he responded emphatically. "That's right."
"Could you please review the findings from your exhaustive testing."
Something about the tone of Gallagher's voice reassured Tamayo. He smiled, sat back and relaxed with a sense of relief. He doesn't know a thing about it. Now Tamayo could demonstrate his vast knowledge of cardiology and undeniable dedication to his patients. Responding, he spoke rapidly, his Spanish accent more pronounced. "I performed numerous tests. As I've said, Michael Conti underwent and ee-lectrocardeeo-gram, chest x-ray, nuclear cardiac stress test, echocardee-ogram, forty-eight hour Holter monitor, and the blood profile includee-ng a cholesterol fractionation."
The doctor intentionally omitted three of the tests mentioned previously: Doppler studies of his carotids and lower extremities vessels, and the ultrasound of his abdominal aorta. These tests were grossly abnormal, showing extensive atherosclerosis of every artery visualized. After learning of Michael Conti's demise, Tamayo destroyed all evidence of those studies: the written orders and scheduling, the video recordings, and his dictated interpretations.
Barnett couldn't resist another comment to his attorney."Numerous tests. Typical for Tamayo. He ordered thousands of dollars' worth of studies for his own profit and probably didn't even lay a stethoscope on the guy's chest."
Burkhardt murmered something about a Tamayo being a quack.
Gallagher spoke, repeating his question for the third time. "And, as you've said, all of these tests were normal?"
Tamayo, anxiously recalled trashing many results. His pulse raced. "Si. . . I mean, yes. That is correct."
"Dr. Tamayo, isn't it true that you left town for a two week vacation just one day after Michael Conti's office visit."
"Yes, that's true."
"I believe you were in Cancun, Mexico."
"Yes, I was."
"And Michael Conti's unfortunate death preceded your return, didn't it?"
"Yes, it did."
"Then could you please explain to the court how you intended to notify Mr. Conti. How you intended to 'immediately' notify Mr. Conti, as you said, of any abnormal test results, if you weren't even in the city or the country for that matter."
Tamayo kept a straight face as he boldly lied. "I reviewed nearly all of the studies before I left on vacation."
Gallagher pounded away for the fourth time, nearly shouting. "And we are to believe that every study you performed was entirely normal?"
Attorney Atkins, on the verge of dozing off in his seat, awoke in response to Gallaghers --------. "Objection, Your Honor. Dr. Tamayo has answered this question three times."
"Objection sustained. Move on, Counselor."
John Gallagher replied, "Yes, Your Honor", and thought, Whatever the fuck you say, your highness. "Doctor, you said you reviewed 'nearly all' of the studies. Which tests were not reviewed?"
Tamayo, the weekend of Michael Conti's office visit, having been absorbed with planning his vacation, had ignored his office work for days and hadn't reviewed any of Michael Conti's test results. He blatantly lied again. "I personally reviewed Michael Conti's electrocardiogram, cardiac stress test and echocardiogram. The only remaining test, a forty-eight hour Holter recording, was not available until it was returned to my office three days later. Likewise, his lab results, his blood work, was not reported for a few days."
Gallagher paused, mentally reviewing the list of examinations Tamayo had mentioned earlier. "Doctor, what about the vascular studies you performed. I believe there were three, carotid, aorta and lower extremities. Correct?"
"Yes, that's correct. My mistake. I was thinking of a different patient. Mr. Conti did not undergo those tests."
Gallager jumped on the 'mistake'. "I see, so your memory is failing you, sir?"
Tamayo glared at Atkins as if to say, Wake up and object you old fool. Atkins, oblivious, simply stared back at his client. Tamayo had to respond. "No, Mr. Gallagher, my memory is excellent. I see many patients, sometimes as many as fifty-a-day. It was an honest mistake."
Barnett whispered to Burkhardt, "He's lying. I've seen Tamayo's standard work up on quite a few of his patients. He always does a Carotid Doppler, aortic ultrasound and peripheral vascular study. For him, it's routine. It generates big bucks." Burkhardt responded with a subtle shake of his head.
Gallagher let it go. "Doctor, since you were in Cancu at the time of this testing, how did you intend to check the results--the results of Michael Conti's Holter study and laboratory work, his blood tests?"
"I have a very competent physician's assistant, Mr. Todd Dagy. He's worked with me for years. Whenever I leave town, Todd reviews all of my patient's pending test results. He calls me religiously with any significant findings."
The response pleased Gallagher. He smiled and forged ahead. "So, Doctor, your physician's assistant is not an M.D., is he?"
"No, he's not."
"Yet you trust him to decide what is, as you said, 'significant'?"
Exasperated, Tamayo replied with a loud, emphatic, "That's correct, Mr. Gallagher! My assistant is well trained, intelligent and very experienced. I trust him implicitly with his review of test results."
* * *
Years ago, when Todd Dagy was first hired, he was dedicated to his career, worked hard to educate himself and put in long hours learning to interpret a myriad of cardiovascular tests. He was, as Tamayo said: well trained, intelligent and experienced. Unfortunately, over time, things changed. The truth was that Tamayo's physician's assistant ignored most test results when his boss was out of town. It had been years since Todd had called Tamayo to report abnormal test results or patient's problems. Todd resented the doctor for leaving him alone in the office--alone with mountains of cardiac studies in need of interpretation, and scores of undictated charts. Even though Tamayo had cancelled all routine office visits during his absence, Todd Dagy remained responsible for the care of unscheduled patients who required immediate attention, many of whom were critically ill and in need of care that was beyond the training and abilities of a PA. Todd was apprehensive about the game of legal jeopardy Tamayo was playing by leaving a physician's assistant in charge; recklessly exposing Todd and himself to potentially ruinous malpractice suits.
The sad truth was Todd Dagy detested Dr. Tamayo. The only reason he stayed under his employ was because of the salary he could demand--a salary he dearly needed to provide for his wife and three children. Few PA's who would accept the burden and liability of running a cardiology practice in a physician's absence, and Tamayo was well aware of that. Todd Dagy was generously compensated for accepting such responsibility.
* * *
John Gallagher pursued the issue. "Doctor, as you've said, your assistant is not an M.D., and he's certainly not a cardiologist."
"No he isn't, but also, as I've said, he has many years' experience in my office, as well as on hospital cardiac wards. I trust his abilities and judgment without reservation." Tamayo instantly regretted mentioning in-patient cardiac wards.
"Your PA works in the hospital as well as the office? Does Mr. Dagy see Coronary Care patients for you?"
Tamayo could have kicked himself. Once more, he'd have to lie his way out. "Yes, he does. Todd occasionally sees hospital patients in the morning, especially if I'm tied up doing something else, such as working in the cath lab or if I'm across town at another hospital. However, Mr. Gallagher, I always follow-up on each of my patients later in the day. In addition, Mr. Dagy consistently calls me for my opinion and consent if he needs to order medications or other treatments. When I return to the hospital, I review and cosign all of his notes. It's a good system for the patients. They're seen twice a day, instead of once, and I'm made aware of any developing problems early in the day, rather than the afternoon or evening."
David Barnett turned to his attorney. "He's lying again." Tamayo often skipped hospital rounds, leaving Todd Dagy alone to care for critically ill patients. Most of the hospital's cardiology staff, and certainly all of the coronary care nurses were aware of Tamayo's illicit practice habits. Todd Dagy was disgusted by it, but because of his financial needs, he was helpless, or at least shamefully reluctant, to report Tamayo's behavior to the hospital administration.
Most of Mercy Hospital's nursing staff had either directly experienced or had heard reports of Ray Tamayo's hair trigger temper and frightening, vindictive nature. To date, none had mustered the courage to report his lax inpatient attendance to the Director of Nursing or hospital administration. Their fear of Tamayo's retribution, including possible physical harm, kept them quiet.
* * *
Medicare rules clearly state that the primary physician must see his or her hospital inpatients on a daily basis. There is no accommodation made for substitution by a physician's assistant. Furthermore, if a physician submits charges for an inpatient visit he never made, he's committing Medicare fraud. Had the doctor been reported, he, at a minimum, would have his hospital privileges revoked, or at a maximum, would be heavily fined by Medicare and possibly prosecuted.
* * *
John Gallagher, reluctantly accepting the doctor's eloquent (discourse--explanation-etc)regarding Todd Dagy's responsibilities, moved forward with a question on Michael Conti's test results. "Doctor, what were the findings on Michael Conti's Holter and blood lab results, as reported by your assistant?"
Tamayo produced more fabrications. "Mr. Conti's Holter monitor and lab results were perfectly normal. His Holter showed a normal heart rhythym for the entire forty-eight hours of recording. The doctor followed with his most egregious lie of all. "Actually, his cholesterol was better than average for his age."
"Well, Dr. Tamayo, I must admit, as an attorney and not a physician, I don't quite understand this sequence of events. Could you please explain to me and the court, how a thirty-eight year-old man can have the extensive cardiac testing you've described, with entirely normal results and then fall victim to a massive, fatal myocardial infarction one week later?"
The doctor repositioned himself in his chair, straightened his back and sat up tall. His face changed from a look of contempt to a deceptive grin. Barnett knew what was coming. It was what Tamayo had been waiting for. David figured the doctor had prepared an (eloquent) response to this anticipated question. Tamayo sat silently for a moment. His grin changed to a smile of self-content.
Gallagher spoke again, more emphatically than before. "Doctor, please help me with this."
"I'd be delighted, Mr. Gallagher." Tamayo's demeanor exuded an air of importance without overt arrogance. He looked dignified, polished. Sitting even higher, he folded his hands across one knee and began an unexpectedly charming oration. "Despite the tremendous advances made in the field of cardiology over the past twenty to thirty years, we must still, we as physicians, must still put our faith in testing procedures that are not one-hundred- percent accurate. All diagnostic tests in medicine suffer from some degree of fallibility. And so it is with the studies I've described."
As Ray Tamayo continued, his Spanish accent became stronger. He was on stage and he loved it. Incredibly, Gallagher didn't interrupt the doctor's (absurd) discourse. Instead, he let his adversary go on and on, hoping he would at some point, contradict himself, giving Gallagher more ammunition for the fight. Tamayo continued.
"An EKG for instance, may be entirely normal just hours or even minutes before a fatal heart attack. The resting ee-lectrocardiogram is most useful for determining past events, not future events. A Holter monitor may show twenty-four or forty-eight hours of totally normal heart rhythm, even in the presence of severe, underlying coronary artery disease. Echocardiograms give us a beautiful picture of the heart muscle and cardiac valves but they cannot visualize the arteries themselves. The only means of truly "seeing" the coronary vessels is through an invasive test known as a coronary angiogram or cardiac catheterization. This entails insertion of a plastic catheter within the arterial system, followed by injection of x-ray contrast into the arteries themselves. This test is expensive, entails a definite degree of risk and is certainly not indicated in all patients with chest pain. Likewise, in view of Mr. Michael Conti's test results, a cardiac catheterization was not indicated, and, in fact, would have exposed him to unnecessary risk."
Exasperated, John Gallagher, having had enough of Tamayo's nonsense, cleared his throat in preparation to halt the doctor's (-----) Tamayo beat him to the punch.
"The most accurate, safe, non-invasive test available for the assessment of coronary artery status, is a stress nuclear examination. This test is very safe, does not require the insertion of a catheter into the body, and is without a doubt the best procedure available to (assess) a patient for coronary artery disease without subjecting him or her to the potential risks of a cardiac cath. This is the very test that I performed on Mr. Conti. However, Mr. Gallagher, in response to your specific question . . . "
Gallagher sucessfully interupted. "Doctor, please get to the point and answer my question. Tell me why your patient suddenly died a short time following your very extensive examination, which included, as you've stated, numerous normal test results."
"I'm doing my best, sir. It's difficult to explain medical technology in lay terms. I want the jury to understand."
"Your Honor, I'd like to treat Dr. Tamayo as a hostile witness."
Judge Richardson nodded with approval. "You may. Please, get on with this."
Gallagher's voice rose. "Doctor, none of us are fooled by your intellectual presentation. Answer my question in brief, succinct terms."
Tamayo, ignoring the attorney's demand, turned to the jury and continued. "I performed a stress nuclear test on Mr. Conti. However, this test, like most, is not infallible. As I've stated previously, all scientific studies have a degree of error or inaccuracy. Medical tests in particular are subject to problems related to the prevalence of any disease within the population studied. That is to say that the predictive value of the test is often directly related to the probability of the disease being present in the patient being studied."
"Your Honor! This witness is either deaf or delusional."
Barnett loved it. This must be how Tamayo talks to his patients. He snows them with charm and pseudo intellect while robbing them blind.
Gallagher was flabbergasted, his frustration visible to both judge and jury. He couldn't believe Tamayo's audacity. He shouted, "Dr. Tamayo! Answer my question!"John Gallagher was beyond perplexed. His voice rose. "Doctor, please get to the point! You say you want to clarify your position with the jury, while in fact, you are only confusing them further. I want you to . . . ."Ted Atkins stood and voiced an objection. "Your honor, Mr. Gallagher has posed a difficult question and Dr. Tamayo is doing his very best to answer it. The councilor's continued interruptions are inappropriate." Frank Richardson looked at Gallagher. "Objection sustained. Mr. Gallagher, please allow the doctor to continue."
The doctor, taken by surprise by the outburst, flinched. His eyes opened wide as he repositioned himself in his chair, and crossed his arms in defiance.
"Years ago, a statistician by the name of Baye, put forth a theorem which nicely explains the pitfalls inherent in a test such as a nuclear cardiac stress study."
Gallagher smirked, rolled his eyes and wisely, or so he thought, allowed Tamyo to complete his dissertation, assuming the doctor's arrogace would bury him. let the doctor carry on with his diversion. Frank Richardson, amused by the visiting attoney's frustration, remained mute.
"If the test is performed on a population of patients with a known low incidence of heart disease, such as a group of young women, the study will show an unusually high incidence of 'false positives'. These are tests that appear to be abnormal, while in fact, the patient has no coronary problem. On the other hand, it the study population has a high probability of coronary disease, such as a group of elderly, male smokers, the test has a much better predictive value but a higher incidence of 'false negative' results. That is to say, a test which looks normal when the patient does have significant coronary atherosclerosis."
Gallagher could not understand the judge's obvious prejudice against him. He turned his back to the bench and to Tamayo, contemplating his next move. It's because I'm an outsider. He thought. Imported from Michigan. I'm not a Buckeye and the judge resents it. Turning back to face Tamayo, he spoke with a loud, blatant tone of sarcasm. "Please do proceed, doctor". (move this paragraph)
Tamayo, feeling he held the judge's sympathy, sat back and relaxed. He spoke with more animation, gesturing with his hands to intentionally irritate Gallagher. Barnett couldn't believe it. Tamayo's arrogance was astounding.
Of course, Mr. Gallagher. It would be my pleasure to proceed. Mr. Conti, being a male at age thirty-eight, fell between the two theoretical test groups I have described; that is, the young female population versus the elderly male population. In Michael Conti's case, the tests accuracy was less than optimal. His stress nuclear study had both a ten to fifteen percent chance of a false positive result, as well as, most importantly, a ten to fifteen percent incidence of a false negative result. It is my contention that Mr. Conti fell into this unfortunate but well described category of patients who have a totally normal stress nuclear test despite having of severe, underlying coronary artery disease as later discovered at his cardiac cathetherization. In some sense, and I have some hesitation to say this, he was simply unlucky. He had only a ten percent chance of his stress test showing a falsely normal result, but that is precisely what happened."
The word 'unlucky', caught Carlo Conti's attention. To him, Tamayo's discourse was an excuse for missing an obvious diagnosis. The doctor's assertion of Michael having bad luck hacked him off.
Burkhardt turned to his client. "David, does this all make sense?"
"Yes, it does. Tamayo may be greedy and unethical but he's not stupid.
To startle Tamayo, Gallagher took a quick step toward the witness stand. He turned to face the jury, hiding his face from Judge Richardson, and, with blatant sarcasm, smiled, rolled his eyes and spoke. "Doctor Tamayo, I'm sure the jury appreciates your detailed and eloquent review of medical statistics." A few chuckles came from the stand. He turned back to Tamayo. "Doctor, I have a few more questions. Michael Conti, as you've described, had severe coronary artery disease, very severe arterial blockages for a man his age."
Tamayo nodded. Gallagher went on. "You've stated that Michael was a non-smoker and an avid exercise enthusiast. Furthermore, you told us that his blood cholesterol levels were surprisingly normal, I think your words were, 'Better than average'. In light of this, do you have any idea why Michael Conti had such severe hardening of the arteries at his young age?"
The doctor smiled. Gallagher, anticipating another exhaustive dissertation, quickly cut him off, asking, actually demanding him to get to the point. Attorney Atkins was just about to object when Richardson deftly waved him off with a subtle motion of his hand. Atkins sat down without complaint.
Similar to Gallagher, the judge was getting fed up with the doctor's ceaseless commentary. "Doctor Tamayo, I can feel Mr. Gallagher's frustration. It would behoove you to be succinct and brief with your responses. Do you understand?"
Tamayo, offended by Richardson's command, sat in thought for a moment. Who the fuck does this guy think he is. A mere judge, telling me what to do? He tersely answered. "Yes, your honor. I understand very well."
Tamayo continued with comments on genetic factors and cholesterol sub-particles as, to date, poorly understood causes of coronary artery disease. He ended by saying it wasn't the first time he'd seen a young male with such severe, premature coronary artery disease in the absence of identifiable risk factors.
Gallagher accepted the answer without question. Barnett, on the other hand, wasn't satisfied. He'd never personally seen Michael Conti's cholesterol results. (Knowing the stress of an acute heart attack, along with the intravenous fluids and medications Michael was given in the cath lab, precluded David's evaluation of his patient's cholesterol levels .) Barnett was suspicious of Tamayo's description of Michael's cholesterol as being '. . . surprisingly good. Better than average'.)
John Gallagher continued, "I have one final question doctor. As you've so elegantly explained, a nuclear cardiac stress test is not infallible. Likewise, despite the myriad of normal test results you've described, you have acknowledged that Michael Conti's symptoms were, in your own words, 'Highly suggestive of coronary artery disease'. Knowing that, why did you discharge Mr. Conti from your office without pursuing more definitive testing, such as a cardiac catheterization?"
Tamayo, having anticipated this question, was fully prepared to respond. "Very good question, Mr. Gallagher. As I've said, cardiac catheterization does entail some very serious risk--risk that should not be taken lightly."
Barnett whispered to Burkhardt. "Tamayo's full 'a shit it. He's grossly exaggerating the risks and the jury'sa eating it up. In a man Conti's age, the chance of a serious cath complications; such as a stroke, heart attack or death, is well under one in one-thousand. Catheterizations are remarkably safe and yield invaluable information." Burkhardt nodded to confirm his understanding.
Tamayo proceeded with his response. "The most serious complications are stroke, catheter induced myocardial infarction, and the ultimate complication, death. The risk of each of these devastating events must always be weighed against the potential benefits of rushing into a catheterization procedure."
Gallagher balked at Tamayo's insinuation of needlessly 'rushing' into a dangerous procedure. Approaching the witness stand, he placed both hands on the rail directly in front of the doctor.
Tamayo flinched and leaned back, away from the attorney. Gallagher smiled. I finally have him. And he know's it.
"Doctor Tamayo, you've mentioned the various potential complications associated with heart catheterization. However, you've not discussed the frequency of such events, the incidence correlated with, what you called, 'devastating complications'. How about it, Doctor? How often do these bad things happen?"
Larry Burkhardt spoke to David. "Gallagher's trapped him. The infamous Dr.Tamayo, has used cath complications as an excuse to ignore an important diagnostic study on his patient. If those complications are as rare as you've said, David, Tamayo's concern about risk becomes moot. Since he was going out of town, he should have, at least, referred Michael Conti to another cardiologist. Michael's death, seven days later, proves the point."
Tamayo stared at the jury for a long, pensive moment before turning to face Gallagher. "Michael Conti's symptoms were not severe, definitely not disabling, and the diagnoses of coronary disease, in my opinion, was less likely than I initially thought."
Gallagher jumped in. "You're saying you changed your mind, Doctor?"
"Yes. After seeing the patient's normal test results, especially his normal stress test, I concluded he did not have angina pectoris."
"Angina pectoris? Please explain that term to the jury."
("Angina is the medical term for chest discomfort or pain resulting from herat disease, so called hardening of the arteries, the coronary arteries.")
"But you've explained, in great detail, how the tests you performed, especially nuclear stress tests, are not infallible. In your own words, they have a proven incidence of 'false negative results'. Meaning, once again as you've said, 'the test can look normal', when in fact, the patient has significant heart problems. Didn't that concern you, Dr. Tamayo?"
Ray Tamayo was beyond mere irritation. He was pissed off. Fuckin' attorneys, he thought.
They have no clue about the long hours, exhausting work and life and death issues a cardiologist deals with. I should tell this prick to shuve it up his ass.The doctor took a deep breath, mentally reviewed his plan and proceeded with another diversional discourse. "There certainly are many conditions that could cause mild chest discomfort and shortness of breath as Mr. Conti described. Furthermore, in this era of medical insurance capitation, rampant malpractice suits, and sky rocketing national health costs, a doctor must always carefully assess the cost--benefit ratio along with procedural risk before with any expensive or dangerous diagnostic investigation."
Barnett wanted to vomit. he lened toward his attorney. "Larry, this charlatan is back tracking. He's using health care costs as a defense for his negligence. He ordered thousand's of dollars of office testing and ignored the most important procedure because it inconvenienced his schedule. It's nauseating.
Tamayo's pontification continued. "Mr. Gallagher, in light of Mr. Conti's relatively mild symptoms and normal test results, I felt that it would be prudent to not burden him with unnecessary risk and financial expense. Therefore, I deferred a cardiac catheterization until I could observe his response to the medical treatment I prescribed. I gave Mr. Conti a prescription for nitroglycerin along with very specific instructions to go to the emergency room if his pain recurred. He was instructed to take one aspirin tablet a day. In addition, given the possibility that that his pain was musculoskeletal in origin, I advised him to try a brief course of over-the-counter anti-inflammatories. I believe my treatment decisions are medically sound, justified and readily defensible."
Tamayo, to everyone's relief, stopped talking. Gallagher was tired and exasperated. Knowing his client'ss, Carlo's, only concern was to punish david barnett, he reluctantly caved on tamayo. "Your Honor, I have no further questions here."
Judge Richardson, likewise disgusted with Tamayo's verbose arrogance, addressed Attorney Atkins."Mr. Atkins, do you have any questions for your client?"
"Your Honor, I believe Dr. Tamayo's testimony clears him of any wrong doing in this case. I request that he be dismissed from these proceedings."
The( judg) turned back to John Gallagher. "Mr. Gallagher?"
"Your Honor, I'd like to speak with my client."
"Go ahead."
Gallagher walked to Carlo's side and asked if he had any objection to dismissing Dr. Tamayo. Still angry over Tamayo's reference to Michael's 'bad luck', Carlo Conti reluctantly agreed to dismiss. He whispered in Gallagher's ear. "Screw that spic. He's an asshole but he's not the one I'm after."
"Your Honor, we agree to dismiss Dr. Tamayo without prejudice."
Frank Richardson turned to the doctor, still seated at the witness stand. "Dr. Tamayo, you are dismissed from these proceedings for the time being. I must remind you that you could be called for further testimony. You may leave."
Tamayo, snubbing the judge, didn't say a word. He stood, straightened his coat and tie, and slowly stepped from the stand. He strode out as though he were a Nobel Laureate leaving the podium. Once again, David saw a sparkle of light reflecting from Tamayo's diamond studded caduceus pin. He wasn't surprised to see Tamayo pull off a dismissal. Raymondo Tamayo was the most charismatic, conniving, deceitful human being David Barnett had ever known.
| Author Notes | This is part one of a long chapter. I appreciate your review, comments and corrections. |
By cardiodoug
"Mr. Gallagher please call your next witness."
"Your honor, I call Dr. Steven Goetch to the stand."
Steve Goetch presented quite a contrast to the impeccable appearance of Tamayo. He was wearing a tweed sport coat which was a bit too small for his portly midriff. His tie was wrinkled as though he had just pulled it from the bottom of a laundry hamper and his Khaki cotton pants were noticeably casual for the setting. His hair was flattened on one side as though he had just gotten out of bed. He walked to the stand and took his seat.
"Dr. Goetch, you are an emergency room physician is that correct?"
"Yes, that's right, I work in the emergency room at Mercy Hospital."
"And you were the physician in charge the night that Mr. Michael Conti presented with chest pain."
"That's correct."
"Dr. Goetch are you board certified in emergency room medicine?"
"No, I am not. I'm certified in internal medicine."
"You're not board certified?"
"Yes, as I said, I am board certified but not specifically in emergency care medicine. I wasn't officially trained in emergency medicine and therefore can not register for board examination."
"You weren't trained in emergency medicine and yet the hospital allows you to run the E.R.?"
"Mr. Gallagher, I'm fifty-eight years-old. When I went through my residency training in internal medicine, there was no emergency medical training in existence. The very first training program for emergency care in the United States or the world, for that matter, was started at The University of Cincinnati in 1974. I was already in my Internal medicine residency at that time."
Gallagher, caught off guard by Steve's answer, still pushed on. "Could you please explain to the court how you qualify, at this time, to be in such an important position, in charge of a large hospital emergency room, despite your lack of training."
"First of all, I'm not 'in charge' of the department. I'm under the supervision of Dr. Lewis, who is a board certified emergency care physician. Secondly, I began working in emergency rooms shortly after completing my internal medicine residency. I actually have more experience, twenty-six years of experience in emergency care, than any emergency residency graduate in the country. I was doing ER work before ER training existed."
Barnett was pleased with the way things were going. Steve Goetch had just given Tom Gallagher a hard slap, for not doing his homework. Gallagher was angry.
"I understand that, Doctor, but your education as an internist did not give you the preparation that today's ER residencies provide, did it?"
"No!" Now Goetch was getting irritated. He had worked with numerous ER certified docs and had met more than one that didn't know shit about emergency care, especially about working under fire in hectic atmosphere of a busy Emergency Room battle. Steve paused and stared at Gallagher. "Mr. Gallagher, the learning process in medicine is ongoing. It doesn't stop when you leave your residency training. In fact, I believe most physicians would agree, that they learn as much or more about medicine in the early years of practice, than they do in residency training. Textbook medicine and hands-on care, especially emergency care, are two very different things. Furthermore, with regard to the case at hand, as a board certified internist, I am very qualified to deal with chest pain symptoms, heart disease and myocardial infarctions. Probably more qualified than most emergency specialists."
In theory, Barnett agreed with what Goetch was saying. However, he had always been suspect of Steve's EKG reading ability. For some reason, Goetch wasn't very good at interpreting electrocardiograms for acute infarcts. He liked Steve a lot. They had worked together in the emergency room on many occasions and he wanted him to get out of this mess. David's concern for Steve Goetch's medical career was empathetic but misplaced. Barnett didn't know that Carlo Conti had no interest in harming Goetch or Tamayo. He wanted to destroy David, who needed to be more concerned about his own medical future than that of his associates.
Steve Goetch's answers made Gallagher feel small and ill prepared. In light of Steve's disheveled appearance, Gallagher found his responses to be surprisingly pertinent and succinct. He resented the snide nature of the doctor's answers, which made him feel foolish.
Gallagher continued. "So you believe you are as good or better at handling an acute heart attack in an emergency room, than, let's say, some or even most emergency care specialists?"
"What I am saying is that I'm a board certified internist with over twenty-five years of experience in emergency care work, and I feel highly qualified to deal with diagnosing and treating heart attacks."
Barnett was getting concerned about Steve's demeanor. He didn't want him to lose his cool. Gallagher was getting to him.
"I see. Then, Dr. Goetch, can you, in light of your vast experience and expertise in cardiac care, please explain to the jury why Michael Conti died in your emergency room!"
Gallagher's sarcasm was blatant and his question was incredibly confrontational. Goetch sat back in his chair with a stunned look. He turned to Larry Burkhardt with a look of surprise. His attorney, knowing that Michael Conti died in the cardiac catheterization lab, not the emergency room, stood and was about to object. However, he quickly realized that an objection would be passing the buck to his other client, David Barnett. Goetch was doing fine against Gallagher; Barnett was the one he was concerned about. Burkhardt decided to let it pass, and quickly sat down. Turning to David, he said, "I've never worked with John Gallagher but he seems to know what he's doing. Lawyers, including myself, can be real assholes at times. The bottom line is getting the job done."
Gallagher went on. "Doctor, please tell us what happened."
Goetch took a deep breath to relax and responded with mechanical, curt sentences. "Michael Conti was brought to the hospital emergency room by his wife. He had symptoms of chest heaviness. He had pain in his left arm. He was diaphoretic."
"Please excuse me, Dr. Goetch. What does 'diaphoretic' mean?"
"It means he was perspiring. He was sweating. It was a straight forward case of unstable angina versus acute myocardial infarction.
"Doctor, could you please explain to the jury what those two conditions are."
"I'd be glad to. Angina implies that a person's chest pain id due to coronary artery narrowings. Unstable angina refers to a condition in which the chest pain or angina symptoms are of new onset or have recently become more frequent, and / or more severe in nature. Unstable angina often precedes an acute heart attack."
"And Dr. Goetch, what is an 'MI'?"
"MI is short for myocardial infarction. A heart attack. If a coronary narrowing progresses to a complete closure, a one hundred percent blockage of an artery, it cuts off blood flow to the heart muscle, the myocardium. The heart muscle is damaged or in medical terms, 'infarcted', hence the term 'myocardial infarction'."
"I thank you for your succinct explanation."
Goetch subtly smirked and thought, Yeah, right. I'm sure you're grateful.
"Dr. Goetch, "Is it easy to distinguish between angina, unstable angina, and a heart attack or infarction?"
"It is usually easy to tell the two apart but, on occasion, it can be difficult."
"And in Mr. Conti's case, what was your impression? What diagnosis did you make in reference to his chest pain?"
Barnett hoped Goetch would choose his words carefully. It sounded like Gallagher knew where he was going with this. Despite previously appearing to be uninformed, he now seemed quite prepared. He had obviously done his homework on heart attacks, and David sensed that he was going to trap Goetch in a contradiction.
Steve Goetch continued. "Michael Conti's presentation and diagnosis was problematic for a few reasons."
"And what were those reasons, Doctor?"
"His symptoms sounded very much like an acute myocardial infarction, a heart attack, however, he was only thirty-eight years old and, as we have already heard in great detail, he had no apparent risk factors for heart disease. I've seen heart attacks in men his age, even younger, but they usually had factors such as hypertension, high cholesterol or diabetes. Most of them were heavy smokers."
Gallagher, after hearing Steve's anonymous reference to Ray Tamayo's exhaustive review of risk factors, used the opportunity to take a jab at Tamayo. "Yes, we've already heard of Michael Conti's lack of risk factors during Dr. Tamayo's extensive, yet elegant, discourse." A few laughs echoed through the courtroom. "Please go on, Doctor. You said there were a 'few reasons' for the difficult diagnoses. What other reasons were there?"
"I took a thorough history from both Michael Conti and his wife. Michael was an avid runner, an exercise enthusiast, and he had never smoked." Goetch paused and looked around the courtroom. His eyes met with Laura Conti's, still seated on the front bench directly behind her father-in-law. "I was informed by Mrs. Conti, that her husband had just gone through a very thorough cardiac testing regimen by Dr. Tamayo. To the best of her knowledge, all of Michael's examinations were normal. That, of course, made the presence of underlying coronary artery disease less tenable, thereby, making the diagnosis of unstable angina or myocardial infarction less likely. In addition, and very importantly, Mr. Conti's initial electrocardiogram in the emergency room was completely normal."
"Very nicely done, Doctor."
To Goetch, the attorney's comment reeked of sarcasm, and in some sense, suggested that Steve was lying.
"What was your diagnosis when you saw the normal EKG?"
Barnett took a deep breath and waited for Steve's response. This could be trouble, he thought.
Goetch continued, "My impression was the same. The diagnoses was still unstable angina versus myocardial infarction." David sighed with relief. His friend had given the right answer.
"Please tell me how an electrocardiogram can be 'completely normal' in a patient, who we now know, was in the throes of a soon to be fatal heart attack?"
Fortunately for David, Dr. Goetch was feeling better, more confident about his presentation. "It's rare but possible. If the heart attack is 'hyper acute', meaning in an extremely early phase, the electrocardiogram may not show any abnormalities. I've seen this a few times over past years."
The normal EKG findings were of no benefit to Gallagher's case. He opted to ignore it. "What did you do next doctor, after seeing the normal electrocardiogram?"
"I initiated treatment for unstable angina with an order for testing to exclude or 'rule out' an infarction."
"And what was the treatment you administered to Mr. Conti?"
"Mr. Conti was given sublingual nitroglycerin and one aspirin orally. He was instructed to chew the aspirin before swallowing. An IV was started in his arm and treatment was started with an IV nitroglycerin drip, IV heparin and a single dose of IV morphine."
Gallagher's next question confirmed that he had definitely done his homework on the contemporary standard for treatment for an acute myocardial infarction. "Dr. Goetch, the treatment you've described is for unstable angina, isn't it?"
"That's correct."
"If Mr. Conti were, in fact, having a full blown heart attack, 'an infarction' this wouldn't be the correct treatment, would it?
Goetch was getting angry. "It sure would!"
"But doctor, doesn't the standard for care for a heart attack include more than what you've described? David was impressed with, and concerned about Gallagher's medical knowledge.
"Current treatment includes exactly what I have described, along with other treatment if indicated; either thrombolytic therapy or urgent PTCA, percutaneous coronary angioplasty--commonly called 'balloon treatment'."
"Thrombolytic. Could you please explain what that is?"
"Thrombolytic therapy was introduced in the early 1980's and has revolutionized the treatment of heart attacks. It's known by the general public as 'clot busting' or 'clot dissolving' medicine."
"And urgent angioplasty. Doctor, what is that?"
"Angioplasty is an alternative to thrombolytics. If a cardiac catheterization lab is immediately available, the patient can be taken to the cath laboratory for an angioplasty or 'balloon treatment' to open the blocked artery. This procedure is more definitive than thrombolytics but it can produce delays in treatment related to the time required to access a lab, including time to organize the necessary personnel. Time is of the utmost importance in treating an acute MI."
"Dr. Goetch, are you qualified to perform an angioplasty or 'balloon treatment'?"
"Certainly not. That requires a cardiologist."
"Then are you qualified to prescribe thrombolytic therapy, as a non-cardiologist?"
"Yes, I am."
"You are?"
"That's right!"
"Dr. Goetch, are you sure of that? Michael Conti presented to you on the evening of _________. Isn't it true that Mercy Hospital's emergency room policy in _______________ required patient's to be seen by a cardiologist before treatment with thrombolytics could be initiated?"
Goetch paused as he realized his mistake. Barnett shook his head. He couldn't believe the shit Gallagher knew about this case. Goetch finally answered. "Well, yes. I'd forgotten that. That policy was dropped a few months after Mr. Conti's hospitalization."
Gallagher was elated. "You forgot! So Doctor, in Mr. Conti's case, in 19_________,if you had diagnosed an acute myocardial infarction or 'heart attack', you would have needed a cardiologist present to deliver the treatment that you yourself have described as revolutionary. Is that correct?"
Goetch felt trapped. He had a brief urge walk out and go home. His head drooped. His anxiety was obvious as he stumbled through an answer. "Yes, at that time. Yes, yes, that's correct. You're right."
Barnett couldn't believe it. Goetch was losing it over some half-assed policy that no longer existed.
"Doctor, when did it become apparent that Michael Conti, was in fact suffering an acute myocardial infarction and not the less severe condition called unstable angina?"
"When I saw his repeat electrocardiogram. There were new changes on his EKG, suggesting that he was in the early stages of an acute infarction."
"So, as policy dictated, did you call a cardiologist?"
The question made David feel ashamed. Even though Michael Conti's fate was sealed by his severe, irreversible coronary disease, David had always felt badly about arriving late to the emergency room. In reality, his presence made no difference. There was nothing anybody could have done to save Michael Conti.
Steve Goetch went on. "Mr. Gallagher, hospital policy requires an immediate call to the patient's primary doctor if a critical condition exists."
"And who did you call?"
"I asked Mrs. Conti who their family doctor was. She informed me that they didn't have one. I was actually quite surprised by that."
"Why were you surprised?"
"Well, I see many people without a family doctor but they're usually of lower income status, no health insurance, etc. It appeared to me that the Conti's were successful people. I was told Mr. Conti was an auto executive. It just seemed unusual, that's all--unusual to not have a primary physician."
"So, there was no doctor to call?"
"Well, yes there was. Mrs. Conti informed me of her husband's recent visit to a cardiologist, Dr. Ramondo Tayamo. I instructed the nursing staff to call Dr. Tamayo immediately."
"And did Dr. Tamayo respond?"
"No. We reached his answering service. They informed us that he was out of the country."
Gallagher responded facetiously. Taking another shot at Tamayo. "Yes, Dr. Goetch, we've all heard Dr. Tamayo's exquisite explanation on that." More laughter rang through the courtroom. "What did you do then, Dr. Goetch; since you needed a cardiologist?"
"I called Dr. David Barnett."
(Add or precede with judges fatique--gives Gallagher one las t question after wkich courtwill be dismissed.)
| Author Notes | Courtroom scene continues. Malpractice suits against three physicians. |
By cardiodoug
Gallagher asked, "Tell me, Dr. Goetch, out of all the other cardiologists in Toledo, why did you happen to call David Barnett?"
"Dr. Tamayo has an arrangement with the emergency room. Since he's often out of town, and because he's a solo practitioner, he needs help from other cardiology groups to cover his practice during his absence. Dr. Barnett's group offered to serve as his on-call backup. I paged the physician on call for that group, Dr. David Barnett responded."
"And did Dr. Barnett come to the hospital?"
David felt anxious, silently embarrassed. His deep feeling of shame about his late arrival to the emergency room wasn't rational or justified but he couldn't make it go away. Michael Conti would have died regardless of the cardiologist's presence at the hospital. Even If David had been at the emergency room when Mr.Conti came through the door, it wouldn't have made any difference. Despite that, it was David's nature to be hard on himself. He'd been that way since childhood.
Goetch responded to Gallagher. "No. He didn't need to."
Gallagher nearly shouted. "He didn't need to! Please explain that."
"At the time of my initial call to Barnett, Mr. Conti's diagnosis was uncertain. There was no evidence of an acute heart attack and his chest pain was improving on the treatment I've already described--IV nitroglycerin and heparin."
"So, what did you tell Barnett?"
"Mr. Gallagher, this all took place over a year ago. I can't remember the details of our conversation verbatim but I'm sure I explained the situation, telling Dr. Barnett that Mr.Conti's condition was stable and that an acute infarction was yet to be ruled out. I do know that I told him I would call him stat if I wanted him to come in."
"And what did he say? Or, should I ask, what do you recall or believe you recall he said?"
Larry Burkhardt shot to his feet. "Objection, Your Honor. The question implies that the witness is lying." Judge Richardson agreed and told Gallagher to watch his step and rephrase the question.
The attorney continued. "Dr. Goetch, please tell us what Dr. Barnett said in response to your phone call."
Goetch was getting tired of what he considered to be incessant nagging by John Gallagher. His patience was withering. "I don't know exactly what I said, and if asked you to recall what you said to someone over a year ago, you wouldn't remember either. You're wearin' me out, sir."
Someone in the gallery shouted. "Yea, you're wearing on me, too."
Raucous laughter broke out in the courtroom. Richardson slammed his gavel down hard, three times and yelled, "Order in this court, now!" The gallery quickly settled. The Judge, likewise weary from Gallagher's prolonged questioning, tempered his reprimand to Steve Goetch, politely instructing him to direct all statements to the questions at hand. Goetch nodded in agreement. The Judge waived Gallagher on.
"Doctor, I sympathize with your fatigue. I'm getting exhausted myself. However, we're dealing with a serious matter, the death of a young man. This may take a while."
Goetch was silent. Staring at his adversary.
Gallagher proceeded. "Doctor, we'll drop that last question for the moment, if you'd like."
Steve Goetch wasn't going to delay this and leave David Barnett hanging and worrying about what could come up later. "No, I'd prefer to answer now."
"Very good."
"I recall that Dr. Barnett agreed with my diagnoses and said he would be available via his pager or cell phone if needed."
David vividly remembered how badly he felt after leaving his daughter's concert and findind a STAT pager message sent thirty minutes earlier.
Gallagher paused, contemplating his next question. "And, Dr. Goetch, can you recall what time it was when you first called David Barnett?"
"I've recently reviewed the Emergency room memo from that at evening. I called Dr. Barnett at six-fifty pm."
Gallagher pushed on. "Do you recall if the doctor told you where he was; how far he was from the hospital?"
The question startled David. He felt weak, worried and ashamed. What is Gallagher getting at? Burkhardt objected again. "Your Honor, why should Mr. Gallagher care where Dr. Barnett was? It's irrelevant."
John Gallagher quickly addressed the charge, "Your Honor, the importance of Dr. Barnett's whereabouts will become evident with later testimony." Frank Richardson overruled Burkhardt's objection and told Gallagher to proceed.
"Dr. Goetch, did Dr. Barnett tell you where he was? Did he say how long it would take to drive to the hospital if he were asked to come in?"
Steve Goetch was as exasperated as ever. "I don't remember. It's none of my business to ask physicians where they are. He told me he would be immediately available, and in my experience, he always has been."
"But you don't know where he was in Toledo, what he was doing or how long it would take him to get to hospital". And as you said earlier, 'Timing is of the utmost importance' in treating heart attacks."
"No, I didn't know his location and it didn't matter. Dr. Barnett is very attentive to his responsibilities. His whereabouts was none of my concern."
Burkhardt leaned over and asked David a question. "David, what's goin' on here?"
"I have no idea. I did arrive at the ER a bit late because I was at my daughter's school concert. But I don't see how that could be any big deal."
"Dr. Goetch, you previously said that Mr. Conti's condition was improving when you called Dr. Barnett. Tell me, did your patient's condition continue to improve?"
Goetch adamantly answered, "Obviously not."
"Tell us what happened, Doctor."
"I ordered what's referred to as 'serial EKG's', that's three electrocardiograms, fifteen minutes apart. In addition, blood work for cardiac enzymes to exclude a myocardial infarction was ordered to be run stat. As I've said, Mr. Conti had been improving, however, he quickly took a turn for the worse. The severity of his chest pain increased, and his second electrocardiogram looked suspicious for a myocardial infarction."
"Dr. Goetch what do you mean by 'suspicious'?" Did the EKG show a myocardial infarction or not?"
Steve's anger peaked. The attorney was pushing his buttons and he was sick of it. He, somewhat irresponsibly, decided to fire a volley at John Gallagher. "Mr. Gallagher, an electrocardiographic diagnosis of myocardial infarction is not always black and white. Of course, I shouldn't expect an attorney to know anything about electrocardiograms or much of anything else about medicine."
Barnett was shocked. His friend was digging a hole for both of them.
Judge Richardson jumped in. "Doctor, there's no place for personal commentary in my courtroom. Do you understand?"
Steve turned toward the bench, answering with a curt, "Yes, Sir."
Gallagher, very pleased by the doctor's outburst, moved right ahead.
"So, Dr. Goetch, what did you do, since your patient was, as you've said, 'getting worse'?"
"I increased his treatment with a higher dose of IV nitroglycerin, an increased dose of heparin and an additional dose of morphine. I also instructed the nurse to call Dr. Barnett."
"And did Dr. Barnett respond? Was he 'immediately available' as you've said he always was in your experience?"
Goetch paused and glanced toward his friend. David forced a smile. Gallagher repeated the question. "Dr. Goetch, did Dr. Barnett respond immediately?"
"No, he didn't. It took about thirty minutes to get in touch with him."
"I see. Did you finally surmise that Mr. Conti was in fact having a heart attack during this thirty minute delay?"
"Yes, I did. The third EKG was definitely abnormal and his chest pain was not responding to treatment."
"And?"
"And what?"
"Doctor, you must have assumed that I'd review your comments on Michael Conti's ER memo."
"Yes, I did."
"So, please tell me more about Mr. Conti's condition at the time of your second
call to Dr. Barnett."
Steve knew what Gallagher wanted. He reluctantly replied. "And, his blood pressure was falling."
Gallagher added, "And his pulse was increasing and he was pale, in a cold sweat. Is that correct."
Goetch gave a smart ass answer. "Yeah, If that's what I wrote."
Gallagher smiled and turned to the jury. "That's what he wrote." A few jurors laughed at the attorney's odd nature.
"Dr. Goetch, please bear with me on this. I realize I'm merely a lowly lawyer, ignorant of the field of medicine, as you've already mentioned. Therefore, I need your help with understanding this. Wouldn't the best treatment for Michael Conti, at the moment you've just described, have been the initiation of thrombolytic therapy? Which, in your own words was 'revolutionary'."
Goetch responded with a terse, "Yes!"
"But hospital policy at that time, prevented you from administering the thrombolytic treatment that was so desperately needed; isn't that true?"
Burkhardt could see that Goetch was sinking fast. He started groping at straws with objections. "Your Honor, Mr. Gallagher is not qualified to label the situation as 'desperate'!"
John Gallagher quickly jumped in. "Your Honor, the patient died. I think things were desperate."
Richardson overruled Barkhardt's objection and turned to the witness. "Please answer the question, Doctor."
Steve Goetch peered at David with an apologetic look. "Mr. Gallagher, I believe the answer is a 'qualified' yes."
"Dr. Goetch, it's either yes or no, isn't it?"
"No, it's not! I had the personal option of ignoring the hospital policy and proceeding with treatment."
"But you didn't do that, did you?"
"I instructed the nurse to have the hospital pharmacy prepare the dose of TPA, the thrombolytic medicine, and immediately deliver it to the emergency room. It was hung on Mr. Conti's IV line ready to go. I was just about to instruct the nurse to proceed with administration when Dr. Barnett called."
Gallagher sarcastically added, "So, the good Doctor finally got around to answering his stat page."
Richardson cleared his throat and said. "Mr. Gallagher, we can do without the sarcasm."
"Yes, Your Honor."
Steve was determined to help his friend. "Mr. Gallagher, I think the term 'finally' is misleading. It's not at all uncommon for it to take fifteen to twenty minutes for an on-call physician to answer his page. They're very busy people."
Gallagher quickly shot back, "We're not talking about 'most' doctors, here. I specifically asked about Dr. David Barnett's response to a stat page from you. A page to the cardiologist you had, a short time earlier, spoken with, to describe Mr. Michael Conti's potentially dire situation."
Goetch remained silent.
Gallagher paused to give the jury time absorb what he had just said. "Dr. Goetch, what did you do after conferring with Dr. Barnett?"
"I immediately proceeded with the TPA, the thrombolytic therapy. Dr. Barnett said he would be there ASAP. He was only ten minutes away."
"We've previously established that Mercy Hospital's policy for the use of TPA required the presence, and, I assume, permission from, a cardiologist. Is that correct?"
"Yes. At that time it was."
"Did the policy allow clearance to be given by a cardiologist over the phone?"
"We sometimes took orders over the phone after faxing a copy of an abnormal EKG to the cardiologist. If the diagnosis of acute MI was obvious on the EKG, the cardiologist would, at times, order TPA via the telephone. The reason was to expedite treatment and save critical time."
Barnett was disappointed with Steve. He wished he hadn't mentioned the fax. But he understood. Goetch was under fire.
"Did Dr. Barnett ask you to fax the electrocardiograms to him? On either of these calls?"
"He said there was no fax machine available. On my second call, he knew a fax would simply be an unnecessary delay since he wasn't far from the hospital."
"Where was he?"
Burkhardt jumped up with an objection. "Your Honor, we've already covered this ground many times. Dr. Goetch has explained that he didn't know where Dr. Barnett was and he didn't care."
Gallagher remained silent and looked towards the judge.
"Objection sustained. Mr. Gallagher let's get off that topic. Move on."
The attorney continued. "So did you in fact break policy by giving Michael Conti TPA, Dr. Goetch?"
"It was a judgment call on both our parts. It turned out to be the right call."
"I'm sure you did all of this in the best interest of your patient." Goetch was really sick of Gallagher's sarcasm. The attorney continued. "Dr. Goetch did you or did you not break hospital policy?"
Goetch shouted back, "It was a ridiculous, inappropriate policy and the hospital knew it. That's why they did away with it shortly thereafter. Nearly all of the other ER docs ignored that policy because it was in the best interest of the patient to do so. As I've previously enumerated, time is critical when treating a heart attack."
"But doctor, isn't it true that the ER policy on TPA was written because of the inherent risks of treating a patient with such a potent anticoagulant--a blood thinner? Are you sure you were acting in Michael Conti's best interest?"
Goetch felt the insult. "Yes, I'm sure! It's true that the risk of hemorrhage is real, but it's quite rare, especially in a young guy like Michael Conti. Most importantly, he didn't have a bleeding complication from the TPA. As I've said, we made the right call."
"Dr. Goetch, in some sense, Dr. Barnett's absence put both you and Mr. Conti in a precarious position, didn't it?"
Burkhardt objected. "Your Honor, Dr. Goetch has adequately answered these questions."
Gallagher responded, "Your Honor, Dr. Goetch had to break hospital policy because of Dr. Barnett's behavior. I think I have the right to pursue this further."
Frank Richardson squirmed in his chair to reposition the cushion behind his back. He looked uncomfortable as he addressed the attorney. "Mr. Gallagher, I believe the term 'behavior' is a poor choice. However, I will let you continue until the hospital policy issue is resolved. Objection over ruled."
Gallagher turned back to Goetch. "Dr. Barnett forced you to break policy, correct? You subjected your patient to potential harm by acting on an unconfirmed diagnosis in a patient who had not been examined by the appropriate specialist."
Burkhardt leaned over to speak with David. "I can't believe Gallagher is pushing so hard. This is crazy."
"Yea, it worries me. I don't understand what he's after."
All of this cross examination was going over Carlo Conti's head. He was barely paying attention. Laura felt sorry for Dr. Goetch. He had been very kind to her in the emergency room, and she didn't feel he had done anything wrong. If he had broken a rule, it was only to help Michael. She admired him for that.
Goetch responded to Gallagher's last query. "I've personally treated hundreds of patients with TPA, Mr. Gallagher. I have years of experience weighing the risk of TPA versus the benefits. In this case . . . ."
Gallagher interrupted. "Please, Doctor. I' m going to ask you to answer my question with a simple yes or no."
Burkhardt objected again. "Your Honor. Dr. Goetch has already explained the perplexity of the question. A yes or no answer is misleading."
Gallagher turned toward the judge and waited for his response. Judge Richardson's back pain was getting to him. He wanted to get this over with, leave the courthouse and go home to bed. He decided to overrule Burkhardt's objection. "A yes or no answer would help move things along, Doctor. Objection overruled. Please answer the question, Dr. Goetch."
"Steve Goetch looked toward David and hesitantly answered, "Yes.
Yes, we broke hospital policy?"
Gallagher stepped back from the witness stand and turned toward the jury. "Since Dr. Barnett was out of contact, location unknown, for a prolonged period of time,
Dr. Steven Goetch had no choice but to break strict hospital policy. In some respects, Dr. Barnett forced his friend to jeopardize his medical career."
Burkhardt blurted out with repeated objections. Gallagher turned back toward Goetch and raised his eyebrows, as if to ask, isn't that true?
Goetch felt trapped. He glanced back to David, gave a slight shrug of his shoulders and turned to face Gallagher. Frank Richardson, hoping to speed this along, overruled Burkhardt's objection and instructed Goetch to answer.
"Your statement is not true, Mr. Gallagher. Dr. Barnett did not force me to do anything. His location was of no concern, his delay of only twenty to thirty minutes was inconsequential and my career was definitely not jeopardized. As I said previously, I've broken that policy many times in the past. The Director of the Emergency Department was aware of that and never raised a question."
Gallagher paused to collect his thoughts. He felt that he was whipping a dead horse, and perceived the jury felt the same. He didn't want the questioning to give Goetch another opportunity to defend Barnett's performance. "I've only one last question for you, Dr. Goetch."
Goetch blurted out, "Thank God!" The jury erupted in laughter. The judge chuckled; even John Gallagher couldn't keep from smiling.
Gallagher spoke with a hint of humor still lingering within his voice. "I agree with you, Doctor. It's been a long session. If you had answered the last question with a simple yes or no, I'd be on my way."
"I did my best."
"Yes, you certainly did. I give you credit for that. Here's my last question. With regard to the treatment of an acute heart attack with TPA or a balloon angioplasty, isn't it true that the single most important factor affecting outcome is time. That is, isn't it true that it is of the utmost importance to give the thrombolytic treatment as soon as possible once a diagnosis of acute heart attack is made?"
This repetive line of questioning made Barnett anxious. His inner guilt surfaced again.
Goetch had been expecting more of the same. He had no way out and had to answer with the blunt truth. "Yes, Mr. Gallagher, that is correct."
"And, with regard to Michael Conti's treatment, Dr. Barnett's delay in calling back, likely had an adverse effect on your patient's outcome. Under the best of circumstances you would've wanted a cardiologist at your side, immediately. Correct?"
Goetch smiled, and broke the tension with a bit of humor. "That's your second question, Mr. Gallagher. You promised only one more. You're a fibber."
The jury roared with laughter. Richardson tried but couldn't hold it in. He thought, Calls the attorney a fibber. What a character.
Gallagher chuckled, finding the doctor's remarks quite humorous. It was obvious to all that the attorney wasn't upset with the Steve's sense of humor. "You're right, Doctor; I guess I did tell a fib. I apologize. I have just one or two or three more questions, I promise."
Goetch couldn't quit with the wise remarks. He loved entertaining his audience. "Well counselor, I think three more questions would be just fine. But not four!"
The judge intervened. "Doctor, it's time to get serious. Please answer the question."
Goetch had forgotten what the question was. "Could you please repeat the question?"
"The question is this. Is it or is it not true that Dr. Barnett's delay in calling you and his late arrival at the emergency room, caused a delay in the treatment of Michael Conti's acute heart attack, and that delay, may in fact have had an adverse effect on the patient's outcome?"
Burkhardt and Barnett were as mystified as ever by Gallagher's tenacity on this timing issue. Fifteen to thirty minutes, either way, was of no major concern in view of the final diagnosis showing severe, untreatable three vessel coronary disease. Gallagher's doggedness on this issue was an enigma.
Goetch carefully thought over his answer. "In certain cases that would be true. In this case, I think the timing is irrelevant."
Gallagher was ready to fire back with another question when Burkhardt stood. "Objection, Your Honor. Mr. Gallagher's pushing an issue that Dr. Goetch has repeatedly answered, numerous times."
Gallagher, turning to the Judge, noticed that Richardson seemed to be in pain. He grimaced and rubbed his lower back. Before Gallagher could speak, His Honor responded to the objection. "Objection sustained. Mr. Gallagher move on and finish up."
Gallagher turned back to Goetch. "I have no further questions, Your Honor." John Gallagher took his seat next to Carlo.
Richardson addressed Larry Burkhardt. "Mr. Burkhardt, I'm sure you have some questions for your client."
"Yes, Your Honor, I do." Burkhardt stood and approached the stand. "Dr. Goetch, in light of Mr. Gallagher's very exhaustive examination, I'll try to keep this short." Goetch smiled to show his relief. "Doctor, in your opinion, based on your many years of emergency room work, do you feel anything could have been done to save the life of Mr. Michael Conti?"
"No, I do not."
"Do you believe that your care for Mr. Conti was compromised at all by Dr. Barnett's performance or for any other reason?"
"No, I do not."
"Once again, in your experience, can you think of anything that could have been done differently to save a patient with such a massive heart attack and such severe coronary artery disease, as was demonstrated on Mr. Conti's coronary angiogram, his catheterization?"
"I know of no medical treatment or procedure which would have altered or improved Michael Conti's outcome. Unfortunately, I feel, just as Dr. Tamayo has previously stated, Mr. Conti's fate was sealed before he arrived at the emergency room."
Burkhardt finished his questioning. "And were there any consequences at all from your breaking the hospital policy on TPA?"
"Absolutely not."
"I have no further questions, Your Honor."
The Judge announced that court was adjourned until nine am the following day. A Sherriff's deputy escorted the jury members out, and the gallery quickly emptied. Judge Richardson sluggishly rose from his seat, using both arms to support himself. He stood, back bent, for a moment; forcing himself upright, he slowly walked to his chambers.
Carlo and John Gallagher were still seated, having a discussion about tomorrows events. Laura stood, said a brief goodbye to the attorney and her father-in-law, and walked toward the back of the courtroom.
David Barnett turned and intently watched her leave. He'd been slyly catching glimpse of her all day but his view was partially blocked by the Plaintiff's table, Carlo and the end of the gallery bench, which looked like a church pew. He hadn't seen her since her visit to his office, nearly six months ago. Now, to his delight, he could refresh his memory.
Barnett mentally collated her image: auburn hair cut just above her shoulders, five-foot- five in heels, one-twenty pounds, chocolate brown wool suit, three button, short wasted jacket, skirt, tastefully hemmed above the knee, soft yellow shade blouse, one button open at neckline, slender gold necklace. Her legs were beautiful, shear stockings, two tone brown and tan high heels. David Barnett was hopeful and happy. "Larry, I have to go. It's a bit urgent. Can we talk later--over the phone?"
Burkhardt sensed David's attraction to Laura; in spite of her even being a plaintiff, David didn't seem to care. "Sure, I'll call you." Larry smiled. "You better get out of here before she get's away on ya."
Barnett was surprised. "Burkhardt, you're either very observant or clairvoyant."
He laughed."Yea, sure. It's part of the job. Now get goin', Doctor."
Barnett practically ran out of the court house. Reaching the sidewalk, he quickly looked in both directions, up and down the street, just catching a glimpse of her as she rounded a corner. He jogged to the corner, stopped to catch his breath, and walked on, trying to look casual. There she was, just twenty feet or so ahead of him. He called out. "Mrs. Conti."
Laura's head turned with a start. "Oh. Hello, Doctor."
David was overwhelmed with anxiety. He felt like a junior high kid. His voice nearly cracked. "Hi...hello."
Laura calmly responded. "Can I help you?"
"No...I mean yes. I thought I'd walk you to your car...it's not safe, you know, sometimes, here, downtown." He walked ahead, stopping a few feet from her.
"That's very polite of you. But, I'm already here. This is my car." She pointed to a red Chrysler just a few feet away.
David's anxiety was gradually dissipating. He relaxed. "Yes, I tried to catch you when you left the courthouse. You were just to quick. You gotta away on me."
Laura laughed. "Well, looks like you caught me after all."
| Author Notes | Appreciate all reviews. best wishes to all FS writers.----Doug |
By cardiodoug
David arrived at Ciao a few minutes ahead of time. Being anxious about his date, he didn't want to make any mistakes, such as showing up late. Ciao, a nicely decorated, moderately priced Italian restaurant on the north side of town, was a convenient location for both Laura and David. The place was comfortable, with brocade upholstering and plush carpet, accented by a few renaissance era appointments and low volume classical music. Most importantly, the food was outstanding. David thought it was a nice choice for a first date.
He entered the foyer, relieved to see that Laura had yet to arrive. After giving his name to the hostess, and reserving a table for two, he took a seat on a long bench to wait. The foyer was chilly and he left his topcoat on. His hands and feet were cold from intermittent waves of winter air passing through the entry to the bar area—an area with which he was quite familiar. After his divorce, he’d spent many lonely evenings in there, diluting his brain cells to make his anguish tolerable. He would often drink until closing, then stagger out to the parking lot.
David recognized a few faces of the steady customers sitting at the bar. He hadn't been there for years, despite that, he wasn't surprised to see many of the regulars he knew from the past. He didn't think poorly of his old acquaintances, rather, they made him feel empty and sad—sad for them and sad for himself, as he pondered his decades of alcoholism, realizing how it hurt Susan, ruined his marriage, distanced him from his children and damaged his integrity and self-esteem. He was keenly aware of the daily turmoil his former drinking buddies were going through, reminding him of how fortunate he was to finally be out of that cycle of self-destruction. I'm the lucky one, he thought. If it hadn't been for my career, I never could have afforded the expensive rehab program I attended.
If not for that opportunity, he could easily be sitting at the bar right now, seeking oblivion from the pain of divorce, a pain that fortunately, probably because of his sobriety, had long since faded away.
He was certain his old pals would love to see him, welcoming him back home with shouts of, "Look who's here!" and "Hey, Dr. B, where the hell ya been?" They’d invite him to join in, just like old times. He had a brief urge to do just that. He let it pass.
"Hello."
Barnett looked toward the door and quickly stood. "Hi, Laura. Did you have any trouble finding this place?"
"No trouble at all. Your directions were perfect."
"I'll take your coat if you want. It's a little cold in here but I'm sure the dining room will be warmer." Barnett hung their coats in an adjoining cloak room and walked with Laura to the hostess.
"Your table is ready, Doctor."
"Great, thank you."
The dining room was warm and cozy. A stone faced fireplace with a large fieldstone hearth stood in the center of the room. Its massive chimney extended high through a cathedral ceiling, which was crisscrossed with large, roughhewn, oak beams. Dining tables, draped with white cloths, were spaced throughout the room, and booths, cushioned with dark maroon leather, lined the far wall. Crystal chandeliers, suspended high from above, gave the room a pleasant glow, enhanced by the golden light and crisp crackles emanating from burning logs in the fireplace. The entire room was covered with deep emerald green carpeting, which deadened the noise of the restaurant, creating a pleasant acoustic quality of intimacy.
David and Laura took a moment to warm up in front of the fire.Their waiter, a rotund, middle aged man with a heavy black mustache, seated them at a nearby table. Barnett was pleased with the waiter’s choice, near the fire place but not so close as to be hot, and isolated enough to provide privacy. The table was adorned with a candle centerpiece and a single red rose in a slender glass vase.
"This is beautiful."
"I'm glad you like it. It's one of my favorites and it’s surprisingly nice, considering the exterior, which doesn't look like much."
"I know what you mean. Looks kinda plain on the outside but it’s lovely in here. I was actually a little leery when I first drove up."
David got caught staring at his beautiful date. She smiled and blushed, just a little. There was a slight irregularity in her front teeth. He found it attractive, different from the perfect teeth, almost too perfect look, common in the era of orthodontia.
The waiter introduced himself and left a menu and wine list. "I'll give you a few minutes to review our wines. I'll be back shortly."
"Laura, would you care for some wine?"
"Sure, I'd love some. Gotta have wine with Italian food. Don't you agree? You choose whatever you'd like, David."
A forlorn look draped the doctor’s face. "Laura, I don't drink. I assumed you knew that."
"No, actually I didn't, but that's fine with me. I won't have any either. How's that?"
"I'd prefer that you have some wine. If you don't, it will make me feel like I'm imposing my problems on you."
"Is there a problem?"
"Yes." He paused. "This is a little awkward for me, mainly because I was so sure you knew."
"I'm sorry, David. I don't follow. Knew what?"
"Knew that I'm an alcoholic."
"You are? Well, that's okay. You don't drink, right? So I guess you're a 'former' alcoholic. Who's to say, anyway? I mean, what makes you so sure you're an alcoholic or were an alcoholic?" Laura was enamored with David, and despite this being their first date, she had already fantasized about them in a long term relationship. It hurt to hear of problems right off the bat, especially after what had happened to Michael. She didn't want more heartbreak and was trying hard to ignore David's issue. She wanted him to be the way she saw him—she wanted him to be perfect.
Barnett looked her straight in the eye. I'm sure I am—I'm sure I'm an alcoholic. Believe me, drinking used to be a big problem for me, mainly during my divorce. Laura, it's pretty much understood that it's a disease that stays with you. You can stop drinking, but you're still an alcoholic, a recovered alcoholic, so to speak."
Laura remained hopeful. "Well, it's fine with me, David. You're not drinking now and it sounds like you've got a handle on it. Why did you think I would have known about it?"
"Because of your father-in-law."
"Carlo? He never said anything to me. How would he know?"
"I'm not sure how he knows so much about my past but it all came out at the deposition. It was obvious that he'd been told a lot about me."
"Laura interjected, I wasn't there, at the deposition."
"I know. But I assumed Carlo would have talked to you about all of this. Unfortunately, I suspect my addiction is going to be a major issue in this malpractice case. Since Carlo was the one to initiate it, I figured he told you all he knew. At the deposition, John Gallagher asked me some direct, pointed questions about it, my alcohol use that is. Carlo never said anything to you?"
"Not a word. Actually he hasn't said much at all about this whole thing. He acts like he has to protect me. That's why I wasn't at the deposition. He didn't want me there."
"Laura, this is all about your husband. Why wouldn't Carlo want you to be involved?"
"David, the law suit is all his idea. I actually had nothing to do with it. I feel real bad about it, especially now."
He was pleased with her statement, feeling it was an indication of her interest, possibly romantic interest, in him. He decided to pursue it. "You feel bad 'now'. Is it okay if I ask what you mean by 'now'? Has something changed?"
Laura blushed as her eyes went wide. "Come on, you know that's not a fair question, but I'll answer it anyway." She smiled, cocking her head slightly "Now, means now that I've gotten to know you. I find you to be a nice man, a good person, and from what I saw of your work in the hospital, I think you're an excellent cardiologist." Smiling broadly, she added, "So there, Doctor Barnett. And that was a sneaky way to find out how I feel about you. But it's okay, I'm glad I told you. Now it's your turn!"
In addition to beautiful, Barnett found Laura cute and witty. My turn, he thought. That’s perfect. "My turn, great. I want to tell you my feelings, which I think are obvious, since I'm the one who asked you out for dinner. Laura, I find you very attractive in all respects, your appearance, your personality, your sense of humor, your intelligence, everything. I do realize that we barely know each other, but at this point, that's how I feel."
Laura, momentarily speechless, blushed again. “I'm flattered, David, and pleasantly embarrassed by your compliments. Thank you. I think I can say, with confidence, that I feel the same about you. That's the reason I'm so upset with my father-in-law. I wish he'd never started this whole thing. I should have stopped him a year ago."
"It's okay. You couldn't have stopped him anyway. He seems so bitter and determined. He would have found a way to sue me, with or without you."
"I suppose your right. He loved Michael so much, and he's so alone now. He lives in a big, expensive house all by himself. I sure it's made him angry: his solitude, his wife, his children. It's so tragic. He blames doctors—he blames everyone else for his problems, everyone but himself."
"Laura, I'm not worried about it, the suit that is. Actually, If Carlo hadn't pursued this, we never would have seen each other again. I wouldn't have been happy with that, especially since I've been thinking about you ever since we met at the hospital. Of course, under those circumstances, there was nothing I could do. But now, more than a year later, I think its ok—it's more appropriate."
Laura, trying to hide her enthusiasm, smirked, and said, “Come on, Dr. Barnett. You’re really pourin’ it on. I may start thinking you’re manipulating me. That wouldn’t be good.”
“No it wouldn’t. And it wouldn’t be true. Sorry if I’m being too abrupt, but I mean what I say.”
Laura, delighted with what she’d just heard, smiled broadly. She’d also had difficulty forgetting David, knowing he was divorced and available. After Michael's death, she was horribly lonely. It was easy to fantasize about meeting a new man, and Dr. Barnett fit her dreams perfectly. Pensive in thought, she silently stared at her date.
David, sensing he’d been too forward, changed the subject. "You mentioned Carlo's wife. Where is she?"
"David, Mrs. Conti, Marie, died three years ago. Michael was all Carlo had after his wife’s death."
"I didn't know about Mrs. Conti. I'm sorry to hear that. Why did you say, or imply, Carlo should blame himself? Blame himself for what?"
"He’s fanatic about not seeing doctors—always has been, at least since I’ve known him. Carlo’s got an irrational hatred for physicians. I don't think he’s ever been to a doctor in his life, at least his adult life, and he refused to let his family go to doctors."
“That's crazy. But Michael went to a doctor. He saw Tamayo."
Yes, he did, but as far as I know, Tamayo was his first. I’m sure, when he was a child, he saw a pediatrician for the usual shots, immunizations and such. Michael said he was never sick while growing up, never until now, or, you know, when this all happened." Laura looked away.
David, reaching across the table, gently touched her hand. "Laura, maybe we should talk about something else."
"I don't mind. I'd rather explain this whole, bizarre thing. I think we should talk about it, especially now, David. Maybe . . . maybe I could help you, you know, help you with your trial."
Barnett was pleased with her offer. His attraction to Laura grew in response to her kind gesture. "I guess it's possible. Maybe you can help me. I’d really like to know what’s goin’ on in your father-in-laws head. That would be helpful.
"David, I'm sorry this is happening."
"Please, you don't have to apologize. It's obvious that it's not your doing. I didn't realize that till now. I thought both you and Carlo were in this together."
"No. Not at all. This was all his idea and he refused to listen to anything I said."
“Laura, I don’t understand his anger—what his complaints are. I’m sure you remember what happened in the emergency room—when Carlo got physical with me. I couldn’t believe it. He was irrational. Weren’t you surprised by his behavior?”
She leaned forward, closer to David, as if to tell a secret, nearly whispering. “I’m not shocked, not in the least. I’ve seen much worse from my father-in-law. Most of the time he’s in control, balanced. But every now and then he’ll explode. Never with me, never directed at me, but often in my presence. If Michael or Marie said the wrong thing or did the wrong thing—wrong in Carlo’s mind, he would erupt. It was terrifying. I think he has a deep, inner anger; he’s angry at the world, especially the medical world. It’s gotta be related to Cassie.”
Right now it looks like John Gallagher doesn't have a case. However, who knows what could come up later in this trial. Fortunately, I'm not that worried about it. It's not the end of the world if I lose a malpractice case. Most cardiologists have, at one time or another. I've got good insurance. It would be a blemish on my record, but, as I've said, it happens. Two of my partners have lost malpractice suits and they're both very good cardiologists."
"But you didn't do anything wrong, did you?"
Her question caught David off guard. As he paused to gather his thoughts, the all too common sensation of guilt returned. Looking directly into Laura’s eyes, he replied, "Laura, I feel bad about the situation. Honestly, at the time, because it took me longer than usual to respond, I felt a bit of guilt. It's my nature to be hard on myself. I wish I’d come to the hospital right away, when Steve Goetch called me the first time." David looked down at the table.
"Would it have made any difference? Any difference if you’d arrived earlier?”
Raising his head, hesitated. "Laura, I don't want this to sound like an excuse, it's not, please believe me. The truth is, in my heart I know it wouldn't have made a difference. Michael's coronary problems were so severe that he was truly in a hopeless situation. I know that logically but it's sometimes impossible for me to avoid feeling shame."
"I believe you. I wouldn't be sitting here with you right now if I didn't."
David smiled. "Why ARE you here with me?" He immediately regretted saying that, having put her on the spot. "I'm sorry, don't answer that. That wasn't a fair question. This whole thing is strange though, isn't it? The way we met, your circumstances with Carlo, all of it. I no longer care about the odd circumstances, Laura. I'm very glad you're here. Very glad!"
She happily reponded. "Me too." At that moment, as if on cue, the waiter returned, placing a basket of bread and two glasses of water on the table.
"I'm sorry I took so long. My apologies. How about a bottle of wine?"
David looked to Laura, "We never did decide on that, did we?"
It's your call, David."
"Alright then, would you like red or white?"
"I would prefer red, doctor".
Pleased with her decision, he grinned and looked up to the waiter. "She'll have a glass of the California Cabernet. I'll have coffee."
The waiter filled their water glasses and took their dinner order. He was just about to leave when he turned back and addressed David. "Sir, please don't think that I'm pushing wine sales. However, I always inform our customers of the cost advantages of buying a bottle. If you're going to have two glasses of wine, you will have practically paid for an entire bottle. In addition, if the bottle isn't emptied, it's our policy to allow you to take the remainder with you."
David looked across the table.
"David, I'm sure I won't have more than one glass."
"It does make more sense to buy the whole bottle. You can take the rest home and have a glass tomorrow if you want." Barnett looked back to the waiter. "As per your suggestion, Sir. We'll have a bottle of the Cabernet."
"Very good, Sir. I'll be right back."
* * *
John Gallagher finished his last bit of scotch and set the empty rocks glass on the table. Across the booth, sat his business partner, Robert Walker, who had driven to Toledo from Detroit to discuss an ongoing case in their firm.
"John, you gonna have another one?"
"I might. How 'bout you."
"I don't think so. I've got a bit of a drive ahead of me. I better play it safe with the booze.
"Yeah, I should probably go too. I've got an early day tomorrow."
"You haven't told me what you're doin' down here. Anything interesting?"
"I'm in the middle of some half-assed malpractice case that’s gone to a jury. Gotta be in court at eight-thirty."
"John, sounds like you better get to bed, too. You ready to take off?"
"No, on second thought, I think I'll have one more and go over some of my notes here. Bob, I'll give you a call tomorrow." As his partner was about to leave, John Gallagher stood and reached for his wallet.
"Hey. Don't worry about it, John. I've got it."
"Okay, Bob. Thanks. I'll see you later. We'll talk tomorrow."
Walker grabbed his top coat from a hook near their booth, and walked out of Ciao. Gallagher, watching his friend leave, looked around the dining room. Caught off guard, doing a double-take, he saw them sitting together near the fireplace, barely fifteen feet away. My God, he thought. What in hell are they doing having dinner together? This is incredible. The attorney leaned back in his seat to be out of Laura's line of sight. Now, I’ll definitely have another drink.
* * *
Laura took a sip of wine. "This is good. Thank you."
"I know. I know it's good. I've had more than my share in the past. But coffee suits me just fine now. I really don't miss it, the wine that is."
She responded, "Good, I'm impressed with your diligence."
Barnett wanted to get off the topic of alcohol. "Laura, I'm still amazed that the Conti family never had any medical care. Didn't Michael's mother complain?"
"David, Marie Conti was deeply in love with her husband, she told me so. He was very good to her, most of the time. But believe me, Carlo ruled the household and we all accepted it."
"But she died. Didn't she go to a doctor? What happened to her?"
"She died in her sleep. Everyone said it must have been a heart attack."
The thought of an autopsy popped into David's head. He didn’t ask, thinking it would be too clinical, too intrusive. "Yea, a heart attack, that's probably what it was. Was she sick before that? Did she ever ask to see a doctor?"
"She did. She told me about it just before her death. Carlo never knew. As far as I know, he still doesn't know. About a month or so before she died, she called Michael and told him she was tired all the time, having breathing trouble. She had some chest kinda chest problem. I remember the word heaviness. David, she was frightened. Marie planned to see a doctor somewhere around Detroit, and she made Michael promise not to tell his father."
“Oh, my God. Michael didn't tell Mr. Conti? And she died.
"No. Michael never said a word. He'd always been dominated by Carlo, horribly intimidated by him. After his mother died he figured it was pointless to mention it, knowing it wouldn't change things and would only anger his father."
“Anger his father! Wasn't he angry, Michael, that is?”
Michael never got angry. I honestly think he was afraid to express anger, or any other deep emotion.”
Barnett stopped, contemplating Michael’s psyche, and the traumatic effects his father’s ridicule must have had on his emotions. Laura, noticing her date’s preoccupied look, waited. Once again, the doctor decided to change the subject.
“How about Carlo? He must have gone nuts when his wife died.”
“I’m sure he did, but I wasn’t there. Michael and I were in Toledo, and Carlo was up in West Bloomfield. By the time we found out, he was pretty calm. Soon after, he refused to talk about it.’
"He wouldn't talk about it?"
“Never. Not since the funeral. And he was quiet, very reserved at the funeral home.”
Once again, David, thought of Michael. "How about Michael's health problems? Did he tell his dad he was going to see Tamayo?
"No way. Never! I had to twist his arm to make him go in the first place. He asked me to arrange his office appointment. I wanted to go along but he wouldn't allow it. Carlo never knew about it until later, afterwards."
Their waiter arrived with an appetizer. Crostini al Funghi and Portabella mushroom. They resumed their conversation as the waiter served Laura a portion of the Portabella.
"May I ask how you chose Dr. Tamayo?"
"I looked in our HMO Pamphlet. We didn't know a single doctor in Toledo and I didn't know what else to do. Tamayo was in the pamphlet. He also has a very large ad in the yellow pages. It said he was both an internal medicine specialist and board certified cardiologist. It was just by chance really. His ad caught my eye."
Barnett envisioned an expensive, full page phone book ad, touting the varied talents of the spectacular Raymondo Tamayo. "Yes, I bet it did catch your eye."
"What do you mean, David?"
Barnett hesitated, again regretting what he said, the remark suggesting a lack of respect for Tamayo. He didn't want Laura to blame herself for inadvertently choosing a charlatan as her husband's physician. "Oh nothing. Tamayo's a good cardiologist. He's just a bit money oriented. I'm not surprised that he has a huge ad in the yellow pages."
"Do you think I made a mistake? Could someone better, a different doctor, have saved Michael?"
Now, Barnett really regretted his comment. He had to lie to convince Laura that Tamayo had been a good choice. "Absolutely not. Tamayo did all the right tests, just as he explained in court today. He's a very experienced and very thorough cardiologist. Believe me, Laura. You couldn't have changed a thing."
Sadness covered her face. Her head fell. David assumed he hadn't been very convincing. "Laura, I'm sorry this happened. I'm sure you loved Michael very much."
Looking up, her eyes meeting his, Laura said, "I guess I loved him. I was never sure."
David was silent, shocked by her comment. Laura continued. "I was once very much in love. It was before I met Michael. His name was Kent. We met freshman year at Hillsdale College. I was crazy about him but it didn't work out. I guess it wasn't meant to be. He left me for another girl during our junior year. I was devastated, a total mess and very vulnerable after that. That's when I met Michael. It was different with Michael. He was very kind but it was different. Something was missing. I suppose it was the passion I had so enjoyed with Kent. With Michael . . . I guess . . . I suppose I was attracted to the security, his family, their wealth, you know. Don't get me wrong, David, I loved him, but it just wasn't the same."
David paused, choosing his words carefully. "I understand. There are different kinds of love."
Laura added, "He was a truly a good person but he was so cautious, so dominated by his father. It was a problem."
"I'm sorry to hear that."
"Don't be. It's over now. It's all in the past and I'm okay."
Intrigued by her candor, David wondered, Could they, the two of them have real passion together? He sat in silence for a moment, imagining making love to her—imagining what it would feel like to kiss her, caress her, touch her and explore her body. He fantasized about them together in a lifelong romance. He wanted to talk about it, about the passion and love and excitement he craved. He’d gone without that for so long, many years, and he wanted to pursue all of it with Laura—wanted to delve into her mind, to excite her with romantic conversation.
"David, are you alright?"
Snapping out of his trance, he cleared his thoughts and smiled. "Sure, I'm fine. I guess I was lost in a daydream."
* * *
John Gallagher looked across the room just as the couple's waiter returned with dinner. Realizing he’d be staying longer than anticipated, the attorney ordered dessert and a Cappuccino.
* * *
"Laura, when I asked about Carlo’s hatred for doctors, you mentioned someone named Cassie. We haven’t discussed that. Hope you don’t mind . . . Who’s Cassie?
"She was Michael’s older sister . . . Carlo and Marie’s first child, their daughter.”
"His sister? I didn't know he had one. I reviewed Michael's medical records to prepare for this case. A sister was never mentioned."
"I know. He rarely spoke of her; it's kind of a forbidden topic, especially when Carlo's around."
"What's the connection, I mean with doctors?"
Her name was Cassandra. She died on her fifth birthday. I think it was in the early fifties, fifty-two or fifty-three."
"Oh no. So young, a five year-old. That's a tragedy. Was it some sort of accident . . . maybe a car accident.
"No. It wasn't. Apparently, there was something wrong with her heart. According to Michael she'd been sick for about two years, the two years prior to her death. She had trouble breathing. Michael never knew all the details. His mother told him a few things but his father refused to talk about Cassie. I once spoke with Marie about their daughter. That was six or seven years ago. Marie said Cassie would have 'spells'."
"What kind of spells?"
“She complained of chest pain. She'd get short of breath and turn blue, sometimes to the point of passing out. They took her to numerous doctors, some were specialists. The doctors couldn't find anything wrong. A cardiologist at Ford Hospital in Detroit, suggested it was possibly an emotional problem. Marie said they took her to a psychologist who thought Cassie was faking the spells to get more attention."
"Oh my God. Then she died?"
"Yes, died suddenly on her birthday. As you'd expect, the Conti's were beyond consolation. Cassie's death really took its toll. They were emotionally destroyed.
"I'm sure they were. This story is heartbreaking."
Laura continued, "Carlo never got over it. He never forgave the doctors for not saving her. He really hated the psychologist who said Cassie simply lacked attention from her parents. It's been over forty-years and Carlo still holds that hatred and resentment to this day."
"Wow! That explains a lot. I couldn't understand the deal with the family not seeing doctors, having no health insurance, the whole thing. It's really unfortunate. It's sad."
"I know. Marie told me Carlo went through a personality change after Cassie died. She said he'd always been somewhat of a free spirit. But he changed. He became a driven man; he wasn't content with his life. She even told me he swore he would never have another child."
"How did Michael come about?"
"I guess Michael was an accident, not planned. Marie told some very personal things, you know, two women discussing life, romance, heart break.”
David gave a nod and smiled. “Yea, I get it.”
She said she knew exactly when it happened—when she conceived Michael. It was New Year's Eve, December 31st, 1960. They'd both been out to some kind of party and were drinking. Marie confided in me, told me that after Cassandra's death, Carlo became obsessed with Catholicism. She thinks he was guilt ridden about leaving the church years prior, before Cassie was born. He truly thought his daughter's death was punishment from God. That's why he refused to use birth control, because of the church. She and Carlo had been using the rhythm method. I guess they weren't careful that night."
"Well, that'll do it." They both chuckled.
"I guess it did."
"Laura, that's quite a story. As I said, Michael never mentioned his sister in any of his medical history."
"I'm not surprised. Cassie was a forbidden topic."
David, curious about the child's death, thought, a five-year-old dying suddenly. What could that be. “Laura you said she had problems with shortness of breath and chest pain?"
"Yea. That's what Marie told me."
"They didn't think it was asthma?"
"I guess not. That would be pretty easy to tell, wouldn't it?"
"That's true. It should have been. I can just imagine their crippling agony, their young daughter dying suddenly for no obvious reason. No wonder Carlo's bitter. And then, to lose a second child. Even at age thirty-eight, that's still young." The image of Michael Conti's coronary angiogram popped into David's head. He became pensive, quietly thinking. Michael had incredibly severe coronary disease for his age. No smoking history, no hypertension or diabetes. Tamayo testified that Conti's cholesterol was better than average but it just doesn't make sense.
"What are you thinking, David. You look concerned."
"No. I'm fine. I was just thinking about the Conti family. Their daughter had shortness of breath and chest pain and died abruptly at age five. Mrs. Conti died in her sleep, and since she’d sought medical attention, I must assume she had some sort of worrisome symptoms. Michael probably. . ." David paused, feeling he shouldn't discuss Michael's death anymore. He switched to Carlo. "Laura, does Carlo have any heart problems? I'm sure he's never been to a doctor. Have you ever noticed anything?"
"Well, actually I have. I've seen him put those little pills under his tongue."
"Nitroglycerin?"
"I guess. He tries to hide it and never talks about it but I've seen him on two or three occasions."
"How’d he get Nitroglycerin without a prescription.
"Oh, Carlo’s very self-sufficient. He’d find a way, even if he didn't see a doctor. What are you thinking, David, thinking about their family?"
"It's really not important, and it's just a wild hunch."
"What hunch? Come on, you have to tell me."
"Laura, it's unusual for a young girl like Cassie to have symptoms of chest pain, and then die. There's a hereditary condition that runs in some families. It's pretty rare--only present in one in five-hundred people."
"What is it?"
"It's an hereditary condition that causes extremely high cholesterol levels. So high, in fact, that young children, even infants, can die from a heart attack. It’s called Familial Hypercholesterolemia, or FH for short."
"Wouldn't the doctor have checked Cassandra's cholesterol?"
"Not back then. There was no test for cholesterol in nineteen-fifty-two. It wasn't until the sixties that the relationship between cholesterol and heart disease was recognized."
"But what about Michael? He didn't die as a child. Just because Cassie had a problem doesn't mean he had it, does it?"
"Laura, I'm just speculating. It's a rare condition and I'm probably off base. Besides, Tamayo said Michael's cholesterol was okay, actually better than average."
Laura persisted. "What if he was wrong; what if the test was screwed up. Can't that happen?"
"It's not very likely."
"But it could happen!"
"I suppose. I've seen some mixed up lab results on occasion." David peered hard at Laura. She looked overtly anxious, concerned. He regretted bringing up the whole issue.
"David, after we moved to Toledo, Michael became obsessed with his diet. He made me change the way I cook. He wouldn't eat any fat. I never understood why he was suddenly so worried about his health."
"Well, did he have his cholesterol levels checked after you moved here?"
"I don't think so. He never said so. How could he? He never went to a doctor. Like I said, I had to push him to see Tamayo." Laura thought for a second and continued. "He also started exercising like mad. I couldn't believe it. He was running every day and swimming at the gym. It was all new for him. I thought it was because he was so stressed-out at work."
"He had a rough time at work? Did he like his job?"
"He hated it. Carlo forced him into it. Michael thought he was under qualified. He was conscientious to a fault and worried about everything. It was a high level position that his father arranged for him. He had to make a lot of important decisions that didn't agree with him. It was really a lot of stress and tension."
Barnett took the opportunity to get off the cholesterol topic. "I bet your right, Laura. The cholesterol condition I mentioned is unlikely. I doubt it’s a factor. Perhaps your husband had lifelong problems with anxiety and stress. It's been shown that prolonged tension can aggravate atherosclerosis of the coronaries, you know, hardening of the arteries, so to speak.” He added, “Laura, I'm sorry I mentioned heredity."
She reached across the table and touched Barnett's hand. "It's okay. You're right. There's no point in my getting upset. I don't want to ruin the evening."
Her touch was electrifying. David felt his pulse race. He looked down at the table as she slowly withdrew her hand. "How's your dinner?"
"It's excellent, David."
"Would you like another glass of wine?"
"Maybe one more."
"Good, good, I like that. I'll have more coffee but I better switch to decaf. I've got to get some sleep tonight."
* * *
John Gallagher finished his dessert. He was getting inpatient and considered leaving but changed his mind when he saw the waiter bring their check. David and Laura made small talk as she finished her glass of wine.
* * *
"Laura, I've really enjoyed this. You're a great conversationalist."
"Oh, come on! I bet you say that to all your girls."
"All of my girls! What girls? I haven't had a date in years."
She looked pleased with that.
John Gallagher looked on as the pair continued talking. Another fifteen minutes dragged by. Laura finished her second glass of wine. David poured the remainder of the bottle into her glass.
"Oh, please, David. Thank you but I've had enough. I have to drive home, you know."
Barnett left cash for the tab and the couple walked together to the coat room.
"I'll walk you to your car. Where did you park?"
"I'm pretty far toward the back. The lot was really full when I got here."
"Okay. Let's go."
There was an awkward silence as they walked together across the parking lot. The doctor was nervous. It truly was his first date since leaving rehab over two years ago. He pondered a goodnight kiss and thought, If I'd been drinking, I wouldn't be so unnerved. On previous dates he was usually emboldened by intoxication. This was something new. Should I shake her hand and say it’s been a fantastic evening. I'll call you some time.
They approached her car. The air was brisk, cold enough to see your breath. Laura's auburn hair was beautifully highlighted by light coming from a nearby street lamp. David concentrated on her face and eyes. Her cheeks were slightly flushed by the chilly air. He was taken by her beauty.
"Well, Doctor B. I had a very nice time."
"So did I. Besides being fabulous company, you're incredibly beautiful.
"Oh, stop. You're much too nice."
"That's my opinion. I think you're gorgeous."
"Well, thank you very much. You're quite handsome yourself, David."
Removing her bag from her shoulder, Laura searched for her car keys. David took a step closer.
"There they are." She looked up to David just as he gave her a light peck on the cheek. Laura's eye's widened as her brows raised. "Thank you!"
In contrast to David, she was pleasantly intoxicated from two glasses of wine and wasn't the least bit nervous. "Why don't you try that again but do it right here." Laura pushed her lips out into a "kiss". David wrapped one arm around her shoulder, the other around her waist, and kissed her firmly on the mouth. Her lips were full, soft and sensuous.
Other than the couple in an embrace, the parking lot was empty and silent. When Laura stood on tip-toes, to enhance their kiss, one of her high heels slipped off, snapping down on the hard, cold pavement with a loud click. The sound rang out in the chilled, crisp air, carrying quickly to the periphery of the lot, where it was heard by attorney John Gallagher, who was intently observing, safely concealed by the darkness of the night.
| Author Notes | Thanks to all reviewers----much appreciated. Good luck to all FS authors.----Doug |
By cardiodoug
Chapter Words: 2019
The Jeep Plant. Toledo, Ohio.
Barnett arrived home to his apartment just after eleven o’clock. He was excited—happier than he’d been in a long time. He stripped down to his T-shirt and skivvies, brushed and flossed his teeth, and jumped in bed. David rarely used an alarm clock, his brain would take care of waking him as it did every day at six am. He lay in bed, rearranging blankets, moving his legs, and adjusting his pillow to varied positions, trying desperately to find a comfortable, sleep inducing position. It was pointless. He was wide awake and the reason was obvious. His date with Laura had sent him to outer space.
David was familiar with the body’s biochemical and physiological response to new love, the adrenocortical hormone surge makes one euphoric, and the associated release of testosterone that was, at the moment, pushing his libido to new heights. His mind raced back and forth between thoughts of Laura, and anxiety filled thoughts about his courtroom appearance in the morning. The scent of Laura’s perfume swirled in his head. After a restless hour in bed, he got up, turned on his beside lamp, grabbed the phone and dialed information.
“What city please?”
“Detroit.”
“May I help you?”
“Yes operator. I need the numbers for three hospitals in the Detroit area. I believe they’re all in the 313 area code.
“Yes sir, go ahead.”
“The first is Henry Ford Hospital’s main campus on West Grand Boulevard. I also need the number for Beaumont Hospital in Royal Oak and Providence Hospital. I think it’s in Southfield, Michigan.”
“One moment . . . Here are your numbers.”
Barnett memorized the first number and jotted down the last two on a pad of paper. A computer generated voice came on and repeated the three numbers. He pushed the receiver button and dialed.
“Henry Ford Hospital. How may I help you?”
“Operator, this is Dr. Barnett calling from Ohio. Could you please connect me with the medical records department?”
“Certainly, Doctor.”
A women’s voice came over the phone. “Medical Records.”
“Yes, hello. This is Dr. David Barnett calling from Toledo. I need to know if one of my former patient’s was seen at your hospital within the past four to five years. The patient is now deceased. Her name is Marie Conti. David spelled out C-O-N-T-I.
“It will take a minute, Doctor.”
“That’s fine. I’ll hold.” Barnett waited for two to three minutes; thinking about Laura the whole time.
“Doctor.”
“Yes.”
“Our computer data bank has six Marie Conti’s all the way back to nineteen-fifty.”
“I’m not surprised. It’s not an unusual name.”
“Four of these are deceased. Do you have a birth date?”
“No, I’m sorry, not an exact date. But I know she died in nineteen-ninety-five and was sixty-eight years old. That would place her birth date at about nineteen-twenty-seven, right?”
“Yes. There is one here. Marie Anna Conti. Born in April, 1927, expired 1995.”
“Great. So she was seen at Ford Hospital?”
“Not here at the main campus. The records indicate she was a patient at a satellite, the West Bloomfield Office. Charts for deceased patients from that facility are kept in a separate archive building in Bloomfield.”
“Can you give me their number?”
After relaying the telephone number, the women added. “Their closed until eight a.m., Doctor. You’ll have to call in the morning.”
David’s enthusiasm waned. “Alright. I can do that. Thanks for your help.”
“Your welcome.”
Since Marie had been admitted to Ford Hospital, there was no need to call the other two hospitals, Beaumont and Providence. David set the phone on the table, rolled back on his pillow, and considered his plan of action for the morning. I have to be in court by eight-thirty. I’ll have to be there by eight to make the call to West Bloomfield. I’ll call from downtown, probably from the courthouse.
David couldn’t decide if he should bother with calling in the morning, especially right before his courtroom appearance. He was about to forget the whole issue when he had another thought, Peggy could call. David had known Peggy, his office manager, for many years. She could make the call for him in the morning. He turned the lamp off and stretched out in bed. It was one-forty-five and he still wasn’t the least bit sleepy.
Doctor Barnett’s mind raced with a frenzy of memories, ideas, past events, old consequences and new possibilities. Thoughts and visions tumbled through his head as he recalled the evening’s conversation with Laura Conti. Imaginings of Laura, Michael, Carlo and Cassie, were interchanged with anxiety provoking thoughts of Judge Richardson, Gallagher, Burkhardt and Tamayo. Intermittently, Susan and his children, Erin, Peter and Jennie, would flash through his mind.
After minutes, seeming to David to be hours, his mind slowed, settling on one thought, —one question. David asked himself, why did Cassandra, Marie and Michael Conti all succumb to acute myocardial infarctions? Recalling Laura’s comment about her husband’s sudden obsession with health, diet and exercise, he surmised, Michael must have been worried about his heart—worried about having a heart attack and his concern started when he moved to Toledo. What happened? Maybe some medical test result bothered him . . . but he never saw a doctor. If he never saw a physician . . . It struck him, a thought flashed through David’s brain. His new job, that’s it. He would have had an executive physical at Jeep, the company would have required it.
Barnett jumped out of bed, switched on the light and dialed the phone.
“What city please?”
“Toledo, Ohio.”
“How may I help you?”
“Yes, the number for the Chrysler-Jeep Plant in Toledo. I would like their Medical Department, if there’s a listing.” As he waited for the number, another thought hit him. His cholesterol . . . he had lab work . . . that’s gotta be it.
“Here’s your number. Another computer generated voice spewed out a number. David hung up and redialed.
“Med Clinic.”
“Yes, this is Dr. Barnett calling.”
“Well, Dr. Barnett, how are you? This is Karen Whitaker.”
David knew Karen from her nursing position at St. Vincent’s Hospital. He’d just seen her a few days ago. “Hi Karen. I didn’t know you worked at Jeep.”
“Nurses have to do a little moonlighting sometimes. You know, gotta make ends meet. What can I do for ya, Doc?”
“Karen, I have a favor to ask.”
“A favor, such as? Don’t start flirting with me Barnett, it won’t help get your favor.
David laughed. “I promise. I’ll be nice.”
“Okay. What do you need?”
“A former plant manager there at Jeep died from a heart attack about two years ago.”
“I remember. It was Mr. Conti.”
“That’s right. Michael Conti. I was involved with his care. As it turns out he had really severe coronary disease, which for a lot of reasons, didn’t seem to make any sense to me. No risk factors, young age, you know.”
“Really. I know he was pretty young when he died. In his thirty’s as I recall.”
“He was thirty-eight.”
“So, how can I help you, Dr. Barnett?”
“Well, quite frankly, I’m currently involved in a malpractice case over his death.”
“You! I can’t believe it. Not the great, David Barnett. What happened?”
It’s a long, complicated story. I’d rather not get into it right now. But I am curious about something.”
“What’s that?”
“I have suspicions that Conti may have had a hereditary cholesterol problem that was never detected. The only lipid test we have for this law suit, was done by Dr. Tamayo and I’m not sure I trust Tamayo’s report on this.”
“No kidding. Who would trust that jerk?”
“So you know Tamayo.”
“Every nurse in Toledo has heard of him. He’s famous around for being a crook and an asshole. Incredibly arrogant. I’ve had some run-ins with him myself.”
“Well, I’m not here to bash another doctor. I was wondering if any blood tests were done on Michael Conti when he was hired. Specifically, a cholesterol profile.”
“They probably were. All of the executives are required to have annual physicals.”
“That’s what I figured.”
“So you want me to check his file for you.”
“If you could.”
“To look for what?”
David raised his voice a bit to give Karen a little jab. “To see if there’s a cholesterol level. What else!”
“Be nice now, Doctor. You know I’ll need a signed consent.”
“That’s where the favor comes in.”
“Dr. Barnett!”
“I know, I know. But it’s just a cholesterol. I don’t need anything else, and I was his physician for a short time.”
“Yea, but now their suing you.”
“Your right. It’s your call. I’ll understand if you don’t want to help me.”
“Okay Dr. B. Knock off the ‘poor me’ routine. You’re lucky I like you so much.”
“You do? I guess I am lucky. And I’m sure you know I like you.”
Karen responded with mock exasperation. “I suppose I’ll have to help you. Hang on a minute.” The phone went silent. David waited. “You still there Barnett? Or did you fall asleep waiting?”
David laughed. “I’m here.”
“Okay. I’ve got the chart and it wasn’t easy finding it.”
“Karen, you’re a sweetheart.”
“Yea, yea. Cut the crap. Now what do you need?”
“First, check the comments on his physical exam.” Look in the lab results to see if there’s a cholesterol level. Hopefully a fractionation.”
“I’m looking.” There was a brief pause. “Here it is. Seems to be ok. It say’s the patient had no complaints or symptoms. The final impression is, ‘Normal Pre-Employment Examination, Lab Results Pending’.”
“I’m curious, who was the physician.?”
“Dr. Lewinski saw him. He’s an old timer who works here, semi-retired.”
“Yea, I know Phil. He’s a nice man and a good family doc. Okay, good. Now, please review the blood test results.”
“I’ve got it. He had the standard profile, CBC, metabolic panel, you know.”
“Anything flagged as abnormal?”
“Yea, the cholesterol level . . . Holy shit!”
“What?”
“His cholesterol is twelve-hundred-sixty-three.”
“Karen. Are you saying it’s one-thousand two-hundred and sixty-three?”
“That’s right doc. It sounds a little high to me.”
David felt a surge of self-satisfaction and exuberance. His hunch was right, Familial Hyperlipidemia, a one in five-hundred shot and he’d nailed it. He excitedly asked, “Karen, did they fractionate it?”
“Did they what?”
“You know, break it down into HDL and LDL.”
“Let me see . . . Yep, here it is. His HDL is, or was, really good at one-hundred-twenty.”
“And his LDL?”
“Wow! Eleven-twenty-three. It’s eleven-hundred-twenty-three.”
“That’s what I suspected. One more thing, Karen. Did they repeat it later?”
“I don’t see any other labs in here, just this profile panel from his employment physical.”
“Karen, look in the physician’s notes to see what they recommended to him.”
“I’ve got it. Lewinski said he called Mr. Conti and strongly recommended treatment for his cholesterol.”
“And?”
“The last entry says Mr. Conti told him he would take care of it with his family doctor.”
“And?”
“And what? That’s it. That’s the last note.”
“Karen you’re a spectacular woman and an incredibly good nurse.”
“And Dr. B, you’re a big bull shitter.”
David laughed, “I know.”
“You’re lucky I was here tonight, Barnett. The usual night nurse would have hung up on you in a heartbeat.”
“Yep. I guess I’m just a lucky guy. Thanks for your help, Karen.”
“Your welcome. Hey, I hope this malpractice thing works out for ya. Good luck with it.”
“Thanks again. I’ll be fine. See you later.”
“Bye-bye, Doc.”
Barnett hung up, thinking of his remark, ‘Guess I’m just a lucky guy’. Maybe I am lucky, he thought. He was starting to believe that. In many ways he was a fortunate person. Many of his problems were behind him. Sobriety was giving him a new life. He thought of Laura, the exciting new entry in his life. He turned off the light, returned to bed and fell asleep. David Barnett had a wonderful dream about Laura Conti.
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