Just Like Someone Without Mental Illness Only More So_ A Memoir - Mark Vonnegut [33]
Malvesti looked like he had a bad taste in his mouth and nowhere to spit it out.
Half an hour after the family went up to the floor, Louis, the weasel of a junior resident who would be Prince of the River Nile Smith’s admitting doctor, called me. “Do you have any idea what was in the herbal compress they were using? There was a case once where a baby almost died from herbal tea.”
“The eyes don’t look all that bad, do they?”
“No, they don’t now, but I’m not comfortable admitting this baby without doing some sort of a work-up.”
“We already have done a work-up, Louis. MEEI has the cultures cooking. And we’re observing the baby.”
“It’s my case, and I can’t see the harm in doing a septic work-up.”
A septic work-up means obtaining blood for culture and complete blood count, urine for culture and analysis, and spinal fluid for cell count and culture. Most unnecessary tests have the good manners to come back normal. But if they come back abnormal, you become obliged to do more tests to confirm or refute the abnormal test. You can end up miles from where you started chasing your tail.
Lynn, a cheerleader-type bubble-brain fourth-year medical student, did the procedures. She got blood on the first stick, the lumbar puncture on the second pass, and the bladder tap. She stopped by to talk with me in the emergency ward.
“What’s wrong with the dad’s eye? It almost seems like he can control it and uses it to spook people.”
“It’s central,” I said.
“Oh. Thanks,” said Lynn. “Louis has agreed to no more tests unless the baby acts sick or has new symptoms. The dad must have taken off while we were doing the tests. At least his mother’s still with him. Is it true that black people are better at breast-feeding?”
I tried to sleep on the sticky black vinyl couch in the chief resident’s office. In a fitful half-sleep dream I watched myself bent backward across Malvesti’s knee, him pulling my head back by the hair with his left hand as he transected my heart with the knife in his right, entering my chest at the anterior axillary line between ribs nine and ten and pulling it to the midline.
A few hours later I got up, had some coffee, and went to senior rounds, where we discussed Prince of the River Nile Smith and all the other admissions from the previous twenty-four hours.
“There was absolutely nothing wrong with that baby,” I was compelled to throw in.
“There might have been,” countered Louis, “Besides, there was a court order. We had to admit and treat that baby. It was the people at Children’s who gave us no choice.”
On to the next case. As I got on my bike and pedaled home, I half hoped that Malvesti or one of his lieutenants might run me over before I could cross over to the Charles River.
I had a job lined up with a small respected pediatric practice. In a month I would be calling the shots, doing my best to keep kids out of emergency rooms and getting tests they didn’t need. There were pediatricians practicing in their eighties who still seemed to be having a good time with it.
The last thing I did as a senior resident was to transport a critically ill newborn girl who was thought to have an overwhelming infection from an outlying hospital to Mass General. I made the guess, which turned out to be correct, that she had congenital heart disease even though she didn’t have a murmur or blueness or any other sign of heart disease. I treated her for heart failure instead of infection and she responded well and survived the trip back to MGH. Her heart was 100 percent fixable. Instead of being dead or crippled, she would grow up with as good a chance as the rest of us.
When the cardiologist praised me to the parents and said that their little girl hadn’t been hurt by her rough start and was going to grow up 100 percent normal I felt sick and couldn’t get out of that room fast enough.
I was just doing my job. It had been a lucky guess. I hadn’t actually diagnosed the specific cardiac defect their daughter