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Worst Case ScenarioWorst Case ScenarioWhat would you do if your grandson needed a kidney transplant but kept getting passed over when one became available? This is a novel in progress about an OB who faced this dilemma.
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Chapter 27
2007-06-24 05:20:00 Angela woke up a little confused when the doorbell rang. At first she thought it was her pager, but then somebody rang the doorbell again when she was looking for her pager and she realized someone was at the door. 5:30 PM. The stress must be getting to her. After got home from the hospital around 10 AM and had gone into her bedroom to lie down for just a few minutes. “Nancy and I are cooking some burgers on the grill. Want to come over?” Mr. Trotter asked. “That is so nice of you to offer, Mr. Trotter. Thank-you, by the way, for taking me to the hospital. I’d love to come over, but I actually have a lot of unpacking to do,” Angela replied. “How did everything go over at the hospital yesterday anyways?” Mr. Trotter asked. Something in the way he asked made Angela wonder if he already knew the answer to the question. “Uh, so-so,” Angela said. “You sure you don’t want to come over? I know can be lonely moving into a new town by you... More About: Chapter
Chapter 26
2007-06-24 00:38:00 Angela woke up at 6 AM on Monday determined to have a good day. She completed her two mile run in fourteen minutes. She ate some oatmeal, showered, and put on her a new blue skirt that she had bought in Atlanta before she moved to Weston. Angela arrived at the office at 7:55, five minutes before her first patient was scheduled. She said polite “hellos” to everybody, but did not spend a lot of time chit chatting with the staff. She went to her office and pulled out her laptop out of her leather bag and started doing an internet search on management of shoulder dystocia. Before she went and talked with Sarah and James, she wanted to make sure she had done everything she was supposed to for a shoulder dystocia. She sent a helpful review to the printer, and en route to picking up the document passed by the waiting room, which was empty. This did not help ease the discomfort she was already feeling from the fact that nobody was talking with her. “Uh, Dr. Jackson... More About: Chapter
Chapter 25
2007-06-24 00:02:00 On the way home, Ted had kept asking Angela questions, and wouldn’t stop. She felt bad for answering almost all of his questions with one word answers, but she really wasn’t in the mood to talk to anybody. He just never seemed to figure it out. She paid him the twenty-five dollars for the ride. That worked out to ten dollars per mile, the most expensive cab ride in her life. At least she was home, keys or no keys. She just wanted to go into her house and hide from Weston. On the way home Angela had thought about calling a locksmith, but figured it would be cheaper just to replace a broken window. She went around to the back of her house. The back door leading into the mud room had a window in it and would allow her access to the deadbolt and the lock on the handle if broken. She picked up a rock weighing about ten pounds from her garden and tossed it through the window. It bounced back, and landed on the cement porch with a thud, almost hitting her foot. A... More About: Chapter
Chapter 24
2007-06-23 23:36:00 Although it had been only two hours since Vanderbilt’s Lifeflight Helicopter had taken Jimmy’s clone to Vanderbilt Medical Center, Larry couldn’t help but wonder what was going on. Had they tested the infant yet and determined that his kidney would be a perfect match for Jimmy? Was his daughter’s cell phone on? He called his daughter to make sure she was by her phone. He had risked too much to let somebody else to get the kidney.Thankfully, she answered on the first ring.“You calling to check up on me, dad, to make sure that my phone was on?” she asked. This was the first time they had talked since Larry had blown up at her at lunch.“No, I was calling to make sure you and Jimmy were coming to our house for lunch again this Sunday,” he said.“We always do, Dad. You know that. Why would you be calling to ask that?” Susan asked.“Well, I know you were upset with me last Sunday,” Larry said.“Dad, I really don’t want to talk to you about this right now,”... More About: Chapter
Chapter 23
2007-06-22 22:42:00 Angela gently squeezed the base of the baby's umbilical cord and felt for a pulse. “No pulse. Start chest compressions,” she said to the nurse. “Where's the oxygen mask?” She was handed and put the oxygen mask over the baby's mouth and nose. Why did the baby's head look so funny? Something was definitely wrong with this baby. She suspected it might be anencephalic. The baby's head had a face and a forehead, and then just sloped in a diagonal fashion towards the neck, rather than having the normal rounded configuration. “Stop compressions and check for a pulse,” Angela said. By this time, thankfully, one of the nurses from the nursery was assisting. She checked for a pulse. “I can't feel any pulse,” she said, looking at Dr. Jackson. “Continue chest compressions. Somebody get the pediatrician here!” Angela said. After about four minutes, a man dressed in shorts and a short sleeve polo shirt hurriedly came in the room. Angela could feel herself ... More About: Chapter
Chapter 22
2007-06-21 06:05:00 Ken felt a shoulder on his arm, slightly shaking him."Sir, we have to clear the shelter out now. The hurricane has blown over," the worker said.Ken opened his eyes. His 44 year old back was sore from sleeping on the cot in the evacuation shelter for the last 16 hours. His clothes were still damp from his wild boat ride. He couldn't believe he was now officially homeless. What a disaster. He stepped out into the warm sun and was surprisingly refreshed by it.Realizing that he didn’t really have any place to go, he just started walking down Alexander Street toward the beach. He figured sitting and watching the waves would help him figure out what he was going to do next.Shop owners were removing plywood from their windows. Most businesses were still closed. As he got to Front Street, there was more evidence of the hurricane. Several palm trees had been uprooted and blown over. Front Street was almost completely covered in sand. His sailboat was not the only one that had washed up on... More About: Chapter
Chapter 21
2007-06-20 04:04:00 Now that the cord was no longer around the neck, Angela felt even more pressure to get the baby out. She grabbed the suction bulb and quickly suctioned out the baby's mouth and nose. The baby's head came out looking straight down at the floor, but then realigned its head with its shoulders so it was facing Sarah's left thigh. Angela placed one hand on either side of the baby's head."All right now Sarah, I need you to give me a push. Let's get this baby out," Angela said.As Sarah pushed, she exerted gentle downward pressure, she expected the baby's right shoulder to slide out underneath the pubic bone. It didn't budge. Great. The baby's left shoulder was stuck below the mom's pubic bone.Stay calm. I've dealt with shoulder dystocias before. I can do this.This time she looked directly in the nurse's eyes: "I need some McRoberts positioning here. Get her legs back on her abdomen."The nurse and the tech each flexed a leg back to open up the pelvis to give more room to deliver ... More About: Chapter
Chapter 20
2007-06-20 02:16:00 Standing on the deck of his now sinking sailboat, Ken didn’t really like the choice he was about to have to make. The waves were at least ten feet and he felt certain they would push him into the pilings holding the pier up. Just as he was about to jump into the water, Ken thought he heard his name being called. At first he figured it must have been the wind, but then he heard it again, and it sounded like it was coming from above. He looked up. Twenty feet above him, his lawyer friend Mark was hanging halfway out a window in the restaurant that was on the pier. “Hold on a second,” Mark yelled, and then disappeared back into the restaurant. Now that somebody knew his predicament, Ken decided to waiting on the boat for help might be a better idea than attempting a swim to shore. But where was Mark? Each wave continued to swamp the boat. Ken was standing on the stern, which at this point was the only part of the boat that was above the water when the waves hit the ... More About: Chapter
Chapter 19
2007-06-20 00:56:00 Angela decided that after sitting alone in church, she didn’t want to sit alone in a restaurant eating lunch. She stopped at the Safeway grocery store on her way home and picked up some hot dogs, a 20 oz bag of cheetos and a 2 liter bottle of A & W cream soda. She'd go home, eat her comfort food, and then jog off the excess calories.After lunch, she changed into her jogging clothes, and put on the Rebocks that she had worn in the Atlanta marathon. She had run about 6 blocks away from her house when her pager first vibrated for 10 seconds and then started beeping. Before she pushed the blue button to display the caller's number, she realized she had forgotten her phone. Somebody was paging her to 712-3331. Angela was pretty sure that was labor and delivery at the hospital.As she turned around to run home, her pager went off again, revealing the same number. Two pages to the same number sometimes meant somebody was trying to get a hold of her in a hurry. She picked up her pace to ... More About: Chapter 1 , Chapter
Chapter 18
2007-06-19 19:44:00 Ever since Jimmy’s dad had left his mom abruptly for another woman two years ago, Larry and his wife Marge had their daughter and grandson over for lunch every Sunday afternoon. Although Larry was certainly no replacement for Jimmy's dad, he felt as a grandfather he might be able to ease some of the pain Jimmy was experiencing since his dad's exit. They met usually around one thirty in the afternoon, which gave Marge time to get home from church and heat up the meal.Until a year ago, when Jimmy had to go on dialysis, Sunday lunches were easy—all Marge did was pick up two extra large cheese and pepperoni pizzas from Pappa John’s... This had worked out well for everybody. But once on dialysis, pizza was out because it made his phosphorous and sodium levels skyrocket.So now Sunday meals were a bit more challenging because Marge had to cook meals appropriate for his dialysis diet. These meals low protein meals were distinctly different from the usual southern cooking that both s... More About: Chapter 1 , Chapter
Chapter 17
2007-06-18 08:35:00 Angela woke up feeling a little sad Sunday morning. While living in Atlanta, she had grown to love attending Jefferson Park Baptist Church. The people at her old church seemed to live out what they preached, especially Ernie and Rosemarie. They were an older couple that had invited her to lunch with them after the service the first time she attended the church. They had become like a second set of parents to her. And Dr. Wright, another older member of the church, had talked with her several times at length when Angela was on the verge of quitting residency. His encouragement had propped her up enough that she had gutted out the difficult four year marathon and had graduated two months ago. Now that she had finished residency, she realized that what at the time seemed like sometimes harsh words from Dr. Wright were in fact just the words she needed to hear to keep on slogging away until she reached the finish line. So even though Angela had a lot to be happy about--she h... More About: Chapter 1 , Chapter
Chapter 16
2007-06-09 04:02:00 Ten weeks ago, buying a $125,000 sailing yacht had seemed like a great idea. It had seemed too good to be true. A happy ending to a very unhappy story. Now that both his yacht and his life were in imminent danger, Ken was starting to doubt his decision to purchase a yacht.Although Ken had long dreamed of living in Florida, he never thought he’d be living there in a sailboat. But thanks to his speedy dismissal from Women’s Physicians, he had bought a sailboat out of necessity.Women’s Physicians had provided Ken with a claims-made malpractice policy while he was employed at the practice. The claims-made policy protected Ken against any lawsuit brought against him while he was working at the practice. But according to his contract with the practice, if Ken was fired, he would be responsible for purchasing the tail policy, which was insurance against any lawsuit from a patient he cared for at the practice that was filed after Ken left the practice.The day after Ken had been fired,... More About: Chapter 1 , Chapter
Chapter 15
2007-06-02 05:40:00 Finally. Angela had passed the test. Her chairman and residency program director felt that Angela had made enough strides in acting like an obstetrician that she could graduate on time with the rest of her class. Two more days until the marathon was over. Finally. In fact it was hard for her to believe she was actually finishing. Since day one of her orientation, she had wondered if she was going to be able to make it to the end. And now she had been assured she would make it. Two more days. She was now off to the coffee shop in downtown Atlanta to meet another lucky soul who was about to finish her residency. Dr. Cheryl Eads was two days away from finishing her Family Practice Residency at Emory as well. Angela had met Cheryl when Cheryl was rotating on labor and delivery. Cheryl was an intern at the time, and Angela had been a second year resident. The two had bonded soon after meeting. Angela considered Cheryl a bosom buddy. They both had simil... More About: Chapter 1 , Chapter
Chapter 14
2007-05-31 06:33:00 “What is it now, Larry?” Dr. Adams asked, not making any effort to conceal his growing impatience with Larry’s ever increasing frequency of phone calls. “I did some internet research on using anencephalics for organ donation, and I really don’t see how this is going to work,” Larry said. “From the beginning, Larry, I’ve taken care of everything, haven’t I?” Dr. Adams responded. “And your grandson’s kidney is coming along pretty nicely, I would say,” Dr. Adams said. “I would say you got me embroiled in a science experiment that’s going to get us both in jail if anybody ever finds out about this,” he said. “Nobody’s going to find out, I assure you,” Dr. Adams said. “What are your concerns about using the anecncephalic’s organs?” “From what I have read, most organs from anencephalics aren’t usable because in the one or two weeks it takes for the babies to die the organs usually dete... More About: Chapter 1 , Chapter
Chapter 13
2007-05-31 05:47:00 Ken was running late getting to the office. He hated being late. He hated making his patients wait for him. He hated feeling like he was always trying to catch up for the rest of the day once he started late. But today he really didn’t have any control over it. His patients were scheduled to start at 9:30 in the morning. His 8:00 laparoscopic tubal ligation had been pushed back an hour because the anesthesiologist who was supposed to staff the case had to go up to labor and delivery for an emergency c-section. So by the time he was pulling into the office parking lot it was 10:15. He had thought about calling over to the office and having his nurse cancel his first couple patients, but decided against it because he was feeling so much pressure to see more patients. He was both relieved but also surprised when he saw there were no cars parked in the patient section of the parking lot. Either the first several patients had not shown up, or they had sho... More About: Chapter 1 , Chapter
Chapter 12
2007-05-27 05:24:00 Larry was hot. Sarah's baby was anencephalic, and he found out about it after the patient knew about it. Why didn't the radiologist call him with this finding? Why didn't Ken call him and tell him. And what kind of prison was he going to rot in if Sarah decided to sue him for inserting a black market embryo into her uterus that turned out to be anencephalic? He was sure that Dr. Adams would not take any of the blame, even though he was at least as culpable as him in this whole fiasco. “The fetus is anencephalic, Jay!” he yelled into the phone. “I know, Larry. Calm down. That's good news,” he said. “What do you mean you know? Have you seen the ultrasound report?” he asked. “That's not what I said. I knew the clone would be anencepalic. It's part of the plan,” he said. “Part of the plan? You had put an embryo into her uterus that you knew was going to be anencephalic?” Larry asked. "Why didn't you tell me? I never would have ... More About: Chapter 1 , Chapter , R 12
Chapter 11
2007-05-27 00:26:00 Pregnant patients of Women's Physicians alternated appointments between Larry and Ken so that the women would feel comfortable with either one of the two delivering them. Since Sarah's pregnancy had been so unusual, she had only had seen Dr. Johnson during her first fourteen weeks of her pregnancy. But today, she had her first scheduled appointment with Ken Kessler.Since the bleeding episode Sarah had 12 weeks, James had been much more attentive to her. Other than the immediate visit after the bleeding, James had come with her to all of her appointments. At the one visit where James was unable to be there, Dr. Johnson had informed Sarah that she probably had miscarried one of the twins. She hated not being able to share everything with James, and this need for secrecy been much harder than Sarah had anticipated.Things had gone much better since she miscarried one of the twins. She had just had her ultrasound performed yesterday at the hospital radiology department and hoped th... More About: Chapter 1 , Chapter
Chapter 10
2007-05-23 00:48:00 June, 2009 should have been the most happy time of her residency, but thanks to the breech disaster in triage, it had turned out to be Angela's worst month of all. Drs. Arnold and Stone had decided that she needed to take some extra call so she could have some more practice “acting” like an obstetrician. They said she needed to be more assertive, and exude more confidence. In her mind, this meant she needed to act more obnoxious, arrogant, and pretentious. Dr. Arnold had made it clear that if she didn’t exhibit that she could exude the confidence and authority of an OB/GYN, she would either be dropped from the program. So for the next several months, Angela decided, she would give them what they wanted. Angela knew she practiced good medicine and had the skills needed to be a good OB/GYN. She just needed to leave her personality at home for the next few months and act in such a manner that Drs. Arnold and Stone would know unequivocally that Angela could act like a t... More About: Chapter 1 , Chapter
Chapter 9
2007-05-18 04:29:00 Dr. Johnson's nurse met Sarah and James at the front door of the office and asked them to have a seat in the waiting room. She explained that Dr. Johnson was still at the hospital rounding on patients but had called and said he would be over soon.The waiting room was warmly decorated in a elegant pink color scheme. When Sarah had called Dr. Johnson and told him she was bleeding, he had told her to just meet him at the office in an hour. From the amount of bleeding she had described, Larry had told Sarah that it probably wasn't anything to worry about, but he offered to do an ultrasound in his office just to make sure everything was okay. “How much do you think those Thomas Kinkaide pictures cost?” James asked Sarah.“You know I'm not good at those questions. I'm not going to answer you just so you can make fun of me,” Sarah replied.“Oh come on, Sarah. I'm just trying to distract you a little so you won't be so worried.”“So I won't be worried? I'm bleeding and yo... More About: Chapter , Chapter 9
Chapter 8
2007-05-18 04:27:00 James came downstairs, still in his blue plaid pajama bottoms, enjoying the smell of bacon and sausage coming from the kitchen. Saturdays were awesome. He walked into the kitchen, snuggled up behind Sarah and clasped his hands around her pregnant abdomen. “Good morning sweetheart,” he said. “You know, Sarah, there's nothing like starting the day off having breakfast with you,” James said, sitting down at the table. “I wonder if it would be so romantic if you were the one that had to get up and make it,” Sarah replied. That bugged James. “Why did you say that Sarah? I just told you how much you mean to me and you answer with a complaint. Don't be so sensitive,” James said. As soon as he said this, he knew his tone had pierced her heart. Sarah finished pouring the boiled water into his favorite coffee mug, the one with a loon painted on it. They had bought it at a gift shop called “Meadow Rue” that they had come across while hiking in N Wisconsin. Sh... More About: Chapter , Chapter 8
Chapter 7
2007-05-14 23:04:00 Ken Kessler was not a morning person. So a 7:30 AM meeting with his boss on his day off was not how he would have chosen to start the day. And being informed of the meeting by Larry's nurse did not help matters. Why didn't Larry have the courtesy to call so they could find a time that worked for both of them? Ken figured Larry had arranged the meeting this way to remind Ken he was just another employee of Women's Physicians, P.C. It was very important to Larry that everybody recognized him as boss. It was easy to keep his nurses and office staff in line, but physicians had more of an independent spirit, and keeping them under his thumb took skill. This meeting, arranged as it had been, was probably just another one of his calculated moves to remind Ken of his place in the organization. Ken was sure that the Larry wanted to meet with him about, as Dick had put it, “the numbers”. And he knew this would not be a fun conversation. How do you tell your boss that he ... More About: Chapter , Chapter 7
Chapter 6
2007-05-12 00:51:00 The timing of this whole thing sucked. It really sucked. Two weeks ago, Angela caught herself actually enjoying life—the first time this had happened since she had started her OB/GYN residency at Emory University. She should have known it wouldn’t last long. Just as she started to think she might have made the right choice to go into OB after all, she had encountered the most difficult clinical situation she had ever faced, and failed.And so today she found herself on the way to meet with her Dr. Sharon Arnold, the residency program director, and Dr. Charles Stone, the famous chairman of the Department of Obstetrics and Gynecology. She knew the meeting had to be about the bad delivery.The bad outcome had occurred when Angela was the senior resident on call on Labor and Delivery. For sure, the case would be discussed in a formal way at the department's monthly morbidity and mortality conference, affectionately known as the M&M conference.But in this case, since there had been su... More About: Chapter , Chapter 6
Table of Contents
2007-04-25 23:08:00 Chapter 1Chapter 2Chapter 3 (revised)Chapter 4Chapter 5 More About: Tabl , Contents , Table , Tent
Chapter 5
2007-04-25 23:04:00 Chapter 5 As he had expected, the patient didn't deliver until about an hour after Larry had been called to the hospital. Fortunately, the delivery went well, the patient had no tears, the placenta delivered soon after the baby, and Larry got back to the office, hoping Sarah Carson was in an exam room. “Is she here?” Larry asked Maria. “She's in room four,” Maria said. “Thank you. How'd you get her back here so quickly?” he asked. “We called her husband at the church, who gave us her cell phone number,” he said. “Why did you want me to have her come back?” Maria asked. “I just think it's important to keep our patients happy, you know,” he said. “What is she here for anyway?” “I don't know, she wouldn't tell me,” Maria said. Dr. Johnson walked into the exam room. “Hello Sarah, how are you doing today,” Dr. Johnson said, extending his hand. “How can I help you today?” he asked, before she could answer. “Hi,” Sarah sai... More About: Chapter 5 , Chapter
Chapter 4
2007-04-25 23:03:00 Chapter 4 Dr. Johnson was at Weston Community Hospital in the physicians lounge on the labor and delivery floor waiting for Rebecca Hines to deliver. Even though she was a multip, and would probably go quickly, he was a little perturbed that Jane had called him over to the hospital so early. When Larry checked her, he felt she was only eight centimeters dilated, and thought it might be another hour before she delivered. If he could have stayed in the office for another hour instead of waiting over at the hospital, he would have been able to see about eight more patients, billing roughly six to seven hundred dollars, he calculated. But the office was an eleven minute drive to the hospital, and given that Susan might deliver in thirty minutes, it didn't make sense for him to go back to the office before she delivered. So to help soothe his frustration, Dr. Johnson decided to come and watch TV while waiting. The doctor's lounge was situated in what had once been a pa... More About: Chapter
Chapter 3 (revised)
2007-04-25 23:00:00 Chapter 3: June 1, 2009 What a way to start the day. Dr. Ken Kessler was upset before he saw his first patient of the day. The son of a carpenter, Ken was happy to be making $225,000 for doing what he knew was physically very easy work. But this morning's meeting with Dick had thoroughly pissed him off, and Ken was already starting to think about the other employment options he might have. Ken had a chance to become a partner of Women's Physicians two years after he started working with the group, but several accountants had advised Ken that the $200,000 buy-in that Dr. Johnson was asking for was at least twice what the asking price should be. Larry wouldn't budge with the buy-in amount, so Ken continued to work for Women's Physicians as an employee. Being an employed physician had its drawbacks. For one, Ken was reminded in many ways that he was just an employee of the practice. He wasn't convinced that Dr. Johnson ever really listened to his input about how the pr... More About: Vise , Chapter
Table of Contents
2007-04-19 22:48:00 Chapter 1Chapter 2Chapter 3 More About: Content , Tabl , Contents , Table , Tent
Chapter 3
2007-04-19 22:35:00 Chapter 3: May 15, 2009 Thursday was usually the easiest day of the week for Larry. His partner, John Kessler, was always on call Wednesday and Thursday, so he took care any of the practice's patients in the hospital. Surgeries were always scheduled on Mondays. So on Thursdays, Dr. Johnson only had to see patients in the office from eight till noon. As chairman of the Department of Obsetrics and Gynecology at Weston Community Hospital, he'd have to go to a lunch meeting at the hospital once or twice a month, but these usually only lasted an hour and so he'd still have most of the afternoon free. This is how the schedule had been set up since Larry started Women's Physicians, Inc. twenty years ago. Until three years ago, Thursday afternoons meant either golf, hunting, or flying over Weston in his Cessna 182. But for the last three years, Larry spent the afternoon picking up Jimmy from school and taking him to dialysis. Having practiced obstetrics for twenty years, a day... More About: Chapter
Chapter 2
2007-04-15 04:18:00 Chapter 2: May 9, 2009 (the day before Mother's day). Sarah Carson hated Sundays, or at least, she didn’t really enjoy them. She knew the exact day she developed this sentiment. September 18, 2006. That was the first day her husband James preached at First Baptist Church of Weston. While she was home miscarrying her first and only pregnancy. James had offered to stay at home with her, but she had encouraged him to go on and preach his first scheduled sermon at his first church. As the cramping got worse as the morning wore on, she wished he had stayed with her. Usually Sarah loved Saturdays. For the last two years, James took Saturday off, giving the pastoral pager to the head elder. It was the one day of the week when he really spoke Sarah’s language of love—quality time. They would usually start the day off eating a leisurely breakfast together at home on their brick patio. But today Sarah woke up in a funk, this Saturday being the day before Mother... More About: Chapter , Chapter 2
Chapter 1
More articles from this author:2007-04-14 18:08:00 Chapter 1: May 1, 2006 “Grandpa, can't you stay and play chess with me?” Jimmy asked. “I'm sorry, Jimmy, but not today. I'm going to have lunch with a friend,” Larry answered. “Who's your meeting with?” Jimmy asked. “An old friend from medical school,” Larry answered. “Your mommy will pick you up,” he said. “I'll see you later squirt,” Larry said, as Jimmy got out and walked into the brick dialysis building. Three months ago, Jimmy's nephrologist had told Larry that his grandson would probably only live another twelve months without a kidney transplant. Since then, saying goodbye to his grandson, whatever the occasion, was becoming more and more difficult. Why can't they find a freaking kidney for Jimmy? How hard can it be? Larry slammed his fist down on the console between the two bucket seats, glad that his wife wasn't there to scold him for losing control of his temper. Larry turned on the radio to try to distract him ... More About: Chapter 1 , Chapter 1, 2 |
