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Sunday, April 24, 2011

("To dream the impossible dream, to fight the unbeatable foe, to bear with unbearable sorrow, to go where the brave dare not go")…Darien/Leigh

(Anh yêu em Tuyet...Tôi yêu con gái KaSandra & Katrina... Tôi thương con trai của bố Luc)

Gabriel's Promise
a novel by nicholas sheridan stanton

Chapter Sixteen

LA General Hospital & Trauma Center…Wednesday, March 23, 2005

The rain had been unexpected, at least by those gullible enough to plan their day based on network weather reports, and everyone knows how reliable those can be! Linda Bradley hadn't been fooled though, she'd felt the weather change coming for days. She was talented that way, with a sixth sense she acquired from her rural upbringing. It wasn’t a spectacular gift, not by any stretch of the imagination, but then again she never had to redo her hair on account of a sudden downpour either. Linda spun around in her chair to face the large bay window behind her and watched the rain pelt the glass with fat drops. The water ran down the building in torrents washing away the filth that had accumulated since the last rainfall. She leaned back and closed her eyes, enjoying the soothing sound and steady rapping of the spring downpour. It was different from the sounds she listened to as a child. When she was a kid the raindrops fell onto the corrugated tin roof of the barn on her Grandparents farm in southern Illinois. Her mom and dad sent her to spend summers with them to get her out of the craziness of the city in Southside Chicago.

As far as Linda was concerned there was something universally wonderful about rainfall. If she were to describe it in a single word she supposed that word would be life, because without the rain there would be no life. The world would just be dry and barren. At any rate, the rainfall was working its magic on her, pushing the rigors, the headaches, and the heartaches of the day to a less sensitive part of her brain. For right now she'd enjoy a couple more minutes of bliss before putting the phone back on the hook and make herself available for the rest of the day’s craziness.

This morning little break lasted longer than most, a full ten minutes by the clock on the wall until it was interrupted by a loud rap on the heavy wooden door insulating her from the chaos permeating a major trauma facility. Break time was over, and the door swung open quickly as her executive assistant, Derek Frost barged in. He was tall, a couple inches over six feet at least, and attractive as well if you went for that Wall Street Preppie look. Mercifully he only looked the part and didn't come with the annoying attitude that most twenty-something over achievers were infected with. He was good at his job though, his knowledge of the overall operation made him invaluable to Linda, especially in the early days of her transition. She suspected he had eyes on her job as well, which was okay with her, every smart executive needed a succession plan. The two of them hit it off right away, a purely professional relationship from the get go. Of course that was pretty easy given she lacked the testosterone required to attract any amorous attention from him anyway. They worked well together, enjoyed each other’s company and respected each other’s role, it was perfect!

“Excuse Ms. Bradley, but the Tate’s are here. I know, they’re early, but I didn’t think that you'd want them waiting in the lobby under the circumstances,” Derek said tapping on his ever present palm pilot with the stylus.

“Thanks Derek, give me two minutes and then send them in,” Linda replied turning to quickly straighten her desk, setting the Tate file down in front of her.

She'd been dreading this meeting; she dreaded all of these kinds of meetings. It's never easy to deliver bad news, especially when it was so personal. It made her feel low, it made her feel ashamed. She knew it was prudent, that it was fiscally justified, and she understood the logic. Hadn't she recited the mantra over and over in her head, sometimes one must do wrong things for the right reasons. The words were losing their power though, and lately she'd had to force herself to accept them before subjecting nice people like the Tate’s to the realities of a business model and the grief that came with accepting the rules associated with them. This was the hardest part of her job and she loathed it. She'd been raised by a family that taught her that when faced with choosing between being right and doing right, the choice should be easy for the righteous soul. The door opened after a short knock and Derek Frost escorted Wallace and Anita Tate into her office. They were a nice middle aged couple, maybe late thirties, a mixed marriage, Caucasian and Hispanic. Linda picked up the Tate file and got up. She walked around from behind her desk to meet them in the middle of the room, extending her hand to first Mrs. Tate then to Mr. Tate and inviting them to be seated and get comfortable.

“Thank you so much for coming, please sit down,” she said sweetly, gesturing to the chairs at the small round conference table beside them.

Mr. Tate shook her hand and led his nervous wife to the closest seat. Wallace pulled out the chair for Anita, sliding it under her gently as she sat down, and then quickly took the seat next to her on the right. Linda circled past them and took a seat directly across from the two them, subconsciously putting a barrier between them, a safe zone if you will. At times like these she had wished she had a long rectangular table to meet at, but her experience was that people took bad news better in intimate settings, face to face. Linda set the manila folder in front of her and folded her hands on top of it as she settled into her seat. Discretely she wet her lips with her tongue as she cleared her throat.

“Would either of you like some coffee or tea?” Derek asked standing at the door.

The couple shook their heads and indicated that they did not and Linda dismissed her assistant with a knowing look who then left the room, leaving the door slightly ajar. Mr. Tate was quick to start the conversation, anxious for news, about their daughter Katie's condition, and more importantly the HMO's position regarding her prognosis and continued treatment.

“Are those Katie’s test results?” he asked, pointing at the file in front of her.

“Yes they are, but if you don’t mind I'd like to wait for Dr. Reynolds before we discuss them,” Linda replied.

“Is he on his way? Can't you just get it over with? We know what you're going to say so just get it on with it! ” snapped Anita, suddenly less passive.

“Please, Mrs. Tate, just a moment longer, he should be along any minute. I’m afraid you were a little early and you know how crazy doctor’s schedules are,” Linda said stalling.

She was about to get up and ask Derek to go and fetch him when Dr. Ryan Reynolds entered the room with one other person. Linda recognized the younger woman as Dr. Elizabeth Andrews, a relatively new addition to the LA General family, although she had not actually made her actual acquaintance officially. The two physicians crossed the room and sat down quickly at the table, addressing the normal greeting formalities. The Tate’s smiled weakly at Dr. Reynolds and Anita Tate surprised Linda when she reached across the table to gently squeeze Dr. Andrews’ hand. Apparently the two had met, a fact that Linda was in the dark about.

“It appears as though everyone knows one another, although I must confess I'm at a disadvantage where you are concerned doctor?” Linda said, trying to read Elizabeth Andrews' nametag.

“I'm sorry, please forgive me, where are my manners anyway? Linda Bradley, Dr. Elizabeth Andrews,” replied Dr. Reynolds apologetically, and introducing the two women.

Lizzie, please,” the young doctor pleaded politely.

“I just assumed that you two must have met previously. Dr. Andrews has taken quite an interest in young Katie’s treatment and has been a welcome source of moral support for the child and her family. I'm certain that the Tate’s will attest to that,” added Ryan Reynolds, trying to explain away the social fumble.

“Oh yes, she’s been wonderful,” Anita Tate added quickly.

“Awwww, that’s so sweet,” Lizzie said, smiling and squeezing the woman’s hand just a little tighter.

“Well, I’m happy to know that you’re all so well acquainted. Now, maybe we should talk about these test results,” Linda said patting the folder gently.

The mood shifted gears quickly from light and friendly to tense and suspicious as she slid the folder over to Dr. Reynolds. Linda rubbed her nose to hide the deep breath she drew and waited for the elder statesman of the Oncology Department to break the ice. The ranking physician at the table fished for his spectacles inside the pocket of his lab coat and then placed them low on the bridge of his nose. He paused to look over the file contents as if he were reading it for the first time, fooling nobody as he composed himself.

“Ahem,” he began, clearing his throat.

“I’m afraid that these aren’t the results we were hoping for,” he continued.

Anita Tate whimpered softly. Her husband rubbed her shoulders while Lizzie continued to hold the woman’s hand. Linda could see why Dr. Reynolds had brought the young lady along and she was grateful for his foresight. The elder doctor was struggling uncharacteristically struggling with his composure and it was getting on Linda's nerves. She didn't want to have to take the lead on this but that is exactly what she would have to do if he didn't get on with it soon.

“This last chemo regiment should have yielded a more positive white count. But as you can see by this chart here, the numbers fall considerably short of the range we talked about. I’m afraid that we’re looking at yet another round of chemo, possibly full body radiation as well," continued Dr. Reynolds finally. Both the Tate's began to softly sob, even Lizzie was tearing up. Linda bit chewed on her cheeks behind lips that were drawn into a tight, benign expression.

"Of course that will have to wait until her body has recovered significantly before we start anything. Right now would be too risky," he continued.

"As for the possibility of a bone marrow transplant, the fact that Katie is an only child works against her. Marrow from either of you would only be half a match at best, and I'm afraid that there isn't time to consider creating a sibling donor at this late date," finished Dr. Reynolds.

The meeting deteriorated to a series of sniffles and whimpers, the air in the room thick with emotion and helplessness. Linda swallowed some blood from where she bit off a small chunk of her cheek and cleared her throat. She looked over at Ryan Reynolds asking with her eyes if he were finished.

"Ahem, I afraid I must defer to Linda regarding the possibility of these options,” the elder physician explained, turning to Linda and yielding the floor.

Linda flinched when she heard her name mentioned out loud, show-time she thought. This wasn't her first rodeo and she composed herself quickly, after all she’d been expecting this moment, and was fairly confident that she could get through this without a big scene. She put a compassionate smile on her face and took her cue.

“Yes, well, Dr. Reynolds is quite right, we must discuss these options. Specifically, the availability of these options,” she began.

It was Wallace Tate’s turn to flinch this time, and he didn’t try to hide it. Linda looked directly at Mr. Tate making eye contact before she went on. She was a firm believer in being direct, if not down right blunt, especially when delivering bad news. Linda convinced herself that it was the best approach 99% of the time. She was wrong though and she knew it. That tactic only made her feel better, but selfishly it was her defense mechanism and it allowed her to sleep at night. Doing right versus being right was still only a theory for her. She still suffered from the delusion that sometimes you have to be cruel to be kind, another myth that cowards often use when they choose to ease their own conscience by breaking someone else's heart.

“As COO of this Hospital it's my responsibility to take situations like Katie’s before the Board, brief them on the prognosis details, and make recommendations on a case by case basis,” she said, reading the Tate’s initial reactions.

Wallace Tate looked positively catatonic, his eyes were sad and red and she hadn't seen him blink in half an hour, it was a little scary. Anita continued to whimper softly, staring at the tabletop. They knew what was coming next, it was obvious. However how they would actually react was still a crap shoot. You never know, ya know? That part of the process always made Linda a little nervous.
“We want to do what's right, but as you've heard the prognosis is rather bleak. The odds are just not in her favor, you understand that don't you?" Linda asked setting the Tate's up for the big finish. They didn't reply they weren't even looking at her.

"If there were any chance that further treatment would do more than buy Katie just a little more time we wouldn't hesitate going forward. However, at the end of the day this is a business and I have a fiduciary responsibility to the shareholders of Peck International. The Board must adhere to strict set of policies regarding protracted and costly treatments and procedures,” Linda continued. The Tate’s remained silent, which frankly made Linda a little nervous. She had done this sort of thing a hundred times or better, you’d think she'd have been desensitized by now, but she wasn’t.
“So, what does that mean for Katie? Let me assure you that her situation was studied very carefully, and was given every consideration. Dr. Reynolds passionately presented her case personally. However, under the circumstances, given the latest test results, and Katie’s prognosis, the Board could not support investing more time and resources on a terminally ill patient. Regrettably we're recommending Hospice as the next course of action. You must admit, she's been through so much already; do you really want to subject her little body to another harsh round of expensive chemo and radiation? Frankly, even your insurance carrier is balking at continuing to fund what they see as a losing effort. I’m sorry; it's time to consider quality of life now. Take your child home while she is still well enough to enjoy what’s left of her life and make your plans for the end,” Linda explained as gently.

She had tried to soften the sharp terms and jagged message with a soothing empathetic voice. But she knew it would be received like a knife in the heart or more truthfully like a stab in the back. She hated making life and death decisions on the basis of the bottom line. She was ashamed of herself. Wallace Tate’s physical reaction did not match the look in his eyes. He remained calm; he remained in control of his emotions while he digested the poison pill Linda had just fed him. He sat across from her, chewed every syllable and swallowed her message one word at a time. Anita had run out of tears and looked to her husband for their next move. Wallace sighed deeply, took both of her hands in his and smiled weakly at her, he looked relieved to Linda. She wasn't surprised, surrender tended to bring peace after a long fight.

“So that’s it?”

“I’m afraid so Mr. Tate, we’ve done all that we can do,” Linda said softly.

“I see,” he replied scooting away from the table and starting to get up.

WAIT A MINUTE, are you kidding me,” Lizzie Andrews shouted!

“There’s still lots we can do, Dr. Reynolds just spelled it out for you! You’re not going to take this lying down are you,” she pleaded, looking from Linda to the Tate’s and then back again.

“Come on, let me talk to the Board, I’ll get through to them. Who gives them the right to play God anyways,” Lizzie shouted.

Dr. Andrews, you are way out of line here, please get control of yourself and sit down!” Linda demanded, scolding the young doctor.

Lizzie sat down on reflex, instantly furious with herself for doing as she was told like a frightened eight year-old. Respecting authority had always been a challenge for her, especially when given an ultimatum. She started to get back up but was held in her seat by Dr. Reynolds. He stood beside her, keeping her in her seat with gentle but firm pressure on her shoulders. Lizzie yielded reluctantly, deciding to wait and see what the senior physician had to say, poised to leap up and continue her protests should he show any sign of weakness.

“Let’s just all calm down, shall we,” he said.

“Look, what Ms. Bradley says is true, further treatment will be expensive and positive results are not guaranteed. In fact, they're not likely. That being said, let me state for the record that as a physician I am trained and duty bound to do everything in my power to preserve life.”

“That’s right, you tell em!” spat out Lizzie, speaking before thinking, as she usually did when her Irish was up.

“Elizabeth please, you're not helping!” pleaded Dr. Reynolds.

“Sorry,” Lizzie replied meekly.
“As I was saying, as a physician I want to recommend treatment, I want to fight. However, as a human being, I'm inclined to say enough is enough.” he explained, looking directly at Wallace Tate.

“I've have no children of my own but I've treated thousands during the course of my career. What I'm about to say I can't say, so you didn't it. But if Katie were my child I would take her home, and create as many smiles as humanly possible before the inevitable,” he said sitting back down.

Lizzie was half way out of her chair when Wallace Tate rose. He gestured for her to sit back down with a feeble waive of his hand and the expression on his face. She capitulated and sat down, turning in her seat to glare at Linda Bradley.

Ahh, I um, understand what Ms. Bradley said about the business of running a hospital, I’m a businessman myself,” he began.

“And I understand Dr. Reynolds’ words and am grateful for his council and compassion,” he added, looking to Lizzie next.

“But I’m inclined to agree with Dr. Andrews here, if there is a chance, if there is the slightest ray of hope, then we ought to pursue it, it would be wrong not to!”

“If it’s just about the money, then give me a little time to come up with it and I’ll cover whatever the insurance company won’t, is that possible Ms. Bradley, can I do that?” he asked, directing his attention to Linda. She leaned back in her chair, crossing her arms defensively.

“Mr. Tate, we’re talking about a great deal of money, several hundred thousand dollars, probably much more. Those are real dollars that you would have to come up with immediately,” Linda explained, trying to discourage him with facts.

“I see, well, can you give me a number and wait until the end of the week for me to raise the money,” he asked?

“Sir, please be reasonable. We’ve already taken into consideration every reasonable and actionable possibility before arriving at this decision, including the possibility of you paying for this all on your own. Truthfully sir, even if you did raise the money, which would require a miracle, I am inclined to agree with Dr. Reynolds, perhaps this is one of those times where enough is enough,” Linda said softly and compassionately.

“How can you say that? It’s his daughter’s life, it’s his decision to make, let him try for Christ’s sake,” Lizzie shouted, unable to hold her tongue.

“Elizabeth, that is quite enough! You’re excused from this meeting, please leave, we’ll discuss this later,” Linda said harshly.

“I apologize Mr. Tate, please forgive Dr. Andrews’ outburst,” she added.

“No, it’s okay. Actually I appreciate her enthusiasm; it’s helped me find my backbone,” Wallace Tate said, looking at Lizzie and smiling.

“Seriously, Ms. Bradley, let me at least try to raise the money, give me to the end of the week. I promise if I can’t do it, we’ll pack up and leave quietly. Please, let me try,” Wallace Tate pleaded.

All eyes were on Linda, the room holding its breath, waiting for her reply. She picked up the Tate folder and held it closely like a child holds a teddy bear. Linda felt as if she'd been ambushed and she didn't like it. These meetings weren’t supposed to turn out like this. She was supposed to be the rock. She was supposed to be in control, invulnerable to tears and sad puppy dog expressions. She was angry with Lizzie Andrews’ intervention, and at the same time she applauded it. She was tired of always being the heavy and she envied Lizzie's Joan of Arc performance, the hero of the day. Most of all she was upset with herself for getting involved. Nobody knew that she had been looking in on Katie Tate. She'd broken her cardinal rule, and she knew it. She still had to do her job, but in the Tate’s case she decided to do right instead of be right this one time. She would allow them the dignity of at least trying to challenge the company’s harsh and inflexible policy of “if you can’t pay, you can’t stay.” Linda set the file back on the table and clasped her hands in front of her as if about to pray.

“Alright Mr. Tate, I’ll take your proposition to the Board. But it’s already Wednesday sir, that doesn’t give you much time. So I'll do you one better and give you until next Friday to do what you can to raise a million dollars. You asked for a figure, that's a conservative estimate. Frankly I don’t see how you’re going to get from here to there, but I wish you luck,” Linda said, looked from face to face, pausing an extra second on Lizzie’s, delivering a silent message.

Wallace Tate leaned back in his chair and stared back at her. He folded his arms in front of him defensively, as if he were about to declare war before he answering her. Anita looked at her husband proudly and smiled for the first time in a long while. It didn't make sense, but all of a sudden she felt hopeful.

"How am I going to do it?" he asked rhetorically.

“Prayer,” he said confidently, his mood changing suddenly, as he grinned and winked at the Hospital COO.

“Prayer, really?" replied Linda Bradley.

"That's right, prayer," he replied confidently.

Linda smiled at him and gave him a best of luck nod. Suddenly she was smiling involuntarily, she felt good, really good. She felt like the Tin Man when the Wizard gave him a heart. She felt human again. It does feel better to do right then be right. It really does…

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