Terminal Therapy Read online

  “Clog?”

  “Wooden shoe-”

  “I know what-“

  “-Tracey, show it to him,” Klansky concluded, unperturbed.

  “I left it inside,” Shanley said.

  I heard a motorboat approaching--more police, I assumed. Its floodlights shone in sweeping arcs across the water.

  “Wait a minute,” Hansen said. “Isn't it possible that Dr. Singer left the boat of his own accord? On the landward side?”

  “Not likely,” Klansky said. “And Mitchell already looked there.”

  Shouts rang out. “Look! Over there!”

  The motorboat was, I guessed, about a hundred feet away. I looked in the direction of its floodlights and saw nothing at first. But then something bobbed above the plane of the surrounding water.

  “No, don't!” Hansen shouted.

  I turned in the direction Hansen was facing, and saw a figure dive into the water. The first few strokes I saw looked professional, but then I lost the erstwhile hero in the darkness. I stared, barely breathing, at the bobbing object in the distance. It wasn't long before the motorboat’s floodlights let us see our swimmer reach the object, and start to bring it back to us.

  I looked to each side. Everyone was looking in the same direction, out over the water, riveted by the aquatic drama. We stared and stared into blackness broken by floodlit glimpses. Our swimmer's return trip, burdened by the extra weight, took much longer than the trip out. I heard gasps when Tracey Shanley and the object she was carrying burst into the light around our boat.

  Someone threw a rope ladder over the side. Shanley swam over to it, and tried to lift her cargo out of the water. An army of hands extended in her direction, and dragged Jonathan Singer's lifeless body onto the deck.

  CHAPTER SEVEN

  “Is there a doctor here?” Hansen asked.

  “I’m a doctor,” I said. I saw Paula nodding.

  The crowd parted just enough to allow me to kneel by Singer's right side. My heart pounded. Take a deep breath and check your own pulse, I told myself.

  I pressed the tips of my left second and third fingers to the right side of Singer’s neck. Something quivered--but too weakly to tell if it was a pulse or a muscle twitch. I leaned over him, then swiveled my head to look at his chest, my cheek over his mouth. No visible chest movements, no feeling of air through his mouth or nose. He wasn’t breathing.

  “He’s in cardiac arrest!” I shouted toward the crowd. “Someone call for an ambulance!”

  I turned back to Singer and opened his mouth to check for objects which might be obstructing his breathing. I pinched his nose shut with my left hand, then tilted his head back with the assistance of my right hand, which I'd placed under his neck. Having straightened out his breathing pathway I took a deep breath, sealed my mouth over his, and exhaled forcefully enough to make his chest rise. I sat halfway up, gulped in a breath for myself, then delivered another breath to Singer.

  Time to compress his chest. I shuffled slightly to the right, found the spot two-thirds down his breastbone, and rested the base of my right palm on it, arm outstretched. I placed my left hand over my right and interlocked the fingers. I leaned forward until my upper body was above Singer's, then pushed his chest down by an inch, allowing my body weight to supply most of the force. Conserving energy was important. You never knew how long you'd have to continue the CPR.

  I completed 15 chest compressions, then shuffled back to the left in preparation for administering the next two breaths. (Note: this is the 1990s version of CPR). I took another deep breath and continued my one-rescuer CPR. I heard Hansen's voice.

  “I'm CPR-trained, too. But at this point getting him to the hospital is more important than helping you. I came in a van and the hospital's only minutes away. Can you handle the CPR while I drive?”

  I considered his question as I continued performing CPR. Studies showed that survival, and survival with a viable brain, correlated with time to initiation of CPR and time until defibrillation--electric shock to convert the heart rhythm back to normal. I guessed that Singer might have been in the water without pulse or respiration for 5-20 minutes. So it might already be too late to revive him.

  No point thinking about that now. Hansen was right. “I agree with your plan, Lieutenant,” I said while continuing chest compressions. “Please get me-”

  “A board to put under him,” he said, completing my request. I smiled as he turned to deputize someone to fetch it. Teamwork is golden, whether in sports or life-and-death.

  I kept my focus on Singer. The board I'd requested was brought and slid under him. While unseen hands lifted the board I arose in concert and continued the CPR.

  Our tag team walked off the boat, down the gangplank to the van. Voices clamored, apparently demanding to accompany us. But the only one Hansen allowed into the van with us was Singer's wife, Stephanie Carstens. She sat next to Hansen in the front. I heard him call the hospital to notify someone of the condition of our patient, and of our ETA.

  Although I concentrated on Singer and the 15-2 rhythm of the CPR, with brief interruptions every five minutes to check for the return of spontaneous pulse or respiration, the ride to the hospital was too long to prevent my mind from drifting. I heard the siren blaring atop our van. I felt thirsty, but that would have to wait. It registered on me that the barely warm body below me belonged to Jonathan Singer.

  Jonathan Singer! One of the giants in the field of psychology, barely below Freud. In fact, Paula had told me, Freud had been his teacher and mentor. He'd followed Freud to England in 1938 to escape the Nazis--unlike the rest of Singer's family, who had stayed behind and perished in the Holocaust. It was in England that he’d changed his name from Jochen to Jonathan.

  In the 1940s and 1950s he’d become disillusioned with what he considered the failings of Freudian psychoanalysis, and had helped to found the more practical, more scientifically rigorous school of cognitive behavioral therapy (CBT).

  My palms moistened as I contemplated the enormity of my task. Trying to save a great man's life. As my pulse quickened I told myself to focus first and worry later. No patient benefits from a doctor in panic mode.

  “How much longer until we're there?” I asked, my neck and arms aching from the rigors of the CPR. As soon as I spoke, however, we slowed down and turned into the parking lot.

  CHAPTER EIGHT

  After parking in the hospital lot Lieutenant Hansen ran around to open the back of the van. Within seconds orderlies in white hospital fatigues appeared. They pulled Singer out on his board and transferred him to a gurney.

  The appearance of reinforcements comforted me. But the very sense of comfort underlined how concerned I was about Singer's condition. I clambered out of the van to continue CPR. A pair of nurses eased me out of the way and took over.

  Someone touched my arm. “Are you a doctor?” she asked. I turned to face a woman in green surgical scrubs. A stethoscope hung around her neck.

  “Yes. I'm Dr. Calder. David.”

  She pushed her brown hair behind her right ear. Her hospital ID was clipped to her shirt, but backwards.

  “I'm Dr. Krista Caldwell. Tell me what happened.” She shifted her weight back and forth, one foot to the other.

  I proceeded to “sign out.” Transmitting my medical findings and actions to my counterpart completed the formal transfer of medical responsibility for Singer.

  “Thanks. See ya later,” she said, and ran inside.

  Funny how we're full of preconceived notions, and how unaware we are of most of them. I'd never given the idea of a hospital on the Cape any conscious thought. But when I walked through a parking lot with over a hundred spaces--albeit mostly empty--and looked up at a three-story, modern sandstone building, I was surprised. I must have expected a tent and a trailer. And a 1920s-era ambulance parked nearby for the once-in-a-decade emergency.

  I was no longer shocked when I walked through sliding, electronically-controlled glass doors, and spied a full-sized emergen
cy room waiting area. A dozen people were seated, plus twice as many empty places. I blinked as I adjusted to the bright fluorescent lighting, whose 24-hours-a-day uniformity in the windowless room rendered the day-night distinction moot. The speckled beige linoleum floor and the molded, hard plastic orange-and-brown seats looked relatively clean--except for the occasional deposits of petrified gum from the Pleistocene era.

  There were three groups of people in the room, with mine in the center. Paula, Lieutenant Hansen, Judith Klansky, and Stephanie Carstens were lined up in the aisle seats of the first four rows. Mitchell sat across the aisle from Carstens, his haunches testing the limits of his seat. No one was speaking.

  Hansen was looking toward the door, perhaps planning his exit. When he spotted me he stood up and beckoned. “Over here, Doc.” I approached. “Grab a seat,” he said, motioning to where he'd been sitting. I hesitated. “Go ahead,” Hansen said. “I feel like standing.”

  I sat; Hansen paced. I guessed that managing an incident involving a person as prestigious as Jonathan Singer wasn't an everyday occurrence for him.

  “What's happening with Dr. Singer?” I asked. I wasn't sure whom to address, so I looked at each person in turn.

  “There's nothing much we can tell you,” Paula said. “They took him inside right away. And told us that they'd talk to us as soon as they stabilized him. If...So, what can you tell us about his condition?”

  I caught myself before replying. Everyone knows that everyone dies eventually. But for most people the concept of death is so unreal, and so painful, that they allow themselves to half believe that it won't happen to them or their loved ones--barring some unforeseen accident or screw-up.

  Such defense mechanisms are understandable, but doctors see too much death to indulge in them. And sometimes forget patients' points of view. I've learned to break bad news gradually whenever possible, mixing truthfulness with sympathy, reality with hope.

  “He was in cardiopulmonary arrest,” I said. “So far as I could tell his heart wasn't beating and he wasn't breathing without my support. People don't usually recover from that.” I heard sharp intakes of breath.

  “But he still has a chance. His pupils, the darks of his eyes, were still responsive. Fluctuating in size. That's an indicator of some degree of brain function, at least. And drowning victims have a higher rate of recovery from cardiac arrest. And as little as I know Dr. Singer, he seems like quite a fighter to me.”

  “That's for sure,” Carstens, Klansky, and Mitchell Singer said at once.

  “How did this happen to him?” Carstens asked.

  CHAPTER NINE

  “I mean how did he end up in the water?” Stephanie Carstens asked it as if we hadn't understood her question.

  “You're one to ask,” Klansky said. “If you'd been by his side, as a wife should be, this never would have happened.”

  Paula and I exchanged glances. Not our business to intervene, we agreed. Hansen was suppressing a grin.

  “Hey, take it easy,” Carstens said. “It's not like he needs two bodyguards.” Even Klansky couldn’t help smiling at that retort.

  “And I was busy all evening,” Carstens continued, “looking for his damn pills. I finally gave up and called a pharmacy for an emergency refill. Couldn't believe our luck, finding a 24-hour pharmacy on the Cape. And then, wouldn't you know it, I found his pills.”

  Her last comment got our attention. She kept our attention by making an exaggerated arc with her hand, plunging it into her pocketbook. When she withdrew her hand it held a pill-box. Voila.

  “You ninny,” Klansky said.

  “You old bitch. You're just jealous.” She threw the pill-box at Klansky but somehow missed her, even at close range. It skittered across the floor but managed to stay closed. Klansky stood up and made a move toward Carstens. Hansen and Mitchell Singer stepped between them.

  “Enough,” Mitchell said. “My father's back there fighting for his life. Hash out your differences some other time.”

  “Whose side are you on, Mitch?” Carstens looked up at him and asked. Tears began to collect. “Don't you believe me? I did too look for the pills in my pocketbook. I couldn't have missed them. Someone took them out and put them back in later.” She turned away, covered her face with her hands, and sobbed. I retrieved the pill-box and placed it on top of her pocketbook.

  The entrance doors slid open. Tracey Shanley stepped inside. Her clothes didn't fit, evidently borrowed to replace her soaked outfit. Her thick blond hair was untied, streaming back, half wet. She scanned the room, saw and joined us.

  “Congratulations on your heroism, Dr. Shanley,” I said, glad to change the subject. “I'm Dr. David Calder. Call me David. What you did was amazing.”

  “Thank you, David. Call me Tracey. I'm a pretty good swimmer, so...and you're the one who kept him alive. He is alive. Isn't he?”

  “Yes. But barely. He's inside. We're waiting to hear.”

  “Can I help in any way?”

  “No. You must be wrung out.” (No pun intended, Paula). “Have a seat.”

  I motioned at my seat. She nodded and sat down. Klansky and Mitchell joined her. Hansen and I remained standing. Carstens, looking at her lap, broke the silence. “I still want to know what happened.”

  When no one replied we all turned to Hansen. The price of authority, I suppose.

  “Up to me, huh? I'm the only one who wasn't there when it happened. Any of you see anything?” We all shook our heads. “Well, I guess I'll poke around. But it doesn't seem like a police matter to me. Just an old man who fell overboard. An unfortunate accident.”

  “With all due respect, Lieutenant,” Paula said, “I don't think it was an accident.” She turned to Carstens. “Dr. Singer is an excellent swimmer. Isn't he?”

  “Yes he is. An hour every morning.”

  “Come, come, ladies. How old is he, a hundred?”

  “There's no need for you to speak condescendingly,” Paula said.

  “Ninety years old,” Carstens corrected.

  “No offense intended,” Hansen demurred, withdrawing his foot from his mouth. “I will take the situation seriously. And do a full investigation.”

  No one spoke. After a minute Hansen looked at his watch, then strode to the reception desk. We all watched him speak to the receptionist. Better than engaging each other.

  Hansen returned, and reported that he had nothing to report. They were still working on Singer. A doctor came out and spoke to one of the other clusters of wait-ers. Grave looks but no tears, suggesting a serious but not fatal condition. They followed the doctor inside.

  A woman with sweaty hair staggered in. One hand was on a man’s arm; the other clutched the lower half of a very pregnant abdomen. She grimaced and grinned. He fretted and beamed. As the two inched their way to the reception desk I smiled. Even an ER isn’t all misery and tragedy.

  CHAPTER TEN

  Diversions concluded, my group was now alone in the waiting area. Lieutenant Hansen checked his watch again. “Time for me to vamoose, folks. Catch you later.” He pinched his right thumb and forefinger and touched his hairline, as if tipping the hat he often wore. I turned to Paula as he left.

  “Don't bother,” she said. “We'll work on him later. Or in spite of him.”

  Klansky looked at me. “Dr. Calder, I'm Judith Klansky. Dr. Singer's personal assistant. You're a doctor. Maybe you can find something out.”

  “Well,” I began. “I have no privileges or authority here.” I hate to intrude on other doctors’ turfs.

  But then I saw the pain on her face. And I had to admit that she had a point. Doctors do often treat each other like guild members. “I'll see what I can do,” I said.

  My powers were even greater than I'd suspected. As I walked to the reception desk Krista Caldwell pushed open the swinging doors from the treatment area. She took a step toward our group, but then spotted and joined me. “I'm glad you're still here, David.”

  “I care about what happens to Dr. Singer, Kr
ista. What's his current condition?”

  Paula had joined us without my noticing. “Dr. Singer's wife is here. Is it OK if she’s part of this conversation?”

  “Of course, of course,” Krista said.

  As we re-joined the others I considered testing Krista. Could she select Jonathan Singer's wife from among Klansky, Shanley, and Carstens? On another day Paula would also have appreciated the entertainment.

  “Dr. Caldwell,” I said. “This is Ms. Stephanie Carstens. Dr. Singer's wife.”

  Krista didn't blink as she turned from Klansky to Carstens. Impressive. “Pleased to meet you,” she said as she extended her hand. “I'm sorry it's under such difficult circumstances.”

  Carstens lifted her head and shook Krista's hand, but didn't stand up. “So how is he? Can I see him?”

  “We've succeeded in stabilizing him. But he's still comatose.”

  Mitchell edged closer. “Hello, Dr. Caldwell. I'm Mitchell Singer. His son. Is he...will he...”

  I saw that Klansky was staring at Krista, hands gripping her seat. Klansky's intensity drew a subtle nod from Krista, as Krista shifted her attention from Carstens to Mitchell.

  “Survive, you mean?” Krista asked Mitchell. “I understand. I wish I could tell you for sure. But I can't. It's just too early.”

  “I see,” Mitchell accepted, but his eyes begged for more information.

  “On the one hand,” Krista continued, “he's an old man in a coma. Not responding to speech. On the other hand, he does react to pain. So his coma isn't profound.”

  I guessed that she regretted elaborating for Mitchell. The truth isn’t always what loved ones are looking for. Especially when the truth is complicated. Or grim.

  Having been in the same delicate position only moments before, I sympathized with her. “Thank you, Dr. Caldwell,” I said. “We understand that it's too early to say anything definite.”