Diagnosis Death Read Free Page A

this. It's an order he didn't write."
    No problem there. Lots of doctors wrote orders—residents, staff taking call for a colleague. Stay quiet, Elena.
    Gross turned the chart to face Elena. "Tell us what you see here."
    Elena leaned forward and read the words she already knew were at the heart of this matter. "DNR."
    "And the signature?"
    "It's mine."
    Gross frowned. "Elena, we all know how difficult it was for you as a physician to let someone else direct your husband's care. And we recognize that the decision not to resuscitate your husband was yours to make. You told Dr. Matney repeatedly that you couldn't bring yourself to withdraw life support. Then, on the same day that a 'do not resuscitate' order appeared on the chart—not written by the attending physician—your husband's respirator was disconnected without the knowledge or participation of any of the staff." She paused like Perry Mason addressing a particularly reluctant witness. "Can you explain that?"
    Two pairs of eyes focused like lasers on her. What could she say? Best to keep it simple. "I'd held off as long as I could, but I finally accepted that we couldn't keep Mark on life support any longer. Dr. Matney, you were in surgery, and I was afraid that if I didn't follow through right then I'd change my mind. Writing the order was sort of symbolic for me."
    Matney's voice was like polished steel. "And did you turn off Mark's respirator?"
    The silence seemed to stretch on endlessly. Elena's shoulders sagged. She looked down at the floor. "I don't know." She swallowed hard. "I honestly can't recall."
    No one seemed to know how to respond to that. Finally, Gross said, "I can understand. It was a very traumatic experience, and we often tend to block out those memories." She looked at Matney, then back at Elena. "I believe we can overlook your writing that order, although you recognize it was a serious breach of both protocol and ethics. And, if you did take matters into your own hands to end Mark's suffering, we can understand that as well. But we have to be certain that nothing like this will ever happen again. You can't let this carry over to affect other patients under your care."
    Elena looked up at the two doctors with what she hoped was the right expression of contrition. "You have my assurance."
    Matney scraped his chair backward and rose. He favored the two women with a single nod and left the room as though marching off to save the world. Gross leaned across the desk and extended her hand. The cold, formal voice she'd used moments before gave way to the kindly tone of an older sister. "Elena, my door is always open. Come and talk with me anytime."
    Even as Elena expressed her appreciation, she knew that no help would come from talking with Amy Gross or anyone else. Nothing would help.

    "I'm sorry, but I'm paying as much as I can each month. There's nothing more I can do right now." The insistent tones of her pager cut through the conversational buzz and clatter of the hospital staff cafeteria. Elena checked the display. Emergency Room. Stat.
    "I have to go." She flipped her cell phone closed and hurried toward the door, shoving her tray onto the conveyer belt without breaking stride.
    Elena slammed through the swinging doors of the ER, looked around, and saw a pair of EMTs wheeling a stretcher into treatment room two. She and the head ER nurse arrived at the door right behind them, trailed by a nurse's aide.
    "Sixty-eight-year-old male found unresponsive by his wife." The EMT grunted out the words as he and his partner shifted the patient from their stretcher onto a hospital gurney. "Comatose. BP 168 over 90, pulse 56, respirations 12 and irregular. He's on Cardizem, Lipitor . . ."
    Elena listened with one ear, her mind already focused on the problem at hand. She ran her hands over the man's scalp, moving aside the silvery gray hair, looking for bruises and lacerations, finding none.
    As she bent to check his eyes, she sniffed the man's breath for the