Department of Social Selection

"Assault"/huntemann                                                                                                                                            Page 426

Chapter Six
Scene [9]

Department of Social Selection

New England Medical Center, Boston, MA
1998/12/22 14:14-15:00 Tuesday [Don]
         Ferne had to work but I was able to reschedule a client so I could go to Kimee’s prognosis meeting at NEMC. Susannah Blass, NEMC Social Worker, had said in her last phone call that DSS wanted to be there, too. NEMC had kept them on the other side of a spokesman, so I assumed they wanted to get a full report on Kimee and be able to ask questions of the doctor directly.

         I had hoped to get there early and visit Kimee first, but traffic was snarled and I barely got there by 14:00. Susannah Blass and Julie Magnano, Kimee’s NEMC primary nurse, were waiting for me just outside the NICU.

         We filed into the conference room where I was surprised by six more people sitting at the table:
                   Dr. Cindy Cole - NEMC attending physician
                   Alan Levine – Kimee’s Guardian Ad Litum
                   Faith Coddon - DSS Social Worker
                   Lori Ortiz - DSS Supervisor.
                   Sue Tobin - DSS director of nursing, and
                   Pat Peterson - DSS nurse.

         Alan Levine and Dr. Cindy Cole sat in plush chairs at each end of the huge mahogany table. The DSS people sat opposite each other on both sides of the room. Julie, Susannah and I found separate chairs.

         After introductions all around, Dr. Cole gave us a report of Kimee's condition:

         “Anoxia at birth caused a portion of Kimee’s brain to die immediately. Significant lesions and loss of tissue occurred probably due to the long time she didn't have a heartbeat or breath following delivery.

         “The resulting swelling caused more damage over the following week or so. And, now, liquefaction of her brain is taking place as her body is in the process of removing the dead tissues.

         “She needs a trachea to bypass her vocal cords which are neurologically paralyzed.”

         I asked, “Can the cords be removed or tied back temporarily instead?”

         Dr. Cole said, “There are more problems with the air-way than just the vocal cords, so that would not work.

         “Her nutrition is going well, but she has no gag reflex yet. The tube into her intestines gets clogged often so she needs a Gastrostomy, a permanent G-tube.

         “To prevent reflux back up her esophagus, she should also get a Fundoplication, a restriction at the top of the stomach.

         “She needs regular PT to prevent onset of contractures... which are already getting worse.”

         Most every item ticked off by Dr. Cole made me think, Just like her mother.

         Dr. Cole asked the DSS nurses to comment on their experience with similar patients.

         One of the DSS nurses said, “It is tragic and hopeless. She will not recover. The best we can hope for her would be to live a few months or years at most. And that will be with total care. Just a vegetable.”

         The word vegetable made me sick. Renee is a vegetable to some people. But not to us!

         Dr. Cole continued, “She is susceptible to infections and has a bout with pneumonia every few days. Her breathing problems, compromised already from being premature, are amplified with every infection. We use a lot of antibiotics to treat them. But, that will eventually fail. The bugs will mutate and become resistant to all of our treatments.”

         I asked, “Is that what the MRSA bug has done?”

         She said, “Yes, but that is more site specific. She will develop her own resistant infections.”

         I asked, “Is she in pain?”

         Dr. Cole said, “She is not in pain. And we will watch that closely. We can stop treating the infection directly, just control for pain.”

         “And just let her die?”

         “It’s hopeless, Mr. Huntemann. The bugs will eventually take her anyway.”

         I said, “No. I want you to treat her for everything. If we lose her because of superbugs, that’s one thing. But we don’t want you to just give up.”

         The second DSS nurses said, “Do you know what it entails to have such a compromised patient? It will have a terrible toll on your family.”

         Are you freaking blind? “We’ve had Renee for three years. We know... we cope.”

         The nurse didn’t seem to know about Renee.

         Cole continued, “Even though, we should consider a DNR. As the treatments fail, her breathing will become more labored—”

          “No DNR,” I interrupted, having been inadvertently warned by Snyder. “Besides, she’s already on a ventilator, getting antibiotics, and therapy. That’s her standard treatment. Not extraordinary.”

         I looked over to Allen Levine, “I’m only a grandpa... and a suspect. I don’t have any authority here, you do. What are you going to do?”

         Levine said, “This’ll not be decided by me. There has to be a judge involved.”

         The first DSS nurses said, “A panel will be appointed to review her case. Usually composed of someone from the legal profession, at least two doctors, someone from the clergy, and a lay person. They will present their recommendation to a judge and he will make the decision.... What religion is Kimee?”

         They want me to agree with them now. Damn!

         I said, “That’s way too premature. Don’t try to start laying the groundwork for some panel yet. We don’t want her to die.”

         My heart was pounding as I looked around the table. All but one looked back at me with disappointment on their face.

         Only Julie Magnano smiled and said, “Speaking for the administration and staff of the hospital, we will follow the wishes of the family. Kimee will get full code care and there will be no DNR.”

         Magnano’s authority was real. Dr. Cole was only a temporary Attending. Levine was also temporary, too. But DSS was Government and could force the issue as long as I was excluded. Magnano’s words were like a comforter on a frigid night. This woman is a real nurse, she cares.

         I smiled back at her and whispered, “Thank you, Julie.”

         That ended the meeting. It was 15:00.


         After the meeting, out in the hall, Alan Levine and Faith Coddon asked if they could visit Kimee. We went over to the airlock, suited up, and visited Kimee for 30 minutes.

         Julie explained all the equipment, monitors, beeping signals, wires and tubes cradling Kimee. Even from behind her mask, I could see the mother come out in Faith’s eyes as she met Kimee.

         But the department wants her to die.


         Early the next day, I called Michelle to tell her the developments of the meeting. There was no answer and I was diverted to her [VM]. I left a short message of my concerns that DSS might try to impose a DNR without us.

         That afternoon I tried again... with the same results.


Pages: 6
Words: 1,127