Early evening on a summer weekday. Matt and Harmony are at Matt's apartment and Phaorah Seti II has acclimated himself to Matt's apartment very well. Seti does not like squalling babies but doesn't seem to mind the television set on all day, especially when Matt forgets to take out his one of his National Geographic DVDs. Seti loves seeing the big cats in action and at times when Matt and Harmony have returned to Matt's place, they find Seti growling and purring contentedly at the videos of the big cats.
Matt has taken to leaving a different NG DVD running to keep Seti entertained during the day. The two humans are just outside Matt's apartment, near the end of a conversation. Inside, Seti is lying on his side, watching the tv. A lion has just made a kill and Seti is licking his whiskers.
Harmony: (a bit anxiously) "But I saw her, Matt. She looked, well, distracted. I don't think she's all right."
Matt strokes his chin and jiggles the keys in the lock.
Matt: "Come on. Ah. there we go. You, uh, know about what happened to her?"
Harmony: "It's an open secret around here. Do you think she's depressed?"
Matt: "Yes. Sometimes the reaction to sexual assault is delayed. One of my patients reported feeling elated when she was able to fend her attacker off. She didn't have any physical injuries but when I saw her one day about four months after the assault, I was shocked at her appearance."
The two have entered Matt's apartment. They see Seti watching the National Geographic show. By way of greeting, Seti turns his head and blinks at their entrance, then turns his attention back to the program.
Matt: (addressing Seti) "Glad you like my dvds."
Seti flicks his tail at Matt's voice, voices a short purr then resumes watching his show.
Harmony: (to Seti; she puts her purse down on a small table) "Acting Pharoah-like, aintcha?"
Harmony: (to Matt) "Total change in personality?"
Matt: "She hadn't changed her clothes in four months, preferring to wear the same pair of cotton leggings on a daily basis. Oh, she didn't bathe for weeks, nor did she wash the leggings or brush her teeth."
Harmony gives a low whistle. Seti perks his ears up.
Harmony: "And you recommended therapy?"
Matt: "More than that. I actually convinced her to stop by for an HIV test then took her around to a clothes giveaway that a designer was holding here at UMC. She didn't want to go in looking the way she did, so I ran her to the locker rooms. She showered and borrowed one of Nick's surgical outfits."
Harmony: "You tricked her? You naughty devil!"
Matt: "Not really...tricking. Rather more a way of offering something that would draw her out of her shell, at least temporarily."
Harmony: "And did it work?"
Matt nods, stooping to stroke Seti the Second's dark fur. Seti purrs like a small motor gone wild.
Matt: "Yeah. She liked the clothes giveaway. Ended up getting enough outfits for a week. I managed to get her into some therapy and today I'm happy to report she is doing quite well."
Harmony: "How long did it take?"
Matt: "Almost two years."
Harmony: "And you think Rae's depressed?"
Matt: "I don't have to think it. I know it. And she's more than depressed, she's angry--angry at herself, angry at her attacker, angry at everyone."
Harmony: "But will she get help? She seems kind of...independent."
Matt: "I can enlist Nick's help. Rae's had a lot happen to her lately."
Harmony: "I'll say."
The next day...
9:48 AM: A bleary-eyed Rae is seen walking groggily towards the kitchen. Norman looks at her retreating back with some concern; he raises his eyebrows in question at Letty, who looks at Jackie, who then catches Jules' eye. None of them have seen Rae looking the way she does.
9:54 AM: Jules and a teen patient's mom, Martina, are sitting in a small tan and pale green reception room that Jules decided would do well for those one-on-one pediatrician parent encounters (she is worried about HIPPA).
The mother of Agnes, Martina is usually good at finding solutions to her teen-girl rearing problems--unless Martina gets together with a group of women friends. Then Martina tends to lose her reasoning to follow the conflicting advice of each friend, and this is what has brought Martina here today.
Jules: (sitting with her knees together and hands clasped) "It would be really helpful if you were the parent and Agnes the child."
Martina: (a tiny wail to her voice) "But she'll say that she hates me. I want my daughter to know I love her."
Jules groans silently; her expression bespeaks all.
Jules: "Did you ever ask her why she says "I hate you" whenever you insist she do something that she doesn't want to do?"
Martina shakes her head.
Jules: "So you want to be popular with her?"
Martina: "Yeah. She's my daughter. I want her to know I can be her friend and that she can come talk to me whenever she needs to."
Jules runs a hand through her hair (recently darkened to a dark coppery red).
Jules: "Parents and children have different kinds of relationships as the child matures. Earlier in her childhood, you had a more dominant role: you told her what to do, she complied. Now that Agnes is a teen, you have to allow her more room to make her own choices and learn from her own mistakes. And that entails learning how to become less dominant but still able to enforce restrictions. Understand?"
Martina hesitates before answering. She scratches her neck.
Martina: "Um, but every time I do crack down, she gets mad and says she doesn't love me."
Jules: "You need to ask her why she says she doesn't want to follow your rules. She gets free rent, free food, free money, free clothes. Why can't she follow a few rules until she goes off to college?"
Jules: "She's got a classic guilt trip on you. She's asking you for permission to do something then she's making you feel guilty when you deny her what she wants. You want to be 'nice' to her and give her more responsibility."
Martina: "Exactly. She needs to learn to make her own choices but there are things that I just don't want her to do."
Jules: "Have you considered asking her to plan her activities and then earn the right to do those activities by helping out around home, volunteering at the Y or by working extra hours?"
Martina: (shaking her head) "Nooo. I must admit that didn't occur to me."
Jules: "Try asking her why she thinks she should be able to do this particular activity. Listen to her responses. Is she saying she wants to do the activity because all of her friends are doing it? Or is she interested in staying out until 2 in the morning simply because she wants more freedom, like an older teen. Why does she want such a late-nite curfew?"
Martina: "I didn't ask those questions."
Jules: "Then give her a taste of what it's like to live in a teen shelter. As part of her community service graduation requirement, have her spend a four day weekend helping out at a local runaway shelter."
Martina: (a surprised look on her face) "Don't you think that's a little...extreme?"
Jules shrugs her shoulders.
Jules: "You asked me for advice as Agnes' pediatrician. You can either take my advice or you can come up with your own advice."
Martina: "But the shelter idea. It's so...tough."
Jules: "Agnes is itching to stay out late at night. She'll get enough of that when she goes off to college. What Agnes needs now is a bit of restraint and perhaps some fun movies to watch with her mom when Agnes comes home from an evening out with her friends. Like a pizza, brownie and movie night. Time the pizza and brownies so that when she comes in from her evening out, the food will be ready. Ask her if she'd like to join you for a late-night, girls night in."
Martina smiles hugely. Jules has just hit the jackpot.
Martina: "Now that idea I can live with." (she looks at Jules with a question on her face) "Perhaps I could teach her some dance moves?"
Jules: "Think--don't answer--but think about what music she likes. Pull out some of her cds and go find some of the albums you used to dance to. Playing the music and dancing when Agnes walks in the door will show her that you can stay home and have a good time."
Martina: "That I can handle."
Jules: "When Agnes moves out onto her own, then you can begin to develop an adult-adult relationship with her. But right now what she needs is a parent. Parenting is not a popularity contest. Unless, of course, your surname is Hilton, Trump, Onassis or Pritzker."
Martina laughs nervously.
Martina: "Nope. Surname is Funder. I guess I can see your point of view. Thanks. Sometimes it's good not to listen to the Mommy Club."
Jules raises an eyebrow in a perfect imiation of Nick.
Jules: "Mommy club?"
Martina: "I'm not, well, sociable. I was a former wallflower and I did things by myself. Of course, being an only child didn't help much. I noticed that the small group of mothers in my neighborhood tend to behave the same way and they tend to create a lot of their own problems regarding their children. Then they like to get together over coffee and cake to try to solve their kids' problems, oftentimes to no avail."
Jules: "Such as?"
Martina shrugs her shoulders.
Martina: "Oh, I don't know. Uhm, oh! Like this one woman keeps telling me that the teenage years are bound to be rocky, so I'd better hang in there for a long bumpy ride. I, with my bigmouth, told her that there are a lot of problems that can be resolved before they even become problems, provided you know how to plan in advance."
Jules: "And how did she take that advice?"
Martina: (claps her hands once and laughs) "She snarled at me."
Jules: "She didn't!"
Martina: "She did. Okay, so she curled her lip like Elvis used to do. But still, a lot of problems you can resolved before they become problems."
Jules: (smiling) "Like today?"
Martina: "Yes. Like today. Agnes is just 14. And she's itching to stretch her wings. I admit there is a lot I don't know about. I had a lot of personal freedom as a child and I want to give Agnes a good deal of that personal freedom. But then again, I grew up in a very small Dakota prairie town where you could walk from one end of the town to the other in seven minutes flat. And there was nothing but wheat fields for the next twelve miles both east and west. So my parents didn't have much to worry about if I didn't come home until midnight."
Jules: "I know the feeling. Parenting is a balancing act. Most of the time, you are not going to be popular with your teen."
Martina: "So I noticed." (she chuckles) "Agnes is peeved at me for not allowing her to babysit a neighbor's newborn."
Jules: "Why did you nix that?"
Martina: "Agnes is only 14."
Jules: "In some cultures, like Judaism, kids become adults at 13."
Martina: "I know. And the new mother happens to be Orthodox Jewish."
Jules: "So what were your reasons for not allowing Agnes to babysit?"
Martina: "First: this particular infant was born to wail. Agnes has never babysat an infant before. Second, Agnes does not have that babysitter certification course I keep forgetting to enroll her in. Third, she's fourteen. Although I know that teens in some cultures marry very soon after menarch, and that they can sign contracts, I just don't think a 14 year old is ready to babysit an infant, with all the wailing and diaper changing."
Martina: "I sat an infant when I was 12 and I knew I wasn't ready to sit the infant. I tried again at 14 and realized that I needed an older kid. Babysit an older child, sure! Agnes sits regularly for two six year olds, a seven year old and an eight year old."
Jules: "Those are some excellent arguments. And you're right. It's best to allow Agnes to learn how to care for an infant before she actually babysits for one. Perhaps you and Agnes could offer to sit the baby. That way Agnes can learn from you how to babysit for an infant."
Martina: "I think that solution will get me out of the doghouse."
9:54 am: This morning is not going well for Matt. His latest patient has been picked up by the police for forgery--and it's Doctor Matt Slingerland's name she forged. Matt discovered this information about a week ago, when the lady in question had just returned from a weight modification ranch in Montana.
The ranch, which prefers the term weight modification ranch rather than weight loss ranch, sent to Doctor Slingerland a handy form telling him that his patient tried to lose her goal for the two weeks: one pound. She failed.
A shocked, angry and betrayed Matt has been reduced to yelling at his patient--Mackenzie Allbright. Mackenzie has just accused Matt of trying to dissuade her from having gastric bypass surgery. Matt is now confronting her about the forgery. Mackenzie is going to come to her own conclusion about Matt's diagnosis and he's shocked at her solution.
Matt: (he is standing in front of his desk, shouting & waving his hands) "But you had no right to sign my name on those papers!"
Mackenzie shrugs her shoulders.
Mackenzie: "I didn't see the problem. I needed a doctor's signature."
Matt: (realizing he's shouted, he runs his hand through his hair. When he speaks, it's in a calmer tone of voice) "I have received warnings about that weight loss ranch."
Mackenzie cuts in.
Mackenzie: "Weight modification ranch."
Matt sighs in frustration and goes to sit behind his desk. He uses this time to calm down a bit.
Matt: "All right. I received some warnings about that weight modification ranch in Montana. And one of those warnings was that the ranch puts the patients in hot tubs. And most of the patients have cardiac problems. I've told you before, hot tubs and cardiac problems do not mix."
Mackenzie: (innocently) "I'm here aren't I?"
Matt: (looking sternly at her) "Mackenzie, I've known you for three years. This week I get a visit from the police department telling me they've arrested you for forgery."
Mackenzie: (in a hurt tone) "And you turned me in, didn't you? Matt, I'm hurt!"
Matt: "It was David, our administrator, who turned you in. He saw the memo from the ranch before I got the memo. When I mentioned the fact that you had forged my signature, he phoned the police."
Mackenzie: "I already knew that. Cops told me."
Matt looks away.
Mackenzie: "Look. I know you're angry about the signature. But look on the bright side, with the recall for Davis in effect and the budget crisis in full bloom, California is too strapped to go to trial. Montana isn't interested in prosecuting, considering how the papers were forged here in California. The DA will probably give me a long probation. I ain't goin anywhere."
Mackenzie raises her hands outward and shrugs her shoulders. As she watches Matt intently, she continues.
Mackenzie: "But what I am going to do is gain fifteen pounds."
She shakes her finger at Matt. For his part, Matt looks horrified at the prospect.
Matt: (his voice croaking) "What?"
He half raises himself out of his seat. Then, he without warning, he drops back down into the seat.
Mackenzie: "Those rules they have about gastric bypass. You need a BMI of 40 before they'll let you have the stapling surgery. My insurance has repeatedly refused to allow gastric bypass for me, despite Doctor Jordan's recommendation. That Doctor Nick--he's so sweet--he wrote a letter in support of lowering the BMI so patients can qualify for the stapling surgery. At five six, weighing two thirty five, I have a BMI of 37.9."
Matt: "So you think the solution is to gain fifteen pounds?"
Mackenzie nods. Matt runs a hand through his hair, not minding that his rather longish hair is standing up.
Mackenzie: "Fifteen pounds puts me at a BMI of 40.3. I qualify."
Matt: "You'll not only get your fifteen pounds added, you'll most likely get a heart attack."
Mackenzie: "Well, you said that hot tubs and cardiac problems don't mix, but I don't have a problem with them. So I think that temporarily adding fifteen pounds to my weight won't make that big a difference either."
Matt frowns in anger as Mackenzie gets up from the chair. She's huffing a little, breathing hard. Matt starts to get up to help her, but Mackenzie puts her hand up. Matt sits back down before realizing the implication of Mackenzie's statement: "I don't have a problem with them." She's intent on gaining that weight.
Matt: "You don't have a problem with hot tubs?"
Mackenzie: "Nope. Use them, oh, three times a week, down at one of the hotels."
Matt: "Ah. Meaning you use hot tubs?"
Mackenzie: "See what I mean? You're trying to keep me from getting the stapling surgery."
Matt: (his expression going softer) "Maccie, I've been racking my brains trying to figure out how to help you. Nothing seems to work."
Mackenzie: "And that's why I want to gain fifteen pounds, so something will work!"
Mackenzie has risen from the couch. As fast as she can, she leaves Matt's office, leaving him sitting behind his desk, worried, angry, hurt and betrayed. Mackenzie's faulty reasoning has also caused Matt to realize that Mackenzie is using any excuse she can to justify her decision to gain fifteen pounds, despite the fact she could have a heart attack.
Matt: (to himself) "Damned if she didn't use the old bait and switch technique. Got me talking about hot tubs, then used that as a reason to justify her gaining fifteen pounds."
9:54 AM: Nick and Rae are sharing a brief coffee break in the kitchen before Rae goes on shift. She's started her shift later in the day and ending later in the day, in order to accommodate another staffer who is needing the time for maternity leave. Soon, Rae will also be needing additional time off, so she hasn't been complaining.
Rae has several patients to attend to today and our favorite shrew, Mrs Winters, has dropped off another batch of gourmet goodies. Little does Rae know that this day will be both good and bad for her.
Rae: "You heard me right. Mrs Winters is opening up a gourmet dessert catering service. In this stinky, Bush-driven economy!"
Nick: "She can cater to all the recall parties."
Rae: (without a lot of enthusiasm) "Now there's an idea! I'll suggest it to her."
Nick: "You doing okay? You've been a little distracted lately."
Rae: "Yeah. Yeah. I'm fine. Why are you asking?"
Nick takes a small bite of a chocolate chip cookie and chews. Swallowing, he says,
Nick: "Oh, I don't know. Perhaps the dark shadows under your eyes?"
Rae touches her finger to her eye.
Rae: "Yeah. About that. Well, sleep and a turbulent pregnancy don't mix."
Nick: "I know."
Rae: "I'm a doctor. And besides, back in the refugee camps we did tend to a lot of pregnant women."
Rae smiles but she has a distracted look on her face.
Rae: "I remember." (she smiles and nudges his arm) "Hey, remember that 15 year old who came in to the Maternity Tent ready to pop? You just about freaked trying to find a woman to deliver the fifteen year old of her baby. You ran around the camp, shouting in Greek..."
Nick: "Forgetting my English..."
Rae: (continuing with a true smile) "And finally, you ran into me, just off the helicopter, my bags still in my hands. You pointed at me, shouted "Neh! Neh!" then you ran up to me, tore the bags out of my hands, picked me up and carried me back to the maternity tent and said, "Here. Deliver her baby."
Nick: "I said that in Greek, not in English, dear."
Nick looks away a moment, then smiles at the memory. He looks back at Rae, a softness is in his eyes.
Nick: "How could I forget? That was the first time I saw you."
Rae: "You didn't even know my name for the next week. You walked around the camp telling everyone how I saved that baby's life."
Nick: "And you did save his life. He was a bit small for a term baby, especially one born in a refugee camp. I've always meant to ask you, where did you come up with the idea to use a hair dryer attached to a long hose with a cloth filter to warm the incubator?"
Rae shrugs her shoulders.
Rae: "Dunno. Just thought it would work."
Nick: "It did."
He smiles at her. He holds out his arms, wanting a hug. Rae looks up at him and Nick has pouted his lips. She can't help but smile and allow him to hug her.
Nick: "This feels nice. I like hugs."
Despite herself, Rae hugs Nick back.
Rae: "I like hugs too."
Norman walks in.
Norman: "Hey, hey, you two. Stop with the PDA's already!"
Nick merely looks at Norman. He tries to look away.
Norman: "Uh, Rae. There's a lawyer and a patient here to see you."
Rae: (shocked; she pulls back fron Nick) "What?"
Norman: "Before you get upset, they told me to tell you they want you to testify at a trial."
Rae breathes a sigh of relief.
Rae: "Tell them I'll be right there. They in my office?"
Norman nods and leaves the kitchen. Rae hugs Nick harder; Nick hugs her back.
Nick: "I'm glad. Sometimes we think that everything that can go wrong, can go wrong and then we get a ray of hope."
Rae: "Yeah. This is something I can do. Help my patient with this trial. This is a war I can fight, dammit!"
Nick: "That's my girl! Go get em!"
9:54 AM: Nick and Matt's summer camp enrollment went smashingly good: 46 teens and one adult enrolled in the free, five week summer camp. Eyebrows were raised at the adult's enrollment, but Nick and Matt said 'why not? she's enrolling at UMC med school this fall. If she can't handle the camp, then she can always back out of med school.'
So was welcomed the 38 year old aboard.
Of course, the new HIPPA rules presented a small problem for David, but Nick, Letty and Matt came up with a workable solution: when practical in each department, patients are phoned or emailed information about the summer camp in advance of their appointment. The patients are reminded that these campers are teens and that patient privacy must be respected.
As the kids are teens (with one exception), David allowed the camp with some restrictions: absolutely no Labor, Delivery and Maternity department visits, no surgical patients with traumatic injuries (Nick wholeheartedly agreed but then thought better of it and asked if any accident victims came in...well, could he have them in the Observation Lounge? It is summer vacation; David deferred on that topic and still has yet to return to it).
Also, no Psychiatry department visits & other restrictions will be put into place if David deems the restriction necessary for compliance with HIPPA.
After David got done handing out the restricted departments, Plastic Surgery, Oncology, Radiology, Internal Medicine, Pediatrics, Cardiology and Surgical. Nick got around David's restrictions by giving engrossing lectures demonstrating the use of the laparascope and scapel on realisitic dummies. Doctor Howland was hopping mad because her department was excluded from the summer camp; David said he might reconsider.
Matt has given the kids a demonstration of how the digestive system works and had them use a mock computer game called: D.M. Dinwiddie, Physician-in-Training (a real-life computer program from Health Media Lab; www.dmdinwiddie.com).
While lecturing on cardiology careers, Letty has been giving heart healthy exams and discovered that one of the teens has a serious, previously undiagnosed heart problem: a congential hole in the left ventrical. The kid is at home, resting.
Jackie has been buzzing around, singing at the top of her lungs for no good reason; the campers have Plastic Surgery as their last round.
Jules' camp is up next week but for now, it's Rae's camp this week.
Harmony has finished her Physician's Assistant training program and as a result of Matt and Nick's summer camp idea, Harmony is being rotated through various departments alongside the teens. The 46 teens and 1 adult who have signed up for the summer camp are enthusiastic but the staffers are quite busy with their regular and David was in a tizzy trying to figure out what to do for assistants...until--much to Harmony's initial dismay--Letty suggested that the PA's help out.
Harmony has less time for her budding romance with Matt but she has discovered that she doesn't mind having less time for Matt--at least, for the moment. Matt has taken to driving Harmony home but lately she's found herself waking up either in his bed or on his couch, so naturally Matt drives her into work as well.
Harmony, Emma Reingold and 17 year old Carl Sanders are walking down the hallway towards the elevator: a clock says it's 9:54 am.
The trio are on their way to the Oncology Department, where Harmony is set to deliver, with the patients' permission, a lecture on the various cancers Rae is treating. Harmony's a bit nervous on this part of the lecture, although Matt has reassured her that it's no different than her Thesis papers on Common Forms of Cancer. In compliance with HIPPA rules, Harmony has asked the patients for their consent; a few opted out and UMC staff have placed those patients down at the far end of the hallway and drawn the newly installed curtains around the beds (UMC slang is 'curtained-out').
The other Oncology patients are grumbling, for the far end of the hall contains a newly-delivered large screen projection television that can only been seen by the patients down at the far end of the hallway. Somehow, the tv is rigged so that the curtained-out patients can see it.
One elderly gentleman on the wrong end of the hallway is bent on getting his sports scores from the tv instead of the paper (for some reason the nurses refuse to allow papers to be brought inside the Oncology Ward, a fact this particular gentleman has complained about endlessly). He is shaking his fist at the unseen television.
Gentleman: "Take that, you screwy old tv! Damn. Should have asked to be curtained-out."
Down several floors and back from the elevators in the hallway, Harmony is walking alongside Carl Sanders, and the camp's sole adult member (Emma Harper), is asking Harmony:
Emma: "And what is Hippa?"
Harmony: "Health Insurance Portability and Accountability Act. Basically, we here at the hospital are not allowed to give out a patient's information without prior consent. We're supposed to keep medical conversations private, something that's difficult to do up in Labor and Delivery."
Carl Sanders: "Aren't all those people walking into the wrong labor rooms violating Hippa?"
Harmony bites her lower lip ever so slightly. This is a tricky question because a lot of people, especially the laboring women, have their own views on childbirth and who they want in attendance during Labor and Delivery.
HIPPA presents a special problem in Labor & Delivery, because allowing a patient's relatives in the Labor and Delivery rooms might compromise the privacy of another patient. Members of the patient's family often walk in and out of the labor room, going up and down the corridor, often without washing their hands or changing the surgical gowns given to them (Matt is upset about this practice because a lot of extra people mean a lot of extra germs around the mother and newborn, and he's still on edge from the recent SARS crisis plus, he remembers all too well the 15-member strong cheering team that one of Harriet's recent patient had in her labor room).
Some of these family members can't remember which room their loved one is laboring in and tend to go up and down the corridor, opening doors and peeking in, saying, "Ooops. Sorry. Wrong room."
But the privacy has been compromised; some women may be in the middle of having a very personal exam when the door was opened on them--creating anxiety, especially if the woman is a sexual assault survivor. Or staff might be relating medical information to the patient or dictating the medical information when the door was opened by a family member of another patient.
HIPPA gives strict guidelines about medical conversations being overheard. Although patients can file a HIPPA privacy complaint, the complaint must be filed with the government and the government will decide if and when to take any action. Action can include steep fines and possible prison time.
This is the very touchy problem that Harmony, Emma and Carl are discussing and Harmony doesn't know how to respond.
Harmony: "That does tend to create a privacy problem, yes. However, Doctor Slingerland can give you more information during the lecture on HIPPA."
Emma: "There's going to be a lecture?"
Harmony: "Yes. UMC considers HIPPA compliance to be of paramount importance. As part of your medical training, you'll be required to follow HIPPA guidelines from the start of your medical training."
Carl: (kind of skips beside Harmony; he's a very tall, bright young man with a lot of energy) "That seems like a lot to take in med school. All those hours. All those courses. Why not just have a privacy training course at the end of medical school? You know, during your residency."
Harmony smiles, knowing she too was daunted by all the courses.
Harmony: "Patient privacy needs to be ingrained in a physician. At least, that's what HIPPA tries to do. So medical schools are having their students follow HIPPA rules from Day 1."
Emma: "But what about this summer camp you're running? Doesn't that violate HIPPA?"
Harmony: "When Doctors Slingerland and Kokoris set this camp up, HIPPA was already in effect. Every patient that you come into contact with has been asked to consent to this special medical camp and the staff ensures that HIPPA compliance is followed."
The trio have reached the elevators. Little does Harmony know...
Emma: "And were there a lot of no's?"
Harmony: (nodding her head) "Surprisingly, yes, there were a lot of no's. We call them curtains-out or that a patient has asked to be curtained-out. If they really object, we sometimes have to scramble for a walled room but better to scramble than to be fined. This is a teaching hospital and most patients understand that med students need patients to learn on. However, there are some patients who don't mind at all. And, we do have one patient who did not mind their particular cancer being discussed in this camp, but the patient refuses to allow any other medical problem to be discussed during camp."
Carl stretches his jaw; it's not a yawn.
The elevator doors ding open and the trio steps in. Harmony is breathing a sigh of relief; she's not sure how she handled those questions about HIPPA and she fervently wishes she can make contact with Matt before any more questions are asked.
Harmony is about to get her wish for she is just about to discover a serious problem...
10:00 AM. In Mattís office, he is running his hand through his hair--for his next appointment is not an office appointment: itís an appointment with Letty.
His patient (Mackenzie Allbright) just left his office in a huff, managing to slam his office door on her way out.
Matt has been trying to help her lose weight but no matter what he recommends or what she does to comply, she canít seem to lose the weight. She does not have a metabolic disorder (the test-loving Matt already checked, much to the consternation of the HMO), nor does Mackenzie have Prader-Willi Syndrome.
Matt wasnít too happy to learn that Mackenzie forged his signature and Mackenzie thought thatís the reason why he is trying to dissuade her from the stomach stapling surgery.
But Mackenzie doesnít want to admit is that sheís developing serious cardiac problems (but not serious enough to convince the HMO to allow the surgery)--and gaining fifteen pounds to qualify herself for stomach stapling surgery could end with Mackenzie losing her life.
Letty knocks on the door.
Letty enters, chuckling.
Letty: "Reporting for duty, sir!"
Matt looks up, his hair is disheveled. Letty tsk-tsks as she enters the office.
Letty: "You look like you've been through the blender."
Matt: "I feel like I've been through the blender."
Letty sits down on Matt's couch.
Letty: "This case?"
Letty: "I can tell you that gaining that fifteen pounds will put her at high risk for a heart attack."
Matt: "That's what I told her. But she really needs the gastric bypass surgery. Nothing works."
Letty: "Does she know about the dumping syndrome?"
Matt: "Yes. I told her. She wants to make sure that she doesn't eat a lot of sugar."
Letty: (snapping her fingers) "She won't be eating much sugar with gastric bypass. She'll get nausea, sweating, fainting and diarrhea if she eats too much."
Matt: "And that's what most gastric bypass patients experience."
Letty: "It's one of the effects. You talk to Nick about this? He's the one who's gonna have to operate on her."
Matt: "Not yet. I've a lunch date with him."
Letty raises an eyebrow and tries to hide a grin.
Letty: "Getting chummy, aintcha?"
She smiles at him and Matt realizes she's teasing him.
Matt: "It's doc chat. Really."
Letty: "You mean, man-talk."
Matt: "Well, that too. We are men, you know."
10:00 AM: Nick has managed to catch David in the hallway.
David turns around and sees Nick. He knows what Nick wants.
David: "Uh, I still haven't made up my mind."
Nick: "The kids can see just what drunk driving can do to a human body. Other hospitals allow kids to view the victims just before they're treated in the ER."
David raises an eyebrow.
David: "Are you championing Doctor Howland?"
Nick: "Her department would first take the accident victims, then they hand the survivors off to my department."
David: "Let me think about it."
He hurries down the hallway before Nick can get another word in. Nick frowns, then goes off in search of Matt.
10:00 AM: Amarie Wilson and her lawyer, Kendra Chock are in Rae's office. They are in the middle of a conversation about the source of Amarie's lung cancer. Amarie has been in remission for two years but this is the first time she's told Rae about the lawsuit against the home developer.
Amarie: "See, I think it's the radon level in my home. The builder knew the radon level in the ground was abnormally high when they built the complex some years back."
Rae: "And you know the builder knew?"
Kendra: "He had to check. We believe he falsified the radon report."
Rae: "You've been playing Erin Brockovich!"
Kendra and Amarie share a glance.
Kendra: "Well...she is a great champion of the underdog."
Amarie: "Plus I met her at a book signing and she said, you go sue em! So that's what I'm doing. And I found documents indicating the the radon levels had been written, then erased and written in again."
Rae: "That's some claim. And when do you go to trial?"
Amarie: "That's the problem. We're just starting the trial. And the judge wants this expert witness to be known to the court by Friday. Can you do it?"
Rae: "Sure. I can do it. Do you need a reporter?"
Kendra: "A reporter would be fantabulistic!"
Rae smiles. Finally, after so many things going wrong in her life--the date rape, the pregnancy, the indifferent treatment by Doctor Howland, Slice n Dice Ellen Etzel to name but a few--finally, things are going Rae's way and she's going to get a day in court. Even if it's helping somone else.
Rae: "I know Amanda Sotheby. I can get her to cover the trial."
Amarie: "That would be great. We'll submit your name to the judge and Kendra will get back to you regarding date and time."
Kendra and Amarie stand up to leave.
Rae: "Aren't you forgetting something?"
Kendra turns around, Amarie just heads for the door.
Kendra: "Oh. Yes. Fees. We'll work something out."
Rae gapes at Kendra but Kendra waves and exits Rae's office. She stares after the retreating women before placing the phone on speaker.
Nick: "Hello, dahling!"
Rae: "Oh Nick! That was so good!"
Nick: (in a playful tone of voice)"Missed you!"
Rae: "Missed you more!
Nick: "Not as much as I missed you!"
Rae: "Prove it!"
Nick: "I will. Later on tonight."
Rae: (laughing)"You're naughty!"
Nick: "I know."
Rae: "Before I forget, I'm to be an expert witness in a trial that, hopefully, Amanda Sotheby won't mind covering."
Nick: "I'm so glad things are finally going your way."
Rae: "You know, I was feeling down this morning, but now I feel like I'm on top of the world. I could just about eat an entire boat of chocolate, I'm so happy!"
Nick: "Then the delivery boy will be just in time."
A knock sounds at Rae's door.
Nick: "I think that's him."
Rae: "You're right."
She waves the delivery boy in her office and signs for the proffered box.
Nick: "Hope you like it!"
Rae: "It's huge! Nick, what is it? Please, please tell me."
Nick: "Open it."
She opens the wrapped gift and squeals.
Rae: "See's Candies! In the five pound box! Oh, Nick! I love See's Candies! Thank you! Come share one with me?"
Nick: "In a few, all right sweetie? You can get me some coffee in a thermal carafe while you wait."
Rae: "Now that I can do. All right, see you in a few."
Rae and Nick click off their phones. Rae opens the huge box of candy and starts eating.
Rae next punches in a number and waits for someone to answer. When Amanda's voice mail picks up, Rae says:
"Chumchoh. (Rae realizes she needs to swallow her mouthful of candy) Hello, It's Rae Brennan. You remember, the Winery Baby? Francesca? Doctor Keating tells me Francesca is doing wonderfully, by the way. What I called about is that I've a news scoop for you. A patient of mine has gone to trial and she's suing a home developer for allegeding falsifying the amount of radon in the newly built homes. It's an Erin Brockovich type of thing, ya know? Home developer files false radon numbers and people develop lung cancer. Yes, radon can cause lung cancer; that's why she sued. Anyways, I'm going to be the expert witness for the case and I wanted to know if you'd be interesting in covering the trial. Oh! I've rambled, but call me back at UMC or just stop by my office. Thanks! Bye. Rae clicks off the phone and grabbing a handful of See's Candies, she heads off to the kitchen to get Nick's cup of coffee.
"Chumchoh. (Rae realizes she needs to swallow her mouthful of candy) Hello, It's Rae Brennan. You remember, the Winery Baby? Francesca? Doctor Keating tells me Francesca is doing wonderfully, by the way. What I called about is that I've a news scoop for you. A patient of mine has gone to trial and she's suing a home developer for allegeding falsifying the amount of radon in the newly built homes. It's an Erin Brockovich type of thing, ya know? Home developer files false radon numbers and people develop lung cancer. Yes, radon can cause lung cancer; that's why she sued. Anyways, I'm going to be the expert witness for the case and I wanted to know if you'd be interesting in covering the trial. Oh! I've rambled, but call me back at UMC or just stop by my office. Thanks! Bye.
Rae clicks off the phone and grabbing a handful of See's Candies, she heads off to the kitchen to get Nick's cup of coffee.
10:12 AM: David has run into Jackie just outside of her office. She is just entering.
David: "Jackie. Just the one I want to see!"
Jackie turns around. She's happy this morning but her face falls as she realizes that David does not make office visits without good reason.
Jackie: "David! What can I do for you? Come in!"
The two enter Jackie's office. Jackie goes to her desk and sits down but David remains standing.
Jackie: "You gonna sit down?"
David shakes his head.
Jackie: "I take it this is bad news."
David: "About the Plastic Surgery camp next week..."
Jackie: "Don't tell me. It's been cancelled?"
David: "More like...been...re-assigned to another surgeon. Legal felt it too risky to put you in a demonstration position when there's the possibility of a lawsuit from Marnie and her mother."
Jackie: "I had a feeling that was going to come back and bite me on the ass."
David: "I can get Nick to get you some antibiotic cream."
Jackie: "Cut the doc humor. And any lawsuit would come from her mother, not from Marnie. Marnie was in seventh heaven after her implants. Plus, (& Jackie wags her finger at David) we have proof that Marnie deliberately gave us a wrong age when she filled out all the forms. That should help, doesn't it?"
David: "But the possibility of a boatload of money may make her change her mind."
Jackie looks confused.
David: "Apparently, Marnie's been telling some of her friends that she was persuaded by you to have the implant surgery."
Jackie: "Oh, ph*ck."
David: "Ph*ck is right. Sorry. I know it's not your fault and I know and Legal knows and Admin knows that Marnie tricked you into the implantation by lying about her age, but still, I have to take you off the summer camp."
He looks apologetic, Jackie just waves her hand.
Jackie: "It's all right. Thanks for the heads-up, though."
David: "Wish it could be different."
Without another word, David leaves Jackie's office, leaving Jackie to sit there and wonder about how a 16 year old got the best of Jackie Collete, MD.
10:17 AM: Matt and Nick are in his office. They are chatting about their respective trust funds. How they got onto this subject is beyond the two of them.
Matt: "Yeah, me too. I think our grandparents must have known each other."
Nick: "I'd have to agree."
Matt: "What I didn't know was that the trustee can change the terms of the trust at any time."
Matt stretches his long legs out on his couch. He's added another couch to his smallish office, creating a cozy look that he enjoys relaxing in.
Nick: "I found that out as well, but fortunately not the hard way. My grandparents changed the terms of the trust several times before they found a formula they were satisfied with."
Matt raises an eyebrow.
Matt: "Such as a thousand a month at age 18, plus a separate amount paid directly to the institution of higher learning?"
Nick: "And a good sized disbursement at both the high school and higher education graduations with the second disbursement significantly higher than the first, even more so with a decent GPA or community accomplishments."
Matt: "Oh yeah. I remember getting that high school graduation disbursement and I went wild. So wild that I went around the world, spent some time in salt flats of Bolivia, and got down and dirty in the Big Apple."
Nick: "Me, I did the whole Africa thing. Went deep into the wilds of Africa, took the Blue Train across South Africa, went to Zanzibar and scuba dived."
Matt: "I didn't know you scuba dived."
Nick: "Now you know."
10:18 AM: Oncology Ward. Harmony, Carl and Emma are standing in the observation area of the intrathecal administration area of Oncology.
Harmony, Carl and Emma are in a large, curtained area. This is not one of the curtained-off areas; rather, this room is used for intrathecal administration. The trio are standing behind the bright yellow "Camper Observation" line that Rae has installed to remind their young charges (and the young-looking adult) that there are limits on how far they can go into the rooms.
Emma: "And what is this procedure?"
Harmony checks her clipboard.
Harmony: "An IV of vincristine."
Finishing inserting the syringe into the cannal, the physician turns around. There are reading glasses hanging by a cord around her neck.
Doc Mary Lunden: "Vincristine? This patient is supposed to get methotrexate intrathecally."
Harmony looks surprised, then looks at her clipboard.
Harmony: "Uh, maybe I have this down wrong. Patient Number 5-W is to receive an IV of vincristine."
Mary: "This is patient number 5-W but the order is for an intrathecal administration of methotrexate."
Mary looks at the syringe then back at Harmony.
But Mary didn't look at the syringe's wrappings...the FDA requires that vincristine carry an overwrap with a warning to be applied to the syringe by the dispensers (ie., the pharmacy) and that vincristine also be placed in an overwrap with the same warning. Both the warning labels and the overwraps are included in the drug carton and pharmacy staff may unintentionally discard the labels and overwraps if they are not made aware of the law.
Mary: "Seems all right to me. No warning label."
Harmony: "Um, according to this note on my clipboard, two healthcare professionals are supposed to be in attendance at all vincristine administrations."
She taps her pen on the clipboard for emphasis. Mary grinds her jaw.
Mary: (angrily) "This is methotrexate. Perfectly safe for intrathecal administration."
Harmony: "Are you sure?"
Harmony: "Then I'm going to ask for another physician to come and verify that."
Mary: "All right. Make it snappy." (she leans over the patient) "Hey, Charlie. This is just gonna take a bit longer. Gotta verify the medication."
Charlie just nods; he has been given a sedative as he is deathly afraid of needles. He nods off to sleep as Harmony goes to the phone; Emma and Carl have been nervously glancing at one another.
Carl: "Uhm, Doc?"
Carl: "Do you get to see a lot of naked people?"
Mary looks shocked. Emma doesn't know what to do and looks at Mary for help.
Mary: "I hope you don't plan on becoming a doctor."
Carl: "Well, yeah. Why not?"
Mary: "Why do you want to become a doctor?"
Emma: (thinking she's being addressed) "I'm looking to help find a medication to slow down the effects of Huntington's Disease."
Carl: "Uh, because I can get on tv."
Mary: "Because you can get on tv."
Carl: "Yeah. Like that Matt fellow."
Emma: "That Matt fellow? You mean, Doctor Slingerland."
Carl: "Yeah. Him. He's been on tv recently with the SARS crisis. That's what got my interest. There's a doctor on tv!"
Mary: "Interesting reason to choose medicine as a career. Have you told this to Doctor Slingerland?"
Carl: "He gave us a worksheet to fill out and that's the reason I wrote down. I handed it in yesterday."
Emma and Mary exchange glances. Mary tries to change the topic. Carl is beaming at himself.
Meanwhile Harmony is on the phone.
Harmony: "Matt? Yeah, I tried Rae but her phone line is busy and Norman says he'll go and track her down to pull her out....uhm, the patient is supposed to receive an IV of vincristine but is receiving an intrathecal administration of methotrexate. I'm thinking it's vincristine in that syringe...that's fatal?...oh, God...Yeah. Thanks."
Harmony clicks off the phone.
Harmony: "Doctor Rae Brennan will be here momentarily to verify."
Mary rolls her eyes.
Mary: "And just who is Doctor Ray Brennan? Your lover?"
Harmony: "She is an oncologist. And I'm currently dating Doctor Slingerland, who is also on his way up."
Meanwhile, back in Matt's office...
Matt: (hanging up the phone. Nick has raised an eyebrow in question at Matt) "That was Harmony. Seems there's a confusion between the administration of vincristine and methotrexate. Harmony's worried that vincristine might be in the syringe that's being used intrathecally."
Nick looks shocked.
Nick: "That would prove fatal."
Matt: "I know. Let's go."
The two docs speed out of Matt's office, and once in the corridor, they break into a run. Seeing the stairs, Nick veers off, shouting,
Nick: "Matt, stairs!"
Nick takes the stairs two at a time; shortly he hears Matt coming up behind him. Matt's legs are slightly longer and he and Nick push up the stairs past people, saying, "Excuse us, emergency, thanks." Fortunately, there are no accidents.
Shortly, the two men reach the Oncology Floor and enter the ward barely breaking a sweat.
She waves at him and Matt and Nick hurry over.
Harmony: "This is Mary Lunden. And those two over there are Carl Sanders and Emma Reingold."
Mary looks the two male doctors over as Nick and Matt nod at the two campers.
Mary: (drily) "Well, if it isn't the dynamic duo."
Matt ignores her.
Matt: (to Carl and Emma) "Would you two mind wandering down towards the television for a moment?" (the two campers nod and move off. Matt addresses Mary Lunden) "I hear there's a problem?"
With her head, Mary indicates Harmony.
Mary: "She thinks there is."
Harmony: "With vincristine you can't be too safe."
Matt: "I have to agree with her."
Nick: "Ditto. Vincristine administered intratecally is fatal."
Mary: "I know. This patient is supposed to receive intrathecal admin of methotrexate."
Matt: "Let me see the patient's chart."
Mary sighs, but gets the patient's medical chart. Nick goes over and examines the wrappings of the syringe. The FDA requires labels for vincristine to the following effect: "FATAL IF GIVEN INTRATHECALLY. FOR IV USE ONLY. DO NOT REMOVE COVERING UNTIL MOMENT OF INJECTION".
There is no sign of a label applied on the syringe. But there is a wrapper with the warning label.
Nick: "Uhm, Mary?"
He holds up an overwrap with the warning label. Harmony sucks in her breath as Matt looks up from the patient's chart. There are two charts and Matt looks at both.
Matt: "Rae is not in error. She has this patient down for an IV administration of vincristine. At least, one patient is down for IV administration of vincristine and the other patient is down for methotrexate by intrathecal admin."
Mary: "But..." (her voice drains off as she realizes she nearly killed a patient) "But I thought this was methotrexate. There was no warning label on the syringe and...and..."
Mary: "And I thought this was patient 5-W getting methotrexate."
Matt raises an eyebrow.
Matt: "This is patient eight-W?"
Mary: "No. Five-W."
Matt: (holding up the chart in his left hand) "This chart is for Patient 8-W to get the methotrexate." (he holds up the chart in his right hand) "This second chart is for Five-W. Five-W is the IV of vincristine."
Mary pales, then reddens as she realizes the implications: she didn't double check the identity of the patients with their wrist band and their chart (the patient--William, not Charles--was too groggy to realize what was going on & that she didn't ask about incongruity over the labeling.
Matt goes over to the patient and checks the wrist band and reads. At UMC, HIPPA has changed the type of information on the wrist band to include the patient number and with chemo patients needing vincristine the hospital has given the method of chemo delivery: IV of vincristine.
Matt: "Patient 5-W. IV of vincristine."
Harmony: "Did you use your reading glasses to verify?"
Mary: (fingering her reading glasses) "I, uh, thought I checked the charts. And I didn't see any label on the syringe so I thought the pharmacy wouldn't send vincristine without the required FDA warning label on the syringe. I just thought the pharmacy was sending all meds in labelled wrappers."
Matt nods in sympathy.
Matt: "The handwriting on these charts is sloppy. The five looks like a poorly formed 8. We'll get this straightened out, Mary."
Nick: "And we'll get the syringe contents tested, just to make sure."
Harmony: "What now?"
With a smear of chocolate on her face, Rae enters the Oncology ward just then and looks at the shocked foursome, so no one answers her.
Matt: "Seems Harmony just averted a pharmacy error concerning vincristine."
Rae is shocked and reaches for the patient's medical chart. Matt hands patient 5-W's chart over to her.
Rae: "This says IV administration of vincristine. What the heck is he doing getting an intrathecal administration? That's fatal!"
Rae doesn't see who the patient is as he is draped. Nick goes over to Rae and puts a hand on her shoulder. He doesn't want to upset her more than she already is.
Matt: "Chart mixup as well."
Mary: "I thought 5-W was to get the methotrexate."
Matt: "Very poor handwriting on the charts. The 8 looks like a 5."
He shows Rae what he means. Rae's face contorts in anger. Nick tries to quell the coming storm.
Nick: "It's a pharmacy mixup as well. There wasn't a required FDA label on the vincristine syringe, if that's what the syringe contains."
Rae: (angrily) "Why those incompetent little bimbos! Sometimes I just wanna..."
Nick: (softly) "Rae."
Rae looks at him. her face full of righteous anger.
Nick: "Calm down. This patient needs an IV administration of vincristine. We don't know what this syringe holds. It would be a good idea to go down to the pharmacy and get the drug yourself."
Matt: "I agree with that idea."
Rae turns on her heel and leaves the Oncology ward. Mary, Matt, Nick and Harmony are standing there.
Matt: "Mary, this really isn't your fault. We'll find out what happened."
Mary: "I should have used my glasses to double check. And I should have double checked before doing anything."
Nick: "Most medical errors are caused by competent doctors."
Harmony: "But the error was caught before any damage was done. Matt, will this be used in a Lessons Learned session?"
Matt: "That's an excellent idea."
As Matt and Nick are walking towards a nearby restaurant for lunch, Matt brings up Mackenzie Allbright's decision to gain fifteen pounds. The events of earlier this morning have resolved themselves and the two men are feeling pretty good.
Matt: "That's right. She tells me she forged my name, then tells me that she wants to gain fifteen pounds to get a BMI of 40. She's going to have a heart attack if she gains the weight. Even Letty agrees. I don't know whether to slap her or be in shock."
Nick: (quietly) "Has she considered lap band surgery?"
Matt looks at Nick quizzically.
Nick: "Laparascopic band surgery. It's the same surgery Carnie Wilson had. It's also reversible, unlike gastric bypass."
Matt: "I remember now! I read about that procedure. Results aren't as stellar as with gastric bypass but they're workable, very workable. Combine a lap band with some water exercise and a good diet and she just might be able to lose the weight."
Nick smiles but Matt rambles on.
Matt: "Have you performed lap band surgery?"
Nick: "No. But I can give some recommendations and information about the surgery, if she wants."
Matt: "I'll make sure she gets the information asap."
That afternoon, Jules is talking with another set of parents...today seems to be her day to dispense parental advise. Sometimes Jules thinks that it's a bit strange--parents coming to her, a single, childless woman, for advice. Today's parents are a step-mother trying to get her husband to see that his children (and his ex's family) are conspiring to harass her (and him) by telephone.
The trio are in the same room that was occupied earlier by Martina. This time, Jules has sodas on the table and the couple (Miles Newman and Bridie Mackenzie) are sipping leisurely.
Jules: "Why do you think his ex's family..."
Miles cuts in.
Miles: "Deborah. Means "bee" in Hebrew."
Jules: "Deborah's family is harassing you and Mike?"
Bridie: "See, Deb's always phoning about the kids' problems. It's like every day there's a major emotional crisis with the kids & Deb calls sometimes three, four times a day and talks for an hour or two about the kids' problems. I swear, sometimes I think Deb's creating their problems so she can get some daily attention from Miles."
Jules blinks. This is the second time today she's heard that mothers might be creating their kids' problems.
Miles: "Bridie, baby. They're my kids. I want to help solve their problems."
Bridie: "But please try to see that kids don't have major emotional crises every day of the week."
Jules: "Miles, I hate to tell ya, but she's right."
Miles laughs nervously.
Jules: "Seriously. Deb might be creating problems--or magnifying them--in order to get some attention from you. She's jealous of your new marriage and she wants to 'control' the amount of time your new spouse has with you by creating problems with your kids. She knows you want to help solve their problems and she may have decided using the phone is an excellent way to get your undivided attention."
Bridie: "See, toots. Instead of meeting face to face with the kids and Deb to solve the kids' problems, Deb phones, and never lets you talk to the kids about helping them learn to solve their problems."
Jules: "The phone is an impersonal instrument. It's faceless and you can talk all you want without having to be in the same room as the other party. It's a control technique she's using. She does all the talking, you do all the reacting and the kids are probably in the den watching a movie, unaware of the whole thing. Did Deb act this way just after you got divorced?"
Miles shakes his head.
Miles: "No. I mean, we were both pretty upset. Bridie here said large geographical distances help just after a breakup and so we went to Easter Island and Chile for a few months. That helped me."
Jules sips her soda.
Jules: "But did Deb phone every day about the kids' problems?"
Miles: "No. When I started seeing Bridie here, that's when Bridie says the phone calls from Deb began."
Bridie: (throwing her hands up) "It's one crisis after another! And when the kids are with Miles for visitation, 'mummy' phones almost every two hours--just checking up on her wee ones!"
Miles looks from Bridie to Jules and back to Bridie. He's understanding what his ex-wife is doing now: using the kids as psychological weapons against him and Bridie via the: kids have this and that problems phone calls so I need to chat with Miles--it's an "Emergency," Bridie--but he doesn't want to believe it and his expression shows that realization.
Jules: "That seems a bit excessive, Miles. The kids might get the idea that daddy can't properly take care of the kids. Not to mention that their stepmother is untrustworthy."
Bridie: "See? Deb's setting up a trust issue. She's calling the kids so much while they're on custody visits that the kids think you're not trustworthy enough to be unsupervised with the kids."
Jules: "With the supervisor being Deb, who phones every few hours."
Bridie: (looking at Jules) "Do you think Deb has a variant of Munchausen syndrome by proxy? Deb sets up emotional crises, thus upsetting the kids, which gives Deb an excuse to seek attention from Miles?"
Jules is suprised and she squirts soda out of the corner of her mouth. She wipes the back of her hand across her mouth.
Jules: "Munchausen's syndrome?"
Bridie: "By proxy means that a parent is deliberately hurting a child or inducing a medical condition in order to receive medical attention. I know the definition. But emotional anguish is a medical condition that can cause long-term depression, anxiety, weight loss or weight gain. And although Deb is seeking her ex-husband's attention, she is still phoning him and talking with him for an excessive number of hours per week. Hell, she's now phoning him daily and talking for several hours per day."
Jules: "Are you a psychiatrist?"
Bridie. "No. I saw a made for tv movie about Munchausen's and I was just wondering."
Jules: "I can't give you a diagnosis by proxy...but Deb does appear to have an excessive need for her ex-husband's attention."
Miles: "I will agree with you on that one. Bridie, didn't Deb let up the phone calls when she sent herself on that luxury vacation and dumped the kids on her mother?"
Bridie: "Yep. She sure did! Didn't phone her mother or the kids even once during the two week vacation. I know, the kids mentioned it when they thought I wasn't listening. I tell you, that sure was heaven, not having her phoning Miles and talking for hours on end with him. The kids groan every time their mother calls and I've heard them say that Deb doesn't phone the babysitter at all when Deb goes out at night."
Miles: "I will admit that I am rather tired of Deb's phone calls. And now that you mention it Bridie, that does seem strange that Deb would phone me and not even phone the babysitter to check up on the kids. But that might be explained that I'm the father."
Jules: (a bit slowly) "Were you by chance the less prominent parent in the household?"
Miles looks confused.
Jules: "I mean, was Deborah the primary caregiver and you the parent who worked?"
Jules: "Deb is trying to create a trust issue and doesn't want to allow you to develop your own parenting style. You weren't around a lot with the kids when you were married to Deb and she may view herself as being the only competent caretaker of the kids. "
Bridie: "Cared for according to her specifications! Enough already! They're divorced. Kids can learn different rules for different households so long as each household consistently applies its rules."
Jules: "True. And fathers need to learn confidence in their own parenting skills. That requires them to be left alone with their kids."
Bridie: "She's right. Look at how Prince Charles was said to be distant and cool with his sons. Now that Diana's gone, he's had to learn and learn he did. Hands-on is the only way."
Miles strokes his chin thoughtfully.
Miles: "So Deb may not have confidence in my parenting skills?"
Jules & Bridie: "Right!"
At the same time as Jules' meeting, on the speakerphone in Matt's office...
Matt: "Mackenzie, Doctor Kokoris has never performed a lap band surgery."
Mackenzie: "I want Doctor Kokoris to perform the surgery! I will not go to someone else."
Matt: "But this is a delicate procedure!"
Mackenzie: "I know Doctor Kokoris is the best laparascopic surgeon that UMC owns. I want him and only him to perform it. He's got to learn it sometime."
Matt: "I can't guarantee he'll say yes. I can only ask him to meet with you to discuss it. You'll have to have someone from hospital administration at that meeting because Kokoris has not performed a lap band surgical procedure before."
Mackenzie: "Why the suit?"
Matt: "Standard procedure here at UMC. When a surgeon performs a new surgical procedure for the first few dozen times--emphasis on the plural--the suits like to know that the patients know that the surgeon is just beginning to perform this particular procedure. So they sit in on the meeting with the patient."
Mackenzie: "Sounds good to me. When can I see Doc K?"
Matt grins, despite his pain at Mackenzie's betrayal by forgery.
Matt: "I'll speak with him and have Norman get back with you regarding time and date."
Mackenzie: "Make it soon. I wanna lose this flab! And thanks, Matt. I'm sorry. I was crappy to you by forging your name but being in my position ain't fun for me. No, I ain't making excuses for myself, you trusted me and I betrayed you. I don't blame you for being angry and hurt. But I do appreciate you getting me in to see Doc K."
Matt doesn't know what to say.
Matt: "You're welcome. I'll have to think on the forgiveness."
Mackenzie: "Take as long as you need for that, cuz I know I'm in the dog house with you for a long time."
Matt nods his head, silently agreeing with her. His pager goes off.
Mackenzie: "I hear that. I'll let you go. Thanks again, Matt. Even when I treat you like crap you give me something to love you for. Bye."
She hangs up, leaving
Matt to start at the phone a moment. He pushes a button and listens to
the phone ring.
Nick has met up with Emma Reingold in the kitchen. It's just after lunch.
Emma: "Say, how did that crisis up in Oncology go?"
Nick raises an eyebrow.
Emma: "Am I not supposed to talk about that?"
Nick: "Correct. And the problem is solved. By the way, how are you enjoying the camp?"
Emma: "It's fabulous. Thanks for recommending me in spite of my 'advanced age'."
Nick: (smiling)"You can't be more than 28 at most."
Emma: "Now here's a man I can like! I'm 38. Now that I have a bit of money, I want to go do something with my life instead of just sitting behind a desk without a purpose in life."
Nick: "Have you decided on a specialty?"
Emma: "I think research."
Nick: "Isn't that sitting behind a desk?"
Emma: "In a manner of speaking, yes. But I want to see if there are medications that can slow down the progress of Huntington's Disease?"
Nick: "Noble venture."
Emma: "More personal than noble. Huntington's runs in families. And more than one offspring can come down with the illness. The gene responsible is not supposed to repeat more than 26 times. I'm normal, but my brother has a repeat sequence of 36, which is scary. But my sister has a repeat of 40 and she has early symptoms."
Nick: "I'm sorry."
Emma: "I wanted to know. And even if I can't help, maybe I can do some fundraisers."
Nick: "Now fundraising is an area that I have experience in. Why don't you come round to the Wharf for dinner? I'm meeting Doctor Brennan tonight."
Emma: "I'd like that. Time?"
Emma: "Be there. Ooops." (a pager goes off) "There's my pager. Harmony said I'd learn better if I'm paged to return to the camp."
It's Nick turn to grin.
Emma: "How come you didn't check your pager?"
Nick: "Turned mine off."
Back at the small conference room...
Jules: "But the problem about the excessive phone calls needs to be documented in the Family Court. Why? So it's written down and looked at by an impartial person. You and Deb and Bridie are way too involved and Family Court will give the parties the opportunity to air her concerns about you and Bridie's parenting skills."
Bridie: "Neat trick. She'll have to respond by putting into print all the things she thinks I'm rotten with, like the fact I serve steak, mashed potatoes and gravy for breakfast instead of steak and hash browns. Miles, Deb can't refuse an opportunity like this!"
Miles nods but Jules continues, tired and thirsty.
Jules: "You said the phone calls are having a detrimental effect on you and the kids & Deb's not listening. The judge will at least listen to you if you ask the court to ask Deb to first set up appointments with family counselors, then to set the kids up in a social skills class run by Social Services. Finally, ask the judge to recommend that future kid-problem solving be done in the public meeting room of the public library instead of via phone."
Bridie slaps her knee.
Bridie: "Kill two birds with one stone! The kids get to choose their books, while Miles and Deb discuss the kids' problems. I like it!"
Jules: "Hold on. The kids need to be in the room, discussing how to resolve their own problems. Any problems that are at school, like the bullies, need to be discussed with school administrators and the bully alongside his or her parents."
Miles: "That seems like a workable solution. But Deb will have a conniption."
Bridie: "I know. She already denies that she's phoning too much."
Jules: "This is why the excessive phone calls need to be documented. Deb doesn't view her behavior as excessive...just 'concerned' for her children. And suggesting solutions will at least tell the Judge and Deb that you are thinking rationally...a big thing since nasty things are being said by Deb's family about Bridie behind yours and Bridie's back."
Miles: "I really hope it works. You know how things can seem so easy to resolve, especially on paper, but when put into actual practice, it's almost impossible?"
Jules: "You only get results if all parties concerned are willing to cooperate. Eventually the kids will figure out who's the problem."
Bridie: "It sure ain't me! I know I get bent out of shape a little, but I never hit the kids nor do I yell at them."
Jules: "This is the best solution we've come up with. After this, I don't know. The ball will be in Deb's court."
Miles: "I hope you're right, Doctor Keating. I don't like the idea of my kids hearing nasty things about my wife being said by my ex-wife and her family."
Jules: (glancing at the clock)"It's a good thing I didn't have patients scheduled for two hours. That's how long we've been in here."
Miles and Bridie look at each other in surprise.
Bridie: "Damn Deb! She's had us talking about her for the length of a movie!"
Miles frowns at Bridie's remark and looks at Jules.
Jules: "Don't look at me. Deb's the problem."
The next afternoon:
Nick, Matt, Harmony and Rae are sitting around a conference room. The detritus of a meeting are strewn about the room. One of the other staff physicians (now an administrator as a result of advancing MS) has a habit of keeping a pocket full of blunt-end paper clips and to help keep her muscle tone in her fingers, she bends the paper clips into metal origami shapes. The metal origami litter the table. Rae picks an origami shape up and absently plays with it.
Coffee cups, and paper napkins full of food are around. The foursome are having an afternoon soda.
Matt: "That was interesting."
Rae: "To say the least. I can't believe people thought I deliberately gave the wrong instructions to the pharmacy!"
Nick: "The mixup occurred when the medication cart overturned because a pharmacy tech wanted to break in her new Jimmy Choos before her wedding. She banged the cart into a wall when she slipped."
Matt: "Then to cover their butts, Pharmacy claimed they didn't know about the syringe labeling law."
Harmony: "Was it vincristine in that syringe? The one that Patient 8-W almost received?"
Nick and Rae nod.
Harmony: "But how did Doctor Lunden almost administer vincristine instead of methotrexate?"
Matt: "That's a bit more difficult to determine. The patients charts were sloppily written. The 5 was so poorly formed and written with a loop at the lower end so as to be mistaken for a not-quite closed 8. Patient 5-W looked like Patient 8-W. By not using her reading glasses, Mary mixed the patients up by not double checking both the chart and the patient's wrist band."
Nick: "Plus, she sets--used to set--her watch an hour behind. She was in a staff meeting just prior to her giving the chemo to Patient 5-W and didn't know that patient 8-W was the patient in that room the hour before patient 5-W. The two charts got mixed up at the nurses station."
Harmony lets out a low whistle.
Matt: (his voice tinged with anger) "Which I might add, was sloppily organized. Patient 8-W's chart should have been put in the Out Patient box. Instead, the nurse claims that the chart, and I quote her--"must have slipped into the In Patient box."
Nick grunts in disapproval.
Rae: "So 5-W ended up getting a lumbar when he shouldn't have had a lumbar at all. I sent a memo around asking all oncologists to go over the method of chemo delivery with their patients, so patients can double check with the Oncology staff at the time of administration."
Harmony: "So Patient 8-W was to get the methotrexate intrathecally, which he did receive thanks to a sharp-eyed orderly, and Patient 5-W was supposed to receive the IV of vincristine but the chemo delivery orders were mixed up by the pharmacy tech who crashed the med cart while breaking in her Jimmy's. Then the doctor mixed up the patient charts and someone has very sloppy handwriting. Whew!"
Rae nods, sipping her diet soda.
Rae: "Yep. Only goes to show that the penmanship classes David is making us take are going to be useful, plus it pays to be vigilant."
Nick: "Can't be too careful in the hospital."
Matt: "That's not all that David is doing. He's been seeing red ever since the mixup occurred. And Mary has decided to have laser surgery so she won't need glasses. She's been afraid of lasers, but is more afraid of another chart mixup."
Nick: "That's good to know."
Harmony stands up.
Harmony: "I need to be off to the pool for a swim. Matt, you joining me?"
Matt: "Yes. You two gonna be allright?"
Nick: "Yeah. Sure."
Rae: "It's sure good to know who of my colleagues trust my judgment. Thanks. I knew I could count on you two. But yea, I'll be all right."
She smiles at Matt and Harmony. Matt nods and he and Harmony leaves the conference room.
Nick: "Does this underscore the need for you to seek some help for the aftermath?"
Rae sighs. Nick takes her hand.
Nick: "You went to marital counseling. Why not counseling for rape?"
Rae: "It's hard to explain. I just feel so...angry. Angry at everyone. You, me, Sean, Robert, the world. It's just hard to discuss."
Nick: "Have you tried attending a meeting of sexual assault victims?"
Rae shakes her head.
Rae: "I thought about that."
Nick: "It's worth a shot. There are some doctors on this staff--excluding myself--who think the assault is affecting your medical judgment."
Rae: (dropping her eyes. Nick pats her hand) "I learned that this afternoon."
Rae sighs and looks at Nick.
Rae: "I'll go to both a therapist and a meeting for sexual assault survivors. Starting this week. Will you drive me?"
Nick's face is nearly split in two by a huge grin. He leans over and hugs her. Rae hugs him back as tears fall from her eyes. Nick, sensing the wetness on his shoulders, hugs her tighter.
At the same time, Matt and Harmony are on their way out of UMC's pool...
Harmony: "I'm glad Rae's not the problem, Matt. That vincristine scare really got to me."
Matt: "Things will be all right, luv. Now, your evaluation of Carl and Emma?"
Harmony bites her lip. Matt glances at her as they walk through the doors.
Matt: "Am I to take it that there is something troubling you?"
Harmony's eyes widen but she tries to hide this.
Harmony: "What makes you say that?"
Matt: "When you bite your lower lip, you are troubled."
Harmony: "To tell the truth, I was a little unnerved about Carl's responses today."
Matt raises an eyebrow.
Matt: "How so?"
Harmony: "He seemed a little...too interested in how often doctors see patients nude."
Matt: "And did you think he was interested in the nudity?"
Harmony: "That was the feeling I got."
Matt: "Good thing we have weekly assessments where we give the prospective med students feedback. Your assessment of Carl is not that good?"
Harmony shakes her head.
Harmony: "No. I think he's bright, but I think the should choose another career."
Later on that evening, after dinner, Nick and Rae are strolling near the cliffs overlooking the Bridge.
Rae: "Is this the spot?"
Rae reaches up and kisses