Preferential Treatment, page 5
“An aneurysm,” replied Jacobson, “is caused by a weakness in an artery. Sometimes this weak area forms a bulge or balloon effect in the artery that can exist for years without anyone knowing it’s there. Due to the pressure of the blood coursing through the arteries as the heart pumps, it—these weakened areas—can get larger, causing this balloon to expand. If the balloon gets large enough or the wall of the artery is weak enough, the balloon—aneurysm—can rupture. If this happens,” Jacobson again paused dramatically, “well, frankly, it can be catastrophic. Death or serious disability oftentimes occurs.”
Mary burst into a fresh stream of tears. Samantha, gave the doctor an irritated look, moved closer to Mary, and put her arm around her in a fruitless attempt to console her.
Jacobson watched Mary sob uncontrollably and wished that he had not been so candid. Although what he said about the risks was true and was information about which the family should eventually be made aware, he realized that telling them probably would have been better left to the neurosurgeon.
“Mrs. Gunther,” said the doctor, “I can assure you that your husband will be in good hands with one of our neurosurgeons on staff here at St. John’s. This condition is very treatable when caught in time, and it appears we have done just that. Your husband’s condition has stabilized, and he seems to be resting comfortably.”
“Please, Doctor. Please don’t let my husband die.”
“He’ll be just fine, Mrs. Gunther. He’ll be just fine,” Jacobson stated with conviction. At least if he’s one of the lucky ones, he thought to himself.
The doctor again patted Mary on the shoulder and left the consultation room. As he walked back toward the nurse’s station to finish his paper work, he shuddered. He vividly recalled that in his neurosurgery rotation during residency training there were some aneurysm patients who weren’t so lucky—those who were operated on and who died on the operating table, or worse, those left permanently disabled as a result of operations that went awry for myriad reasons.
After Jacobson had left the bewildered Mary and Samantha, Mary’s thoughts wandered back to happier times. Although not people of wealth, Mary and her husband had lived comfortable and generally uneventful but happy, satisfying lives. Joe was a journeyman machinist. He had worked at the same job and for the same company since he graduated from high school in 1979. An avid hunter and fisherman, avocations which he learned at an early age from his father, Joe was a devoted husband of twenty-five years and a dedicated father of four, ranging from age 24 to 13.
Mary, a devoutly religious Methodist, worked as a receptionist at Darnell, Smyth, Woodall & Coombs, the largest and what many would say the most prestigious law firm in the city of Abbington, West Virginia. She, like her husband, had been among the ranks of the employed ever since she and Joe married shortly after high school graduation.
The couple had toiled throughout their entire married life to rear and educate their children, three boys and one girl. They had had little time and, more importantly, no money for vacations or other luxuries. It was their goal, or more accurately their obsession, that each of their children would receive a college education and would have the opportunities in life that neither was afforded growing up. Taking vacations and spending money on other indulgences would just have to wait for the two Gunthers, Joe always said. There would be time for that when the children were educated and out of the nest.
Their last child, Steven, was in the sixth grade at Abbington East Middle School. The next youngest, Adam, was a freshman at Abbington High School while Joe, Jr., aged 20, was a sophomore at West Virginia University. Their only daughter, Samantha, had graduated with honors from Marshall University with a double major in accounting and finance.
Joe and Mary had looked forward to the day when they could spend some of the fruits of their labor on themselves and, more importantly, spend some time alone together. Now it appeared their dreams had been abruptly placed on hold.
I have to just trust in my faith in Joe’s doctors and God to get us through this, thought Mary. She shuddered, jolted from here musing, hearkening back to the warnings of Dr. Jacobson. The words “catastrophic” and “death” resounded in her mind.
My God, what would I do without Joe?
Later the same day, Mary Gunther sat by her husband’s bed holding his dry, cool hand. An IV stand stood sentinel nearby as dextrose water dripped inexorably from its translucent bag into Joe’s right arm. Samantha, sat in the corner of the stark hospital room in an uncomfortable pale green plastic chair, her eyes darting alternately between her father and the television that was mounted high on the far wall. Joe lay in his hospital bed, his head propped up on two pillows.
Shortly thereafter Joe awakened from a restful nap, smiled broadly at his wife, and squeezed her hand with a firmness that surprised her. Throughout the late morning and early afternoon, Joe had alternated between sleep and wakefulness with periods of gradually increasing lucidity. By late afternoon, Mary and Samantha had noticed marked improvement in his level of awareness.
“Dad,” said Mary softly. “What have you gotten yourself into this time?” She smiled affectionately at her husband.
“You know me, Mary,” Joe said with a faint smile. “I’m always getting into something I’m not supposed to.”
Mary felt a sense of mild relief as Joe attempted to resurrect his usual pleasant demeanor, but Samantha was not amused. Despite her uncharacteristic display of emotion earlier in the day while talking to the ER doctor, she had now regained her typical serious affect.
“Daddy, have you had a chance to talk to the doctor about why you’re here?” asked Samantha, unsure of just how much the doctor had told Joe or the degree of Joe’s understanding of his precarious situation.
“Yeah. Said something ‘bout a weak spot in a blood vessel in my brain. Don’t surprise me none. I’ve always said I had weak spots in my brain,” Gunther laughed weakly, attempting to make light of his condition.
Samantha frowned. “Seriously, Daddy. Do you understand what’s going on?”
The smile on Gunther’s face faded. “Sorry, Honey, I know you’re worried about your ole’ dad. I guess I shouldn’t make light of things. It just helps me cope, ya’ know.”
“So, what else have they told you?”
“Well, looks like they might have to operate on my brain. They might need to fix that weak spot on the blood vessel in there before it pops. The doctor said they thought it was what they call an aneurysm. Told me if I have one and it’s not fixed, eventually it could do me in. Dr. Jacobson—nice fellow—tells me that I should be expecting to see a brain surgeon sometime later today. He’ll be doing any surgery that I might need, I reckon.”
“Did he tell you that you’d need surgery for sure?” asked Mary.
“No. Said he’d leave that up to the brain surgeon depending on results of some other test they need to do. Called it an angio sompin’ or other. He’ll make the final call on that. He did say I’d probably have to have surgery, though. That’s after they find a surgeon to see me. I guess I have to have my family doc tell the HMO it’s okay for one to take care of me. Dr. Jacobson said he didn’t think that should be a problem.”
Gunther looked at his wife. Her reddened eyes betrayed her attempt to put up a strong front. Joe knew she had been crying.
“Don’t worry, Baby. I’ll be fine. You and I have some catching up on life to do when this thing gets fixed. Maybe it’s just a reminder that there’s more to life than work.” Joe reached over and gently stroked the back of his wife’s hand. “We’ll get through this. We’ve gotten through everything else.”
Samantha glanced at her wristwatch. 5:45 p.m. She sprang from her chair and began pacing the room. “If she’s got to give the green light for a neurosurgeon to see you, then where the hell is she?” an increasingly impatient and agitated Samantha said.
She strode toward the telephone on the nightstand at Joe’s bedside. She pulled open the drawer, found a phone book, and riffled through the Yellow Pages searching for the family doctor’s number. Finding it, she furiously punched it in on the keypad.
Telephone pressed against her ear, Samantha anxiously waited. After listening to and selecting options from an interminable menu provided by the automated receptionist at the Abbington Family Practice Clinic, she was placed on hold. Answering machines drove her crazy.
What gives them the right to think that my time is less valuable than theirs?
Dreadful Musak played for what seemed an eternity. Suddenly, she was rewarded with the sound of a human voice.
“Family Practice. How may I help you?”
“This is Samantha Hunter, calling on behalf of my father, Joseph Gunther. He is a patient of one of your doctors—Dr. Bloomburg.”
“Yes, ma’am. What can we do for you today?”
“My father is at St. John’s hospital. They think he has a brain aneurysm. Dr. Jacobson, the emergency room doctor that saw him this morning said my father would probably need a neurosurgeon. It’s now almost six o’clock and he still hasn’t seen one. It’s my understanding that we’d need Dr. Bloomburg’s approval since my father’s HMO requires the family doctor to be contacted first so she can make the referral. She hasn’t been in to see him, and I’m becoming impatient.”
“Let’s see here. Okay, I’ve got him pulled up on my computer. Looks like he’s with Center Health Management System. You’re right. He’ll need a preauthorization from Dr. Bloomburg before he can see the specialist—unless this is an emergency.”
“No. He’s stable right now according to the doctor,” said Samantha.
“Okay, Honey. I’ll leave word for Dr. Bloomburg. She’ll probably be in to see your father later on today when she makes her hospital rounds. You take care, now.”
Later? Probably? Samantha felt the urge to dive through the telephone and grab the receptionist by the neck. She needs to see him now! Samantha wanted to scream. She took a deep breath and bridled her anger. Don’t kill the messenger.
“Thank you. I appreciate your time. We’ll wait to hear something from the doctor, sooner, we hope, rather than later.”
Early evening approached and Samantha paced the hall outside of her father’s hospital room. She craved a cigarette, and her inability to smoke made her increasingly irritable. After several minutes of wearing a path in the shiny hospital floor, she reached her boiling point and charged down the hall to the nurse’s station.
“Is there any way one of you could try to get Dr. Bloomburg?” Samantha demanded to no one nurse in particular.
The nurse closest to Samantha looked bewildered. “I’m sorry, Miss. Can I do something for you?”
“I need to talk to Dr. Bloomburg. She was supposed to come in and see my father, Joseph Gunther. He’s down in Room 428. It’s getting late, and I need to talk to her. Can you try to page her or call her or something?”
A nurse seated at the opposite end of the station looked up from a patient’s chart in which she was making entries. She arose and walked toward Samantha.
“Hello. I’m Judy McFarland. I’m going to be helping take care of Mr. Gunther. I just came on for my shift and have gotten the report on him. And you are …?”
“I’m Samantha Hunter, Mr. Gunther’s daughter.”
“Okay, Mrs. Hunter.”
“It’s Ms. Hunter,” Samantha interrupted.
“I’m sorry, Ms. Hunter. I’m sure Dr. Bloomburg will be in to see your father shortly. I’ve looked at his chart, and it looks like Dr. Jacobson has already contacted her and has reported your father’s condition. She should be in soon. I usually see her about this time of day when she comes in for her afternoon rounds. Is there anything else I can do for you right now?”
“No,” Samantha sighed. “I guess I’ll just wait to see the doctor.”
“Okay. I’ll be down in a few minutes to check on Mr. Gunther.”
“Thank you,” said Samantha. She turned and slowly walked down the hall and entered her father’s room. Mary and Joe both turned their attention away from the television and eagerly peered at their daughter.
“The doctor ought to be in shortly, according to the nurse,” Samantha announced. She walked toward the corner of the room and sat. The three Gunthers waited and absentmindedly watched the television.
Soon, the trio heard a muffled exchange of words coming from the hallway. Within seconds, a stately, impeccably coiffed, Dr. Gretchen Bloomburg appeared in the doorway. Her steel-gray hair and half reading glasses perched on the end of her nose made her look older than her fifty-three years. Twenty-five years of treating patients with every condition from sniffles to heart disease and diabetes had begun to take its toll. She wore a white lab coat that was unbuttoned in the front, revealing a navy blue tunic that bedecked her tall and attractively slender frame. A stethoscope was draped around her neck. The words “Gretchen Bloomburg, M.D.” were embroidered in red above her left breast pocket.
“Joe, what the heck are you doing here?” Dr. Bloomburg said, feigning surprise.
“Hey, Doc,” said Joe. “Somebody grabbed me off the street and put me in this hospital against my will. Glad you’re here to spring me. Can I go home now?”
Bloomburg grinned broadly at Joe.
“No, we’d better see what’s going on with you before I turn you loose.” The doctor perused the room. “Hello, Mary. How have you been?”
“Fine, Dr. Bloomburg. At least until last night. How are you?”
Not waiting for a response, Mary motioned in Samantha’s direction. “Doctor, this is our daughter, Samantha.”
“Hello, Saman…”
“Doctor, what can you do for dad?” Samantha interrupted. The abruptness of her inquiry surprised the doctor.
Bloomburg’s smile disappeared from her lined but attractive face. “Wellllll,” Bloomburg drawled, directing her attention toward Joe. “Joe, you’ve got a potentially serious problem.”
Mary’s jaw clenched.
“I talked to Dr. Jacobson, and he says you had a bleed in your head, possibly due to a ruptured or leaking aneurysm. We need to confirm the cause of the bleed. If it was caused by an aneurysm, you’re probably going to need to get it fixed. You’re going to need a neurosurgeon to take a look at you. He’s probably going to do some tests to see just exactly what caused your bleeding. That’s about all I can tell you right now until we find out more.”
“Has a neurosurgeon been contacted yet?” asked Samantha.
“I’ve got a call in to Dr. Hall, James Hall. I just called a little while ago and couldn’t reach him. I left word with his answering service. Someone from his office ought to get back to me no later than tomorrow morning.”
Samantha’s brow furrowed. “Doctor, don’t you think it would be a good idea to have a neurosurgeon see dad as soon as possible?”
“I understand your angst, Ms. Hunter, but Dr. Jacobson tells me he believes your father is stable right now. If it is an aneurysm causing his problem, in my experience, Joe will need to rest for a few days anyway before anyone even thinks about operating.”
“Instead of waiting, is there someone else you could contact to try to see him?” Samantha persisted.
“We have one other neurosurgeon in the area who deals with Joe’s HMO. His name is Dr. Goldstein, but he’s out of the country for a month on vacation.”
A shrill series of beeps erupted from Bloomburg’s cell phone. Bloomburg thrust her right hand into her lab coat pocket and silenced the irritating noise. She glanced at the display on the phone and dropped it back into her pocket.
“Excuse me, folks. I have a call to make. I may have some information on your neurosurgeon for you in just a few minutes.”
In the hallway outside of Joe’s room, Bloomburg called the number shown on her text message. “This is Dr. Bloomburg. You messaged me?”
“Yes, Doctor. This is Dr. Hall’s P.A. We understand you are looking for Dr. Hall to see a possible intracranial aneurysm patient at St. John’s?”
“That’s correct. Could he see the patient no later than tomorrow?”
“I’m sorry, Doctor. Dr. Hall has decided to not perform any more craniotomies. He’s limiting his surgical practice to cervical and lumbar spinal surgeries.”
“Since when?” asked a surprised Bloomburg.
“Oh, it’s been a few years ago. He’s had some lawsuits against him, and he just doesn’t want to take the risk anymore.”
“Well, I have a patient here that needs to be examined and probably treated by a neurosurgeon that still does craniotomies,” spat Bloomburg. “To whom does Dr. Hall refer patients that need these services that he no longer provides?” Bloomburg flushed. She instantly wished she had been less caustic.
Unfazed, the physician’s assistant replied, “I think he refers all craniotomies to Dr. Hammond and his group.”
“That won’t do, I’m afraid. That group doesn’t participate with the HMO. My patient’s a member, and it won’t pay the cost for any surgeon that is out-of-plan unless there is absolutely no one else in the plan that’s available and qualified to do the work.”
“Sorry, Doctor. That’s about all I can tell you. I’d let you talk directly to Dr. Hall, but he isn’t available. He just left for a conference out of town.”
“Yeah. Uh—thanks,” Bloomburg stammered. Time for Plan B.
Bloomburg shoved open the door to Joe’s room. All eyes anxiously turned toward the doctor.
“Did you find a neurosurgeon to see him?” asked Samantha.
“We’ve got a little problem,” said Bloomburg. “The text I just got was from Dr. Hall’s office. Seems as though Dr. Hall can’t see Joe and can’t do his surgery.”
“Why not?” asked Mary.
“Well, unfortunately Dr. Hall isn’t doing craniotomies anymore. Gave them up because he’s afraid of getting sued.”
