Pennsylvania's Finest, page 17
“8.1 is impossible,” said Knight shaking his head and looking at the floor.
“I agree,” said Dr. Barnes. “It surely must be a lab error.”
“I would tend to agree,” said Dr. Riles. “A potassium swing from 2.1 to 8.1 doesn’t seem possible in a two hour period.” Silence then gripped the room for several more seconds as the attending physicians all pondered further comment.
Dr. Riles then pompously continued while sensing the moment was his, “This is the importance of M and M rounds. Only in this environment of academia can so many wonderful minds gather to discuss a case. Not just any case, but a case that results in death. Remember that death is a mythical creature that we try ever so hard to defeat. But in the famous words of William Shakespeare, “all that live must die, passing through nature to eternity.” Visiting professor Riles then held his chiseled jaw upwards towards the ceiling, as a sense of awe filled the room.
“Very well put,” said Dr. Barnes as he arose and approached the revered Bostonian. “Very, very well put.” Barnes allowed a few more seconds of adoration to occur from the crowd, which was appreciated by his long time friend. He then looked at his watch saying, “Now let’s get to the second case presentation today.” Upon doing so he sat down next to the exalted Dr. Riles, allowing surgical Morbidity and Mortality rounds to continue that Thursday morning.
Throughout the remainder of the conference Phil noticed a somewhat catatonic posture to overtake Dr. Knight. It was obvious that he was paying no further attention to the cases being presented, as he stared somewhat distraught at the floor, with a series of deep furrows across his forehead. He failed to speak throughout the remainder of M and M rounds and cancelled his office hours that afternoon. His demeanor remained uncharacteristically reserved throughout the following day, which was obvious to all personnel around him.
That Friday evening Phil Drummer and Jennifer Ranier went out to dinner together. They sat at a corner table, in a quiet restaurant, in downtown Philadelphia. The meal was simple, as was the conversation. A bottle of red wine was shared between the two. Topics varied from high school memories to favorite sports teams. Ranier had a physical attraction to Phil that she had not felt in years. The young surgical intern was overwhelmingly smitten by his stunning date. Each of them sensed an indescribable force that had collided their young lives together. A momentum that could not be denied, despite the obvious risks it entailed. They spent that October night together in the one bedroom apartment of Phil Drummer. Throughout the entire evening, the name of Dr. Richard Knight was never mentioned.
CHAPTER 16 The Knight Prowler
Doctor Richard Knight was a Russophile. His 50th birthday was celebrated in Saint Petersburg, Russia, with his wife. While visiting the Resurrection of Christ Church, the good doctor claimed that a personal religious experience overtook him. The church was built on the spot where Tsar Alexander II was mortally wounded, and therefore Knight sensed the Tsar’s presence. While offering a prayer on bended knee, Knight claimed the Tsar’s spirit entered his body, thus changing his bloodline to Russian. His wife however assured him that the local vodka was the only deity speaking to him on that junket. Regardless, from that point forward, Dr. Knight’s devotion to Russia intensified.
He loved Russian culture, specifically music and literature. Knight was capable of reciting lengthy verses from Alexander Pushkin’s Eugene Onegin. The greatest love story ever written, according to Knight, was Tolstoy’s Anna Karenina. In an academic pursuit of self-discipline, he had just reread War and Peace. However Knight’s most beloved gem of Russian literature was Boris Pasternak’s Doctor Zhivago. He felt a kinship to Dr. Yuri Zhivago and his struggles with the utter chaos surrounding him. Knight drew strength from Zhivago’s uncompromising pursuit for medical knowledge and excellence. Likewise, he personified Zhivago’s passion for marital infidelity and lust. To Dr. Knight, Zhivago was an icon, despite only existing in literature.
The weekend after M & M rounds was mentally tumultuous for Dr. Knight. A recent visit to the director of laboratory services was met with disdain. The director informed Knight that no possible laboratory reporting error existed. He was tersely schooled on the exactness of blood testing, including a constant internal monitoring and calibration of the system. Absolute assurance was given to Knight that all blood values were accurate. A reason for the potassium level discrepancy therefore did not exist. Dr. Knight could not accept this fact, which contributed to his angst.
Also occupying space within Dr. Knight’s cranium was the pending autopsy report of Brett Charles. An uneasiness regarding the record existed since Knight was unable to attend the autopsy. Visions of Dr. Falcon authoring a report while high on caffeine danced in his mind. Her sinister laugh permeated his senses as he occasionally glanced at the fax machine, which faithfully awaited her report.
Lastly, the situation with Jennifer Ranier resonated within his skull. She had boldly refused submitting her body to a gynecological mission of discovery. Repeatedly she had proclaimed her innocence and allegiance, which Knight was beginning to believe. Most disturbing however, was a recent phone call from a good friend, who espied his mistress having dinner with a “young stallion” that Friday night. Knight thought of Dr. Zhivago and his tumultuous affair with Lara. He pondered the future possibilities with Ranier that Saturday night, alone in his home. He had begun drinking some vodka immediately after dinner that evening. This was a warning sign to his wife, who smartly remembered and departed for a social date across town that night.
Sitting in his study he opened a chart on his desk containing the records of Mr. Brett Charles. With surgical eyes he poured over every detail of the case. The surgery itself was textbook in nature with no complications. All was well in the recovery room and throughout the immediate SICU care. Knight then paged to the day of Mr. Charles death, including the brief note that he wrote after seeing the patient. The note was scribed as “Doing well, no complaints. Exam stable. Plan transfer to floor today.” Knight then remembered his bedside conversation with the patient and the prolonged handshake that Ranier had received. His memory banks then pictured a nurse hanging an IV bag and chief resident Larson mumbling something about a low potassium level. Knight’s senses peaked at that moment, like a cat hearing a noise behind a wall. He quickly paged to the patient’s morning blood work, seeing a low potassium level. Subsequent physician orders were reviewed which appropriately instructed nurse Cruise to hang a bag of potassium. Knight then rapidly forwarded through the chart to the cardiac arrest section. There was no written record of any blood being drawn during the code. This was not an uncommon event, depending on the chaos of the code and the ability of the team to obtain blood. He checked the exact time of the code and returned to the laboratory section, trying to identify any blood results obtained during that time frame. There were none. The last potassium level drawn was several hours before the demise of Mr. Charles. An empty feeling now entered the cluttered mind of Dr. Knight.
As he closed the chart he noticed a legal document adhered to the front inside cover. It was a subpoena from a well know law firm in Philadelphia. Knight immediately recognized the law firm name and the attorneys involved. Their names instantly matched those of mean looking, ambulance chasing faces seen on T.V. commercials, asking the populace to call if they or a loved one had been injured. Injured by negligence, defective devices, motor vehicle accidents, workplace mishaps, nursing home abuse, or medical malpractice. The subpoena requested the complete chart of Mr. Brett Charles, per the request of his widowed wife and his estate. It was the first sign of a pending lawsuit against the hospital system and Knight himself. The law firm used a childish jingle that rhymed in all of their ads, offering a free consultation in order to right their wrong. Without prompting, the jingle added to the cacophony of noise in Knight’s head, signaling the success of a local advertising firm’s marketing campaign. “In legal need, call S.R.T. – In legal need, call S.R.T.” The lonely drinking of Dr. Knight continued well into the morning hours of that Sunday.
Fortunately, like all great Russian czars, Knight was a tenacious man. Over time he had developed a well-disciplined intellect that allowed him to process and categorize multiple pieces of information. Once placed in a tidy corner of his mind, the data would be available for immediate recall and processing, therefore allowing forward and purposeful progress to continue. As Knight dozed off alone that evening his sights were set upon the week ahead, which was already burdened with a noticeable increase in surgical cases.
That week saw an invigorated Dr. Knight assault the cardiothoracic program with a vengeance, with an extra hop in his step. This hop included an additional day of surgery that the residents took in stride. The resident team of Drs. Larson and Polk adapted well to the upswing in surgical case volume. By the Friday of their first week, the cardiothoracic team was in good spirits as they started their final case.
“This is Stravinsky’s Petrushka,” said Knight to intern Polk who was assisting him at the head of the table.
“I find Igor Stravinsky fascinating,” said Polk. “Do you know that he spent the majority of his years in Los Angeles?”
Knight stopped his work and looked up at Polk. The room went quiet. Knight then said, “No, I was unaware of that fact young man.” He returned to his trade looking down into the chest cavity saying, “Please continue Dr. Polk.”
Polk did indeed continue with a polite discussion of Stravinsky’s life including his sordid affair with Coco Chanel. During his off call nights Polk drained the internet of all information regarding Russian classical music. Knight was therefore quite impressed with the young intern. To Knight, the portly image of Dr. Polk was omnipresent throughout the PGH system. Wherever he turned, it seemed Polk was there.
“Dr. Larson, are you aware that this intern actually sleeps here in the hospital?”
“Yes I am sir,” replied Larson knowing where the conversation was headed.
“Just like the old days, when a house officer meant the intern actually lived in the house,” said Knight shaking his head. “Reminds me of my residency days.” He continued, “By the way, how is taking in house call going over with the chief residents?”
“Great,” said Larson, lying to the elder surgeon. Larson and all the other chief residents despised the decision to make certain chief residents sleep in house during their call nights. They considered it punishment for the recent death of Mr. Charles.
“The way it should be,” said Knight. “The way it should be. Don’t you agree Dr. Polk?”
“Of course,” said Polk. “And besides, I get free internet and cable T.V. down in the on call lounge.”
Knight erupted into laughter as he continued the operation. The remainder of the surgical team joined in laughter. Polk, in a twisted way, pacified Dr. Knight, and they all appreciated the fact.
The case soon finished with Dr. Knight stepping back and breaking scrub. He took off his surgical gloves and arched his back saying, “Good work team. That was our ninth case this week.” He stretched downwards to touch his toes continuing with, “I believe this Friday O.R. date will work out well. Don’t you agree?” No one else spoke.
Dr. Knight then instructed the team that he had to leave town after he spoke to the patient’s family. An order was given to the team to round on all patients that afternoon. Larson would then call Knight with an update on all the patients. Knight instructed Jennifer Ranier to please round with the team to assure continuity of care. He specifically noted that the current patient on the table was a member of the hospital board of trustees. An emphatic plea was given to monitor her closely. He then left the room.
“You’re like his svengali,” said a fascinated Ranier to Polk. She was amazed of the soothing effect that the physically unappealing Polk had on Dr. Knight. “Somehow, someway, he enjoys having you in the room.”
“Did you say svenjolly?” asked Polk.
“No, I said svengali,” answered Ranier.
“I think you said svenjolly,” said Polk. “In fact I’m sure you said svenjolly.”
“Don’t let him continue,” said Larson jumping in. “He is just trying to relive another Seinfeld moment.”
Polk smiled at Ranier as she sneered back at him. Polk was well aware of her interactions with Dr. Drummer, yet somehow didn’t broadcast it all over the hospital. He considered Phil a friend. One who requested that he keep their recent actions quiet. Rick Polk, like Drummer, found Ranier quite fetching. However, he was aware of his standing with Ranier, which was low on her totem pole. Therefore he relished his newly christened role of svengali with a particular zest.
Later that afternoon the official autopsy report of Brett Charles arrived in the office of Dr. Michael Barnes. As chairman of the surgical department, Dr. Barnes reviewed the autopsy report of all in house fatalities first. It was a routine that the prior chairman instilled upon him years ago. Barnes methodically read through the report authored by Dr. Jane Falcon. The official cause of death was acute cardiac arrest. No other contributing factors were listed amongst the final diagnosis. It was noted that all surgical venous and arterial grafts were intact. The usual terminology within the report appeared routine to Barnes. Wording of Dr. Falcon regarding a concerning breakdown and disruption of orderly cardiac cell membrane did not appear unusual to him. Dr. Barnes smiled and placed the report on a stack of papers for his secretary. He wrote atop the report, “Please fax to Dr. Knight.” His secretary Rose went home early that day, therefore allowing the report to sit on his desk over the weekend.
Just as Dr. Barnes placed the report down on the desk, he looked up to see CEO Rineman enter the room.
“Michael, just passing by,” said Rineman.
“Sit down, sit down,” said Barnes motioning to the chair in front of his desk.
Rineman did sit down while saying that he was in a hurry. He then asked, “How is it going with Richard?”
“O.K.,” replied Dr. Barnes. “We got him another day in the O.R. and he is filling it up.” Barnes looked at Rineman with amazement just shaking his head. Both men wondered where Knight was able to find surgical patients on such short notice.
“How did it go with Mrs. Hine?” was Rineman’s next question. He was referring to the board of trustee member that was operated on that day.
“From what I hear, excellent,” said Barnes. “Let’s just hope it stays that way.”
“I agree,” said Rineman, “No more excitement for this year at least.”
“I think we will be O.K.,” said Barnes. “Again, I think too much emphasis is placed on that darn article.”
“Any other contact from the Chronicle reporter?” asked Rineman. Before Barnes answered, he continued with, “Maybe we should send him a bottle of scotch for the holidays.”
“Nothing since our dinner,” replied Barnes. He sensed that Rineman had more important questions in store for him.
A moment of pause occurred before Rineman spoke again asking, “How is Richard doing overall?”
“I’m not sure what you mean by overall,” said Barnes.
“Overall, you know, professionally, socially, mentally,” said Rineman.
“Why do you ask?” said Barnes, “Is there something I should know?”
“Well I was out with a client for dinner last Friday night,” replied Rineman. The CEO then leaned forward towards Dr. Barnes and in a lower tone said, “And I saw his blonde hottie out with a young man.” Rineman paused momentarily as he shifted position in the chair before saying, “Boy, that girl is smokin’ hot.”
“So what,” said Barnes, “Probably her brother or friend.”
“Not the way they were acting,” said Rineman. “They were sitting too close for comfort.”
“Don’t worry about Richard, he can handle himself when it comes to matters of the heart,” quipped Barnes.
“I know, I know,” said CEO Rineman. “Just want to make sure that our prize surgeon isn’t under any undo stress.”
Barnes laughed at the terminology used in describing Dr. Richard Knight.
“The young man, or should I say boy that she was with, looked quite familiar,” said Rineman. He looked to the right of Barnes with a pensive frown saying, “I know I’ve seen him around before.”
Dr. Barnes realized that Rineman always expressed an interest in the extracurricular activities of Dr. Knight. His lifestyle fascinated the CEO, as did his distinct taste for women, especially Jenna Ranier. Barnes however thought the private life of Dr. Knight was somewhat of a taboo subject as he said, “Don’t worry, I’ll keep an ear to the ground for any more info.”
“Keep an eye on him,” said Rineman. “And please, keep me posted.”
“Of course,” said Barnes now fully understanding why the CEO stopped into his office that Friday afternoon.
That Friday evening a freakish sleet storm hit the greater Philadelphia area, cancelling Dr. Knight’s travel plans. Begrudgingly he caved into his wife’s demands to go out to dinner that night. Mrs. Knight complained recently of her husband’s mood swings, while voicing concern over his accelerated drinking and lack of interest in their sham marriage. Having nothing else to do that evening, and with the 76ers out of town, he conceded to a dinner date with his wife of twenty-nine years.
They dined at a swank new restaurant located in the Philadelphia suburb of Manayunk. A good friend of Mrs. Knight had recently opened up the eatery to rave reviews. The food was delicious as was the wine selected by the chef himself. The couple sat at a cozy side table with a small adjacent window overlooking a terrace. A single candle lit their faces as they spent quality time together. Mrs. Knight rambled on throughout the dinner while covering a wide range of topics ad infinitum. She informed her husband of the latest gossip amongst the fine arts committee. He was shocked to hear of a pending divorce between their good friends of thirty years. Updates were given on their three children and their respective career progress. A donation to the Philadelphia zoo was decided upon, being quite generous in nature.
