Blood Oath

“Please Dr. Tepper, I’m not sure I can do this,” the distressed medical student explained while considering her options. 

Surprised by her level of resistance, the esteemed chairman and hospital administrator reasoned, “Ms. Gaines, I don’t believe you fully understand the situation before us. That boy wasn’t going to survive either way.”  

“You may be right, but we both know he didn’t die from his wounds. He was given the wrong blood. I overheard the nurse tell the ER doc she mixed up the two patients...” Helen Gaines clarified her position before being fiercely interrupted. 

“This conversation has gone on long enough. Ms. Gaines, you are a medical student in my hospital with no experience attending to such matters. You need to see the big picture. That young man suffered multiple gunshot wounds, including one which likely ruptured his spleen. There was no way he could’ve been saved in time. And while I’m not even commenting on your accusation, I’m telling you nothing would have changed the outcome.” 

“But then why not be honest with the boy’s family?” Helen questioned. 

“Young woman, I know you are just a student, but there are somethings you can’t learn in a textbook... or on one of those ridiculous TV medical dramas. I’m trying to protect this hospital, our hospital, from an unnecessary, multimillion dollar lawsuit,” rationalized Dr. Tepper, who observed defiance in the student’s eyes. He then decided it was necessary to up the ante. 

“Remember Ms. Gaines, this hospital is a private institution, and with donations way down over the past year secondary to COVID and the recession, it has limited resources. I was recently made aware of your interest in one of our two highly sought-after Dermatology residency positions. You should know, even though funding for training programs comes in part from the government, this only covers a small portion of the cost to run these programs. Sadly, the smaller programs, like Dermatology, are the first ones to be cut if we can’t find the money. 

But, on the other hand... I am close friends with Kate Halston, the Director of the Dermatology program. And, even though she has received over two hundred applications for those two positions, what she's looking for most is a team player, if you know what I mean.” 

Helen Gaines resisted the urge to reflexively reply and stood silent. Her eyes stared past Dr. Tepper and focused in on the room where she had witnessed the tragic passing of eight-year-old James Bryant. The words, “They have a right to know,” were on the tip of her tongue, but for the moment, would proceed no further as she clearly acknowledged the doctor’s threat, his bribe.  

An uncomfortable twenty seconds passed and Dr. Tepper interpreted this silence as confirmation of his message. He looked the petite, twenty-four-year-old student in the eye, offering a few final words before he was off to his next pressing matter in the ER. 

“As I’m sure you’ve learned over the past few years, being a doctor is not easy. There are many decisions we make on a daily basis which extend well beyond the realm of medicine. But you showed me something today, Ms. Gaines. And that takes a lot of maturity and courage. We’re expecting big things from you in the future.  

Now, I know your shift doesn’t end for another hour, but it’s been a difficult day. Why don’t you write your note and take off a little early? I’ll make sure to personally read it over in the morning. And don’t worry, I have already made Dr. Connolly aware.” 

Helen received the doctor’s message loud and clear. Although she was in her final year at the medical college and had distinguished herself amongst her peers, Helen was often reminded of her place within the hospital’s hierarchy. After all, it couldn’t be more obvious. Even though her conscience was determined to resist, Helen reluctantly accepted Dr. Tepper’s terms.  

Before they parted ways, she confirmed, “Ok, I’m just going to offer my condolences to the Bryant family and then I’ll be on my way.” 

Dr. Tepper found this unwise and not worth the risk. He replied, “Maybe it’s best you leave that to me and head straight home. They’re grieving and we don’t want to overwhelm them.”  

Once again, Helen thought to herself, “Message received.” 

After parting ways with Dr. Tepper, Helen Gaines collected her messenger bag and headed for the exit. Heeding the chairman’s warning, she passed through the main hospital building to avoid both the Bryant family and giving off any appearance of insubordination. When she was finally clear of the hospital, Helen finally found herself able to process the events which had taken place. The tragic death of an innocent eight-year-old boy. The medical error. The intimidation. And finally, the bribe. 

She played back the scene over and over, trying to justify her acquiescence and resulting inaction, yet this only confirmed her doubt and disappointment. One final time, Helen reviewed the events in slow motion.  

She recalled how by the time he’d been wheeled into the ER, James had already lost a lot of blood and his vital signs were unstable. In fact, things were looking so bad that the ER attending, Dr. Connolly, urgently called the OR to prepare for emergency surgery. But then, something changed. Helen wasn’t sure whether it was the fluid he’d received or another medication, yet for the moment, it seemed the situation stabilized. She now remembered Dr. Connolly commenting how James’ blood pressure and oxygen saturation were no longer dropping. She could still see the glint of hope in his eyes and hear him call out, “What’s taking so long with that damn blood?” 

Moments later, the very same nurse who Helen later overheard confess her mistake, ran in with blood to transfuse. With her eyes fixed on James, after the nurse entered the room, Helen failed to pay her any mind and assumed she followed protocol, initiating the transfusion. It was then the situation once again changed, however this time, not for the better.  

Suddenly, the monitors, which had only been quiet for a short while, alerted the team that something wasn’t right. The alarms crescendoed with the rapid increase in James’ heart rate and subsequent drop in his blood pressure. The look on Dr. Connolly’s face instantly transformed, reflecting the grave turn in the boy’s condition. He shouted commands to his team, but in the end, they were futile and James' vital signs flatlined. 

Dr. Connolly initiated CPR, turning to a young resident who was assisting him, asking, “I’m not sure what happened. It seemed like he’d stabilized.” 

The resident shrugged his shoulders while he continued compressing the boy’s chest. The only explanation was that his internal bleeding had reached a critical level.  

After attempting to resuscitate James Bryant for more than fifteen minutes, finally, an exhausted Dr. Connolly instructed his team to stop. Despite having worked in emergency rooms throughout the city for more than twenty years, this part of the job never got easier. 

“Time of death... 4:07 PM,” he declared. The team, Helen included, bowed their heads before slowly vacating the room. 

Having reached her apartment by the time she concluded her review, Helen’s mind was made up. It had to be the transfusion. Sure, Dr. Tepper wasn’t wrong in his assessment of James’ internal injuries and prognosis, however, had he not received the wrong blood, at least he had a chance. The problem now with confirming this realization, was that Helen saw herself as an accomplice to this cover up and deception; no different than that bastard, Ken Tepper. 

That night, Helen Gaines tried her best to move past her transgression, but this was more difficult than even she imagined. She worked out in the gym for an hour, picked up dinner at a local taco joint, and even tried to study for her upcoming Internal Medicine exam. Unfortunately, all she could see were images of James Bryant and his grieving family. And though she considered whether her obsessing was simply a product of the tragedy she’d witnessed, deep down she knew the truth. 

It took Helen a few hours to fall asleep that night, and by the morning, she understood the necessity of coming to terms with her actions. After logging onto the EHR to see that Dr. Connolly had signed off on her abridged note for James, she accepted there was no going back. Sure, Helen knew she could call the Bryant family and come clean, regrettably, the consequences for doing the right thing were simply too severe. By the time her morning ER shift had concluded, Helen had reluctantly made peace with her decision. 

With a weight having been lifted from her shoulders, Helen repeated her exercise and study routines that evening. Although she remained morally conflicted, right or wrong, Helen employed Dr. Tepper’s train of rationalization regarding James’ chances for survival and whether she could place all the years of hard work and her future in jeopardy. After dinner, she completed some additional studying and was ready to turn in and catch up on her sleep, when the phone rang. It was her friend, Talia. 

“Hey Tal, what’s going on? I was surprised not to hear from you yesterday,” she answered the call, but could immediately tell something wasn’t right. 

“Yeah, sorry... but...” 

“Talia, you don’t sound well... Are you ok?” inquired Helen, who then recognized soft, audible sobbing coming from the other end of the phone. 

“It’s my mom,” Talia began to explain. “She... She died today.” 

Talia’s emotions peaked, and for the moment, she began to hyperventilate while Helen comprehended the shockingly tragic news.  

Having grown up together on Long Island, Helen had known Talia and her mother for almost twenty years. She immediately felt a sense of personal loss, in addition to sympathy for her friend. It took a few seconds before she collected herself and carefully chose her words. 

“Oh my God, what are you talking about? But how? I didn’t even know she was sick.” 

Unsuccessfully attempting to inspire a few deep breaths, Talia replied, “That’s the thing... She wasn’t. I can’t believe this is happening. I just can’t believe it!”  

“Tal, take a sec and try to slow your breathing,” Helen guided while trying to coach each inhalation and exhalation. 

“Slowly in... and out... That’s better. Now, are you’re able to tell me what happened?” 

Talia focused on her breathing while fighting back a more explosive emotional outburst. After an exaggerated inhalation, she explained, “I just don’t know Helen... It all happened so fast. She called me yesterday from the emergency room and told me she had severe stomach pains and felt lightheaded. A few docs, including a GI consult, saw her and suspected she had ulcer, but since her blood pressure and blood count was stable, they planned to admit her to the Medicine floor to prepare for an endoscopy.  

I immediately booked the first flight from LA to New York, but my flight had a stopover and was delayed. By the time I reached Memorial Hospital, instead of finding mom on the Medicine floor, I was directed to the ICU where I was told that she suffered a heart attack.” 

“Did you say Memorial?” interrupted Helen. “You should’ve called me. I’m doing my ER rotation at Downtown Memorial. I would’ve stopped by and tried to help.” 

“Well, I still might take you up on your offer. You see, when I spoke with the ICU attending a few hours before she died, I was told that the ER and hospitalists were confused how my mom went from having a stable blood count and vital signs to a massive coronary.” 

“But that doesn’t make any sense,” Helen added. 

“Tell me about it. All I know is that she’d just come back from having a CT scan of her abdomen and was resting when her heart stopped. One of the docs told me her hemoglobin was 9, which was low, but shouldn’t have been low enough to cause a heart attack... In fact, they were even giving her a blood transfusion to boost up her level just in case her bleeding increased...” 

 “So, you were able to see her before she passed?” inquired Helen before her heart suddenly skipped a beat as she honed in on only two words of Talia’s account.  

“Well, Kinda...” Talia described with noticeable difficulty. “By the time I reached the ICU, she was sedated on a ventilator. I was told that since her initial arrest, her heart had stopped another time and she again needed to be resuscitated. I was only with her for a few hours before she had a final cardiac arrest and the ICU team was unable to save her.” 

Talia briefly removed the phone from her face and wiped the tears from her eyes. In the background, Helen could hear an older gentleman comforting her. She transiently brushed aside what she prayed was a coincidence and asked “Is that your dad? Are you still at the hospital?” 

Talia raised up the phone to answer. “Yeah, but we’re heading out shortly. I’m gonna stay with him for the next few weeks; work remotely from the house in Hewlett.” 

“Will you be there another twenty minutes, Tal? I can throw on some clothes and run over... I feel so bad I wasn’t there for you.” 

“Please don’t worry. You know my family. We deal with life in our own way. Eventually, we’ll be ok. I knew I should’ve called. Everything just happened so fast. I just can’t believe she called me yesterday around three from the ER, and a little more than twenty-four hours later, she’s gone.”  

Hearing this reality aloud, once again, Talia’s eyes watered, however she fought through to conclude the call. 

“Thanks for the offer, Helen. But it’s late. You don’t need to come by. I’ll let you know about the funeral, but I should really go. Thanks for being such a great friend!” 

The phone cut out and Helen was left standing alone in her apartment, feeling as if she’d been stabbed through the heart. There was no longer any doubt. She then walked over and sat down on the edge of the bed, placing her head in her hands. 

“Yeah, such a great friend,” Helen said aloud and hopelessly burst into tears.