In David Hellerstein's Stone Babies Dr. Jay Sones is a young doctor struggling against the odds to begin a private obstetrical practice specializing in fertility problems, when he is hit with a triple whammy. Denied privileges at the upper east side hospital in whose prestigious infertility lab he was a star researcher, sued for malpractice, and demoralized by a near-fatal assault that leaves his partner brain-damaged, Sones struggles to make ends meet working in the dreaded outer boroughs of New York City. With one foot in the glamorous world of his wealthy girlfriend and the other firmly planted in the poverty and squalor of the slums where he practices medicine, his suspicions grow that the three disastrous events are related, and he finds himself obsessively pursuing the truth. Stone Babies combines edge-of-the seat suspense with immersion in the reality of "Labor and Delivery," and provides ironic takes on the contrasting life styles of Manhattan's Upper East Side and Brooklyn's slums. Stone Babies is a medical thriller, a stylish and satiric novel, and an eye-opening read that leaves the reader with a healthy skepticism of the goings-on at prestigious hospitals, and fully educated on the inequality of medical care in this country.
Excerpts from STONE BABIES
Excerpts copyright©2000 by David Hellerstein
He awoke to heat, unbearable heat, and the thumping of machinery nearby, and to one of the nurses calling him to get up, get up, Room 2 was having late decelerations, and when he stood he nearly fell over. Must have been asleep all of twenty minutes, after a night of God knows how many deliveries, and he was totally dehydrated-reeling, dazed, bewildered-despite having chugged cup after cup of lukewarm orange juice all night.
Sister Jolie stood outside, yelling at him:
First child, mother began laboring three a.m., back labor, external monitor shows dropping pulses, she's hemorrhaging now, pressure's falling, you'd better get out here fast!
He stumbled, willed himself into awakeness. His greens were crumpled, and his shoes-when he jammed his feet into them-were soggy from the madness of last night. How many babies had he already delivered this shift? Nine? Twelve? Two babies delivered in the hallway, one in the supply room. A flood in delivery room number 3. A brownout during the last C-section that lasted nearly ten minutes-and they stood there praying that the emergency generator would kick in before the woman died. And then, while he was holding the woman's uterus in his hand, the boyfriend, a cheerful drug dealer, wouldn't stop rapping about how he had dusted a rival gang member, first shot, then stabbed, then throttled with bare hands, how he "wouldn' go ta sleep."
Now Jay came out into the nursing station, blinking at the red Bronx dawn, and squinted over the chart. It was stifling out here, palpably hotter than the windowless call room where he had been sleeping-here you were under the full glare of the morning sun.
Sister Jolie led him down the long marble-floored corridor into Delivery. Pulled a mask onto his face, tied a heavy blue gown behind him. The woman was howling, and when he came around the table he began howling too: the umbilical cord hung down between her legs. Prolapsed.
Get oxygen, 100%!
There's no oxygen, doctor, Sister Jolie responded.
Then we've gotta set up for a C-section.
I don't have the staff. No anesthesiologist. Only two nurses for the whole floor.
Then what am I supposed to do?
Deliver it fast.
He did. Rather, the mother did. Reacting to the heat, the screaming and clanging, she grabbed the sides of the delivery table, and with a great rush of fluid expelled her child into Jay's midsection.
Meconium! Fetal distress! Jay roared. Where's pediatrics?
Not in yet! shouted Sister Jolie.
He stopped swiping at the mother's wet bottom and turned his attention to the baby, searching for some kind of suction apparatus. He fell back on holding the baby upside down, ripping off his gloves and sticking a bare, none-too-sterile finger into its toothless mouth, then smacking it until it wailed.
"All right!" he whooped, euphoric, crazily ecstatic.
The mother wept in gratitude. Drenched in sweat, Jay leaned over and presented the glistening purplish-black infant to her.
"A perfect baby boy!"
He nearly passed out: the mother, with puffy tearstained face, and neat pink barrettes holding back cornrow braids, was a girl no more than 14 years old.
That was how the day began: in Hell.
It didn't help that the air conditioning at Sacred Lamb Hospital had died weeks ago. Early summer had been mostly cool and overcast, so the AC had hardly been missed; but now, the last week of August, 1991, a record heat wave had surged through the New York area, and halted once its epicenter reached Jerome Avenue. Up and down the Cross Bronx Expressway, angry motorists cursed outside their stalled cars; in the streets below, half-naked brown bodies splashed through the few still-spurting hydrants. EMS workers pulled octogenarians, shriveled and delirious, from steaming brick tenements. And day and night, the gleeful rattle of automatic weapons echoed through the streets.
The tropical front-bloated and overheated as the nation's post-Crash economy-billowed and swelled until the tall, ugly, yellow-brick Victorian buildings of Sacred Lamb Hospital shimmered like bakery ovens. Stifling was hardly the word-it was more as if the Sun herself rested gently against the hospital's leaky old mansard roofs, incubating some mutant offspring into the wretched landscape of the South Bronx.
"Well, look who's here! Back from the heart of darkness!"
Becky Okum, Eurobond trader, squealed and zoomed over to hug Jay. Her husband Mike, star of the initial public offering markets, punched his shoulder.
The cool, cool darkness of Janine Stern's apartment. Full of friends.
Edmundo Jarquet and Jakki Furagama sitting on the couch discussing the Mets-or was it The Met? Louise Encard, New York Post Page Six reporter and tireless busybody, emerging from the dining room with a radicchio and endive salad and running over to kiss him. And Janine Stern, gold earrings and sequined blouse glittering-her black hair pulled straight back, her skin seared to almost Iroquois darkness-rushing forward to kiss Jay juicily on the mouth.
It was a great party, a perfect release from months of L&D, from the entire past year. The past year's disasters had been followed by months of isolation-and then, when reality set in, when Jay realized the enormity of his commitments and the precariousness of his finances, by panic. First there was the lawsuit. Then Alli. And then the mess around his application for hospital privileges at Manhattan Medical Center. And afterward, months of frenzied attempts (by moonlighting at one hospital and clinic after another) to pay his malpractice premiums and the overhead on his Park Avenue office. Recently, though, Jay had begun to stanch the rapid outflow of funds. Not entirely-the waiting area in his Park Avenue office was still empty most hours-but at least business had grown to the point where he could pay the interest on the interest on his loans. And cover his receptionist's and nurse's salaries, and have enough left over to gas up his Subaru.
Which called for celebration.
Janine's party was a perfect way to revel. The CD player reverberated with Talking Heads, hazy partygoers danced on the terrace, a startling bouquet made the air glow above the Steinway baby grand, and the dining table sang with artful arrangements of mesquite-broiled shrimp and chalupas, and the charred flesh of endangered aquatic species, and crystal bowls of ceviche and guacamole. It was perfect. Everything he had missed during his endless years of medical training, everything he had yearned for throughout his Queens adolescence-all the riches of Manhattan, and more.
Lustful vapors filled the air-conditioned, high-ceilinged rooms of Janine's apartment. Everyone looked stunning, tanned, prosperous, at least five years younger than their birth certificates would allow. Especially Janine Stern-she looked not only more graceful and lithe than ever, but also more desirable than Jay recalled; less calculated and over-deliberate as the more cognizant parts of his cerebrum usually knew her to be. Dare he think it-she even looked sexy.
The exception to this glamour was Jay Sones, MD. Jay caught a glimpse of himself in the antique gilt-framed mirror over the dining room buffet, saw shards of Sonian flesh in a crystal obelisk that rose above the flowers on the piano. The good doctor looked stubby and disreputable, even diseased. His complexion was saturnine.
Ducking into a bathroom, Jay scrubbed the South Bronx off his face-the fifteen year old, pregnant by her stepfather; the young mother riddled with syphilitic lesions, giving birth to a twitchy coke baby; the thirty-three year old multiple rape victim who had watched her husband murdered; the five months pregnant speedball junkie, no prenatal care, popping out a 1500 gram baby girl . . . Jay's face reflected The Lamb. He slapped his cheeks to introduce some color. A futile attempt, however; he looked merely bruised.
On his way back into the party, Elly Townsend, a blond tax lawyer, pulled Jay aside to ask some medical advice.
"Sorry to bother you," she said nervously, "but I'm really scared."
Black silk rubbed his bare forearms. Jay took her hand.
"Last weekend," she said, "I bumped myself working out. In the shower I noticed . . . not only did it hurt, but now . . . now this lump was growing." She inhaled sharply. "Can-can I ask your opinion?"
He followed her into Janine's study. A huge aquarium, phosphorescent with fish, cast tremulous turquoise shadows across them. Elly pulled aside the strap of her dress. Her lovely shoulder was warm in his right hand; he reached out and touched her bare, lovely breast with his left. A hard bump rose beside the nipple-mobile, exquisitely tender. She looked fearful.
"Nothing," he said at last, "nothing but cellulitis."
As he described the remedy-warm soaks, heat, Advil-her anxiety began to fade.
"If it doesn't get better in a few days, give me a call," advised Jay. "You might need a prescription." While she readjusted her dress he reached into his suit-jacket pocket, where he kept a thick stack of engraved business cards for just such eventualities. He peeled one off. He was sweating. "I think maybe I have . . . yeah, here's one of my cards. Give a call if it's not better by Monday."
"There you are! Turning my study into a satellite clinic!" Suddenly Janine was at Jay's side, grabbing his shoulder. "Elly, watch yourself with this man! He comes to parties claiming to be a doctor, he takes girls away to examine, and they're usually found floating in the East River!"
Elly winked at Jay, and Janine dragged him back into a glare of halogen and crystal.
"Honestly, Jay, please don't seduce my guests!"
Jay leaned forward and kissed her.
Janine's arm stayed around him for most of the evening, though Donna Hastings, who bought oil tankers for Chemical Bank, dragged Jay off to ask about PMS., Anne Fellowes, an historian, needed a refill of birth control pills, and a platinum-blond music video producer whose name he couldn't quite catch had a litany of worries about her fibroids. By midnight the stack of business cards had become noticeably smaller without considerable effort on Jay's part. After each foray Jay would return to Janine's side and she would put a proprietary arm back around him. Around two o'clock the guests left.
Then, for the first time in fifteen months, Jay and Janine made love.
The only way to describe making love with Janine Stern was that it was like being acquired by a corporate raider. That is, having been carefully scrutinized and evaluated, your balance sheet toted up, your liabilities shrewdly estimated, your future growth potential researched, after courtship and tender offers, your assets were suddenly seized, whether you were ready or not. And yes of course you would like it, because suddenly bought out, you were floating in gold.
Anyhow, that was the fantasy, the promise. Actually, their love-making that night was rather awkward-he was exhausted, she was wired, jittery-and their final sweaty ecstasy felt earned, not given.
Jay flipped over to the other line. "Anyhow, Vince-to continue. About six o'clock Sunday morning Mrs. Valley finally gets to the ER. She waits two hours to be seen by the ER doc-not Bharig, who's gone off duty, but some Iranian guy-Haradim, I think. Haradim doesn't put in an IV, he doesn't get the nurses to follow her vital signs, he just leaves her in a room waiting for Cowell. And just as he's getting ready to see her she arrests. Haradim tries to resuscitate her, he calls the doc covering the ICU, who is equally stupid and just puts in a tiny peripheral IV. And then I'm unlucky enough to come walking through the door."
And Jay went though the whole gruesome tale. How he had arrived at the ER, taken over. Put in a central line, hydrated her, ordered stat blood, paged anesthesia, got her into the OR. How Cowell, the general surgeon, finally showed up.
"Just barely. She had a complicated post-op course, had peritonitis, abscesses, all that. Had to be transferred over to MMC, where they have a decent intensive care unit. Had drains in her belly for a few months. Drains means little plastic tubes so the fluid can drain out-you pull them out a few centimeters a day. Lets a track develop so the wound will heal."
"But she was okay."
"Except for one thing. Lost her uterus. Ergo, no babies. Ever."
"So what was the flaw in her treatment?"
"No flaws really. Beside that two day delay before she agreed to come in to be seen. Well, maybe things were a little disorganized once she did show up in the ER. But Haradim was waiting for Cowell. Basically what he did is standard procedure at The Ghost-keep your hands off the patient until the big shot private Attending gets there. The real flaw is that Witt probably shouldn't have given her X-11Q during the implantation. It was still experimental; only patients in the protocol were supposed to get it. Maybe fifty or sixty women had received it-and they were all followed under controlled conditions . . . nobody really knew the complication rate."
"What about the IFGR procedure itself? You think Dr. Witt could have screwed that up?"
"I don't know if screwed up is the word. It's possible he poked the catheter through the wall of the fallopian tube or lacerated a blood vessel. But she was okay for three months, so it seems doubtful."
"So they're just naming you as one of the accessory physicians?"
"I think so. I assume Cowell and Witt and Bharig and Yao and everyone else will be getting letters too. I mean, I don't think I would have done anything else differently if it happened over again. Maybe just insist that she come to the hospital immediately Friday morning, or get the husband to bring her. But that's it."
"What's she suing for?"
"How much money? I have no idea."
"That too. But I mean what reason? Is she angry at Witt or The Ghost or does she want revenge for the pain and suffering or what?"
"I couldn't tell you."
"Well, you'll find out eventually," Vince said.
And so it was that day, on entering the laboratory, that Jay immediately perceived how much was amiss, in an extreme of disorder, and only gradually was able to give it a name, a label, and then to act in a rational way. Possibly, in retrospect, he concluded, because it was so unexpected, so horrific. His first thought, entirely nonsensical, was: Usually doctors commit the violence in hospitals! For the sight of blood, blood everywhere through the lab, red-purplish, blackened, puddled across countertops, chairs, computer keyboards, laboratory equipment-all made him think immediately of the operating room and its associated violence, generally committed in the service of healing.
Then-and it must have been only two or three seconds-came the shock of naming, and a sudden airless terror as the word "murder" entered his mind. And half-recalled stories about the occasional terrifying attacks on hospital staff members by deranged patients, by intruders, by rapists, by thieves interrupted.
He saw her.
She was lying on the linoleum. Right below her computer, on whose screen flickered a black and white image of naked babies, cherubs, floating in space. Her head was black with blood. Her hands clasped something. Her clothes-
The miracle only slowly dawned on him; she was breathing. His hand went to her sticky, blood-slicked neck, her naked shoulder. He felt a pulse.
And then something automatic, entirely without feeling or sensation, took over, and he did all the things that a doctor might be expected to do in such a situation. Checked her airway. Began CPR. Grabbing a telephone, dialed in to call a Code. Watched frantically as the silent surface of early morning, the majestic calm of the hospital and the ordered rush of doctors and nurses coming to work, was interrupted by a horrible discordance, a ragged, urgent invasion of pallid men and women-friends, colleagues-throwing aside their paper bags of breakfast, their coffee cups, screaming for intubation tubes, for oxygen. For a stretcher.
He was no use in this: stood aside, near the blood-spattered computer printouts. Slumped finally onto a laboratory stool. Heeded from a great distance the imprecations of Security officers-and the New York City police officers-to touch nothing.
As though that mattered: there were bloody footprints everywhere. Needle and IV wrappings, blue chux pads, coils of tubing, stepped-on EKG tape. He dully noted that she was no longer in the room, and then became aware that familiar faces stood before him-Linda, the chief Infertility Lab technician, Turin, Wei Li, others, most in tears, and he discovered to his surprise, he too was in tears. And that a police officer, who had, oddly enough, only three fingers on his left hand, was speaking to him. No matter what he did, he couldn't catch his breath.
Around the corner, Jay opened the trunk of his Subaru and tossed the athletic bag and squash racquet inside. Then he turned the motor over and ground the old transmission into Drive, and following Eddie Polito's directions he headed East across one of the lesser East River bridges and into the immensity of Brooklyn.
Immediately he got lost. Around one o'clock, after stopping in several gas stations, Jay finally pulled up before a brick-and-plate-glass storefront which had a large blue and white plastic sign:
BROOKLYN WOMAN'S CLINIC, EDDIE AND TONY POLITO, DIRECTORS.
Stretched across the front window was a banner reading:
COME IN TODAY!!!
FOR YOUR FREE PHYSICAL!!
Jay walked in.
Brooklyn Woman's Clinic's waiting room trembled with concupiscence. Enormous Haitian ladies in tent-like dresses and gaunt Chinese women with swollen bellies and plump Hispanic girls in stretch pants-sitting on folding metal chairs, leaning against cast iron columns, trading gossip, applying eye makeup, complaining about their heavy bellies and their aching feet, juggling and cooing at their wailing infants, screaming at the innumerable toddlers that crawled around them on the floor.
A man approached. He wore a white coat whose seams were strained to the limit by his enormous free-weight biceps and barrel-chest.
"Hey there! Gomez! Am I glad to see you!"
"Sones," responded Jay.
"Sorry, gotcha confused with one'a those Puerto Rican fellas. C'mon in, Dr. Somez. I'm Eddie Polito, medical director of Brooklyn Woman's, my brother Tony is the chief financial officer-he went out for lunch, but he oughta be back before you leave. C'mon back, let me show you your office. We got patients up the wazoo!"
He led Jay back through the store, between glass counters that looked like they once held huge slabs of beef, to the offices. There were five or six tiny exam rooms on one side, each with an examining table, and along the other wall an antique weighing scale and sphygmomanometer, and a shelf of plastic laundry tubs containing a seemingly random assortment of glassware, syringes, plastic specimen containers, cotton balls and culture swabs. Apparently, overhead was low.
A plump gum-chewing Filipino girl in a pink smock was taking the blood pressure of a Hasidic woman. Polito snapped his fingers to get her attention.
"Corinne, want you to meet our new Wednesday doc. Doctor Somez."
"How d'ya do," Jay said.
Corinne smiled wetly. She removed the blood pressure cuff and waved the patient in the direction of the examining rooms. Jay stared at her: she was not using a stethoscope. You could not get a blood pressure without a stethoscope. Moreover, you cuffed the upper arm, not the forearm.
"Corinne, show Dr. Somez where the prescription forms and lab slips are, and get him a stack of Medicaid forms. And tell Candida to put patients in all the rooms."
Corinne waddled out front. In a few minutes Candida, a frail bluish-skinned Dominican woman also in a pink smock, began herding patients from the front room into the tiny examining cubicles.
"Now," Eddie said, "c'mon back to my office, we'll talk business." He shepherded Jay through a heavy metal door into the furthest-back room. Paneled in white plywood, it had a large desk on which rested a TV, a VCR, three telephones, and a pile of magazine clippings. Faded Penthouse calendars were tacked to the walls. He motioned Jay down on the couch. "This'll take a minute, then you can get started. Here's the rules. You work five or ten hour shifts, minimum of ten hours a week. You buy your own malpractice. Worry about your own benefits. And I pay sixty bucks an hour, cash."
"You said seventy-five," Jay said.
"Today you get seventy-five for helping me out, but I can only afford sixty." There was a pause. "Look, sixty is good money. Take it or shake it."
Jay stood. "It's not enough. It takes too long for me to get out here, it's not worth it for sixty."
"Hey! Don't get frustrated and leave. Tell you what-listen, Dr. Som-ez, you can make more than that. A lot more. We've got a bonus system-just listen, let me tell you about it, then you can decide. I'll pay you sixty-five if you want straight cash, but sixty in the bonus system will bring you a lot more."
"Shoot," Jay said.
"Okay, here's how it works." Eddie went through it, the way he and Tony had set it up. There was a bonus for seeing more than a certain number of patients a day. Plus an incentive system, where Jay would get a dollar for every lab test he ordered-bloods were drawn down the block at a lab that Anthony and some of his friends owned. For x-rays, there was an arrangement with a fella on DeKalb Avenue. Also, if he steered patients toward his cousin Ricci's pharmacy on the corner of Flatbush instead of the discount Buy-Rite, then there'd be a little extra bonus, a five or ten dollar bill every shift. "Now, these are poor people, unhealthy people, right?"
"So we figure that they need lots of blood tests, because something serious might be wrong, y'never know. They need lots of medicines too. Plus, we know that the generics aren't any good-so we give brand name medicines, because they work better."
Jay must have looked dubious, because Eddie continued:
"You work it however you want. Take it from me, the extras can only help. And ultrasounds-you know, the Indian fella who just quit, he found a couple ovary cancers by getting ultrasounds on everybody. We're doing good here, Dr. Somez. 'Do good and do great!'-know what I mean? Tony and me, we realized this is a growth area, medicine, as long as you set your clinics up right and see a lotta patients. An excellent business. We'll be setting up clinics all over Brooklyn before you know it, and if you want work, Somez, we can keep you busy twenty-four hours a day. Maybe you could even be Medical Director some day."
Jay smiled. Really, what Eddie was saying didn't seem a whole lot different than the talk you heard in the hallways at MMC. All those new Harvard MBA types with their slicked-back hair and yellow ties-if you actually listened to them in the elevator they'd be talking about "vertical integration of health services," and "maximizing reimbursement by optimal CPT coding," and "strategies for shortening length of stay." Same shit, different words.
"You been doing this for a long time?" Jay asked.
"Just two years. We come from construction, contracting, and before that, rubbish cartin'. Construction, that's a good business too, but too cyclical, too many ups and downs . . . To be honest, doc, this one's got more potential. Most MDs in the community, they don't know how to run a business." Polito stretched, and did a sudden air-karate punch. "Oos! Anyhow, enough warblin', you got patients out there. Go for it!"
Jay walked out and began shuttling from one tiny curtained alcove to another. He showed Corinne the proper way to take blood pressures, and even poked his head out every so often to see that she was still using the stethoscope. He showed Candida how to set the patients up on the examining tables, how to drape them, how to get their feet in the stirrups, their bottoms just over the edge of the table, how to set up the speculums and cotton swabs and culture tubes close at hand, and the basics of instructing in breast self-examination.
At ten p.m. he scrubbed his hands one last time, and pulled on his jacket. Jay hurried past the bodega next door, where a group of home boys stood staring down the passers-by. He crossed the boulevard which echoed with the roar of mufflerless cars and gunned the motor of his Subaru, all too conscious of the fact that he was carrying in his front pocket a grimy white envelope with seven hundred fifty dollars in cash.