Compacted Life
Jace
I’m sitting outside the room where my fate is to be decided, taking one more minute to go over my prepared remarks.
There are going to be plenty of questions, plenty of ways for me to explain exactly why and how I did what I did, though I doubt Dr. Marcum’s name will ever come up at all.
I would have loved nothing more than to have Grace’s support for what I’m about to do, but the simple fact is that she’s not here and she’s not going to be.
“Dr. Churchill?” Dr. Preston calls from the now open doorway. “We’re ready for you.”
I stand and straighten my tie. There’s probably nothing of consequence they don’t already know, but that doesn’t make this hearing redundant. It matters what I say in there and it’s going to matter just as much how I say it.
If I play it off like it wasn’t a big deal or that I didn’t really do anything wrong, they’re going to skewer me. This isn’t the kind of thing they tell you might become a problem when they’re doing what they can to pound the ethical code of conduct down your throat in med school; this is the kind of thing you know before you’re sitting in the class.
I sit down across the table from Dr. Preston.
To his left and right are board members and department heads, all members of the disciplinary committee. I know them all personally. That doesn’t mean this is going to be any easier.
From left to right, there’s Dr. Quinten, who I’m going to push into hating me for the fact that I violated the terms of a clinical study, something that’s big money for the hospital.
Next to him is Dr. Star, who’s going to soften a bit at the fact that I did this for a woman I care about, but she’s going to overcorrect her judgment so the others don’t catch on to her sympathies, something she considers a weakness.
In the middle is Dr. Preston, Dean of Medicine and a man who hasn’t stopped staring at me like he’s trying to figure out how much money his hospital can save by revoking my license and kicking me the hell out of it.
To the right of him is Dr. Jepsen, who’s one of those people you always think is on your side, right up until the moment he opens his mouth to let you know just how little he thinks of you — I’m pretty sure for no other reason than that he can.
Finally, we have Dr. Belkin, Grace’s doctor when she was brought in here after her first seizure. He’s difficult to read, but from what I know of him, I wouldn’t be surprised if he takes it personally that the doctor who assumed treatment of his patient could have made such a stupid mistake.
All in all, I think it’s pretty safe to say that I’m fucked.
“We’re meeting this morning in order to determine what, if any, disciplinary action would be appropriate for Dr. Jace Churchill,” Dr. Preston starts. “The committee has looked over the allegations surrounding your case, Dr. Churchill, and we are prepared to hear your testimony if you’d like to begin.”
“Grace Miller, the patient in question, was initially referred to me by Dr. Belkin. She came into the hospital after an idiopathic seizure. When it was discovered that she had an oligodendroglioma, she was referred into my care,” I start.
“Dr. Churchill, at that time, were you aware that there was a clinical trial that would be starting within the months following your initial contact with your patient?” Dr. Belkin asks.
And I thought I was going to be able to get through my initial statement before they set about crucifying me. “No,” I answer, “it was some time thereafter that I was sent an email discussing the trial.”
“Go on,” Dr. Preston prompts.
“When I did find out about the clinical trial, I began to consider the possibility that some of my patients may benefit from their inclusion,” I continue.
Dr. Belkin interrupts again, “How many patients of yours have oligodendroglioma?”
“I’m sure that’s in the file,” I tell him.
“Do you not know how many patients of yours have oligodendroglioma?” Dr. Belkin asks again.
“I have three patients with the condition,” I answer. “The first has phase three of the condition and thus wouldn’t be permitted entry into the clinical trial. The second patient was admitted in good faith and meets all criteria. The third, Grace, has phase two oligodendroglioma, and although she doesn’t meet the duration criteria, I thought her inclusion in the trial might have a positive impact on her prognosis.”
“You were aware at the time that you were putting forth an invalid candidate?” Dr. Quinten asks.
“I was,” I answer.
“Didn’t it strike you as a grave risk to yourself, to the patient, and to this hospital, not to mention to the results of the study to put forward a patient that didn’t meet the requirements of that study?” Dr. Quinten pursues.
“I was aware of the risks.”
“I’m not just speaking of the professional risks, Dr. Churchill,” Dr. Quinten continues. “The girl could have had an unforeseen reaction, or she could have skewed the results of the study, potentially preventing a helpful drug from being approved or even enabling a dangerous drug to slip through the cracks. Do you understand this?”
“I don’t think that a single patient in a clinical trial-” I start.
“Did you or did you not understand the risks apart from those to your professional status?” Dr. Quinten asks.
This isn’t going so well.
“I understood all of the risks regarding what I was planning to do,” I answer.
“Then why did you do it?” Dr. Star asks.
I’m about to gain her sympathy, but I’m going to just as quickly lose any chance of her voting for leniency.
“I had become quite fond of this patient, and I wanted to go the extra mile to ensure she had every chance she could to live a longer, happier life,” I answer. “I was advocating for my patient.”
There’s only one way this next part can go, and it’s going there quickly.
“You were having a sexual relationship with this patient prior to her admission to the trial, is that not true?” Dr. Jepsen asks.
“Not at the time she was accepted into the trial,” I answer.
“But you were having a sexual relationship with her before the commencement of the clinical trial?” Dr. Star asks.
I hesitate, but it’s a useless flourish. “Yes,” I answer.
I can see the look in Dr. Star’s eyes when it becomes clear I did this because I really care for Grace, but as predicted, just as quickly as I see the look, she sees me looking at her and the expression changes completely.
“So, you’re admitting to having an inappropriate relationship with your patient before the clinical trial began?” Dr. Star asks.
“Whether or not it’s appropriate isn’t my call to make, but I was having a relationship with Grace Miller before the trial began, yes,” I answer.
“Would the American Medical Association call your relationship with the patient inappropriate?” Dr. Star asks.
“I believe so, yes.”
“That’s all I need to know,” Dr. Star says, and tries to play down the fact that she’s looking for signs of approval from her fellow committee members.
I was hoping that she wouldn’t be so predictable.
“I think that the matter is clear enough as it is, but I would like to ask if you have any regret for what you’ve done,” Dr. Belkin asks.
“I’m sorry, could you repeat the question?”
“Do you feel any kind of remorse for the way you’ve so brazenly defied AMA codes of conduct, the policies of this hospital, and the requirements of the clinical trial?” Dr. Belkin asks.
This might be the only way in which I’m able to persuade anyone on the committee to show leniency. The first thing that anyone in the world wants is power, and people love nothing more than having someone approach them on hands and knees to beg forgiveness.
Maybe I’m just cynical.
“No,” I answer. “If given the opportunity, I would absolutely do it again.”
“Excuse me?” Dr. Quinten asks.
“I would do it again,” I repeat. “We have so much stacked against us so often in our profession, and if I were to have the chance to possibly turn the tide for one of my patients in the future — any of my patients — I doubt that I would hesitate to try to find a way to afford them that chance.”
“So, you persist in thinking that your personal feelings for your patient didn’t affect your judgment in this matter?” Dr. Star asks.
“They affected my judgment a great deal, and in many ways. However, they were not the sole reason that I put her forward as a candidate for the trial. We’re all doctors here,” I tell the committee. “I know that doesn’t mean we get to do whatever we want whenever we want, but when there’s an opportunity to help someone…isn’t that the reason we all got into this business in the first place?”
“I got into-” Dr. Star begins, but I’m sick of the hypocrisy.
“I know it’s the big joke of the medical world, that everyone says the same thing when asked why they became a doctor, but if we didn’t want to help people, we would have found something else to do with our lives,” I interrupt. “Did I breach ethics in getting Grace into the trial? Absolutely. But this was something that could have helped a young woman live a little longer or a little better, and isn’t that the point?”
“You didn’t take the same course of action for your patient with stage three oligodendroglioma,” Dr. Jepsen says.
“No, I didn’t,” I respond, “but that’s not because I didn’t want to try to do everything for him. If I put forward a patient with the wrong stage of the condition, it would not only require forging medical records,” yeah, I’m not going to mention Dr. Marcum, “but after the first scan, the doctors in the trial would have immediately disqualified him.”
“So, it was more important for you to get your girlfriend into the trial under false pretenses than it was to advocate for your other patients?” Dr. Jepsen asks.
“I always advocate for my patients,” I answer. “What I’m saying is that my advocacy wouldn’t have amounted to anything in that situation. He would have been removed from the trial before the first dose of the drug was given.”
“Were you aware that your patient, Grace Miller, was on the placebo?” Dr. Preston asks.
It never occurred to me that Grace might be on anything but the real drug.
“No,” I answer. “I was not.”
“With that knowledge, does your position change?” Dr. Preston asks. “Knowing that all of the rules you’ve broken, all of the ethical standards we have in place to prevent favoritism and promote objectivity, do you now regret that you lied to get your patient into the trial?”
“Objectivity?” I laugh. “Which one of us has any kind of objectivity with any of our patients? We all know that there are patients we like more than others and that some of our patients are so distasteful to us, for one reason or another, that we’ll often try to pass them off to someone else. Nothing about medicine is objective. If we were truly objective, we wouldn’t care whether our patients lived or died, we would do our work in a vacuum, and I have not met a doctor yet that hasn’t, at least once, bent the rules in favor of one of their patients. None of you can tell me that doing so wasn’t in a way personal.”
The room is so quiet I can hear the members of the committee breathing.
“We’re not objective, but we’re not heartless. If our worst enemy comes in, it’s our job to do whatever we can to cure them,” I continue. “If I wasn’t in a relationship with Grace, or if I didn’t have feelings for her before the relationship began, I still would have tried to get her into the trial. The fact that I do have feelings for her is merely something you’re going to tie around my ankles before you throw me off the bridge, but it has nothing to do with the way I acted in this instance.”
“Am I to understand your implication that you’ve done this sort of thing before?” Dr. Star asks.
“Not exactly,” I answer. “But I know for a fact that each one of us have gone out of our way and crossed one line or another in order to help a patient. Dr. Jepsen,” I start, “you give out free samples of medication to patients who can’t afford the prescription, and I’m not just talking about one or two doses.”
This isn’t going to end well for me, but I’m already in it so I may as well continue.
“Dr. Star, you’ve made house calls to your patients and taken hospital property with you when they can’t make it out of their houses,” I continue. “Dr. Quinten, you’ve been in a longstanding battle with the administration of this hospital over not allowing low-income patients of yours to stay in the hospital as long as you think they should be allowed, and it’s even your position that the hospital should write off the majority of medical bills for those patients you know can’t afford treatment any other way.
“And, Dr. Belkin, you’ve come in on your days off to meet with patients who took a bad turn. If I’m not mistaken, you’ve even gone so far as to treat patients when you were on mandatory leave — that mandatory leave, by the way, having been ordered because you refuse to take a day off and the hospital was concerned you were going to burn out.”
“What’s your point?” Dr. Preston asks.
“My point is that I know what I did was unethical and I know that you’re going to have no choice but to seek discipline for my actions, but isn’t it about time that we stop worrying so much what drug companies and insurance companies think and just start doing what’s actually best for our patients?”
I already know I’ve lost all hope of any kind of leniency, but that’s no reason for me to shut up now.
“I understand the reason for not having personal relationships, particularly to the level of my relationship with Grace Miller,” I tell the committee. “There’s objectivity, and there’s objectivity. While none of us may be capable of complete objectivity, this kind of relationship can cloud judgment to the point where we actually harm the patient in the process of saving them. Maybe that’s what I’ve done here, maybe not. I’m sitting here before you today not to pretend ignorance of the rules and codes, possibly laws, that I’ve broken, but because it is my job to treat my patients the best way I possibly can. So let me save you all a lot of time. I did what I’m accused of doing. I knew it was in violation of the rules. I am not sorry that I did it, and I would do it again.”
There, I feel better.
I’ve just torpedoed my career, but I feel better.
“Dr. Churchill, if you’ll excuse us,” Dr. Preston says.
“Yeah,” I answer, standing.
I’m sure that all of them had more questions, but I made it really easy for them. I did what they say I did and I did it knowing that I was breaking the rules.
I walk out of the room, not anticipating a long discussion.
More than once, I pull out my phone because I want to talk to Grace. I want to see how she’s doing, and I want to be with her. More than anything, I just want to talk to her.
After that day in the chemo lab of Parkside Hospital, she hasn’t been answering her phone or her door.
This round of chemo is over, though, and the plans I made after leaving Melissa in my apartment that night are almost complete.
The hearing was going to go the way it was going to go even if I didn’t accuse pretty much everyone else in the room of impropriety. The hearing was always going to end the way it’s about to end.
Whether it’s my whole career or just the immediate future of it, one way or another, this is going to put a mark on my record that’s never going to come off, and I’m sure that at the very least I’m going to get fired.
I can’t do anything about that. What matters, though, is what happens after the hearing. Whether I have a viable career or not, there’s something I need to know.
Deliberations, as I thought they would be, are short. Dr. Preston opens the door and tells me that they’ve come to a decision.
I rise once more and adjust my tie before following him back into the room. There’s a part of me that still has hope, but that’s the stupider part of me.
Everyone in the room is looking at me intently as I walk back in, but nobody speaks. We all know where this is going and how it’s going to end. Dr. Star even looks like she feels bad regarding what’s about to happen. That doesn’t mean she’s going to do anything about it.
“Dr. Churchill,” Dr. Preston starts. “I want to begin by saying that the committee recognizes that you are a talented physician who has, in the past, been a credit to our hospital. However, in light of the events surrounding your treatment of Grace Miller, specifically the falsifications that took place…”
He trails off when somebody’s phone starts ringing. I wish it was less obvious that the phone is mine. No doubt it’s Yuri calling for the 16th time since she blew the whistle on me.
“I’m sorry,” I tell him, pressing the mute button. “Please go on.”
“…and the inappropriate nature of the relationship between you and this patient,” he continues, “this committee has no choice but to find you in breach of hospital policy and the ethical standards of this profession according to the AMA. It is not lost on us, Dr. Churchill, that you performed this fraud in order to provide your patient with a chance she wouldn’t have had otherwise, but this does not excuse your actions.
“To that end, it is the finding of the board that you should be suspended without pay for a period of no less than four weeks, effective immediately, after which, we will reconvene to decide where to go from there. I want to impress upon you, Dr. Churchill, that despite your protests that any other doctor would behave as you have, we do have rules, and those rules are there for your protection, the hospital’s protection, and the protection of our patients.”
“Four weeks?” I ask.
“Yes,” Dr. Preston answers.
“That’s it?”
Where am I going with this?
“Excuse me?” Dr. Preston returns.
“If the codes of conduct that I’ve been found to have violated are indeed so serious as you would make out. then why is my license being spared at all?” I ask.
“First off, we haven’t decided not to recommend the revocation of your license, Dr. Churchill. Still, some feel that, although you have been misguided, there is still an opportunity for you to do good things at this hospital,” Dr. Preston answers. “If you have an objection to that point of view, however, we would be more than happy to revisit the subject.” Dr. Preston says, “At the end of four weeks, we will reconvene to decide whether or not to recommend that your license be revoked permanently.”
So that’s it. My career is up in the air.
In a lot of ways, the hearing went better than expected, but there’s no way of telling what’s going to happen next, and I’m not too optimistic about coming back here in four weeks.
If nothing else, though, it’s over for now. I’ve got a month between now and a final decision: plenty of time to update and circulate my résumé, though I’m not sure who’s going to hire me.
That’s not what’s pressing on my mind, though.
I pick up the phone and call Grace. She doesn’t pick up, but I leave her a message, simply telling her to be at her apartment at 8 o’clock tonight.
I just hope she’s there.