An excerpt from Act of Negligence. Copyright © 2021 by John Bishop. All rights reserved. Published by Mantid Press.

Beatrice Adams

Monday, May 15, 2000

“Morning, Mrs. Adams. I’m Dr. Brady.”

There was no response from the patient in Room 823 of University Hospital. She was crouched on the bed, in position to leap toward the end of the bed in the direction of yours truly. I could not determine her age, but she definitely appeared to be a wild woman. Her hair was a combination of gray and silver, long and uncombed and in total disarray. She had a deeply lined face, leathery, with no makeup. Her brown eyes were frantic, and her head moved constantly to the right and left. She was clad only in an untied hospital gown which dwarfed her small frame. My guess? She wasn’t over five feet tall.

“Ms. Adams? Dr. Morgenstern asked me to stop by and see about your knee?”

She did not move or speak; she just continued squatting there in the hospital bed, bouncing slightly on her haunches, and staring at me while her head moved slowly to and fro.

I looked around the drab private room with thin out-of-date drapes and faded green-tinted walls. There were no flowers. I judged the patient to most likely be a nursing-home transfer.

I made the safe move by backing out of the patient’s room, and I walked the twenty yards to the nurses’ station. The white-tiled floors were freshly waxed, but the medicinal smell was distinctly different from the surgical wing. There was an unpleasant pine scent in the air that could not hide the odor of decaying human beings and leaking body fluids. It was the smell of chronic illness and disease.

“Cynthia?” I asked the head nurse on the medical ward, or so announced her name tag. She was sitting at the far side of the long nursing station desk performing the primary duty of a nursing supervisor: paperwork. She was an attractive Black woman in her mid-forties, I estimated.

“Yes, sir?”

“Dr. Morgenstern asked me to see Mrs. Adams in consultation. Room 823? What’s the matter with her? She won’t answer me. She just stares, sitting up in the bed on her haunches, bouncing.”

She smiled and shook her head. “You must be a surgeon.”

“Yes, ma’am. Orthopedic. Dr. Jim Brady.”

“Cynthia Dumond. Mrs. Adams has Alzheimer’s. Sometimes she gets confused. Want me to come in the room with you? Maybe protect you?” she said with a smile.

“Well, I wouldn’t mind the company,” I said, a little sheepishly. “Not that I was afraid or anything.”

“She’s harmless, Doctor. She’s just old and confused.”

We walked back to the hospital room together. The patient seemed to relax the moment she saw the head nurse, a familiar face. “Hello, Ms. Adams,”

Cynthia said. “This is Dr. Brady. He needs to examine your . . .” She gazed at me, smiling again. “Your what?” “Her knee.”

“Dr. Brady needs to look at your knee. Okay?”

The patient had ceased shaking and bouncing, leaned back, slowly extended her legs, laid down, and became somewhat still.

“Very good, Ms. Adams. Very good,” Cynthia said, grasping the elderly woman’s hand and holding it while she looked at me. “Go ahead, Doctor.”

The woman’s right knee was quite swollen, with redness extending up and down her leg for about six inches in each direction. When I applied anything but gentle skin pressure, her leg seemed to spasm involuntarily. How in the world she had managed to crouch on the bed with her knee bent to that degree was mystifying.

“Sorry, Ms. Adams,” I said, but continued my exam. The knee looked and felt infected, but those signs could also have represented a fracture or an acute arthritic inflammation such as gout, pseudo-gout, or rheumatoid arthritis, not to mention an array of exotic diseases. I tried to flex and extend the knee, but she resisted, either due to pain—although I wasn’t certain she had a normal discomfort threshold—or from a mechanical block due to swelling or some type of joint pathology.

“What’s she in the hospital for?” I asked Nurse Cynthia.

“Dehydration, malnutrition, and failure to thrive, the usual diagnoses for folks we get from the nursing home. The doctor who runs her particular facility sent her in.”

“Who is it?”

“Dr. Frazier. Know him?”

“Nope. Should I?”

“No. It’s just that he sends his patients here in the end stages. Most of the folks that get admitted from his nursing home die soon after they arrive.”

“Most of them are old and sick, aren’t they?”

“Yes.”

I looked at her expression while she continued to hold Mrs. Adams’s hand.

“Were you trying to make a point?”

“Not really.” She glanced at her watch. “Are you about through, Doctor Brady? I have quite a bit of work to do.”

“Follow that paper trail, huh?”

“Yes. That’s about all I have time for these days. Seems to get worse every month. Some new form to fill out, some new administrative directive to analyze. Whatever.”

“I know the feeling. There isn’t much time to see the patients and take care of whatever ails them these days. If my secretary can’t justify to an insurance clerk why a patient needs an operation, then I have to waste my time on the phone explaining a revision hip replacement to someone without adequate training or experience. One of my partners told me yesterday about an insurance clerk that was giving him a bunch of—well, giving him a hard time—about performing a bunionectomy. He found out during the course of a fifteen-minute conversation that the woman didn’t know a bunion was on the foot. Her insurance code indicated it was a cyst on the back and she couldn’t find the criteria for removal in the hospital. She was insisting it had to be an office procedure, and only under a local anesthetic. Crazy, huh?”

“Yes, sir. It’s a brave new world.”

“Sounds like a good book title, Nurse Cynthia.”

“I think it’s been done, Doctor.”

“Well, thanks for your help. I do appreciate it. Not every day the head nurse on a medical floor accompanies me on a consultation.” “My pleasure. You seem to be a concerned physician, an advocate for the patient, at least. As I remember, that’s why we all went into the healing arts.”

She turned to Mrs. Adams. “I’ll see you later, dear,” she said, patting the elderly woman’s forehead. Still holding the nurse’s other hand with her own wrinkled hand, Mrs. Adams kissed Cynthia’s fingers lightly, probably holding on for her life.

John Bishop is a retired orthopedic surgeon. He is the author of The Doc Brady Mystery Series. 

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