Time to Testify

By John N. Haswell

Time To Testify provides a fascinating view into the private practice of obstetrics and gynecology.

Dr. Jay Atwell is on duty when the wife of a JAG officer goes into labor and ruptures her uterus.

The instant his scalpel enters the abdominal cavity, a sea of red floods over the edges of the table and splatters onto the green tiled floor. He worries about the baby, hopes it wouldnt be brain damaged.

The first rays of dawn barely visible, he knows how little time separates light from darkness, how only minutes separated triumph from disaster, and how only seconds separate life from death.

His relationship with a navy nurse is more than comradery. He leaves the navy and searchs for a place to set up practice, checks out a Catholic hospital.

Sister Agnes, your hospitals reproductive policies are oppressive to women, offensive to my own beliefs, and incompatible with those of my profession. Do you get special absolution from the Vatican to distort the truth?

In his struggle to upgrade Clarkesvilles obstetrical department he locks horns with hospital bureaucracy and demands that obstetrical nurses be trained to scrub-in for emergency cesareans in order to meet the required thirtyminute start-up time.

Vivian, his longtime patient, begs him to deliver her next baby by VBAC (vaginal birth after cesarean). He refuses to handle her pregnancy. Vivian ruptures her womb, loses her baby and her uterus.

Dr. Atwell blames the hospital. I repeatedly warned this hospitals administration that our department of obstetrics was a disaster waiting to happen and they did nothing to correct the problems. A disaster is exactly what happened.

After Vivian is awarded thousands of dollars she names Dr. Atwell as a defendant in a malpractice suit. Eight years later, he stands trial. A surprise witness testifies for Vivian, but her testimony backfires. Dr. Atwell was the obstetrician on duty the night I was born . . . the night my mothers uterus ruptured. He performed an emergency caesarean . . . pulled me out . . . saved my life.

Ellen Jones, a retired navy nurse and Dr. Atwells old flame, attends the trial. The jury deliberates, Vivians attorney becomes ill.

The verdict is in.

Setting and Location

A labor and delivery ward in Northern Maryland, Portsmouth Naval Hospital, and Naval Air Station, Patuxent River, Maryland. Dr. Atwells private office, Doctors surgical lounge, Clarkesville Memorial Hospital. The Gulf Coast of Florida. A courtroom.

Main Character

Dr. Jay Atwell opens doors into the real world of obstetrics. He is frustrated, but relentless and compassionate in his fight for womens rights.

Other Characters

Claire Foley, wife of a U.S. Navy JAG Officer
Commander Ellen Jones, navy nurse
Quincy Sadler, obstetrician
Bill VanBuren, An Errol Flynntype general surgeon
Vivian Andrews, longtime patient
Lauren La Fonte, chief nurse
Reggie Lehman, hospital administrator
Derek Brooks, orderly
Georgette Cohen, newspaper reporter
Lawyers and physicians

Themes

Malpractice/the legal profession
VBAC (vaginal birth after cesarean)
Professional jealousy
Sterilization/abortion/religion
Action Scenes

Operating rooma ruptured uterus
Cesarean section for breech
Vaginal delivery/hydrocephalic Breech
A deadly courtroom scene

• Language: English
• Publisher: Xlibris US
• Release date: Dec 14, 2005
• ISBN: 9781462843473

John N. Haswell

John Haswell is a board–certified obstetrician gynecologist. He received his medical degree from the University of Wisconsin and delivered seven thousand babies before moving to Florida. He has published three articles in Medical Economics and won their runner–up writing contest in 1997. He is an active member of the Sarasota Pops Orchestra, the Suncoast Concert Band, the Sarasota Jazz Ensemble, and the Sunshine Brass Quintet.

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Copyright © 2006 by John N. Haswell.

All rights reserved. No part of this book may be reproduced or

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retrieval system, without permission in writing from the copyright owner.

This is a work of fiction. Names, characters, places and incidents either

are the product of the author’s imagination or are used fictitiously,

and any resemblance to any actual persons, living or dead, events,

or locales is entirely coincidental.

This book was printed in the United States of America.

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Contents

ACKNOWLEDGMENTS

CHAPTER ONE

NIGHT CALL

CHAPTER TWO

LEAVING ALONE

CHAPTER THREE

ELLEN

CHAPTER FOUR

ANN

CHAPTER FIVE

CLARKESVILLE MEMORIAL

CHAPTER SIX

DOCTORS’ LOUNGE

CHAPTER SEVEN

SISTER AGNES

CHAPTER EIGHT

DECISION TIME

CHAPTER NINE

THE HEART AND SOUL CLUB

CHAPTER TEN

A FINAL SALUTE

CHAPTER ELEVEN

MAIN STREET

CHAPTER TWELVE

OPEN FOR BUSINESS

CHAPTER THIRTEEN

COMPETITION

CHAPTER FOURTEEN

VIVIAN’S FIRST PREGNANCY

CHAPTER FIFTEEN

SETTLING IN

CHAPTER SIXTEEN

FOR BETTER OR WORSE

CHAPTER SEVENTEEN

DROPPING OUT OF OB

CHAPTER EIGHTEEN

DON’T TAKE IT PERSONALLY, DOCTOR

CHAPTER NINETEEN

ROE VS. WADE

CHAPTER TWENTY

VIVIAN’S CESAREAN

CHAPTER TWENTY-ONE

THE BIG EASY

CHAPTER TWENTY-TWO

CROSS-TRAINING STONEWALLED

CHAPTER TWENTY-THREE

WAITING FOR DISASTER

CHAPTER TWENTY-FOUR

VIVIAN WANTS A VBAC

CHAPTER TWENTY-FIVE

THE PRESSES ROLL

CHAPTER TWENTY-SIX

THE BACK PEW

CHAPTER TWENTY-SEVEN

BOSTON AND BIRD

CHAPTER TWENTY-EIGHT

THE DISASTER

CHAPTER TWENTY-NINE

INVOLVED OR MEDDLING

CHAPTER THIRTY

DON’T WORRY, DOCTOR

CHAPTER THIRTY-ONE

COME-TO-JESUS MEETING

CHAPTER THIRTY-TWO

BACK HOME AGAIN IN INDIANA

CHAPTER THIRTY-THREE

SERVING UP JUSTICE

CHAPTER THIRTY-FOUR

VIVIAN TAKES THE STAND

CHAPTER THIRTY-FIVE

STEVE TESTIFIES

CHAPTER THIRTY-SIX

IMPROMPTU THEATRE

CHAPTER THIRTY-SEVEN

SURPRISE WITNESS

CHAPTER THIRTY-EIGHT

TIME TO TESTIFY

CHAPTER THIRTY-NINE

THOSE TWO IMPOSTERS

ACKNOWLEDGMENTS

Writing a novel has similarities to pregnancy. After conception, it is

often too late to turn back. At first, it was fun and I felt great. It grew, I gained weight, and my ankles became swollen. Way overdue, I self-published.

I want to thank my wife for her encouragement and patience. She asked, Are you going to write a second novel? I replied, Like having a baby, one is enough for me. I’m getting too old for this.

I wish to thank Mr. Bob McGrath, who kindled my interest in writing; Patrika Vaughn, for her seminars, guidance, and editing; and my granddaughter, Kristen Evans, for her editing skills.

Finally, I wish to thank the thousands of women I have had the privilege of attending during my professional career. Obstetrics is a wonderful mistress.

Helping bring a new life safely into the world remains the single most satisfying event in the life of any obstetrician.

CHAPTER ONE

NIGHT CALL

By the time Dr. Jay Atwell finished his first year of residency at Parkland

Memorial Hospital, he looked hollow-eyed and haggard. He had shed fifteen pounds from his six-foot frame and felt like a caged animal.

Parkland’s obstetrical department had a reputation of having one of the best teaching programs in the United States, but it was also a baby mill, cranking out five hundred deliveries a month. For the privilege of working eighty hours a week, residents were paid one hundred fifty dollars per month.

Jay liked delivering babies and was certain he had found his niche, but his savings teetered on empty, and his wife hated their cockroach-infested South Dallas apartment. With his busy schedule they barely spoke. The crowning blow came when the chairman of the OB department issued an edict that prohibited any resident from working outside the hospital. Most residents worked part-time at walk-in clinics to make ends meet. If Jay couldn’t work an extra job, his family wouldn’t have food and he would have to leave the program.

Frustrated, Jay reenlisted in the United States Navy. As a lieutenant, he reported for duty at the Bainbridge Naval Training Center in northern Maryland. The aging military facility sat nestled on a bluff above the Susquehanna River, fifty miles south of Philadelphia, and only a buggy ride from the Amish settlements of Lancaster. Built during World War II and now nearly abandoned, the dilapidated wooden buildings and overgrown grass resembled a worn-out veteran gasping for air.

Jay’s luck changed when his commanding officer found an opening for a second-year OB resident. Within forty-eight hours, he would begin the last two years of his residency at Portsmouth Naval Hospital.

At exactly 5:00 PM, he dialed the black rotary phone and waited, hoping Ellen would answer. Commander Ellen Jones, a single nurse in her early thirties, had short frosted hair and gorgeous blue eyes. Jay would like to have toasted her with a cold Michelob at his going-away party, but she was on duty that evening.

Labor and delivery, Ellen Jones.

It’s Jay. I’m checking in.

Hi, Jay. Isn’t this your last night?

It is. I’m all packed. Anybody in labor?

No, it’s spooky quiet.

Any elevated temperatures?

No, but the coffee’s fresh if you want to drop by. I’d like to see you before you shove off.

I’d like to . . . but I can’t. The packers have been at the apartment all day, and the movers are coming at the crack of dawn.

I’m sorry I missed your going-away party.

Me too . . . I wanted to buy you a drink, said Jay.

And I wanted to toast your transfer. I hope we meet again.

I hope so too, replied Jay.

Next time I’ll buy, said Ellen. At least you’re getting to leave this dump.

You can leave anytime, he joked.

How do you figure?

In The Wizard of Oz movie, the good witch told Dorothy to close her eyes, make a wish, and click her heels together three times.

I’d like to kick up my heels, but I’m sure not going back to Kansas like Dorothy did.

So what’s your plan?

I’ll keep looking so I don’t become an old maid.

That’s not likely to happen.

That’s sweet of you. The only call I got today was from the 11-7 nurse. She claimed she was too sick to come in to work . . . sounded like she was at a party.

So you’re stuck there all night.

Yah, I checked through the undelivered OB charts.

Any surprises?

There’s seven women overdue and tonight’s a full moon.

You believe that moon stuff?

Maybe I do.

Should I get tucked in early? asked Jay.

Wouldn’t hurt.

What’s your Ouija board tell you?

Don’t be a smart alec. My mother had one of those; she swore by it. I almost forgot. Dr. Hershey said to remind you that you’re assisting on Mrs. Foley’s repeat cesarean tomorrow morning.

Anything I need to know?

I talked to Mrs. Foley on rounds. She’s an interesting lady. Said the book club she belongs to had a speaker from up in Bryn Mawr. Mrs. Foley told the speaker she was having her second cesarean.

And?

That’s when this speaker lit into her, informed her in no uncertain terms that most of her friends demanded a vaginal birth rather than have a second cesarean. The speaker proceeded to tell her all about vaginal birth after cesarean. They call it VBAC. Mrs. Foley asked what I thought.

What’d you tell her?

I told her VBAC was dangerous.

That’s for sure. I saw a VBAC birth my first year at Parkland. The lady ruptured her uterus; her baby died. The third year resident performed an emergency hysterectomy. It was the bloodiest thing I’d ever seen. Is Mrs. Foley having any contractions?

No.

Let me know if she starts anything.

Of course.

Anything else?

Dr. Hershey left early again . . . his golf clubs in the back seat of his Mercedes, said he was taking a retired admiral to the driving range to hit some balls. Then they were going to the Officers’ Club. God, he’s uppity.

Lieutenant Victor Hershey III was in charge of labor and delivery. He sported a preppy crew cut and dressed in the fashion of Gentleman’s Quarterly. He lived on base in a two-story house reserved for the base obstetrician. The house was conveniently perched on a corner of the base golf course. He bragged how he captained the Duke golf team for three years in a row.

He’s uppity, but he’s a great surgeon, and he’s got great hands.

He’s got naughty hands.

You’re joking?

He acts like he isn’t even married.

Maybe I’ll be single next time we meet, added Jay.

Don’t say things like that unless you mean it, said Ellen.

I mean it. My wife and son flew home to her parents’ yesterday, left me with most of the packing. I’m not sure she’s coming back.

I’m sorry you’re having trouble; it’s been the scuttlebutt.

Do you gals know everything?

Bad news travels fast. Stay in touch and be good to the OB nurses at Portsmouth.

The OB nurses at Dallas were pros. They taught us lots of things that weren’t in the books.

Good luck and smooth sailing.

Jay parked the Buick station wagon in front of their off-base duplex and took a deep breath before he opened the front door. Inside he saw the stacks of sealed packing cartons. His son was gone, maybe forever. He stared out the window and cried. He ate the remaining two macaroni-and-cheese TV dinners, watched the nightly news, and made a phone call to Sally. Tom was excited to see his grandparents.

He took Ellen’s advice and turned in early, tuning the bedside radio to a classical station. He set the timer for sixty minutes. Eugene Ormandy was conducting the Philadelphia Orchestra; tonight’s program included The Overture to the Merry Wives of Windsor. He closed his eyes and reminisced about the time he had heard that overture in New York City’s Radio City Music Hall. He remembered the enormity of the sounds, the joyous feeling, and he could visualize the ninety-piece orchestra rising slowly from the pit. He wondered what his life would have been like as a professional musician.

The phone jarred him back into the nighttime world of obstetrics. He fumbled, heard the sound of a plastic water glass bouncing off the floor, followed the cord, and pulled the receiver to his ear.

Jay, this is Ellen. You awake?

What time is it?

One thirty. Get in here right away.

What’s happening?

It’s Mrs. Foley. She’s in active labor.

Dilated?

Five centimeters. I’ve started an IV and put a catheter in her bladder. I’ve called the OR crew and the anesthetist; told them to hurry.

Call Victor, then take her straight to the OR.

Her belly looks weird, like a double-humped camel.

I’ll be right there, said Jay.

He slipped on a pair of scrubs and cranked up his Buick wagon. A lone sentry recognized his window sticker, snapped a salute, and motioned him through the gate. He bounded up the loose wooden steps, entered the back door of the hospital, and headed toward the operating room. He grabbed a cap and mask, heard gurney wheels vibrating, saw it rounding the corner, and helped push it into the operating room. The operating room technicians looked ready. Ellen flipped up her mask.

Is Victor on his way? asked Jay.

I called him. His wife answered. She said he had too much to drink at the club last night. She tried to wake him. I told her to keep trying . . . that we were taking Mrs. Foley to the OR.

I may have to do it without him, said Jay.

How many cesareans did you do in Dallas?

Enough.

Here’s her chart. Take a look at her belly, said Ellen.

Jay flipped through the chart and stared at the last page. He flipped it shut, clenched his teeth, and frowned.

What’s the matter? Ellen asked.

Did you read the summary from her first cesarean at Guantanamo Bay?

No.

It’s an old photocopy, said Jay.

It stated that Claire Foley had had a high fever and a major wound infection after her cesarean. She had sustained second-degree burns on her abdomen during childhood. The next sentence completed the story. If she decides to have another pregnancy, she shouldn’t be allowed to labor because the uterine scar could be weakened by the postoperative infection.

Jay got the message. Her past infection could make her vulnerable to a uterine rupture. Jay flipped up his mask and introduced himself. Good morning, Mrs. Foley. I’m Dr. Atwell. I thought we had an eight o’clock date.

I’m the impetuous type, couldn’t wait. Is Dr. Hershey here?

Not yet.

Claire Foley had lively hazel eyes and russet hair. She squirmed with every contraction. He saw the brawny thick skin of her abdomen, her misshapen belly. Ellen was right. It looked like a two-humped camel. The lower hump felt like a distended bladder, but the catheter was draining clear urine. He gloved and did a pelvic exam. Her cervix was ten centimeters—full dilatation.

We can’t wait for Dr. Hershey, said Jay.

Go ahead, Doctor, replied Claire.

Other than a distended bladder, the only other possibility was that the lower bulge might be the bag of waters ballooning out through a hole in the old scar of her uterus, something he’d only read about in his textbooks. If Claire’s uterine incision was starting to break open, he needed to act fast.

He tied up his mask, scrubbed, and peered into the operating room through a small window above the sink. The old operating room looked as abandoned as the rest of the base. The once-white ceiling panels, yellowed with age and peppered with black mildew, were loose, ready to fall on command. Fluorescent lights flickered, emitting mercurial hues, and danced rhythmically against the green floor tiles.

Excuse me, sir, said a corpsman. Mr. Hopper and I want to know what’s with the early-bird emergency. We’re all set up, sir.

I’ll explain as soon as I’m scrubbed, answered Jay.

Yes, sir, responded the corpsman.

Jay pushed his buttocks against the door, swung his hips inward, and stepped into the operating room, his hands held upward, soapy water dripped from his elbows.

Claire Foley lay on her left side; Commander Jones held her in position. A wide leather retaining strap hung loosely over Claire’s thighs. The anesthetist prepared the spinal, mixed solutions from glass vials.

The scrub technician walked toward Jay and in two seamless motions gloved Jay’s sterile hands. At the end of each motion, the tech suddenly released the taunt rubber cuffs and intentionally snapped them against Jay’s bare wrists.

Good morning, sir, I’m Mr. Hopper, your early-bird scrub tech. Behind you, tying your gown is Mr. Barlow, your early-bird circulator.

Corpsmen knew how to sprinkle sarcasm into their rhetoric and then add sir to avoid insubordination.

Ellen heard the snapping sound, the arrogant smart-aleck talk. She walked to within inches of Mr. Hopper’s face, her hands on her hips. Hopper, I got eyes in the back of my head, and my ears heard your smart mouth. Both you and your sidekick report to me immediately after this case. Do you understand?

Yes, sir, they answered.

Jay knew they were pissed about the early morning call-in and he knew he didn’t have to take any crap from enlisted men; he passed it off. He motioned both corpsmen toward him.

Good morning, Hopper, Barlow, said Jay.

Where’s Dr. Hershey? they asked.

He’s stayed too long at the club last night.

Why the early wake-up, sir? Commander Jones instructed us to ‘move it.’ Expecting something unusual, sir?

I’m worried about the strength of Mrs. Foley’s uterine scar. She had her last cesarean at Gitmo twelve years ago, got a nasty wound infection. Let’s hope her uterus holds together.

Anything else you need, sir? asked Hopper.

Yes. Have Barlow pull out a second suction machine, hook it up, and test it to be sure it’s got power and enough rubber tubing with a large bore metal tip so it won’t get plugged up with blood clots.

Yes, sir, said Hopper. Mr. Barlow heard the conversation and headed to the closet.

Jay walked to the head of the table.

Is everything OK? asked Claire.

I briefed the corpsman on your previous cesarean. You’ll be numbed up in a few minutes.

He glanced at Claire’s belly and saw the baby move. He glanced at Ellen. She looked sexy; the florescent lights made her blue scrubs iridescent; her blue eyes sparkled. She knew the importance of timing, what calls to make, and she had the room staffed and set up ahead of time.

The anesthetist numbed Claire’s lower back with Novocain; her intravenous fluids ran wide open. Victor had already ordered blood to be cross-matched. The anesthetist finished the spinal. Ellen helped turn Claire onto her back, adjusted the leather restraining strap over her legs, and placed the catheter under her leg. She positioned both arms, secured them on arm boards, and adjusted the height of the IV pole. Victor was nowhere in sight.

Hopper, you’ll have to assist me, said Jay.

My pleasure, sir.

Jay moved to get a better look at Claire’s belly; the two humps persisted. Mr. Hopper finished the betadine prep of Claire’s belly.

At that moment, Jay saw Claire’s baby do a sudden flip-flop. In a split second, Claire’s belly twisted from the distorted two-humped shape into one formless hump. Mr. Hopper froze. Jay knew immediately. Claire’s uterus had contracted forcibly enough to complete the rupture of the old scar and expel the fetus, as if it were a human cannonball, out into the abdomen. Ellen saw the convulsive movement. Jay took charge.

Hopper, drape now. She just ruptured. Barlow, when we’re draped, hand over the suction tubing and turn on both machines.

Aye, aye, sir.

Mr. Hopper flipped one end of the prefolded drapes across the table. He secured the suction tubing. Hopper slapped a scalpel into Jay’s right palm. The time had arrived. Jay wasted none.

Barlow, start the clock, snapped Jay.

He knew he only had a few minutes before the oxygen levels in the baby’s brain would drop to zero, and the baby would be dead. The instant his knife pierced the abdominal cavity, a sea of red flooded over the edges of the table, across the drapes, and splattered onto the green-tiled floor.

Scissors, snapped Jay.

He quickly widened the incision. Ellen tossed clean drapes onto the floor and pushed them under their shoes, so they wouldn’t skateboard on the slippery mess. Except for the sound of blood gurgling through suction tubing and the deafening high-pitched whine of both suction machines, the room fell silent. Jay hoped they weren’t too late.

Even with both suction machines on high, the operative field overflowed with bloody fluid. He and Hopper