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Bitter Medicine
Two Doctors, Two Deaths, and a Small Town's Search for Justice
By Carlton Smith St. Martin's Press
Copyright © 2000 Carlton Smith
All rights reserved.
ISBN: 978-1-4299-2578-5
CHAPTER 1
THE STORM
The snow began in mid-morning. At first it fell in big, fat, wet flakes that disappeared almost as soon as they hit the ground; later in the afternoon, as temperatures fell, they became small and hard, and so began to stick.
The storm was from the northwest, made pregnant by the evaporation from the warm north Pacific current; its moisture-laden airstream rose over the masses of the Olympic Peninsula, where the colder air awaiting atop the peaks froze the evaporation into ice crystals, which hung in the air, growing heavier by the hour. The wind drove the crystals southeast across the southwest corner of the state of Washington, toward the Columbia River and then, in a carom shot off Oregon's share of the Coast Range, due east toward Portland. Heavy snow and rain shut down Portland International Airport that afternoon, and soon forced closures of the major highway arteries to the east.
Visibility was reduced to almost nothing on Interstate 5, the main north-south connector between Portland and Seattle. By dusk on Sunday, January 11, 1998, the snowstorm assaulted Centralia, Washington, eighty miles or so north of Portland, with almost a foot of whiteness, tying up all the local roads in the process.
Early the next morning, the winds shifted with increasing strength from the northwest to the west, and the snow and ice directed its attention to the Puget Sound area. By the afternoon of January 12, the white fallout had reached a depth of three inches in Seattle — a huge amount for a major urban area unaccustomed to significant snow. The accompanying cold led to a frozen fire hydrant near Tacoma, which in turn prevented a fire crew from extinguishing a blaze in a six-unit apartment building, which then burned to to the ground. Cars smashed into pile-ups from Olympia to south Seattle, and almost every road was decorated with the carcasses of stranded automobiles that had spun out on the ice before lurching into the parallel drainage ditches which accompanied almost every road in the region.
A man in Tukwila, a suburb south of Seattle, was killed when his pickup truck lost control and swerved in front of a tractor-trailer rig; a 12-year-old boy was seriously hurt when the sled he was riding lost control and slewed into oncoming traffic.
At the University of Washington, frat boys pelted each other with wet snowballs, and the police were called out to make sure that everyone kept as cool as the weather.
That same afternoon, the small town of Port Angeles, Washington — about 19,000 people, well-established on the south side of the massive strait of Juan de Fuca, some seventy miles west-northwest of Seattle and about eighteen miles across the water from Victoria, British Columbia — finally got its own taste of the snow that had tied up the rest of the region for the previous twenty-four hours.
Ordinarily, Port Angeles and the northern Olympic Peninsula of Clallam County missed most of the region's worst weather; the majestic Olympic Mountains usually acted as a barrier to the winter storms, and the warm current running into the strait from the Pacific helped keep temperatures north of the Olympic peaks above freezing for most of the year.
As a result, snow in Port Angeles was rare, far more rare than in inland locations like Seattle and Portland.
But based on the weatherpeople's predictions, authorities in Port Angeles knew they could expect to receive a substantial snowfall that afternoon; with plummeting temperatures and the Pacific storm hanging up on the crags of the mountains, more than a few inches of white could be expected to fall throughout the afternoon and evening. The Clallam County road crew started spreading sand along the roads that morning, in preparation for forecasts of unusually slick driving conditions.
By late afternoon, Port Angeles Police and Clallam County sheriff's deputies were overwhelmed with calls about minor fender-benders and incapacitated vehicles; one woman in a pickup was run over by a log truck as she tried to enter the main highway east of town, and had to be cut out of the squashed wreck.
By 4:45 p.m., the sun had finally set, even as obscured by clouds as it had been for several days, and the city of Port Angeles was plunged into its usual mid-winter darkness, while the snowfall grew ever stronger. After-school activities were cancelled, and many people rushed to the supermarkets to lay in supplies of food and other necessities in case the storm persisted.
From his own offices at the Peninsula Children's Clinic, across the street from Olympic Memorial Hospital, Dr. Eugene Turner watched the snow come down and tried to decide what to do.
That afternoon, he'd been scheduled to go ice-skating with a disadvantaged 14-year-old boy. That was the sort of thing Gene Turner did with his own time: getting involved with people who needed more than he did.
At 62, Dr. Turner was a legend; an Olympian, as it were, among the people of Clallam County. A pediatrician, the genial, sandy-haired doctor was said to have delivered as many as a third of the babies born on the Olympic Peninsula over the previous three decades.
Before that, he'd volunteered for the Peace Corps. In his off hours in Port Angeles, he cut wood for poor families, or volunteered for any number of good works. Turner had provided funds for Habitat for Humanity's first housing unit in Port Angeles, and had helped with its construction. His clinic even picked up the trash along a stretch of Highway 101, the main highway leading into town, and Gene Turner usually did it himself.
Around 5 p.m. Dr. Turner took a telephone call from his wife, Norma, a mover and shaker in her own right among the cognoscenti of Clallam County. Dr. Turner reminded Norma that he'd promised to take a boy ice-skating that afternoon.
But what about the weather? Norma asked. With all the snow, maybe Gene should postpone the outing, she suggested.
From his clinic window, across from Olympic Memorial Hospital, Turner glanced at the slate-gray sky, the darkening horizon and the increasing snow. He knew Norma was right. He cancelled the skating session and headed toward home, a few miles south into the foothills overlooking Port Angeles.
Even as Dr. Eugene Turner was making his way home, another family was settling in for the night of the storm. Martin and Michelle McInnerney had been married for less than a year; on the Friday before the storm Michelle had given birth to the couple's first child, Conor Shamus McInnerney. After spending Friday and Saturday at Olympic Memorial Hospital in Port Angeles, Michelle and Conor had been released to the couple's modest house on South Pine Street in the western portion of Port Angeles.
On the Monday following, at the height of the storm, they were visited by a close friend of Marty's, Byron Sifford.
The McInnerneys were young — she was 20, he was 22. Sifford was also young. They were representative of much of the population of Port Angeles: children of blue-collar workers who had labored for generations in the town's preeminent industries: lumber, paper and fish, the backbone of the town's economy — much of which had been decimated over the previous decade by dwindling timber resources and declining fish runs. Indeed, both Marty and Michelle had been marginally employed in the recent past, and their immediate economic future appeared bleak.
Sifford had worked with Marty when both were teenagers, and they had become friends. Later, he, Marty and Michelle had shared a house in Port Angeles. After spending some time in Oregon, Sifford had returned to Port Angeles and renewed his acquaintance with the couple. Married, with a child of his own, Sifford nevertheless spent a considerable amount of time with the McInnerneys.
On this Monday, in fact, Sifford dropped by the McInnerneys' house to show them a board game he had been given for a recent birthday. As the snows continued, the three set up the game and began to roll the dice to play.
Infant Conor was initially sitting in a child's swing. Sifford noticed that the baby seemed slightly agitated, but Michelle picked him up and walked him around to calm him, as Sifford later put it. A bit after that, Conor seemed hungry, so Michelle began to breast-feed him, even as all three continued the game. Michelle reclined on a couch while feeding the baby, and Marty and Byron rolled for her.
After a few minutes of this, Sifford noticed that Conor "started getting a little fussy."
Sifford asked Michelle what the trouble was, and Michelle told him that Conor wasn't yet quite proficient at breast-feeding. After a few minutes, Conor "quieted down," Sifford said later, and Sifford thought nothing more of it. The three kept playing the game, according to Sifford, with Michelle continuing to recline on the couch, tending the infant.
A few minutes after Conor had quieted, Michelle noticed that something was not right.
"Is he breathing?" she asked.
Sifford stopped focusing on the board game. He looked at Michelle and her baby and noticed that Conor wasn't moving. He knew something was dreadfully wrong.
CHAPTER 2
HEARTSTOP
"Oh, my God," Marty said, taking Conor from Michelle. The baby's heart seemed still. Marty screamed at Sifford to call the paramedics. Michelle was panicking. Sifford remembered her milling around helplessly as Marty began performing CPR on the baby. It was just after 7:40 p.m.
The emergency operator told Sifford how to instruct Marty on CPR, but Marty already knew what to do. He opened his infant son's mouth and tried to breathe into the tiny lungs to get Conor to take a breath, while trying to massage the heart into resuming its beat.
The Port Angeles paramedics arrived less than four minutes later. They took Conor from Marty and tried to intubate him — that is, put a plastic tube down his throat — to make it easier to get air into his lungs. They also noticed that Conor's heart had ceased to beat. Time was running short. He was turning blue before their eyes.
Michelle continued to mill around the living room as the paramedics worked. Somehow she found her way to the couch and collapsed, moaning, "Don't take my baby." Marty stood by anxiously.
The paramedics were having difficulty with their intubation effort; Conor's throat was so small that it was difficult to seat the tube correctly. Strictly speaking, the tube wasn't vital; ordinarily it was helpful in anchoring a mask, which in turn was connected to a rubberized air bladder, over the face and mouth. Once in place, the tube would free a pair of EMT hands for other tasks by stabilizing the air bladder's input.
Somehow, the tube was inserted; one of the techs began squeezing the bladder to pump air into Conor's tiny lungs, while another attempted to get an interosseal line seated in Conor's lower leg; he was unable to do so.
The interosseal line, headed by a thin needle that was supposed to be inserted into the lower leg bone, ordinarily would have been used to administer life-saving drugs for a baby Conor's age.
Failing to achieve such an insertion put pressure on the EMTs to find another way to administer drugs. Usually a vein is the next best alternative. As it happened, the EMTs couldn't find a vein in so small a child, and were therefore unable to adminster drugs intravenously to restart Conor's heart, which still refused to beat on its own. The EMTs then decided to administer the vital drugs through the throat tube. Epinephrine and atropine were given in an effort to jump-start the heart, with no apparent result.
With one of the paramedics continuing to "bag" the baby, and another attempting to massage his heart back into action, or at least force it to pump blood through his tiny system, the paramedics made ready to transport Conor to the Olympic Memorial Hospital emergency room, a bit over a mile away. Michelle climbed into the ambulance to accompany her new-born baby in the fight for his all-too-short life.
By the time the ambulance got rolling, it was just about 8 p.m.; by the official clock, baby Conor's heart hadn't had its own beat for more than twenty minutes.
To the people in the hospital, it seemed like it was taking far too long to receive the stricken infant.
The crew in the hospital emergency room got the call about the distressed infant at just about the same time that the paramedics had. They began preparing to receive the baby, readying an infant "crash cart" with all the supplies and medications likely to be needed, finding a special hot-lighted bassinet known as a "baby warmer," all the while communicating with the paramedics, who were having so much trouble with the throat tube.
An emergency room team has much in common with other, far more mundane groups: like a basketball or baseball team, every player has a part; the assemblage works best when everyone plays their own position, and does only what they are trained to do.
What makes an emergency room team different from an athletic ensemble is that it must deal with matters of life and death; and more, every decision has to be made within a matter of minutes, or sometimes even seconds. The pressure to be right as well as fast is tremendous.
The ER crew at OMH that night was headed by Dr. Bruce Rowan, a 33-year-old specialist in emergency care. Most people at the hospital thought of Rowan as a brilliant physician: bright, charming, caring — the sort of person anyone might want their daughter or sister to marry. He seemed down-to-earth, approachable.
A native of Idaho, he often signed his name with a simple "Rowan," as if he had no need for the pretension implied by a full name accompanied by a medical degree; occasionally he referred to himself lightly as "Dr. Bruce," a touch that some thought indicated both his youth and his open nature.
Rowan was not a hospital employee, but an emergency room specialist in a partnership of doctors who had a contract with the hospital; each of the doctors in the partnership rotated twelve-hour shifts, around the clock, which meant that most worked about twenty-four highly paid hours a week, or about ten twelve-hour shifts a month. The specialized work was lucrative; Rowan earned nearly $185,000 a year from the partnership.
As the emergency room physician on this evening, it was Rowan's job to diagnose problems and direct the others on the team; in effect, Bruce was the ER's quarterback, calling signals to the other team members — "the code," as it was called.
And on this particular night, even as Conor McInnerney was being raced the mile and a half to the hospital, Rowan had his hands full with all manner of other medical emergencies.
No sooner had he dealt with the woman who had been run over by the log truck, than a man came in with a massive coronary. Rowan began calling for help, and soon, one of Rowan's emergency group partners was extending his own shift to take care of the heart attack victim.
The snow continued to pile up, and all the minor medical emergencies associated with the unusual weather continued to stream in.
In the midst of this, little Conor arrived at the emergency room about 8:05. His heart still wasn't beating, and his only breathing was being provided by the paramedics' "bagging" with the rubber bladder, which was forcing oxygen down the tube and into his lungs.
Ideally, this action might be performed by a respiration machine; as it happened, Olympic Memorial Hospital did not have a machine suitable for a three-day-old infant. So, in Room 2A of the emergency room, the staff continued the bagging and the heart massage, while Rowan began dealing with the most immediate problem: to get Conor's heart started.
If the heart can't beat, the blood can't circulate; if the blood can't circulate, it can't get to the brain. A brain without oxygenated blood quickly builds up an accumulation of carbon dioxide and other metabolic waste products, a condition leading to something called "cellular acidosis."
The acidosis in turn begins to kill the body's cells, including critical cells in the brain: first, the higher brain structures such as the cerebral cortex, then, as minutes unfold, ever more basic brain structures — the mechanisms that control breathing and heartbeat, mostly located in the midbrain and at the top of the spine, the brain-stem.
(Continues...)
Excerpted from Bitter Medicine by Carlton Smith. Copyright © 2000 Carlton Smith. Excerpted by permission of St. Martin's Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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