“It’s not that bad.” Mr. Kelly smiled. “I’m not even hurting now.” He was a forty-two-year-old house painter who’d been having intermittent chest pain for two days. Three wires ran from under his patient gown to the monitor in the corner, where a fine green line bounced with every beat of his heart.
His wife shifted in her chair. A disposal box for contaminated needles jutted from the wall, next to her head. She leaned away from it, as if she wanted to scoot her chair over. A stainless steel supply rack hemmed her in on the other side.
“It was just a nagging little pain.” He gestured toward his chest. His fingernails were square and stubby, trimmed close. His nails glowed pink against the white paint stuck to his cuticles.
“How long did the pain last?” I asked.
“I don’t know, Doc.” He looked at his wife, then back to me. “About ten, fifteen minutes.”
“Did you tell him about your arm hurting?” Mrs. Kelly was a thin woman. She sat with her feet tucked beneath the chair and her hands held tightly together in her lap.
“It didn’t hurt that bad.” He rolled his left shoulder. “I mighta pulled it at work. You know, moving ladders and all.”
Mrs. Kelly shook her head.
I asked him about the cardiac risk factors: he didn’t know his cholesterol, he smoked about a pack a day, and his father had had a heart attack when he was in his late fifties. I wrote orders for the standard workup: EKG, cardiac enzymes, chest X-ray, and routine labs. “When the results come back, we’ll talk.” I went to see my next patient.
The EKG was done promptly. Normal. The blood work and chest X-rays were normal too. But I had been practicing for ten years, and knew that in the evaluation of chest pain the symptoms and risk factors are more important than the tests.
During a myocardial infarction—a heart attack—heart cells die, releasing enzymes into the blood. Early on, the level might not reach the threshold of “positive.” We check subsequent levels to catch any rise that may occur over time. The safest thing to do would be to admit Mr. Kelly overnight.
Mr. Kelly didn’t have a physician, so I called the on-call doctor to arrange for an overnight admission and serial enzymes.
In training, interns and residents work incessantly. I remembered being on call, and to a bleary-eyed intern who was hoping to sneak off and take a nap at 3:00 in the morning, no page from the ER was good news. It didn’t mean that I was getting the opportunity to help someone, or that I was getting a case I could learn from. It just meant that I was getting screwed out of the few hours of sleep I’d been hoping to steal.
When a patient needed to be admitted to the hospital where I trained, the senior resident went to the ER and checked on the patient. If an admission was unavoidable, the senior called the intern, who came down to do the history and physical and write the admission orders. If there was some doubt as to the necessity of an admission, the senior resident might put up a fight with the ER attending physician, and try to talk him into sending the patient home. Some of the senior residents never questioned the ER attending. We called them “sieves,” because they let everyone in. Those who consistently argued against admissions were called “walls.” “Sieves” were despised by interns. “Walls” were worshipped; they shielded their interns by thinking of fifty different reasons every patient could be discharged. And they just seemed smarter than the “sieves.”
This attitude is understandable when you consider the hallucinatory, sleepless fog of residency and the fact that residents are young, still in training. Most physicians gradually outgrow this attitude as they work easier hours and take on more responsibility for patient care. Some, though, even years out of training, seem to take pride in being a “wall,” sending people home from the ER. George Packard was one of those guys.
He was the doctor on call for patients without a primary care physician, so I called him. He’d been in practice for years, and he was a “wall.” Proud of it. Had a cocky little walk he did when he discharged a patient from the ER. When we called him about one of his own patients, he’d try to talk us into sending him or her home. When he was on call for unassigned patients, he argued even more stubbornly. I wasn’t looking forward to the call.
George returned the page, and we talked.
“Sounds like he could go home.”
“I don’t know, George.” I stared across the ER at a drunk who was leaning farther and farther across the side rail of his stretcher. Blood dripped slowly from a laceration on his forehead. I covered the phone’s mouthpiece. “Someone help that guy in Room 8,” I yelled. “He’s about to fall.” One of the health care techs strolled into the room and pushed the drunk back on the stretcher.
“The guy has a strong family history and he’s a smoker,” I said into the phone. “Stoic guy, may be in denial. I think he’s real, and he needs to come in.” “You think everyone needs to come in.”
“This guy has a good story.” The drunk had his head over the side rail and was looking at something on the floor.
“You’re saying you think he’s having a heart attack?”
“I’m saying he could have a plaque that hasn’t ruptured yet.”
“Didn’t you just tell me he had a normal EKG and negative enzymes?”
We both knew Mr. Kelly could be having a heart attack and initially have normal studies. That’s why we admit patients for serial tests. “I don’t know what to tell you, George.” I shook my head. “Guy’s dad had an MI in his fifties, he smokes a pack a day, and his pain is typical of ischemia.”
“With a normal EKG, and negative enzymes after two days of intermittent pain. If anything was going to be positive, it already would’ve been. You know that.”
“I think he needs to be admitted.” I wished we had an equation we could apply to the problem. So many points for this risk factor, so many points for the other. But there isn’t one. It all comes down to a judgment call, based on a few risk factors and very subjective symptoms. Pain versus pressure, discomfort versus pain. Is the patient exaggerating or minimizing his symptoms?
“I’d be glad to squeeze him in at the office, first thing in the morning. Do an accelerated outpatient workup.”
“I don’t think he should go home tonight.”
“Do you know how many hundreds of patients with bullshit chest pain we admit for every patient who has real disease? Or have any idea how many billions we spend every year on these worthless admissions? How much ‘covering your ass’ costs?”
“I’d love to talk about that sometime, but not right now.” The drunk had given up whatever he’d been trying to do, and lay with his head half off the stretcher, passed out. “And we’re not talking about ‘covering my ass.’ We’re talking about a guy who needs to be admitted to rule out MI.”
“If I come in, I’m just going to send him home.”
“That’ll be your decision.”
“You’re going to make the patient wait another two hours?” George’s voice scaled upward with incredulity. “Just for me to come in and send him home? I’m offering to see him first thing in the morning. That’s only fourteen hours from now.”
Two paramedics stood in the hallway with an asthmatic patient on a stretcher, waiting for the charge nurse to tell them where to put him. He opened his mouth like a fish with each inspiration, the muscles in his neck tightening into cords with the effort. His skin was gray, and shiny with sweat.
“George, the guy needs to come in.”
“It’s up to you.” George was probably shrugging on the other end. “I’ll come in, but it sounds like he can go home.”
We didn’t have a bed for the asthmatic, and he was too sick to stay in the hall. No point in tying up a bed with Mr. Kelly if George was going to send him home. “You’ll see my guy first thing in the morning?”
“Glad to.” George’s voice warmed up.
Mr. Kelly and his wife looked at me when I walked into the cubicle. “Your EKG and labs are normal.”
Mr. Kelly smiled, looked at his wife, then back to me. He waited.
“I think we can let you go home.”
“Great.” Mr. Kelly grinned and gave me a thumbs-up. His wife looked down at her hands.
“I’ve spoken with Dr. Packard, the doctor on call. He’ll see you in the morning, in his office.”
His wife didn’t look up. I got the feeling she wanted her husband to stay, but she didn’t say anything.
“I think you’ll be fine, but if you have any chest pain, come back immediately.” I waited for them to respond. If either of them objected, I could call Packard back and tell him they were balking at going home. Mrs. Kelly didn’t look up. Of course, I could call Packard back anyway, and tell him to get himself to the ER and see the patient. Let him send the guy home.
I didn’t.
Joanne, the charge nurse, had pulled a different patient into the hall to make room for the asthmatic.
Lisa, one of the nurses, was slapping the back of the asthmatic’s hand to find a vein in which to start an IV. “The line EMS put in blew.” She didn’t look up from her task. “I went ahead and started another breathing treatment.”
“Good.” I nodded to the patient, then, with my stethoscope, listened to the tight, high-pitched wheezing sounds of air barely moving in and out of his lungs. “You sound tight,” I said to the man.
He nodded.
“Let’s give him Solumedrol,” I said to Lisa.
“Got it in my pocket.” She looked up. “Can you hand me some tape?”
I tore two thin strips of tape and handed them to her.
“Thanks.” She taped the IV in place. “There.” She looked to me. “Portable X-ray?”
“Yup.” With good nurses, an ER doc can get a lot done, just by saying “yup.” I saw Mr. Kelly and his wife walking toward the exit. I wanted to call out, “Wait, let’s check another EKG.” But a repeat EKG would probably be normal too, and I would’ve felt foolish asking him to stay after I’d discharged him. And I’d arranged follow-up for the next morning. He’d be OK for fourteen hours.
“Paul,” Lisa called, “this guy’s looking sick.”
I turned to the asthmatic, and forgot Mr. Kelly.
The next day when I started my shift, Joe, one of the other ER doctors, was sitting in the dictation room. He was a runner, and looked like it. Tall, bony guy with broad shoulders and a skinny butt. He looked up from the chart he was working on. “Paul, you remember a guy named Kelly?”
My stomach felt queasy. “Guy with chest pain?”
“Yeah.” Joe looked up from the chart he was holding. “He came back, about 4:30 in the morning. Cardiac arrest.”
I sat.
“You OK?”
“Yeah.” I felt prickles in my scalp and down the back of my neck. I glanced at the trash can, afraid I might vomit. “He’d been having chest pain off and on. Didn’t have any while he was here.”
“I worked the code for at least thirty minutes before I called it.”
Mr. Kelly was dead.
Joe adjusted the stethoscope draped around his neck. “I looked over his EKG and labs from when you’d seen him. They were normal.”
“I know.” I’d sent Mr. Kelly home, and now he was dead.
“It’s gonna happen.” Joe shook his head. “We can’t admit every single chest pain that comes in. I would’ve done the same thing.”
I still wanted to puke. “I had a bad feeling about him when I let him go.”
Joe shrugged. “I sent home a guy last year. Came back a couple of hours later with ST segments like Mount Everest.” He was describing a classic EKG pattern of a heart attack.
“Did your guy make it?” “Yeah,” Joe said, “but that’s not the point. I’d sent him home. I was just lucky.”
He was trying to help me feel better. Every doctor has had a patient die as the result of a wrong judgment call, or a brief lapse of attention. It’s inevitable when fallible people make mortal decisions. There are people who’ll say, “This should never happen.” And they’re absolutely right. It shouldn’t.
I struggled through the shift, oppressed by the knowledge that I’d sent Mr. Kelly home, and that he’d died. Maybe if I’d paid attention to his wife, her unease would’ve prompted me to ask more questions. Maybe I would have learned something to make me insist on his admission. But I’d looked Mr. Kelly in the eye and told him I thought he’d be OK, even though I had misgivings. I’d not paid enough attention to an intuition, an uneasy feeling, and there hadn’t been enough hard data to convince George Packard to come in. I’d trusted his judgment over mine.
In lectures, seminars, and magazine articles, malpractice lawyers tell you never, never, never to discuss a potential malpractice case. With anyone. The other side will ask if you discussed it, and ask for a list of names. Then they’ll interview people until they find one who remembers your admitting a mistake. In one class I listened to on cassette tape, the speaker told about a doctor who’d confided in his wife about a mistake he’d made. Before the case went to court, the doctor and his wife went through an acrimonious divorce. In the malpractice trial, the ex-wife took the stand against him with a vengeance. The class had roared with laughter at the poor schmuck’s bad luck. You don’t discuss the case, and you never, ever, apologize. To the malpractice lawyers, “I’m sorry” is just another way to say “I’m guilty.”
The shift moved slowly, like a bad dream. Finally, it was over. Before I left, I copied Mr. Kelly’s phone number down on a scrap of paper.
When I got home, everyone was asleep. I wanted to talk with my wife, Sally. But she was sleeping soundly, so I went downstairs and turned on the TV.A tall, handsome attorney with a very good toupee was on the screen. His voice was deep, and caring: “If you, or anyone in your family, has been injured by a doctor or a hospital, call me.” A 1-800 number flashed on the screen. “We’ll get the money you deserve.” He somehow managed to mix enthusiasm with sadness in his voice. I vaguely wondered if Mrs. Kelly was at home alone, watching the same ad.
“What if she is?” I asked out loud. I clicked off the TV. “She may want to give dip-shit a call.” I went to the kitchen, got a beer, and went out on the front porch and sat on the steps. Two large magnolia trees shaded me from the streetlight. Mrs. Kelly was probably awake, too. Maybe sitting on her front porch looking out into the night, stunned by the emptiness she faced.
The next morning I was off duty. After the kids were in school, I told Sally. She listened to the whole story.
“Paul, there’s no way you could’ve known he was going to die.”
“His story was good enough to buy an admission.”
“No one’s perfect.” She shook her head. “I know it makes your job scary, but everyone is going to make mistakes.”
“Yeah, but not like this.” I rinsed my coffee cup. “Missing a fracture, or a UTI, stuff like that, sure, you’re going to miss a few of them. But sending a guy home to die?” I felt the pain continue to build, of all places, in my chest. Maybe if I cried, I’d feel better.
“You didn’t send anyone home to die.” Sally sounded a little irritated. “You evaluated him, and made a decision.” Simple as that. “No one expects you to be perfect.” She hadn’t seen the ad last night on TV.
“Even if I’d admitted him, he probably would have died.”
“That’s true.” Sally nodded.
I leaned against the kitchen counter, my back to the sun coming through the kitchen window. “Must’ve been a huge MI, to have killed him so quickly.” I needed to believe Mr. Kelly would’ve died even if I’d admitted him, because nothing in my experience had prepared me for feeling so guilty. Up to the moment I’d heard about Mr. Kelly, the possibility I could make an error of that magnitude had remained an abstraction, a theoretical possibility with no grounding in personal experience. I’d been trained well and I was careful. I thought that if I was vigilant enough, I could practice indefinitely without seriously hurting anyone.
I sat at the kitchen table, replaying the scene of Mr. Kelly and his wife shuffling down the hall in the ER, wishing I could rewind it all and call out to tell them that I’d changed my mind, that I’d admit him to the hospital.
The phone rang. It was Ken, one of the guys in our group. He’s been an ER doc for twenty years. He has graying hair, a calm voice, and never seems to hurry. Even when the ER is rocking, Ken looks like he just strolled off the golf course. I don’t know how he does it: each month we get a report on how many patients we see each hour, and Ken’s numbers are consistently good, but he rarely seems perturbed, and I’ve never seen him look rushed.
“Paul,” he said, “I was going to drop by if you’re around.”
“Sure,” I said. “You know our address?”
“Yeah,” he said, “I’m about a block away.” Car phone.
“OK.” I hung up. “That was Ken,” I said to Sally. “He’s coming over.”
“It’ll be good to talk with him,” she said. “Why don’t I go work in the yard some, give you guys some space.” She stepped forward for a quick hug, then walked out the back door.
I went to the bathroom, then looked at my face in the mirror, hoping I didn’t look as vulnerable as I felt. I also hoped I wasn’t in trouble with the hospital, or the group of ER docs I worked with. I felt vaguely nauseated again.
Ken knocked on the door, and I let him in. He followed me back to the kitchen.
“I was just about to make a pot of coffee,” I said.
“Sounds good.” He sat in the chair at the end of the kitchen table. “Are you here about Mr. Kelly?” I rinsed the basket of the coffee maker and put in a clean filter.
“Yeah.”
I turned to look at Ken. “I feel terrible.”
“You should,” he said. “The man died.”
I turned back around, hoping I hadn’t outwardly flinched. Neither of us spoke as I silently counted the scoops of coffee. I dropped the scoop back into the coffee jar, and closed it.
“And good doctors,” Ken continued, “are bothered when one of their patients dies.”
Ken still thought I was a good doctor? I felt a wave of gratitude and relief. I put the coffee pot under the basket and punched the button to start the brewing. “I feel like I killed the guy.”
“Whoa,” Ken said. “Back up a minute. You didn’t kill anybody. You’re not even sure of the cause of death.”
“Guy comes in with chest pain, comes back dead?” I turned to face Ken. “Not exactly rocket science.”
“OK, say the man died of a heart attack. No matter how careful, how smart, or how compulsive you are, eventually you’re going to make a mistake.”
“Yeah, I know.” I sat in the chair at the other end of the table. “Missing something really obscure, or something so rare no one else would’ve picked it up either.” I shrugged. “To me, that wouldn’t be so hard to live with. But sending home a patient who is having a heart attack?”
“Paul, we can’t admit every single patient who comes in with chest pain.” Ken shook his head. “It’s impossible. The hospital wouldn’t hold them all.” Ken looked over his shoulder at the coffee pot. “I think it’s ready.”
I got up and poured us each a cup.
“I’m just glad it was you, and not me.”
“Thanks, pal.” I tried to chuckle.
“What can I say?” He sipped his coffee. “Luck of the draw who picks up what chart.”
“Ken, have you ever sent someone home and they came back dead?”
He carefully set his cup down, and gently rapped the table with his knuckles. “Knock on wood.”
I wrapped my hands around the mug of coffee to feel the warmth.
“But Paul,” he said, “It’s going to happen. It’s like driving a car. No matter how careful you are, someday you’re going to glance down at the radio to change stations, look up, and there’s a car right in front of you. You’ve had a clean driving record for thirty years, you’re a model citizen, and boom. You’ve plowed into some little old lady’s Cadillac.” He shook his head. “I’m not saying you made a mistake with this guy, but even good drivers have accidents.”
“How do you do it?”
“Do what?”
“Keep on making life-and-death decisions, knowing that you’re fallible.”
“Paul, I don’t make life-and-death decisions.” He carefully put his coffee cup on the table. “I make medical decisions.” He gave a slight shrug. “I work as carefully as I can, but it’s not up to me, who lives and who dies.”
I stared at Ken’s face.
“That’s God’s department.”
OK.
“Do you know what happens when a patient dies?”
“Yeah,” I said. “The doc feels like shit.”
“That’s not what I mean.” Ken looked away, then looked back. “We can describe, down at the molecular level, what happens when a cell dies: membranes break down, oxidative phosphorylation fails, hydrogen ions accumulate in the cytoplasm, all that stuff. But do we really know why people die?”
I couldn’t see what he was getting at.
“Say someone comes in with a pulmonary embolism. We understand the pathophysiology: hypoxia, hypotension, acidosis, etcetera.” He paused. “And we know how to intervene.”
I nodded. “But when a patient dies, what happens?” He raised his eyebrows. “I mean, one moment they’re alive, and the next, they’re not. You’ve felt it. We all have. Something’s happened, and we don’t know what it is. Sure, we can trace out the failures of the circulatory system, and we can get EEGs for brain activity.” Ken shook his head. “But the fundamental thing of death itself is something we still don’t understand.”
“So?” I said.
“So, I look at each EKG as carefully as I can, and interview each patient as carefully as I can, and I make decisions as carefully as I can. Then I do my job and I let God do his.” Ken held his hands out, palms up. “How can we possibly claim the credit for success, or take the blame for failure, in a process we don’t really understand?”
I shrugged. “Paul, you and I both know you did your best for that man.” Ken shook his head. “That’s all any of us can do.”
When I’d first started working in Durham, I’d been surprised by how much I liked talking with Ken. In so many ways, we’re polar opposites: He’s a conservative Republican. He wears knit shirts and khaki pants on his days off. He belongs to two country clubs: one here in Durham, one at his beach house. He thinks Rush Limbaugh is smart. I’d always thought of Ken as someone with useful answers to questions about buying stocks or avoiding taxes, but I hadn’t thought he’d be the one to say something that would help me deal with the unexpected death of a patient.
Ken stood, and took his coffee mug to the kitchen counter. “Give my love to Sally.”
“I will. Tell Barbara I said hey.”
Ken rinsed his cup, and left it in the sink. “You’re going to feel bad for a while,” Ken said. “That’s OK. Just keep feeling bad. You’ll eventually feel better.”
We walked to the front door.
“When do you work again?”
“Day after tomorrow.”
“See you then.” He stuck out his hand. “Paul, you’re a good doctor.”
“Thanks.” We shook hands and he left. I felt my eyes fill, and hoped Ken hadn’t noticed. It must’ve been awkward for him to come by and talk with me, and I didn’t want to go all gushy on him. I felt as though being a good father, or a good husband, or a good man was a hollow success if I wasn’t a good doctor as well. Sure, he’s a great guy, just don’t go to him if you have an emergency. I was relieved that Ken thought I was a good doctor. I just wished I could agree with him.
After Ken drove away, I walked outside. It was a bright, sunny day, but Mr. Kelly was still dead. I sat in a wicker chair and wondered if I could get some relief by praying. A Quaker upbringing had taught me to pray silently. I started that way, but felt a need for something more physical and real than closing my eyes and thinking about God. “Lord, you know I’m not much of a Christian. I doubt. I curse. And I think about sex all the time. You know that. And you know I’m too quick to laugh at tragic stuff if it’s funny.” I took a deep breath. “You know all that. And you know I sent Mr. Kelly home. And he died.” I blew my nose into my fingers. “I don’t know if it counts as an honest mistake or a sin.” I wiped my hand on my jeans, and looked out at the street. The sun was still bright, the porch was still in the shade. A woman walked past, a dog tugging on a leash. I closed my eyes. “God, forgive me. And be with Mrs. Kelly, and their kids, if they have any.” I took a deep breath. “Comfort them. And let them know I did the best I could, and I’m sorry.” I opened my eyes. No change.
Maybe I should talk with Karen, or James, I thought. They’re our pastors, at the Pilgrim United Church of Christ. When Sally and I had kids, we started going to the Pilgrim UCC in Durham. The folks there seem like Unitarians, only less embarrassed to be called Christians. We went to Sunday school and church almost every Sunday I was off duty. Matthew, my Sunday school teacher, was a constitutional law professor at Duke. Worked with Janet Reno and Al Gore on some legal issues. I felt lucky to discuss Christianity with such smart people, because so much of Christianity in the South seems anti-intellectual—TV preachers sputtering about sin and pleading for money, telephone numbers flashing on the screen. I’ve always felt like a second-rate Christian, insufficiently saved, with inadequate fervor. At the same time, I feel the Bible drawing me back, particularly the four Gospels. I believe there are answers there. And a model of grace. A model of how I can live.
I wiped my hand on my pants again, then went inside and called Karen. She said I could come over right then. I changed jeans, splashed my face, and drove to our church, a brick building that’s mostly roofline, tucked in among a thick stand of trees that shields it from the traffic on the street.
When I knocked on her office door, Karen said, “Come in.” She walked from behind her desk, and gestured to an upholstered chair. Another chair faced mine. She pulled it toward mine a little, and sat. “Are you OK?”
“Yeah, basically.” I told her the story. “I feel so bad. So guilty.” I looked at the floor, then back to Karen. “You know, in the Bible, it says if we want God to forgive us for something we did to someone else, we should first ask that person’s forgiveness? Something about leaving the gift on the altar, straightening out the problem, then coming back.”
Karen nodded.
“I want to call Mrs. Kelly and tell her I’m sorry.”
“It’ll be a tough call to make,” Karen was looking me in the eyes.
“Not as hard as walking around feeling as bad as I do now.”
“Maybe.”
“I don’t know if I’m wanting to call Mrs. Kelly to make her feel better, or to make myself feel better.”
“And?” Karen’s face seemed to say that either reason would be OK.
“It’s probably a little of both.”
Karen waited.
“Do I have the right to call Mrs. Kelly, just to make myself feel better?”
“Paul,” Karen’s voice scaled down several tones. “It’s all right for you to want forgiveness.” She shook her head. “God doesn’t want you to carry guilt and pain every step of your life.”
I didn’t feel anything in my chest loosen up, or feel any burden lighten. But I caught a glimmer of the possibility. I thanked her.
When I got home, I looked at the phone number on the scrap of paper.
Sally walked into the kitchen. She was sweaty from mowing the yard. “How did it go with Karen?”
“I’d hoped I would feel better.”
Sally smiled. “You look a little better.”
“I think I’ll call Mrs. Kelly.” I walked to the sink and got a glass of water. “Tell her I’m sorry.”
Sally hugged me from behind. I could feel the damp of her shirt. I sat the water on the counter, and turned to return the hug. Mrs. Kelly didn’t have a husband to hug any more. Damn.
“If I call her, and it goes to court, they’ll make a big deal about me calling her to apologize.”
Sally shrugged.
“If the award goes past my malpractice coverage, it could come out of our pockets.”
“So what. It’ll probably never happen.” She shrugged again. “And if it does: Fuck ’em.”
If nothing else, I’d married well.
Sally pulled back to look at me.
“Call her. You may feel better.” She hugged me again. “I’ll be on the front porch.”
Mrs. Kelly picked up the phone on the third ring.
“This is Paul Austin. I’m the doctor who took care of your husband the first time he came to the emergency room.”
“Oh.”
“I’m calling to say I’m sorry.” I paused. “I’m sorry your husband died.”
She didn’t answer.
“Mrs. Kelly?”
“I’m here.”
I waited. “If you have any questions, or concerns . . .” There was another pause.
“Why did you send my husband home?”
The question thumbed me in the chest. “I thought he would be OK.”I took a breath. “I was wrong. And I’m sorry.”
She didn’t answer.
I waited.
She didn’t say anything.
I looked down at the crumbs on the floor. “If there’s anything you want to say to me . . .” I winced at the accusations she might unleash, but held a glimmer of hope she’d say she forgave me.
“I’ve got nothing to say to you right now.”
I gave her my home phone number, and told her if she ever had anything to say, or any other questions, I’d be glad to talk with her.
We hung up.
I didn’t feel any better. And it seemed Mrs. Kelly didn’t feel any better either.
I walked out to the front porch.
Sally looked up from her novel. “How did it go?”
I sat in the chair next to her. “She didn’t have anything to say to me.”
Sally closed her novel, keeping her place with her finger.
“I didn’t really expect her to flat-out forgive me, but I’d hoped for something.” Glints of sunlight reflected off the hard, waxy leaves of the magnolia tree in front of the porch. I could barely make out the pitted gray bark of the trunk through the dark openings between the leaves. “Some human contact.”
“It’s early.” Sally patted my knee. “Did I call too soon?” I felt my dismay grow heavier, like a rain soaked coat. Had I added to Mrs. Kelly’s pain, just to ease my own? Every place I turned, I was screwing up.
“Probably not.” Sally shook her head. “But who knows when you should’ve called? She might’ve been sitting at her kitchen table just now, wondering why the ER doctor hadn’t even bothered to call.” Sally turned in her chair to face me. “At least now she knows her husband was important to the doctor.”
“Yeah, I guess.”
“You guess? Paul, you’ve done everything you could—you saw the guy, did all the tests, thought about it, and told him to come back if he had more pain.” She held up a finger with each point. “Nobody’s perfect.”
“I know.” Every single thing she’d said was true.
But Mr. Kelly was still dead.