Chapter 1

Biderman's chart of coercion. The beginnings. Know your target and understand their weaknesses.

'You are a medical consultant asked by a surgical colleague to see a 78 year old woman, now 10 days after abdominal surgery, who has become increasingly short of breath over the last 24 hours. She has also been experiencing what she describes as chest discomfort which is sometimes made worse by taking a deep breath (but sometimes not). Abnormal findings on physical examination are restricted to residual tenderness in the abdomen and scattered crackles at both lung bases. Chest radiograph reveals a small right pleural effusion, but this is the first radiograph since the operation. Arterial blood gases show a PO2 of 70, with a saturation of 92. The electrocardiogram shows only non-specific changes. Hutchinson what would you do next and what is your preliminary diagnosis?' Dr Freidrich's voice caught the young blond man unawares and he looked up like a rabbit caught in the headlights of an oncoming car.

'Oh..um…I…think um….'

'You think "um"? Oh come on man. Spit it out. You're supposed to be an up and coming doctor. There's no time for "um" and "oh". What's your opinion?'

Ken Hutchinson cleared his throat and tried to get his thoughts into order. 'Well, I would …um, has she received any heparin?'

Freidrich nodded. '5000 U of heparin twice a day'.

'Ok, then maybe she has a pulmonary embolus. I would probably request a ventilation-perfusion scan and ask for the result to be reported to the nurse over the phone to avoid delay'.

'Fine. The report is that it's "intermediate probability" for PE' Freidrich pushed. '

Then I would order full anticoagulation'

'Good. Took you a while, but you got there' Freidrich said and moved on to the next unsuspecting medical student. Ken breathed a sigh of relief, clutched his notes to his chest and moved on, trailing behind the rest of the consultant's firm. He hated this. Hated the interminable ward rounds where he and a dozen other students followed the professor round the hospital, talking about the patients like they were lumps of meat. Freidrich was old school through and through. He saw beds filled with diagnoses rather than people and constantly referred to "the pulmonary embolism in bed three" or "the mononucleosis in seven".

It angered and embarrassed the young student to be associated with someone like that, and although he admitted that he'd learned a lot from the man, it still didn't stop him from wanting to wring the man's neck at some point of each day. As he walked past the end of the bed, he gave the woman there a warm smile and stopped a moment.

'How are you feeling?' he asked quietly.

The "pulmonary embolism in three" smiled gratefully back at him, warmed that the handsome young doctor would take an extra interest. 'Not feeling too bad today doctor' she said.

'Oh..um, I'm not a doctor. Just a medical student. Won't be a doctor for another two years' he whispered conspiratorially.

'Well I'm sure you'll make a good one' she smiled back.

A flush bloomed over the young man's face, starting at his neck and flooding his handsome features like a red hot tide. He mumbled something that sounded like 'See you later' and backed quickly away.

He didn't want to be a doctor. He wanted to help people for sure, but the idea of spending every day doing the same thing repulsed him. It wasn't that he was scared of sickness, or that he found the studying too difficult. He wasn't top of his class, but he was better than average. It was the thought of slipping into a white coat each day and hiding behind the mystique of being a medic. He'd seen it so many times before. How an irate, confused or angry patient would turn into the most docile meek lamb just because the consultant had appeared. Or the relative who had been giving the nursing staff a hard time for hours would calm down in seconds and ingratiate themselves to the person they perceived to have the most power.

It wasn't so much that he'd chosen the wrong profession, more that the wrong profession had been chosen for him. His father, the eminent Dr Richard Hutchinson was a consultant surgeon specializing in Cardiothoracic surgery and was permanently on call to rush anywhere in the country to assist in major, complex surgeries. He'd written paper after paper on surgery, had been awarded countless honors and of course, expected his only son to follow suit. It didn't matter that Ken's sister had more aptitude for surgery than he ever would. It didn't matter that she graduated top of her class in chemistry, biology and physics while he'd managed only fourth place. She was a girl, and in Dr Hutchinson's eyes, daughters were there for one purpose and one purpose only – to get married and have babies. The Hutchinson line rested fairly and squarely on Ken's shoulders, and the line could only progress correctly if each successive generation was as successful a doctor as Richard was.

'You did good'. A voice from behind him startled him, and crystal blue eyes opened wide.

'Huh?'

'You managed to shut the professor up with your answer. You did good'.

Ken smiled warmly at John Farmer, his good friend and fellow student.

'Just luck. I was boning up about it last night and he just happened to ask the right question'.

'You mean you weren't out with the lovely Vanessa?'

Ken made a sour face. 'Sore point. She likes the idea of me being a doctor. She doesn't like the idea of me having to study all the hours God sends to actually get there'.

'You mean you had another argument?' John asked. He was used to it. Ken and Vanessa had an average of one argument per week, culminating in a real doozy once per month.

'Shall we just say she registered her displeasure' Ken grinned and pulled back the cuff of his white coat, showing his friend the livid red scratches which Vanessa's red painted talons had raked down his forearm.

John whistled softly. 'Bet she bites too'.

'Oh yeah! But that's a whole different ball game' Ken grinned as they moved off to follow the professor to his next unsuspecting victim.

They entered the room of a relatively young woman. It was quiet and still, only the hiss whoosh of a respirator breaking the silence. Surrounding the young girl's bed, machinery filled the room and at the back, sitting with quiet dignity was a small, dark eyed woman, looking tired and washed out, dark rings circling her eyes. The professor started to talk about the patient as though neither they, nor the other woman were there.

'This patient was admitted two days ago with Guillain-Barre Syndrome. She had rapid onset debilities, ending in complete muscle paralysis, including all muscle groups. As you can see, her breathing is being assisted and at this moment she is probably awake, but trapped in her body, unable to speak, breathe, blink, swallow or communicate in any way with the outside world. The situation may or may not be permanent'.

'Can anyone tell me the primary symptoms of Guillain-Barre Syndrome? Farmer?'

John looked uncomfortably at the woman and the paralysed girl. 'The first symptoms of this disorder include varying degrees of weakness or tingling sensations in the legs. In many instances, the weakness and abnormal sensations spread to the arms and upper body. These symptoms can increase in intensity until the muscles cannot be used at all and the patient is almost totally paralyzed. In these cases, the disorder is life-threatening and is considered a medical emergency' he managed to rhyme off quietly.

'What? Speak up man' Freidrich muttered tetchily.

'What's her name?' Hutch asked

The professor looked stunned, as though the question was the most stupid thing he'd ever heard. 'Name? What's that got to do with anything? Do you want to cure her, or date her Mr Hutchinson?'

One or two of the students laughed politely at the joke, but Ken persisted.

'I just think it's important to get to know the person you're trying to heal' he said.

'Well it isn't' Freidrich snapped. He turned away and Ken was left staring at the shell of a girl who was once vibrant and alive. He looked at the paralysed body and wondered what it would be like to withstand being a prisoner inside your own flesh. And then to have a doctor talk about your prognosis as though you weren't there. He shivered in sympathy and his hand trailed over the girl's hand.

'Her name's Amy' the woman at the bedside said. 'I'm her mother. Thank you!'

Ken smiled at the woman. Gently he bent down over the body and whispered in her ear.

'Hello Amy. You'll be fine, I know you will. He's an asshole!'

The rest of the day followed the same sort of path, although Freidrich's earlier friendly demeanor towards the blond had eroded so that for the most part he was ignored. Which was fine by Ken. He was used to it, and as he and John sat exhausted in the locker room at the end of the day, his friend asked him what he was going to do that night.

'Bury myself in my books. I have a wrestling match for the college team tonight and then its study study study. The end of semester papers are out next week and I still have a shit load of stuff to do. But it'll be quiet at home'.

'Your folks gone away again?' John Farmer was used to his friend telling him his Mom and Dad had gone away. Flown first class to some remote corner of the US to attend an award ceremony or present a new research paper. John's own family life was so different. The tall, red headed boy from the "wrong" side of Duluth and lived with his Dad in a small rented apartment on a busy road. His Mom had died when he was born and both he and his Dad shared everything, their love shining through all that they did and making Ken envious of his friend's home life. They had very little money, but John's Dad had taken a second job to pay for his son's progress through medical school and John worked extra hard at his studies in order to make his Dad proud of him.

'Uh huh. Just me and Chancita for supper again'. Ken sighed. It was usually the same. He and his Mom's Mexican maid alone in the huge kitchen eating fajitas as she taught him some of the choicer Mexican swear words. He was closer to the woman than he was to his own mother and Chancita was always there for him. The middle aged, slightly portly maid had been with the family now for almost all of Ken's life and she was the one he would run to as a little boy when he fell and grazed his knee, or the one who nursed him through the measles, chicken pox and other childhood ailments. He liked her company and turned to her for the love and affection he'd never received from is blood relatives. It had never been too bad when his sister was at home, but since she'd left to get married to one of Dad's colleagues' son, Ken was very much alone. The new Mrs Marissipio lived up in Canada now, her husband being in the front office of the Canadian football team.

'You want some company?'

Ken grinned. 'Nah. Wouldn't want to inflict the Hutchinson fortress on you buddy'. They'd often laughed about the gated community the family lived on and how difficult it could be to actually get into the house in the first place.

Picking up his bag, Ken made for the door. 'Call me later. By the time I've ploughed my way through "segmentation", the "chime response" and the "functions of Acetyl Co A" I'll need a shoulder to cry on!'

John chuckled. 'No problems buddy. See you later'.

Ken walked out of the big stone building on the campus of the medical faculty and slowly walked to his car. His Dad refused to have the vehicle parked outside his house. Ken had enough money to be able to but himself pretty much any car he wanted and Dr Hutchinson had tried all ways to have his son drive a nice little T-bird or Corvette. But the younger Hutchinson saw this as a way he could rebel against his Father's iron will. Instead of going to the car show rooms and buying a nice little sporty number, he'd gone down to the second hand car lot and become the proud owner of a small, dark blue, rusty Ford Falcon.

Getting in, he picked up the thin wooden wedge and jammed it into the driver's side door to make it stay closed, put the keys in the ignition and drove out through the gates of the university and off to his house.

As he drove, his mind went back over the day. He hated Professor Freidrich. He hated the hospital. He hated the fact he didn't now enough to help any of the people he saw day after day and he hated the fact that his Dad had forced him into this position. Ken cursed out loud, slammed his fist against the wheel of the car and wondered what he'd like to do if he didn't have to go down the medical route.

15 minutes later he parked his car under the shade of some of the big trees overhanging the wall surrounding Hutchinson Palace and thumbed the numbers on the key pad to let himself in. He walked up the long driveway and was stunned to see not only Dr Hutchinson's gleaming Jaguar parked outside his house, but also a black and white police car. Something must be wrong to have his Dad at home instead of in Alaska doing his talk on God knows what.