Chapter 18: Because Only Kindness Matters

In the PCGH Emergency Department, Dr. Monica Quartermaine took the EKG the nurse was handing her and studied it closely for a few minutes before she looked up. "It really looks a lot better; I think you just needed some potassium and phosphorous. We will let the infusion finish up, repeat the electrolytes and one more EKG, and if everything looks ok, then you can spend another night in your own bed," she said.

"So, you aren't going to send me away?" Bree Barrett asked.

Brenda Barrett-Rodriguez ran her hand through her little sister's hair lovingly. "Bree, no one wants to do that but we're going to do everything we have to for you to get better," she said.

"Emily is a much nicer doctor than Dr. Lawrence!"

"In my opinion, Breanna, doctors should never be nice. I think we should treat patients with dignity and be kind but allowing someone to have their way when it's just making them sicker isn't kind at all," Monica said.

Bree frowned. "So, you are going to make me go to that awful place in Arizona?" she asked.

"That wasn't what I was saying. My point was that Emily, and I are willing to try to support your family helping you at home because we think that can work. It isn't about Dr. Lawrence being mean, her perspective was just different," Monica said.

"On that note, it's ten-thirty so I'm going to go find you a snack. I'll be back," Cruz said.

"I probably can't eat with this IV thing," Bree said.

"I don't see any reason why you couldn't. Cruz, I'll let you into the kitchen if you want," Monica said.

Breanna frowned again but didn't say anything.

"Actually, I was going to go to the cafeteria, but thanks" Cruz said.

"I can just call for an early lunch tray if you want," Regina offered.

"No, that's alright, we should be home in time for lunch," Cruz said. "I'll be back," he repeated as he walked out the door.

"Well, I've got one more patient to check on so I'm going to do that. Regina, as soon as this infusion finishes repeat the EKG and draw the electrolytes I ordered. If you page me when you do that, I'll come back," Monica said.

"Ok," Regina agreed.

"Thanks, Monica," Brenda said.

"Yeah thanks," Bree said.

Monica smiled. "You're very welcome, Breanna. You are going to get better, and your family loves you very much."

XXXXXX

As she walked back in the direction of the CCU, Monica recalled the earlier conversation that had led them all to where they were.

December 19, 2007
Dr. Monica Quartermaine opened the door to the family conference room on 5-East and waited for Brenda and Cruz Barrett-Rodriguez to file past her before she stepped inside and closed the door. She had a good idea of what Brenda had wanted to discuss as she sat down across the table from them.

"Thank you for agreeing to meet us after five. I really wanted Cruz to be able to be here for this," Brenda said and then looked down at the table.

"That's fine, Katelyn isn't usually done with indoor track practice until six so I can just stop at school and get her rather than making a separate trip later. If this ends up being a longer conversation then I guess Edward will have an excuse to take the limo, you know just in case half of her team needed a ride home as well because they might not all fit in his car," Monica said.

Brenda laughed. "Does he still give Purcell new gloves with a one hundred dollar bill every year for Christmas? It is still Purcell, right?"

"Yes, it is still Purcell and I believe he is getting a scarf this year. I think Shannon convinced him they were the new "it" accessory and of course he wouldn't want his driver to be behind the times," Monica said.

"No, of course not, that just would never do," Cruz agreed.

"Anyway, I guess we didn't really come to find out what Edward is giving everyone for Christmas. I know the pneumonia is getting better and I guess maybe they can switch to oral antibiotics in a few days which is great but I'm afraid that when she goes home, she will end up in trouble again. I've already gotten the whole lecture on how we can't be the food police, and this could take years and honestly that just makes it more terrifying," Brenda said.

Monica thought for a moment before she said anything. "Well, I firmly believe, and there is literature that backs up this belief, that restoring nutrition has to be the first focus and nothing will get better until that happens. I think programs that focus first on addressing the underlying issues, in hopes that then eating will be easier, usually fail because every day that someone starves the brain starves and I think it just gets harder."

"That makes sense, it's kind of like an abyss. But Dr. Lawrence thinks that we need to send her somewhere. She thinks that the fact she ended up in the PICU is proof of that," Brenda said.

"Yes, but, honey, she also hasn't seen your sister since she let her walk out of her office last week," Cruz said.

"She doesn't have privileges here so that probably makes it harder for her to know what is happening now. I do think Emily tried to call her when Bree was admitted initially," Monica said.

"Is there a reason she doesn't have privileges at PCGH?" Cruz asked.

Monica tensed at his question, but she took a deep breath and continued. "She doesn't have privileges at PCGH because she never applied for them."

"But I'm sensing there is something more there," Cruz said.

There was a lot more there, but Monica believed firmly in professionalism and patient confidentiality. She chose her words carefully. "Dr. Lawrence and I have different opinions on a few things I suppose you could say," she said.

"What kinds of things?" Cruz asked.

Monica felt as if she was being interrogated. She supposed in sense she was. After all, Cruz was a PCPD lieutenant detective. "What defines medical stability, treatment priorities, and I suppose that I don't think you can just allow children to decide to starve to death. Maybe that's because I'm a mother and I wouldn't accept that explanation if it was one of my children. However, that isn't really all of it, I really don't believe that someone can clearly decide they want to get better in the depths of starvation," Monica said.

"That makes sense," Cruz said.

Brenda twisted a lock of hair absently. "So that sounds kind of like the Maudsley concept."

"I think the Maudsely Method with good medical support is not a bad plan in a lot of situations," Monica said.

"When is it bad?" Brenda asked.

"When it is being used with children who really need to be hospitalized; when it is being used without appropriate medical monitoring and backup; when kids are not safe at home and that issue is being overlooked; those are probably the most dangerous examples. I also think, and there is no shame in this we all have limits, that some parents and families just can't make it work. There are also a few families where this method is used in a way that is unhealthy and perhaps even abusive," Monica said.

Brenda sighed. "So, you wouldn't recommend we tried that with Bree either."

Monica took another deep breath. "I didn't say that. I think by the time your sister is ready to be discharged none of those concerns will be applicable. Although I guess if she's going to see Dr. Lawrence, she's really the one who has to feel that way. She also has to understand that if you do this at home, she's going to need close medical monitoring for probably at least a month, and maybe longer than that. If she isn't comfortable that she can do that, I would be willing to do that part; but only if Dr. Lawrence was on board with that."

"Dr. Lawrence thinks Maudsley Method is just a cop out for parental vindication or something like that," Brenda said.

"I suppose I have a different perspective on that also," Monica said.

"I don't know maybe I just am not allowed to have an opinion on this," Brenda said.

"If someone told you that I disagree. You don't have to be a biological parent to care for a child. Emily is just as much my daughter as Allison, Katelyn, and Nicole are even though I didn't give birth to her," Monica said.

"No, that wasn't Dr. Lawrence's argument. She meant because I'll never see this issue rationally because of my own history," Brenda said.

Cruz reached for his wife's hand again. "Brenda, we discussed this. She's wrong about that, honestly, I think she's wrong about a lot of things. In this case, I think if Bree doesn't want to go back to her maybe she has a point. Maybe we do need to find someone else."

"I think Bree mostly said that because she thinks Emily is cool, which she is but," Brenda said. She stopped speaking without really completing her thought.

"If you want her to see Emily and you want to build a team around that and Emily is willing to do that, I could supervise that," Monica said.

"Maybe," Brenda said absently.

"Bren, there is something you're not saying. What is it?" Cruz asked.

"The more I read about this Maudsley Method it sounds like what Sonny and Lois did for me years ago. So maybe that's good, or maybe that's bad. I guess I haven't really figured that out yet," Brenda said.

"I guess it worked, right?" Cruz said.

"I think it did in a sense. I mean I trusted him when I couldn't trust myself. I think that the problem was that I never really took the few final steps on my own and that's why it wasn't really over. That's what I want to believe is different now for me."

Monica reflected on Brenda's words from a couple of perspectives. It was an interesting analogy and, from what she could piece together of what had happened, she could believe that was what Sonny Corinthos had done even if he didn't realize it. She also thought back to the initial patient she and Dr. Lawrence had disagreed over. Monica was afraid that patient had never taken those final steps on her own either. Perhaps that was why that patient had seemingly traded her eating disorder for another equally harmful maladaptive coping approach.

"So maybe the last part will be different for Bree later. I think it happens in steps, you can't make her take the last steps at the beginning of the journey though, and it sounds like that is what Dr. Lawrence is insisting on," Cruz said.

"I agree. Ultimately you and Cruz need to make the right decision for your family. I know there are a lot of other things going on. It is ok if you can't do this for Breanna now, and it doesn't mean you don't love her. However, I think if you can, and if she can be safe while you try, that is her best chance. For what it's worth, Rose Lawn's eating disorders program has come full circle over the past ten years, and I think they are back where they started in the late nineties when I would have recommended them. So if you can't do this at home, that may be an option, and that's just in Shepperd so it isn't far."

"Did their changes coincide with their medical director changes?" Cruz asked.

"That would be a logical explanation. Dr. Childs was really a very compassionate and caring person, and she did believe that restoring nutrition was paramount. However, she was perhaps not as aggressive on that front as I would have always liked when we shared patients. Overall, though she did some amazing things. Her death was nothing short of a tragedy. They hired Dr. Sami Garretson last July and she is just out of her Pediatrics Residency, but she trained at Stanford, so she does have a lot of background," Monica said.

"Do you have other questions? Or do you and Cruz just need some time to think about this?" Monica asked.

Brenda appeared shell shocked, but she turned to Monica and said, "No, I think you've given us a lot of information and I guess you're right we have to make some difficult decisions. Thank you."

The decision Brenda and Cruz had made didn't surprise her. It would have been the decision she would have made if it was one of her daughters, which didn't mean it was universally the right thing for every family, but for Brenda, Cruz, and Breanna she thought it was.