The medical library of Cresheim Valley Hospital was on the main floor, its sliding glass doors opening on the lobby. At its far end, directly opposite those doors, was a fire door to the northwest parking lot. The librarian disliked this floor plan, because it turned her sanctum into a shortcut for doctors who parked in that lot. With no authority to make those Hippocratic ― leaning on the letter a ― priests take the long route, she suffered in silence until she became the incidental beneficiary of a building project. When it was complete, both fire door and parking lot were gone, and a new, mud-free runner graced the center aisle of the library.

~~~~~~~~~~

At 10 a.m. on Sunday, July 9, 1989, a small group of visitors entered from the lobby and headed for the opposite end. Reaching for his keys while walking through the library came as naturally to the group’s leader as opening his mouth while lifting his fork. This key, however, did not fit the ignition of his Lexus, which was now parked elsewhere. He unlocked a recently installed sliding glass door and motioned the party into the structure beyond. They were standing in a greenhouse measuring forty by sixty feet. One of the long walls was the brick exterior of the hospital. The other three, as well as the roof, were glass.

“Surprisingly dark for this time of day,” Alan Avery pointed out, “even in bright sunshine.”

“It’s in the shade until late afternoon,” the chief executive officer, J. Bartram Overbridge, pointed out. “That was taken into account in the plans, so that films and slides can be shown during conferences. Once the sun comes round that eight-story wall, it gets too bright.”

They walked to the center of the greenhouse and stopped under a large chandelier. The area in which they stood was large enough for two hundred folding chairs, a lectern, and a portable screen. The only permanent structures were four round marble columns, twenty-eight inches high, set in a rectangle four by eight feet. A single word was engraved in the side of each: Competence. Compassion. Conscience. Courage. Potted plants stood on their flat tops.

As Alan and Karen Avery and Calvin McCrae stepped back ― for they’d been here before ― Overbridge led Doctor Frances Peterson, the city health commissioner, to where a massive Plexiglas tabletop leaned against a drape on the brick wall. Its underside featured four circular cutouts. Overbridge explained. “From time to time we’ll need a conference table. No matter what the subject of the meeting, we want our deliberations to rest, physically, conceptually, and visibly, on the principles carved into the table legs. That’s why the table top is made of Plexiglas.”

Peterson nodded vigorously. Her eyes turned to the side boundaries of the conference area, which were marked by shrubs about eight feet high. “I got the impression, coming in, that the walls of the building were quite a bit farther out. Is it solid plantings all the way?”

“No, let me show you. We can do just one side; they’re both the same.”

They walked through a gap between the shrubs and the brick wall to the southwest glass wall. Peterson looked to her right, eyes bright with amazement and pleasure. There was, indeed, a sizable space between the shrubs and the wall, in the shape of a long, narrow rectangle. Against the wall was a series of stone benches with vinyl cushions, and between the benches and the shrubs were three rectangular pools. Walking up to one, she saw a water circulator in operation, and a half dozen goldfish swimming among assorted aquatic plants.

“What a wonderful place for reflection!” she said.

“Now we’d like to show you two more features, Commissioner, but I prefer that Doctor and Mrs. Avery take over.”

They returned to the center. Karen pointed to another glass door at the far end, opposite the door through which they had entered. “I want you to notice that sapling outside. You can see it from the lobby, looking through all three doors, like concentric frames.”

“Yes, I can picture that,” Peterson said. “Does it have a special significance?”

“It’s a young maple. Our daughter loved the maples in our backyard, especially in their fall colors. This one was growing wild against the fence, obviously from a random seed. So we had it transplanted. It’s her tree.” She bit her lip and stopped.

“A lovely idea,” the commissioner said, touching Karen’s arm. “A living memorial.”

Turning back, Alan led the way to a seven-foot marble column standing to one side of the door to the library. Near its top was a bas-relief of a girl, and beneath it the following words:

This Garden is dedicated to the memory of Eden Avery, who died at Cresheim Valley Hospital on July 12, 1988.

Six inches below that inscription were four more lines, in slightly smaller letters:

In this place, healers shall reflect on their fallibility.

In this place, healers shall contemplate their awesome power and the far-reaching consequences of their actions.

In this place, healers who have erred shall honestly face themselves, their colleagues, and their students.

In this place, healers shall welcome the judgment of those who have suffered because of their mistakes.

Another six-inch space separated those lines from the one that followed:

And in this place, healers shall reconcile themselves with their consciences, and shall themselves be healed.

The commissioner read the inscription and did not speak for a whole minute.

“Is it all right to ask who composed those words?” she asked.

Calvin McCrae spoke for the first time. “A lot of us worked on them together, including a couple of people who aren’t here. That’s why there’s no attribution.”

“Good words for doctors to live by,” Peterson said. “You’re all to be commended. By the way, I notice the memorial inscription calls this place ‘Garden.’ ”

Overbrook motioned the party back into the library. Inside, above the door, a dark blue cloth covered a sign. “It’ll be officially unveiled on Wednesday. I’ll show you.” Climbing on a chair, he lifted the cloth, revealing an ebony sign with the words The Garden etched in gold.

~~~~~~~~~~

The dedication took place on July 12, 1989, the anniversary of Eden’s death. Present, in addition to administration officials, trustees, and clinical department heads, were the health commissioner, deans of the city’s schools of medicine and nursing, a representative from the mayor’s office, the chief executive officer of Healers Protective, and reporters from radio, television, and the press. The entire social service department of Cresheim Valley Hospital was there, along with patient representatives, hospital chaplain, off-duty nurses, and about a third of the medical staff. The proceedings were carried through the public address system to those who could not leave their posts. Invitations had been sent to administrators, medical staff officers, and social and pastoral service departments of the largest hospitals in the city and suburbs, and to representatives of other malpractice insurance carriers. Most accepted.

J. Bartram Overbridge had personally telephoned the presidents of the county medical society and bar association. Both had other commitments.

Even standing room was scarce. The Averys and Calvin McCrae were seated with the dignitaries. J. Bartram Overbridge had wanted Archbishop Arciszewski to bless the new endeavor, but he had yielded to Calvin’s plea that the honor be given to Father Joseph Conley.

Overbridge asked the audience to take their places.

“Commissioner Peterson, Doctor and Mrs. Avery, distinguished visitors, members of the medical staff, friends. It is my privilege to preside over the dedication of this building, given to us by the parents of a young girl who lost her life in this hospital. Throughout the years, donors have bestowed gifts on us, in gratitude for the care received here or in recognition of our work for the community. Never to my knowledge has a gift been inspired by such a tragedy as this within its own walls. He turned to the Averys. “Our gratitude goes out to you, Doctor and Mrs. Avery, together with our deepest sympathy for your loss. We accept it as our responsibility to spare no effort to make your gift fulfill its promise.”

There was a smattering of applause. “I will call first on Doctor Robert Temple, president of the medical staff, who will tell you about the Garden and the activities planned for it.”

Dr. Temple described the features of the building. Then, pointing back, he said, “Outside that door is a sapling, progeny of one of Eden Avery’s favorites from her own backyard. It is a symbol of growth, a model for our program to follow. The Garden is meant to be a place for reflection, solitary and shared. The design, with its secluded spots and the open space, was conceived for that dual purpose. We’re pleased with the way the building turned out, but what we’re most excited about is the program we’ve planned for the area in which you’re sitting. The basic concept is simple, but we believe ― and hope ― that it’ll have important consequences.

“In this place we’ll hold clinical conferences, where we discuss patients’ illnesses and our therapeutic strategies; and mortality conferences, where we discuss events leading to patients’ deaths. This is a time-honored vehicle of continuing education for doctors. What’s new in our program is that we’ll routinely, routinely, invite patients or their families to take part. They’ll be encouraged to ask questions and we’ll answer them in ways they can understand. To keep us honest, as well as comprehensible, a social service staff member will monitor our answers and intervene as necessary. Only lawyers will be excluded—” scattered laughter “—not out of disrespect for that profession, but because we don’t want our physicians to feel threatened. As the success of our program removes that perceived threat, there’ll be no reason to deny anyone access.

“We’ll go a step further ― a large step. When cases are not scheduled for presentation ― and our habit is to select those with the greatest teaching value ― patients or families who want an open discussion will have that right.” He paused. “They will be so advised on admission and again at least once during their stay. There will be no small print. We’d like to think of this as patient education, to which they’re certainly entitled along with management of their medical problems. In cases of adverse outcome, we’ll offer honest explanations of the reasons. If we think nothing we could do would have made a difference, we hope we can convey that belief in a candid and compassionate manner. They’ll still have the right to reject our explanations and sue us, but we hope that honest communication will reduce the need for lawsuits.

“There will also be times ― few, we hope ― when we have practiced bad medicine ― when, in the words of the legal profession, we have failed to meet accepted standards of care. What then?” He looked at the audience as if expecting them to answer, then slowly went on. “We acknowledge our mistakes.” Pause. “We know legal assistance may then be needed, but with a difference. Our lawyers’ job will not be to deny culpability, but to help craft a fair settlement, one driven not by the threat of a trial, but by an honest desire to compensate for a loss.

“Last but by no mans least, we hope that our doctors and our hospital will be seen as being there for our patients when they most need us. The medical profession announces to the world that the patient comes first. We intend to honor that creed.”

Temple stayed at the lectern. At first there was silence, then a crescendo of murmurs. Finally, as if reminded of an obligation, the audience applauded.

“You must be wondering how this place and our program came to be. It’s a story that should be told by those who brought it about. I’ll ask Mrs. Avery to lead off.”

“Good evening,” Karen began, in a voice whose very softness commanded total silence. “I’m Eden Avery’s mother. I’m also an attorney with the firm of Frazier & Drummond, which represents plaintiffs in medical malpractice suits. I speak to you in the triple role of mother, plaintiff, and attorney. My husband is also a member of the medical staff of this hospital. I want you to know this and be assured that there are no differences between me and anyone up here on what I’m about to say, some of which may strike you as straightforward to the point of tactlessness.

“The money for the Garden was part of a settlement with this hospital for the wrongful death of our daughter. The rest of the settlement was a commitment to the program Doctor Temple described. All parties with an interest in our suit ultimately agreed we were entitled to damages, and had our case gone to trial, we’d likely have won more than twice the cost of this building. However, Doctor Avery and I resolved not to take for ourselves a single penny of the settlement. We don’t need the money. We make a good living, and we no longer worry about college tuition, wedding expenses, gifts for grandchildren, or an estate to pass on.”

The silence was broken only by the snap of pocketbooks as women reached for tissues.

“You may wonder why we would forgo a damage award of that size just because we’re not needy. After all, money has value even to those who already have more than they know what to do with. Or why, if we wanted to give it away, we would choose this institution ― this perpetual reminder of our loss ― over all other beneficiaries. To me ― and now I speak in the singular ― that decision did not come easily. For months after Eden’s death I was determined to follow the usual path for victims of medical malpractice, with all my professional resources behind me. Since my daughter would never be restored, at least I’d have the satisfaction of exacting a price. How my attitude was transformed is a long and very personal story. Suffice it to say that in the end, by opening my eyes, ears, and heart to people with greater vision than mine, I realized that a few million dollars in my pocket would not be a fitting memorial to Eden.”

She paused a few seconds. This time there were a few nods of appreciation, and some of the listeners looked at their neighbors as if to confirm what she had said.

“What’s happening here is something I deeply believe in. In my practice I’ve seen again and again the frustration and anger of patients who could not communicate with their doctors. And always that anger adds an extra degree of motivation to sue. When things don’t go well, we need to understand what went wrong and why. Sadly, in this situation we don’t always find the doctor more accessible; sometimes the opposite is true. That’s why open conferences so appeal to me. With them, you, the doctors of Cresheim Valley Hospital, are reaching out to those who’ve been hurt, inviting them into your confidence, letting them know that even if you’re at fault you’re still there to help them. You’ll be exposing yourselves, you’ll be tested, you’ll be embarrassed, but in the long run you’ll be rewarded. On behalf of your patients, their families, and the lawyers whose help they seek all too quickly, I wish you the best of luck.”

Applause. Temple walked to the lectern, took Karen’s hand in both of his, and said, “Thank you, Mrs. Avery. It won’t escape anyone that whatever we do to stay in touch with our patients, even if the outcome is disappointing, reduces their need to seek legal redress. For you as a plaintiff’s lawyer to encourage this effort, even to pay for it out of your own pocket ― and all this after suffering the worst of all losses ― speaks volumes about your generosity.”

The audience applauded again. Temple went on. “Mrs. Avery has opened our eyes to the importance of communication between patient and doctor. But the Garden is designed also for introspection. I call on a respected member of our own medical staff, Doctor Alan Avery.”

“Ladies and gentlemen, colleagues. The usual purpose of a memorial is to keep alive the past. In conceiving of this Garden, we wanted to create something for the future. Those of us closest to Eden felt that the surest way to give meaning to her life, and the only way to give meaning to her death, was a lasting change in how we do things. That way Eden’s spirit will not be entombed in the column you pass when you enter, but will be a constant guiding light for the proceedings to be held here. If ever open conferences become so commonplace that we no longer wonder how they came into being, that we no longer need to remind ourselves that a seventeen-year-old girl died to give them impetus, then Eden’s work will be complete.

“Eden died because of a careless act, a lapse in the conscientious practice of medicine. Her death demonstrates two truths that no doctor should ever forget, the awesome power we hold in our hands, and our fallibility. Our calling puts us on a rickety pedestal. Patients attribute supernatural powers to us, and we sometimes fall into the trap of believing in those powers ourselves. I don’t even want to talk about arrogance, though that term accurately characterizes a few of us. More common, if less visible, is our liability to error. Patients pay with their well-being, sometimes with their lives; we pay with our malpractice premiums. But we incur an added debt, one that cannot be measured in dollars and one that is never fully paid up. That is the debt of conscience. Perhaps there are those among you, my medical colleagues, who have never made a serious mistake. To you I can only say, be warned, the danger will follow you all the days of your practice. To those who have erred, no matter how long ago, I say with confidence that you still feel it. And if any of you think otherwise, please speak to me and explain your technique of denial.

“Eden did not die in vain, because her physician was of that rare stripe that not only did not deny his conscience but insisted its cry be heard. It is to him that we owe the idea of a forward-looking memorial. He erred, he overcame one obstacle after another for the chance to atone, and he deserves to be forgiven. His story needs to be told. Hear it, then ask yourselves, if we must make mistakes, would we not all be better doctors for facing them with courage and compassion? And would we not then merit our patients’ forgiveness? Thank you.”

Once more the audience applauded, but there were some expectant looks because the architect of this historic event had not yet been identified. Some suspected that Alan was too overcome to continue; others, that the omission was deliberate, so as to heighten the dramatic effect of the address to follow. The next introduction answered their question.

“Ladies and gentlemen, as our final speaker I introduce the prime moving force behind the Garden project, the one person who, more than anyone else, is responsible for bringing it about. Doctor Calvin McCrae is a resident physician in our Department of Pediatrics.”

Everyone sat bolt upright. There were murmurs of surprise that a man still in training was behind such a significant event. Out of house staff uniform, wearing a dark gray suit, white shirt, and navy blue tie, Calvin looked like a young man about town. The audience fell silent.

“Ladies and gentlemen. When Doctor Temple says I’m responsible for bringing this about, he’s right in more ways than one. Yes, I was involved, together with Doctor and Mrs. Avery and the hospital administration, in developing the concept and working out the details of the Garden. But my greater responsibility is of a different kind. I am the cause of Eden Avery’s death.” He paused and looked out at the rapt audience. “Except for exacting this terrible price, I have no more claim to the Garden than all the others who worked on it. Eden died because, in a moment of carelessness, I ordered a drug to which I should have known she was allergic. I was allowed to continue my internship with the understanding that I’d learned a lesson I’d never forget.” Cora Hamilton, seated with the other department chairs, released one of her rare smiles. “It was more than I deserved. My action also made the hospital liable to a medical malpractice suit. My role in that suit should have been to cooperate in my defense. That would have required me to claim that I had acted appropriately ― at least understandably ― in the circumstances. But I knew I hadn’t, and from the beginning I could never convince myself otherwise, nor go along with legal counsel to defend myself. But refusing to act in my own defense was not enough. For months I searched within myself, and pleaded for help, for a way to give meaning to Eden’s death, to create something of value from the void my carelessness had brought about. I didn’t have the intellectual or emotional resources to do that alone, and it would never have happened without the help of friends much wiser than I. I wish I had time to tell you about the unflagging support of Father Joseph Conley, who stood between me and virtual self-destruction; and of Joshua Rabin, who looked beyond his personal grief to open his heart to me. With Father Conley’s help and Joshua’s intercession, I was able to bring my pleas to Doctor and Mrs. Avery. Their generosity in listening to me is beyond measure. What you see here, and the program you have heard described, is their gift to the hospital and the community in their late daughter’s name. For me, it is a chance for professional and spiritual rebirth. With all my heart, I thank them and I thank each and every one of those who stood by me.”

This time the applause was genuine and uninhibited. All were on their feet and half a dozen folding chairs were lying on their sides. There was a lightning storm of flashbulbs as Calvin shook hands with the Averys. He next walked over to Joshua, stood before him a few seconds and, instead of shaking his hand, embraced him. There were tears in the eyes of Father Conley as he, too, embraced Calvin. Only then did Calvin go down the line of dignitaries.