{"id":346,"date":"2016-09-10T14:26:56","date_gmt":"2016-09-10T18:26:56","guid":{"rendered":"http:\/\/www.herbheineman.com\/?page_id=346"},"modified":"2024-07-26T09:58:54","modified_gmt":"2024-07-26T13:58:54","slug":"chapter-37","status":"publish","type":"page","link":"https:\/\/herbheineman.com\/Eden\/edensgarden\/chapter-37\/","title":{"rendered":"Chapter 37: Eden’s Garden"},"content":{"rendered":"\t\t
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PART III<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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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 \u2015 leaning on the letter a<\/em> \u2015 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.<\/p>

~~~~~~~~~~<\/p>

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\u2019s 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.<\/p>

\u201cSurprisingly dark for this time of day,\u201d Alan Avery pointed out, \u201ceven in bright sunshine.\u201d<\/p>

\u201cIt\u2019s in the shade until late afternoon,\u201d the chief executive officer, J. Bartram Overbridge, pointed out. \u201cThat 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.\u201d<\/p>

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.<\/em> Potted plants stood on their flat tops.<\/p>

As Alan and Karen Avery and Calvin McCrae stepped back \u2015 for they\u2019d been here before \u2015 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. \u201cFrom time to time we\u2019ll 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\u2019s why the table top is made of Plexiglas.\u201d<\/p>

Peterson nodded vigorously. Her eyes turned to the side boundaries of the conference area, which were marked by shrubs about eight feet high. \u201cI got the impression, coming in, that the walls of the building were quite a bit farther out. Is it solid plantings all the way?\u201d<\/p>

\u201cNo, let me show you. We can do just one side; they\u2019re both the same.\u201d<\/p>

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.<\/p>

\u201cWhat a wonderful place for reflection!\u201d she said.<\/p>

\u201cNow we\u2019d like to show you two more features, Commissioner, but I prefer that Doctor and Mrs. Avery take over.\u201d<\/p>

They returned to the center. Karen pointed to another glass door at the far end, opposite the door through which they had entered. \u201cI want you to notice that sapling outside. You can see it from the lobby, looking through all three doors, like concentric frames.\u201d<\/p>

\u201cYes, I can picture that,\u201d Peterson said. \u201cDoes it have a special significance?\u201d<\/p>

\u201cIt\u2019s 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\u2019s her tree.\u201d She bit her lip and stopped.<\/p>

\u201cA lovely idea,\u201d the commissioner said, touching Karen\u2019s arm. \u201cA living memorial.\u201d<\/p>

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:<\/p>

This Garden is dedicated to the memory of Eden Avery, who died at Cresheim Valley Hospital on July 12, 1988.<\/em><\/p>

Six inches below that inscription were four more lines, in slightly smaller letters:<\/p>

In this place, healers shall reflect on their fallibility.<\/em><\/p>

In this place, healers shall contemplate their awesome power and the far-reaching consequences of their actions.<\/em><\/p>

In this place, healers who have erred shall honestly face themselves, their colleagues, and their students.<\/em><\/p>

In this place, healers shall welcome the judgment of those who have suffered because of their mistakes.<\/em><\/p>

Another six-inch space separated those lines from the one that followed:<\/p>

And in this place, healers shall reconcile themselves with their consciences, and shall themselves be healed.<\/em><\/p>

The commissioner read the inscription and did not speak for a whole minute.<\/p>

\u201cIs it all right to ask who composed those words?\u201d she asked.<\/p>

Calvin McCrae spoke for the first time. \u201cA lot of us worked on them together, including a couple of people who aren\u2019t here. That\u2019s why there\u2019s no attribution.\u201d<\/p>

\u201cGood words for doctors to live by,\u201d Peterson said. \u201cYou\u2019re all to be commended. By the way, I notice the memorial inscription calls this place \u2018Garden.\u2019 \u201d<\/p>

Overbrook motioned the party back into the library. Inside, above the door, a dark blue cloth covered a sign. \u201cIt\u2019ll be officially unveiled on Wednesday. I\u2019ll show you.\u201d Climbing on a chair, he lifted the cloth, revealing an ebony sign with the words The Garden<\/em> etched in gold.<\/p>

~~~~~~~~~~<\/p>

The dedication took place on July 12, 1989, the anniversary of Eden\u2019s death. Present, in addition to administration officials, trustees, and clinical department heads, were the health commissioner, deans of the city\u2019s schools of medicine and nursing, a representative from the mayor\u2019s 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.<\/p>

J. Bartram Overbridge had personally telephoned the presidents of the county medical society and bar association. Both had other commitments.<\/p>

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\u2019s plea that the honor be given to Father Joseph Conley.<\/p>

Overbridge asked the audience to take their places.<\/p>

\u201cCommissioner 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. \u201cOur 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.\u201d<\/p>

There was a smattering of applause. \u201cI 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.\u201d<\/p>

Dr. Temple described the features of the building. Then, pointing back, he said, \u201cOutside that door is a sapling, progeny of one of Eden Avery\u2019s 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\u2019re pleased with the way the building turned out, but what we\u2019re most excited about is the program we\u2019ve planned for the area in which you\u2019re sitting. The basic concept is simple, but we believe \u2015 and hope \u2015 that it\u2019ll have important consequences.<\/p>

\u201cIn this place we\u2019ll hold clinical conferences, where we discuss patients\u2019 illnesses and our therapeutic strategies; and mortality conferences, where we discuss events leading to patients\u2019 deaths. This is a time-honored vehicle of continuing education for doctors. What\u2019s new in our program is that we\u2019ll routinely, routinely<\/em>, invite patients or their families to take part. They\u2019ll be encouraged to ask questions and we\u2019ll 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\u2014\u201d scattered laughter \u201c\u2014not out of disrespect for that profession, but because we don\u2019t want our physicians to feel threatened. As the success of our program removes that perceived threat, there\u2019ll be no reason to deny anyone access.<\/p>

\u201cWe\u2019ll go a step further \u2015 a large step. When cases are not scheduled for presentation \u2015 and our habit is to select those with the greatest teaching value \u2015 patients or families who want an open discussion will have that right.\u201d He paused. \u201cThey will be so advised on admission and again at least once during their stay. There will be no small print. We\u2019d like to think of this as patient education, to which they\u2019re certainly entitled along with management of their medical problems. In cases of adverse outcome, we\u2019ll 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\u2019ll still have the right to reject our explanations and sue us, but we hope that honest communication will reduce the need for lawsuits.<\/p>

\u201cThere will also be times \u2015 few, we hope \u2015 when we have practiced bad medicine \u2015 when, in the words of the legal profession, we have failed to meet accepted standards of care. What then?\u201d He looked at the audience as if expecting them to answer, then slowly went on. \u201cWe acknowledge our mistakes.\u201d Pause. \u201cWe know legal assistance may then be needed, but with a difference. Our lawyers\u2019 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.<\/p>

\u201cLast 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.\u201d<\/p>

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.<\/p>

\u201cYou must be wondering how this place and our program came to be. It\u2019s a story that should be told by those who brought it about. I\u2019ll ask Mrs. Avery to lead off.\u201d<\/p>

\u201cGood evening,\u201d Karen began, in a voice whose very softness commanded total silence. \u201cI\u2019m Eden Avery\u2019s mother. I\u2019m 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\u2019m about to say, some of which may strike you as straightforward to the point of tactlessness.<\/p>

\u201cThe 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\u2019d 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\u2019t 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.\u201d<\/p>

The silence was broken only by the snap of pocketbooks as women reached for tissues.<\/p>

\u201cYou may wonder why we would forgo a damage award of that size just because we\u2019re 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 \u2015 this perpetual reminder of our loss \u2015 over all other beneficiaries. To me \u2015 and now I speak in the singular \u2015 that decision did not come easily. For months after Eden\u2019s 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\u2019d 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.\u201d<\/p>

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.<\/p>

\u201cWhat\u2019s happening here is something I deeply believe in. In my practice I\u2019ve 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\u2019t go well, we need to understand what went wrong and why. Sadly, in this situation we don\u2019t always find the doctor more accessible; sometimes the opposite is true. That\u2019s why open conferences so appeal to me. With them, you, the doctors of Cresheim Valley Hospital, are reaching out to those who\u2019ve been hurt, inviting them into your confidence, letting them know that even if you\u2019re at fault you\u2019re still there to help them. You\u2019ll be exposing yourselves, you\u2019ll be tested, you\u2019ll be embarrassed, but in the long run you\u2019ll 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.\u201d<\/p>

Applause. Temple walked to the lectern, took Karen\u2019s hand in both of his, and said, \u201cThank you, Mrs. Avery. It won\u2019t 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\u2019s lawyer to encourage this effort, even to pay for it out of your own pocket \u2015 and all this after suffering the worst of all losses \u2015 speaks volumes about your generosity.\u201d<\/p>

The audience applauded again. Temple went on. \u201cMrs. 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.\u201d<\/p>

\u201cLadies 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<\/em> way to give meaning to her death, was a lasting change in how we do things. That way Eden\u2019s 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\u2019s work will be complete.<\/p>

\u201cEden 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\u2019t 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.<\/p>

\u201cEden 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\u2019 forgiveness? Thank you.\u201d<\/p>

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.<\/p>

\u201cLadies 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.\u201d<\/p>

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.<\/p>

\u201cLadies and gentlemen. When Doctor Temple says I\u2019m responsible for bringing this about, he\u2019s 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\u2019s death.\u201d He paused and looked out at the rapt audience. \u201cExcept 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\u2019d learned a lesson I\u2019d never forget.\u201d Cora Hamilton, seated with the other department chairs, released one of her rare smiles. \u201cIt 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 \u2015 at least understandably \u2015 in the circumstances. But I knew I hadn\u2019t, 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\u2019s death, to create something of value from the void my carelessness had brought about. I didn\u2019t 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\u2019s help and Joshua\u2019s 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\u2019s 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.\u201d<\/p>

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.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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Chapter 38 >><\/a><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

PART III 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 […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":21,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-346","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/pages\/346","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/comments?post=346"}],"version-history":[{"count":5,"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/pages\/346\/revisions"}],"predecessor-version":[{"id":883,"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/pages\/346\/revisions\/883"}],"up":[{"embeddable":true,"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/pages\/21"}],"wp:attachment":[{"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/media?parent=346"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}