by Barbara Ebel
He glanced toward Sam’s bassinette and said with emphasis, “It is our responsibility to not over-feed Samantha.”
“I’ll be sure not to mention the diagnosis to the mother until you do. Would it be all right if I visit and pick up baby Barker?”
“Be gentler than you would be with any other newborn,” he said and motioned her over. “And, if you are a remarkable student wanting to learn as much as you can, add OI to your list.”
Annabel smiled. One more topic to read, she thought, or at least an abbreviated summary because her OB/GYN one and only exam needed her primary focus. However, she would get her hands on an abbreviated summary of OI.
She leaned over the bassinette, took the swaddled neonate in her arms, and darted her eyes back to Dr. Thomas with alarm. Samantha had bluish gray sclerae.
“Yes, the whites of her eyes have color. A feature of OI.”
Annabel nodded.
“Don’t fret too much,” Dr. Thomas said. “Out of a person’s differences come great successes and the birth of extra creativity. Look at me. Part of my face was unsightly when I was a child and I was bullied like hell and made fun of. Instead of rolling up in a ball and letting life pass me by, I became stronger and excelled. I became the first person in my family to go on and earn an advanced degree. I also chose pediatrics because I can empathize with the plight of children, especially those who are different than the norm.”
Annabel held the baby ever so gently. “Thank you for sharing,” she said. She hoped she would see him again during her pediatrics rotation. She picked up more information from him that she could bank away and always remember, than from her present teammates.
Dr. Thomas gave her a good-bye tap on the shoulder and went out the back door. She knew of no other way to hold a baby except gently, but with this one she followed his advice and cuddled with extra care. What if, because of her frailty, she suffered a shortage of hugs and physical closeness as a baby, as a child, or her whole life? Annabel held her closer and the baby opened her eyes. She slipped her index finger into Sam’s light grasp and their eyes locked.
“Welcome to the world, Samantha. You’ll be fine, just fine.”
-----
Dr. Harvey and the residents were gathered in the lounge when Annabel returned. The attending doctor had stripped off his white jacket and was preparing yet another cup of coffee. She hoped it was decaf because he twitched and paced like he was waiting for the delivery of his own infant. They ignored her as she slinked to the couch and decided to heed her gut inclination not to interrupt the brooding group about baby Sam’s diagnosis.
“Mike Chandler and his wife are still downstairs in the basement with their daughter,” Caleb said to Roosevelt. “Sorry if we called you too early.”
“That’s okay. They’ll be more ballistic if they come up and wait on me. In the meantime, we still have no answers about the woman’s death.” He wrapped his fingers around the handle, and with his other hand, he tapped the mug with his fingers.
“Since you all did H&Ps on her, was there any inkling that she could have had a diagnosis we didn’t know about? Say, for instance, a Wolfe-Parkinson-White syndrome heart condition? Or a weird subset of sleep-apnea? Or maybe there was a heart problem at birth that she never followed up on but was supposed to? Patients often don’t go back to their doctors. They start feeling better and believe that the diagnosis went away.”
At this point, Caleb and Ling leaned against the counter. He was pouring her a coffee while the attending trailed off mumbling to himself. He finally snapped out of it. “Does anyone know if Mary Chandler was her parents’ only child?”
Caleb poured creamer in Ling’s coffee. “I believe so,” he said. “At least Mary told me it was going to be the parents’ first grandkid.”
The door to the lounge opened wider and Kristin Fleming poked her head in. “Emmett wheeled a patient up straight from admissions. She’s an induction on the OB schedule for today. She already told the nurses she’ll want an epidural so holler after someone’s seen her and gets her labor going.”
“We’ll holler,” Ling said. “And Annabel, pick her up as a patient. Do your H&P soon with or without us, which will be more experience for you that you are lacking. You’ll have to think on your feet without copying our notes.”
Annabel held her tongue. More and more, Ling was treating her like it was her first day of medical school.
The phone mounted on the wall rang; Ling answered and raised her eyebrows at Roosevelt. “It’s the director of the lab downstairs,” she said and put the call on the speaker.
“It’s Dr. Harvey,” Roosevelt said. “Is there anything you determined from the items we sent down from Mary Chandler’s room?”
The man cleared his throat. “We finished analyzing the IV bag contents that were hanging on the infusion pumps upon your patient’s death. I bring bad news. Very bad news.”
Roosevelt Harvey placed his coffee squarely on the table and stood tall. He signaled to Ling to close the door.
“I’m listening,” Roosevelt said.
“There were two one-liter Lactated Ringer’s bags, one of them drained more than the other. The one clearly labelled as ‘Magnesium Sulfate 40 mgs’ only contained Lactated Ringer’s solution with no Magnesium in it at all.
“The other bag? Testing that bag which had no label, in other words, the straight Lactated Ringer’s solution, revealed that it contained 40 grams of magnesium sulfate. The infusion rate on the pump was at your probable rate of her maintenance fluids.”
Roosevelt Harvey gasped and looked at Ling.
“300 mL/hour,” she stuttered.
“300 mL/hour is correct,” the director said. “I’m sorry to break this to you, but more sorry for the patient.”
Roosevelt’s head nodded up and down and up and down like a marionette on a string. Refusing to let the information sink in as fact and not fiction, he stayed speechless for a few moments.
“I’m not a praying man,” Dr. Harvey managed to say, “but I’m going to say all the Hail Marys that go on a rosary bead that you mixed up the bags yourself when they were deposited there.”
“Doctor, I’m sorry. The bags, the labels, and the pump in front of me spoke for themselves.”
Roosevelt dropped his head and closed his eyes. “Thank you. You are doing your job. I know what you’ll be doing next. Filling out all the incriminating paperwork.”
“Every drop of it.”
Dr. Harvey hung up. Ling sat at the table, knowing not to open the door again. She nervously patted her shoe on the floor. Caleb rubbed his bearded chin. The two of them searched each other’s eyes, wondering if either or both of them had anything to do with the mistake.
Annabel tried to keep her pulse in check. The discovery was abominable and the fallout to her superiors might impact them the rest of their careers.
“We have our cause of death,” Dr. Harvey said painfully. “Mary Chandler received a lethal fast dose of magnesium sulfate.”
-----
The group piled out of the lounge like it was on fire. Her team had other blazes to put out because of this news and were probably, in more ways than one, in deep trouble because of the medical error. At some point later, she needed to tell them about Samantha Barker’s diagnosis.
While she thought about it, Annabel plopped herself straight into the end of the couch and went to a major pharmaceutical textbook to reference magnesium sulfate more thoroughly. It was a Godsend in obstetrics, but it was obviously lethal if overdosed or used in the wrong way. She scanned the primary description: … a small colorless crystal used as an anticonvulsant, a cathartic, and an electrolyte replenisher in the treatment of pre-eclampsia and eclampsia; it causes direct inhibition of action potentials in myometrial muscle cells. For its main mode of action, the summary stated … excitation and contraction are uncoupled, which decreases the frequency and force of contractions.
Annabel squirmed before even coming to the overdosage part. The drug pos
ed as an acute toxin by most routes: inhalational toxicity, skin or dermal toxicity, and toxic if swallowed. But an outright overdose brings bigger problems like a slowing heartbeat, severe confusion and muscle weakness, drowsiness and dizziness, all succumbing the patient to a loss of consciousness.
She closed her eyes tight. Mary Chandler had ended up pregnant at a young age and there was no mention of the father of the baby. Apparently, he was out of the picture. She bet Mary would have thought twice about having a few minutes of sex with him if she had had a crystal ball to look into the future.
She opened her eyes and considered the end result. The eighteen-year-old had died a shocking, terrible, unforeseen death. Magnesium sulfate had been the premier drug of choice for her preeclampsia, which in and of itself, was a dangerous situation and diagnosis, but it went without saying that safety in the use of of all drugs was paramount … especially in a hospital!
CHAPTER 13
Roosevelt Harvey mustered up his courage as he took off down the hallway. Sometimes the responsibilities of being the attending doctor in a teaching hospital were enormous. It was better to be straightforward with the Chandlers about what had been discovered than procrastinate to buy time. The chances of them not suing the hospital and the doctors involved were slim. Honesty and timeliness were paramount and he would maintain the ethical and moral standards he believed in and always practiced.
After being given instructions by Dr. Harvey, Ling and Caleb had their own tasks to perform. They huddled inside the supply room to make a game plan and split up their chores. Ling spotted a stepping stool and sat down on the top step. She swept her hand back to grasp her ponytail, her ring gemstone lacking its luster as she changed her expression into a deep frown.
“I’m as tired as a bear in a den,” she said.
Caleb leaned in. “You should be perky. They say women often look rosy with an ‘afterglow’ after good sex and last night was felicitous, if I must say so myself.”
A moment of silence ensued. “Maybe for you,” she quipped.
Caleb felt a twang of ridicule besides being surprised. “Do you really mean that? I had no idea.”
“I’m just tired, that’s all.”
“You’re tired after getting adequate rest? We managed at least seven hours, which is a windfall for residents.”
“Yeah, well, for once, I’d like to be a normal person who sleeps that much every night.”
“There are a ton of people working other jobs and doing other things who get less than seven or eight hours a night. It’s not just us, you know.”
“Don’t you think you’ve pontificated enough?”
“I’ll shut up.”
She tilted her head and stopped fiddling with her hair. “I’m half sorry. Half the time, I feel defeated.”
“Defeated about what?”
“This case, for instance. A dead patient. No. A dead patient and baby. We’re not in it for that. Being a doctor in and of itself means to ‘do no harm.’”
Caleb maintained eye contact with her, trying to relay some empathy. “In actuality, you did not harm her. A mistake was made, which is what you are going to go talk to the head nurse about. Health care is run by humans, and although our record of safety is almost clean as a whistle, humans will make mistakes.”
Caleb extended his hand, hoping to help her down. She clasped it and stood in front of him. “You go see the new patient Kristin told us about, especially before the stupid bleached dark-blonde medical student goes in there.”
Dr. Gash let go of her hand. “Ling, you were a medical student once. I hope no one belittled you like that. Rumor is Annabel Tilson is far from stupid.”
“You can stick up for her. What? Have you become enamored with her?”
Caleb frowned. “I’d better go take care of our new patient.” He turned and glanced back over his shoulder. “And I don’t think she colors her hair. She’s as natural as the sunrise.”
Ling fumed as Caleb disappeared down the hallway. But forget about him, she thought. She marched past the elevator area and waiting room to the gynecology section and knocked on the first door.
The tall woman who swung the door open was the hospital’s head nurse and administrator of OB/GYN. “I just housecleaned that chair and alleviated it of a backlog of files. Have a seat. You’re Dr. Watson and, of course, I’m Elaine Rice.”
Ling wondered if the woman’s nasal voice had anything to do with her crooked nose. “I’ll sit, if you don’t mind.” She looked at the chair like it was a piece of chocolate cake. “A plushy, upholstered seat cushion is a rarity for a resident. I guess the hospital reserves that for their own main employees rather than the doctors and residents who keep hospitals afloat.”
Mrs. Rice threw her a dirty glance. “Feel free to speak your mind, Dr. Watson.”
“The reason I’m here is to discuss Mary Chandler. You must have been informed of her death yesterday.”
“Yes. My hand is on the pulse. It was an awful occurrence and I was informed immediately.”
“Have you been told yet what killed her?”
Mrs. Rice squinted. “Apparently not.”
“We only just found out. I’m sure diligent hospital employees will be calling you any minute.”
“Please lay the groundwork, Dr. Watson.”
“Your staff screwed up the labels and contents of two IV fluid bags yesterday on Ms. Chandler’s treatment of preeclampsia. Magnesium sulfate was bolused and dripped into our patient at an obscene rate … which was the rate of the hydration we had ordered for normal Lactated Ringer’s solution.”
Elaine Rice gripped her hand into a fist and placed it on the desk.
“Sherry was the nurse working yesterday who was taking care of her and her unborn child. She’s not here today, but I believe it was her actions that led to the demise of our patient. Poor Dr. Harvey is dealing with the patient’s parents as we speak. He spoke to the mother before, but now the father is here. Mike Chandler is spending an inordinate amount of time in the basement with his dead daughter before the medical examiner begins his autopsy.”
Elaine Rice squirmed and her hyponasal speech became worse. “I’ll talk to our laboratory immediately as well as do a thorough nursing investigation.”
“I’m new to such matters, but I’m sure that’s what your hospital attorneys are going to advise. Keep us abreast of what you find out.”
“I agree. It would be unwise if the medical team and the hospital staff do not directly communicate. Misinformation could jeopardize getting to the bottom of this.”
“Or put you in a worse situation.”
Ling rose and was at the door. “Nice meeting you, but the nurses you hire leave a lot to be desired.”
Mrs. Rice stared past the open door. What ever happened to tactful, non-accusatory, professional speech from a resident, she thought. Not only did she have a possible overtly negligent nurse on her staff to deal with, but a bitchy resident was running loose too, who basically thought she was mightier than the attending physician.
-----
With Melba Fox, RN finished with her last round of dispensed drugs, Elaine Rice found the medicine cart stashed in the supply room. She hovered over the book that would incriminate and hold accountable a formerly trustworthy and dependable nurse. She licked her index finger and skimmed to Mary Chandler’s page. The doctors had clearly written the mag sulfate order as well as her maintenance fluids. Ms. Fox had also checked off and logged in a time when she had carried out the orders.
Someone can check off doing something as much as they want, Elaine thought, but if they aren’t doing it correctly, then what good is it? Except that it set a more accurate timeline of administration and death to the patient.
Sometimes she hated her job; this was one of those times. Next stop was administration and, no doubt, their decision would be to put the middle-aged nurse on a leave of absence when she showed up for work the next day.
-----
Glad to get away fr
om the drama on the ward, Annabel strode into Room 4, where her new patient and husband were settling in. The man wore a T-shirt and blue jeans, which defined his muscular build. He unpacked a navy nylon bag with his wife’s things in them and neatly stashed clothes and toiletries on tables and in drawers like they were away on vacation.
Already dressed in a hospital gown, the woman sat with a pleasant smile in the room’s comfortable chair as she watched and directed her husband. Annabel nodded at them as she perched herself on the end of the vacant bed.
“I’m Dr. Tilson, one of the medical students. One of the residents will be in shortly. May I ask you some questions?”
“Sure,” the woman said. “This is a teaching hospital, so we expect students. They were loitering around for my first baby too. I’m Amy Wagner and this is my husband, Harry.”
Annabel had read the woman’s limited paperwork which functioned as her ticket for admission. The thirty-one-year-old had last been seen in the clinic a few days ago. Despite her large girth from her pregnancy, she appeared to be in excellent condition like her husband: her legs and arms slender, firm, and shapely. Her skin glowed like all she did was eat fruits and vegetables and take fast-paced walks on nature trails.
She was just the patient she needed to work-up, Annabel thought, to fend off the cloud that had fallen on the rotation.
“So this is not your first baby?”
“Second one. We have a little girl at home. This one’s a boy.”
“Any other pregnancies at all?”
“No.”
Annabel grabbed an index card from her pocket and wrote G2P1. “I read you had a previous C-section. What was the reason?”