by Barbara Ebel
“Social apps? I would have never thought medical students have time for that.”
Annabel almost blushed; she used a social app for a lot more than only checking tweets.
“Dr. Burk,” she said, “it doesn’t take that long to pop on and off those sites. And you’re not too old to do it; you’re only a few years older than me.”
“Maybe one of these days,” Robby said, shrugging his shoulders as the doors opened and they stepped out on the first floor.
“Where are we going?” Annabel asked.
“Before I start making phone calls, I’m going to lunch. And medical students need to eat, too.”
Annabel smiled. She suddenly had an appetite.
-----
As Annabel and Robby sat by the cafeteria window, the trees lining the street past the parking lot swayed and a young woman coming towards the hospital steadied the hat she wore as her skirt blew against her legs. The remnants of a tropical system were sweeping northeast from the gulf and a deluge of rain was on its way as well as heavier winds.
“Looks like we’re in for a bit of a storm,” Robby said.
“We need the rain,” Annabel said. “Plus, I do my best studying in bad weather.”
“Well, then, Mother Nature can bring it on,” he said, sprinkling salt on the tacos he’d made.
“Would you mind very much if I came to the meeting you arrange for tomorrow?” Annabel asked.
“Your thinking is why we’re going to arrange it. Of course you will be there. And for today, why don’t you grab your anesthesia resident friend and go to the head anesthesia tech responsible for drugs, supplies, and ordering, and ask her help with drug batches. See if she can’t pull up as much information as possible for our meeting. When I call the chairman, I will also alert him that his resident and my medical student will be snooping around asking questions of the principal anesthesia tech.”
“That’s a good plan and thank you.”
“No, it’s me who should thank you.”
She took a sip of water, glancing at him. He wore a handsome signet ring on his right hand and his sleeves were rolled up the way she liked them; he wore no tie today and the top button of his pale shirt was unbuttoned. Despite the half-harsh weekend he’d had, his outlook seemed to have perked up from earlier and he looked confident and pleased. His fiancée must have been blind and stupid, she thought, to behave the way she did.
In her peripheral vision, Annabel saw two white-coated individuals weaving around tables towards them. Marlin slipped right into the chair next to Robby and Brandy smiled and sat next to Annabel.
“Perfect finding you two here,” Marlin said, glancing skeptically from Robby to Annabel. “Annabel, Mr. Blair just went to his room. Be sure and have his postop labs ready to report for this afternoon’s rounds.”
“Actually,” Robby said, “I am sending Dr. Tilson on a clinical errand after lunch so I’ll expect you to follow up on that.”
Marlin frowned with displeasure and Brandy glanced at Annabel with a slight smile.
“I think I’m finished here,” Annabel said, putting down the last bite of her sandwich and pushing away from the table. It was bad enough to be on the same rotation with Marlin but eating lunch with him was like sharing a room with a python.
With newfound enthusiasm that Robby had listened to what she said with interest, she hastened to the OR with previous data she had put together. She found her favorite resident doing a case and they discussed quietly what Robby and she had talked about. Wilbur called in the anesthesia tech and explained the need to track two nondepolarizing neuromuscular blockers associated with certain cases and asked her to gain as much information about them as possible for a meeting the next day. Annabel enjoyed the visit; she learned more about the drug carts stocked for every case.
“There is a lot of equipment and drugs you have at your disposal every day,” Annabel said.
Wilbur smiled. “Precisely,” he said. Proud of his specialty, he continued. “Anesthesia looks at physiology, pharmacology, and organ function perhaps like no other doctors do. We need supplies for medical issues, not just for giving anesthesia.”
She stayed with Wilbur to the end of the short case and went off to check on her patients before rounds.
-----
Annabel packed her overnight bag as she heard the distant rumbling of thunder. She had studied all evening so getting ready gave her a break. But with the diversion, she thought about her doctor’s appointment on Wednesday. Her dad had called a few hours earlier and she had the feeling he held back information because he didn’t want to alarm her. However, he said her doctor would probably schedule her for surgery to definitely remove the melanoma.
“I bet you don’t want to put your rotation on hold,” her father had said, “so start brainstorming who should do your surgery there rather than coming home. One of us could come and lend our support.”
“All of you are too busy,” she had responded. “It would be a burden. Let’s wait and see what the doctor says.”
She zipped up her bag as a sudden flash of lightning lit up the sky outside her window. Slumping into her easy chair with her cell phone, she opened up Findar. Before she went to her own profile, the screen image showed a twenty-something male wearing no shirt and giving a thumbs up. “Ohio Finder,” he said under the photo. “Ain’t nothing like the real thing, baby.”
Annabel ignored that and opened up the last dialogue from Tony which had been posted that morning. That’s one thing she liked about the individuals on the site … at least so far. She could get back to someone as soon or late as she wanted and it wasn’t a big deal. No one’s feelings got hurt and that seemed much different than carrying on a boy/girl relationship with traditional dating.
His message said, “Good week?”
“Better than last week! We meeting soon?”
After she showered and put on pajamas, she checked Findar again.
“Sure. Weekend okay?”
“Not Saturday,” she replied, knowing the team would be on call. “Sunday evening?”
“Cool. How about at Eden Park, at the gazebo? 6 p.m.?”
“Perfect. Let’s walk!”
Tony popped up a smiley face.
“See you then,” she finished. Hopefully they’d do more than walk if they were mutually interested.
-----
Annabel fixed her own coffee at home, took a to-go cup, and left for the long day on call. She manipulated her bag over her shoulder while holding the cup and an umbrella. The warm, fat drops had started falling from the sky overnight and the lightning and thunder had ramped up. It wasn’t easy keeping the umbrella from turning inside out plus managing the other things.
She bypassed the coffee bar in the hospital, especially since she still had some of Bob’s favorite treats in her lab coat. Somehow, she’d even grown fond of them.
First stop after entering the office was to check on Gustavo Blair. Since he was her most recent surgical patient, she winced going into his room not knowing if he had done okay after the team had left yesterday. Annabel smiled when she saw him in a reading chair.
“Good morning,” she said.
“Not outside in that foul storm,” he said. “But I’m coming along like that Dr. Burk promised me I would.”
“Yes, it’s no weather to be out in. How was your night and how is your pain?”
Mr. Blair squirmed in the chair and pointed. “I’m sitting on a pillow like a dog bed which makes the pain easier. Somebody called it a hemorrhoid pillow.”
“Whatever it takes,” Annabel said. “Glad it helps.”
“And I slept off and on. Trying to get comfortable took more time than sleeping.”
Annabel nodded, checked his bedside chart, and listened to his heart and lungs. “Your IV antibiotic morning dose should be coming soon,” she said “and we’ll see you on rounds.”
“And so will biscuits ‘n gravy. I could eat a horse!”
“I hope not,” she said
with a grin and went to write a daily progress note on him.
By 8 a.m., the team had gathered. “Dr. Pittman won’t be joining us this morning,” Robby announced, “so let’s get going.”
As they walked, Robby turned to Annabel. “But he will be attending our meeting at 12 noon.”
“We have a meeting today?” Marlin asked.
“It’s not for residents,” Robby said.
Marlin shoved a hand into his tacky coat and gave Annabel a dirty look. When they went into Mr. Blair’s room, Gustavo had the breakfast tray he had hoped for.
“The most important results we are waiting on are culture and sensitivities of Mr. Blair’s abscess sample,” Annabel said to Robby before Marlin. “The first results won’t be ready until later.”
“Yes, those are very important,” Robby said. “And how do you like that pillow I ordered for you?” he asked Gustavo.
“It’s great,” he said. “Makes all the difference in the world … I mean my butt.”
“I went to order it,” Marlin said, “but Dr. Burk beat me to it.”
-----
At the end of rounds an hour later, some of the team went to the office; Robby headed down the hallway in front of them. By the door, stood a woman in a pants-suit and a man who was staring at him.
“Can I help you?” Robby asked.
“I’m here to see Dr. Burk,” the man said.
“I’m Dr. Burk.”
“I’m Brad Simmons. The brother of the deceased patient that you were responsible for.”
The name took Robby by surprise; he had been told that Simmons’ brother was going to come talk to him but he never showed up. After that, the next thing he knew was getting hit by a lawsuit.
Annabel put her hand out in front of Bob; they stopped and stood against the wall.
“Mr. Simmons,” Robby said. “I’m very sorry for your loss. And I did receive your papers.”
“But you’re not getting away with your negligence that lightly.”
Robby looked at the woman, waiting for an introduction.
“Helen Radamaker,” she said. “Mr. Simmons here alerted me to the newsworthiness of what happened to his brother. I am a reporter with a Cincinnati paper. I’ll be doing a little story on hospital foul-ups for the Life section and thought I’d come to hear your side of it.”
“Mr. Simmons,” Robby said. “You had obviously elected not to talk to us after your brother’s death and began legal proceedings right away instead. I, unfortunately, have been instructed by my attorney and the hospital’s attorney to not speak about your brother’s case unless we are giving depositions or with our counsel present. I’m sorry I can’t help you either, Ms. Radamaker.”
“Dr. Burk would not speak to me,” she said as she scribbled it on a notepad.
“Sure enough,” Mr. Simmons said angrily, “you doctors think you can botch up a person’s life or even kill them and get away with it because you have M.D. behind your name, like some kind of waiver by society that you can do what you want.”
“Mr. Simmons,” Robby said, “I think you had better leave. There are sick people in and around these hallways and you are disturbing their serenity.”
“I’ll give you serenity,” he said raising his voice and waving his arms. “All of you patients in these rooms, I’d leave if I were you. You may just end up dead like my brother who walked into this hospital with a small problem!”
Knowing he may be escorted out soon by hospital security, the man looked at the reporter and said, “Come on. There’s no justice here.” In a flash, they were at the elevator and gone.
Along with other patients and staff, Mr. Blair stood at the nurse’s station watching the commotion, his IV pole in one hand and holding the pillow against his butt with the other.
Annabel and Bob slipped into the office as Robby dropped his head and went to his own room.
-----
In the little time Annabel had after witnessing the outburst against Robby and scampering around to finish her morning clinical duties, she went to visit the anesthesia tech before the noon meeting. She found the wiry, small woman in a drug room behind the ORs stacking shelves with supplies from a box on the floor. The woman looked at Annabel from a stepping stool and rubbed her hands on her purple scrubs.
“I played drug detective and have all the information you requested,” she said. “It wasn’t easy but the chairman of the department also wanted me to cooperate with you.”
“Thank you so much,” Annabel said.
She followed the woman to her desk where she pulled out sheets from a folder. “Both neuromuscular blockers involved came from their own drug lot number. All patients involved had one or the other of the drugs from one or the other of these lots.” She pointed to her data.
“And you have more of these drugs from other batches that aren’t linked to these, correct?”
“Yes,” she said. “And thinking there may be a problem, otherwise you wouldn’t have asked, I have pulled all the muscle relaxants from those two batches. None of the carts and no one as of today is using them. I’ve put them in a closed box over there and have even ordered more vecuronium bromide and rocuronium bromide knowing they are recently made and different than what’s in those boxes.”
“Perfect,” Annabel said. “By later today, I’m sure your chairman will talk to you. You made a wise decision on your own.”
Annabel took the sheet, said good-bye, and left for the meeting. Not knowing if she should go by herself, she decided to go by Robby’s office where she found him putting on his white coat.
“I’m sorry,” Annabel said. “That man should not have done that let alone drag a reporter with him.”
Robby’s despair showed on his face. “Yes, that was not the high note of my morning. I called the department’s attorney who is handling the matter and he said to document the exchange. That’s all we can do for now.”
Annabel searched his chocolate eyes as he looked down at the folder she carried. “Is that the muscle relaxant information?”
She nodded and Robby said, “Come on. We have a joint department meeting to attend.”
Chapter 23
The surgery department hosted the meeting in their conference room and the list of people attending had grown. The cafeteria staff had placed pitchers of water and petite sandwiches on the sideboard. Annabel followed Robby’s lead and they sat in the middle of the elongated table.
The department’s chairman, Dr. Allen, was known by all students who rotated through. He was a lanky man with a comb-over and a pointy nose, and was better known for his published papers than his hands-on clinical skills. When everyone sat down, he scrambled through brief introductions. He rattled off their own attending doctor, Jacob Pittman, and then Robby and Annabel, who he labeled as “an inquisitive medical student.”
The anesthesia department was represented by the already-involved chairman, Dr. Parker, who had a poor complexion like leftover teenage acne. Annabel had wondered if they would spring Wilbur Gill from his clinical duties to attend … and they had; he sat to the left of the chairman.
A woman with sweeping hair and heavy lipstick introduced herself as Dr. Potts, the Chief of the hospital medical staff. A person sat directly across from Annabel with a lunch plate. “I’m Mr. Sweeney, vice president of the hospital,” he said as his small eyes swept around the table like a cat on the prowl.
Although Annabel derived some comfort that Robby sat next to her, she felt nervous to be in close quarters with such senior doctors and the hospital’s V.P. She gave a faint smile to Wilbur and hoped he didn’t feel uneasy because she’d been responsible for dragging him into this.
“Thank you all for the introductions,” Dr. Allen said. “For some of us, it meant putting a face to a name. All of us know why we’re here because, starting with a surgery medical student and an anesthesia resident, we’ve passed on information in what I call the ‘sandbag’ method, from one person to the next. We know both departments have had
a rash of deaths and a lot more needs to be done to look into them,” he continued, “but if these neuromuscular blockers are the culprit, then we can’t take any chances. So, Dr. Parker, please tell us the latest from your department.”
“I’d be happy to. With the anesthesia tech and Dr. Gill’s help, we have pinpointed drug batches of the two aminosteriods used in the implicated cases and they have been pulled off our shelves. Then I called the drug manufacturer and explained our suspicions; also, a fresh overnight order of these drugs are being shipped to us.”
“Thank you. Perfect,” Dr. Allen said and then looked at Robby. “You and Dr. Pittman were proactive, too.”
“Wondering whether or not we can trust a possible duplicitous drug company,” Robby said, “we called the FDA. They are going to look into these drug batches. They already called me back and will implement what you have, in essence, done. They are enforcing a nationwide drug recall and will begin their own investigation.”
Annabel attentively watched and listened, realizing how small a medical student figured in the scheme of handling a complex situation, like a minor fundraising person for a presidential candidate’s campaign.
“It is too bad we didn’t recognize a drug problem sooner,” Mr. Sweeney said, his eyes darting back and forth between the department heads. “We don’t want reporters coming out of the walls like cockroaches and mudslinging the hospital.”
“Sir,” Dr. Pittman said, “we are probably not the only hospital experiencing a problem. And has anyone yet thought about a causative factor, like why the drug all of a sudden failed?”
“I don’t know the answer to that,” Sweeney said. “But hopefully the problem is solved. Let’s have another meeting in a week or two for any follow-up information we need to share with one another.”
Dr. Allen nodded. “Does that suit everyone?”
They all agreed. Robby cleared his throat. “I want to especially thank Dr. Tilson and Dr. Gill for their fine attentiveness with patients and the joint effort they undertook between two very different departments. Sometimes both specialties are like cats and dogs across the blood-brain barrier, i.e., the surgical drapes.”