Medical Error pft-2

by Richard L Mabry

  Nick frowned, but hurried to erase it before Anna looked up. "You know, I'm in the pathology department. If there's a test out there that we can't run, I haven't heard about it."

  "Well, Dr. Pathologist, in that case, why don't you open it and see what it is? And if I have trouble interpreting the results, I've got an expert on hand."

  Nick fumbled with the envelope. "Are you sure, Anna?" There was no levity in his voice now. "This is confidential stuff. Look." He held out the envelope and pointed to the large red letters in the lower-right-hand corner: CONFIDENTIAL.

  "I don't mind if you know my cholesterol or my triglyceride or whatever. Go ahead. I almost have our picnic set up, and I don't want to stop."

  Nick ran his finger under the flap and pulled out a single sheet of paper. He scanned the results with a practiced eye. Then he looked at the top of the page and double-checked the name and address of the patient. Finally, he asked, "What's your date of birth?"

  "Why do you ask?"

  "Just making sure this is really your report."

  For the first time, Anna looked up. "July seventh."

  "That matches." Nick said. "Did your doctor talk with you about ordering any unusual tests?"

  "Nick, you're scaring me," Anna said. "What is it?"

  He handed the report to her. "You'd better see this yourself."

  Anna put down the loaf of sliced sourdough bread she was holding and looked down at the report in her hand. "Why did Dr. Reed order these? And why were they sent to a lab outside the medical center? The names of the tests are vaguely familiar, but I can't quite place them."

  Nick eased onto the sofa and patted the cushion beside him."Anna, sit down."

  She sank into the seat, the picnic forgotten. "I don't understand," she said.

  "Let me take your questions in order." Nick's voice was quiet, his tone sober. This wasn't the Nick who'd walked in her front door a few moments ago, the one who made her perk up. He'd changed. And it wasn't good. "First, Dr. Reed must have ordered these tests because he had reason to suspect a serious illness."

  "What kind of-"

  "I'll get to that. Second, he probably sent them to an outside lab because he was being considerate. By and large, our lab personnel at the medical center are professionals. They respect patient confidentiality. But sometimes they let things slip. He didn't want this information to get out."

  Anna took a deep breath. She couldn't recall feeling this way since she waited for the dean's office to post the list of those who'd passed their courses and would receive their MD degree. When the list went up, she almost turned away without reading it. She ached to know the verdict but was afraid of what she'd see.

  "Anna, are you okay?" There was concern in Nick's voice."Can I get you something to drink?"

  "No, I'll be fine. Go on." Anna tried to swallow, to move her heart out of her throat as she waited for the other shoe to drop.

  "You're right about the tests. You don't deal with them every day, but I do." Nick held up the paper. "If this first one is positive, it's followed up by another. If that one is positive, they do a third. If they're all three positive, then we do a confirmatory test. Even then, some clinicians insist on a fourth assay as sort of a fail-safe. If that's positive, there's no doubt."

  "What are you saying?"

  It seemed to Anna that Nick shrank back a bit. "You're HIV positive."

  She felt as though someone had slammed a fist into her gut."That can't be true."

  "They ran all the tests," Nick said. "To be sure. After all, this is an area where false positives and false negatives can be disastrous."

  Anna shook her head, as though trying to dislodge what she'd just heard. "No, no. I mean, there's no way I could be HIV-positive." She stopped, trying to figure out how to couch her reply. "I haven't had any exposure."

  "Sure you have." Nick's tone was neutral, nonjudgmental."You've been in patient contact for what? At least the last three years of med school, three or four more in residency, then in practice. Didn't you ever notice a hole in your glove during surgery? Maybe you had a little cut on your hand at the time but paid no attention to it. Did you accidentally stick yourself with a needle? Sure you've had exposure. It doesn't take sexual contact to contract AIDS. Blood exposure to non-intact skin will do it."

  Anna felt the initial adrenaline rush of fear fading. Think logically, she told herself. Think about it. Once more she looked at the report, this time a lot more carefully. Studied it as though her life depended on it, which in a way, it did. She moved past the lab values themselves, and concentrated on the heading of the report.

  That was her name, her date of birth. She didn't know her insurance number offhand, but she was willing to bet the designation at the top of the page was correct. Her home address was right, down to the added four digits after the ZIP code, numbers that Anna never could remember. And she could see why her doctor might have had the report sent to her at home, to protect her privacy. But why would Gary

  … wait a minute! The name of the requesting doctor wasn't Gary Reed. And the address wasn't the faculty clinic on Harry Hines Boulevard. No, the order came from Dr. Khalid Mahmood. The facility was the Metro Medical Center on Grand Avenue. This test was sent to the lab by what Anna often heard called a Doc- In-The Box, a walk-in clinic, one located in one of the more depressed parts of Dallas.

  "Nick, I found it. I know what happened," Anna said.

  "You mean you know how you were exposed?"

  "No. I mean I think I know how this test was done using my name and insurance information."

  She saw the doubt in his eyes, knew he was probably thinking she'd gone somewhere she wasn't known to have the test done. How was she going to convince him that she was an innocent victim? And why did she care so much about what he thought?

  Anna handed the report to Nick and watched his face as he took the paper. He didn't look down at it. He looked at her, like he was giving her a lie detector test with his eyes. Finally, he lowered his gaze and tapped the top portion of the report."Anna, this is your name. Your address. The fact that the test was done at an out-of-the-way clinic doesn't change that."

  She shook her head. "Can't you see? The same thing's happened to me that happened to Eric Hatley. Someone's using my identity to get medical care. They got hold of my insurance information and used it the same way they used my credit cards and DEA registration. This is just another part of the identity theft."

  "It makes sense, I guess. I want to believe you. But these test results-"

  "Besides the fact that I know these aren't my tests. Think about it logically. It came from another clinic. That implies that I was trying to keep the results a secret. If that were my intent, would I have asked you to open the envelope? No, I'd have made sure the envelope stayed hidden while you were here. Hey, I'd have opened it myself the moment it arrived."

  She watched Nick's frown deepen, then gradually fade."Okay, I see what you mean. But let's say this isn't your test. What can you do about it?"

  "I've got an idea. It's crazy, but so is everything that's happened to me so far."

  Nick handed the report back to Anna. "What's that?"

  Anna began to pace. "I've been thinking about the credit theft and the narcotics thing separately. They're not. I've had a vague feeling they were related, but now I think they're part of something a lot bigger. Someone-we don't know who-got hold of all my personal information. They either used it themselves or passed it on to other people. If I trace one of these incidents back to the source, I've got my answer."

  "You keep saying that you're going to do this," Nick said."What happened to the 'we' that we talked about? Did I get thrown offthe team?"

  Nick was right. Her problems seemed to be piling up faster than she could deal with them by herself. "You're right. Two heads are better than one. We'll brainstorm this and figure out our next move." She surprised herself by reaching out for Nick's hand. "But you do believe me, don't you?"

  Nick took the offer
ed hand and squeezed, and his expression changed. "Yes, I believe you. I don't understand it all, but we'll figure it out." He dropped her hand and pointed to the forgotten picnic, now all laid out. "But can we do it while we're eating? After all, low blood sugar hinders the thinking process. Isn't that right, Doc?"

  Anna relaxed as she saw that Nick had apparently accepted her innocence. "Sure," she said. "Let's eat."

  The picnic, once it started, involved more eating than talking. Anna found that the afternoon's events hadn't blunted her appetite. "My compliments to your deli," she said, wiping mustard from her lips with a paper napkin.

  "Thank you. I think-"

  A pager went offand they both jumped. Anna's hand went to her waist in an automatic gesture that ended in frustration when she recalled that her pager was still on her desk at the medical center. She wasn't on call. No one wanted her.

  Nick thumbed the button, looked at the display, and frowned. "Gotta call in. Okay if I use your phone?" When he hung up, the frown had turned to a look of disgust. "I have to go back to the medical center. There's a medicolegal autopsy they want done ASAP."

  "Go on. I'll clean up here."

  "Should I come back when I've finished?" The look on his face made it clear that he wanted to do just that.

  "Can I take a rain check? I'm beat. And there's nothing either of us can do about any of this before Monday." Anna wrapped the remaining two sandwiches and a handful of cookies in one of the napkins and shoved them at Nick. "Take these with you. You're more likely to want them than I am. And thanks for the picnic. I enjoyed it."

  When Nick stopped at the doorway, Anna thought he might be about to turn back and kiss her. Would she let him? The question became moot when he said, "I've enjoyed it too. Don't forget. I'll be by at ten-thirty in the morning."

  She closed the door, leaned against it, and replayed the scene in her mind. If the question of the lab report hadn't come up, would the afternoon have ended differently? She wondered.

  9

  Anna awoke before the alarm sounded. She looked at the clock,

  tried to recall what day it was, struggled to define the feeling at the back of her consciousness that something was supposed to happen today. It had nothing to do with work-she was still on unofficial suspension. It was… Sunday. And Nick had agreed to attend church with her.

  She kept reminding herself that she should be cool. Nick was a friend, nothing more. She didn't have time or space in her life for anything else, certainly not with everything swirling around her. But she did her makeup with extra care. Then she spent an unusually long time in front of her open closet door. Anna didn't have a lot of clothes-her budget was far from limitless-but she'd bought wisely, choosing good quality things that set offher red hair, green eyes, and pale complexion. She finally chose a simple green dress.

  At ten-fifteen she started fidgeting. By ten-thirty she was checking her watch every fifteen seconds. At ten-forty, her phone rang.

  "Anna, this is Nick. I'm so very sorry."

  She felt as though she were on a roller coaster that had just started to drop. He was going to cancel. She'd scared him offby asking him to go to church with her. "That's okay, Nick."

  "No, you don't even know what I'm apologizing for. I got a call this morning from George Race. He's the pathologist on call today, and his daughter is being christened this morning. The doctor who was supposed to cover for him got sick, and he needs me to work-at least until noon."

  Anna felt her heart start beating again. She was a doctor. She could understand a situation like this coming up. It had nothing to do with her invitation to church. "Of course you have to cover for him, Nick. I'd be disappointed if you didn't."

  "I'll be through at noon. Can we still have lunch together?"

  Anna rummaged through the notes scattered on the coffee table in her front room. There it was. "I can do better than that. Some friends are having a party this afternoon. There'll be food there."

  "Will I know any of these people? Are they doctors? Neighbors? What?"

  Anna gripped the phone a bit tighter. Better tell him the truth. "It's a group from our church. They're a lot of fun. And there'll be tons of good food."

  "How can I turn that down? When can I pick you up and what can I bring?"

  It wasn't that Nick didn't believe Anna when she said this party wouldn't be like church. It was just that perhaps her idea of "church" was different from his. Oh, well, at least he'd have a chance to be with her.

  "Looks like a pretty big party." Nick squeezed his car into a parking space a block away from the house that Anna said was his target.

  "Not too big. And I think you'll like these people."

  He climbed out and hurried around to open the car door for her. She looked ravishing in a green blouse and tan slacks. Then again, Nick recalled that she looked great in scrubs and a wrinkled white coat too. Maybe it wasn't the clothes.

  "Thanks for coming," she said as they approached the house.

  "Wouldn't miss it," he said. Well, I would have but it gives me another chance to be with you. He stabbed at the doorbell.

  "Everyone's around back." A middle-aged man hurried up the walk behind them, two grocery sacks in one arm and a large plastic bag of ice in the other.

  "Thanks, Chet," Anna said. "Nick Valentine, this is your host, Chet Conway. Chet, Nick is a colleague of mine."

  "Nice meeting you. Come on this way." Chet nudged a gate open with his foot, and led them through into a large fenced backyard filled with chattering people. People talked in small groups while others bustled back and forth between the kitchen and a long table loaded with food. "Nick, help Chet with those sacks. I'll put this pie down and see if his wife, Martha, needs a hand."

  Chet shoved a sack into Nick's arms and said, "Napkins, paper plates, plasticware, cups. Find the nearest person in the kitchen and then run like the wind. Otherwise you'll be drafted." He laughed. "When you escape, find me and I'll introduce you around."

  Nick did as he was told. Soon, he stood with Chet and two men whose names he had already forgotten, trying to follow their conversation without being drawn into it.

  "I don't know what we're going to do with those people in Congress," the first man said. "No wonder our country's going to the dogs."

  "We've always had bad people around. Doesn't mean they can't be good leaders," Chet said.

  "Yeah, but it's more likely to happen if they're decent in the first place. Isn't that right?" The second man looked at Nick with a "back me up on this" expression.

  Nick managed a shrug.

  Chet grinned. Nick had seen that grin before. It was the expression of a staffphysician when a medical student made a statement that wasn't going to stand up under close scrutiny. This could be good.

  "Why don't we consider some of the leaders in the Bible? Would you agree they were good people?" Chet said.

  The first man nodded. "Sure."

  Chet grinned. "Start with Moses. Great leader. Led the Israelites out of captivity. God gave him the Ten Commandments. Moses was bound to be a pretty good guy? Would you sign offon that?"

  The first and second man looked at each other, apparently wondering where the trap was. "Sure," they said in unison.

  "Remember where Moses was before all that? He was hiding in the desert, because he'd killed a man," Chet said.

  The men didn't seem to have an answer for that, but Chet wasn't through. "Ready for another try?"

  "Sure," the first man said, not quite so eager now.

  "King David," Chet said. "Saved his people by slaying Goliath when he was just a kid. Became king of Israel. Wrote the Psalms."

  "Yeah, and the Messiah came from his line," the second man said. Surely this one was a winner.

  "Remember what David did after he was king? Lusted after another man's wife and had her husband killed by sending him to the front lines. There's your good man."

  Nick let the rest of the conversation wash over him, as he thought about what he'd heard. Ni
ck always figured he'd blown his chance with God when he pulled that trigger. Maybe he'd been wrong.

  Meanwhile, the game-for that was what it had become- was in full swing. One man would give an example of a leader. Another would point out his flaws.

  "Peter. Lead apostle. Called 'the rock.' "

  "Hot-tempered firebrand who cut offa man's ear in a fight.

  Denied his Lord three times when the chips were down."

  Nick eased away. He'd heard enough to start him thinking. No, this hadn't been "church, the second installment," but there'd been some good stuffthrown around.

  "Enjoying yourself?" Anna eased up beside him. "I'm sorry I left you alone for a bit, but I had to help get the food on the table. Ready to eat?"

  "Sure," Nick answered. He pointed to the group of men he'd just left. "I don't remember those guys' names, but are they on the church staffor something? They were slinging Bible stuff around right and left."

  "Chet, the host, is an insurance agent. Charlie, on the left, is a mechanic. Rick, on the right, is a dentist." She looked around and pointed. "The only minister I see here is the man in Bermuda shorts and flip- flops. That's Robert, our pastor."

  Nick reached for Anna's hand, and she allowed him to take it. Together, they strolled toward the long table, where people were already lining up with paper plates in their hands. During the meal, Nick managed to take a polite interest in the conversations that flowed around him, but his thoughts kept coming back to one point: God probably hadn't written him offwhen he'd killed that holdup man. Maybe he had a second chance coming.

  On Monday morning, Anna's phone rang while she toasted an English muffin.

  "Anna, this is Ross Donovan. Hope I'm not calling too early."

  She caught the muffin as it popped from the toaster and immediately dropped it on a plate. "No, not at all. What do you have for me?"

  "Agent Hale at the DEA finally returned my call. He agreed to meet with me this morning. Kramer will probably be there too. Do you want to come?"