by Gary Birken
Table of Contents
Title Page
Copyright Page
Dedication
Epigraph
PART ONE
CHAPTER 1
CHAPTER 2
CHAPTER 3
CHAPTER 4
CHAPTER 5
CHAPTER 6
CHAPTER 7
CHAPTER 8
CHAPTER 9
PART TWO
CHAPTER 10
CHAPTER 11
CHAPTER 12
CHAPTER 13
CHAPTER 14
CHAPTER 15
CHAPTER 16
CHAPTER 17
CHAPTER 18
CHAPTER 19
CHAPTER 20
CHAPTER 21
CHAPTER 22
CHAPTER 23
CHAPTER 24
CHAPTER 25
CHAPTER 26
CHAPTER 27
CHAPTER 28
CHAPTER 29
CHAPTER 30
CHAPTER 31
CHAPTER 32
CHAPTER 33
CHAPTER 34
CHAPTER 35
CHAPTER 36
CHAPTER 37
CHAPTER 38
CHAPTER 39
CHAPTER 40
CHAPTER 41
CHAPTER 42
CHAPTER 43
CHAPTER 44
CHAPTER 45
CHAPTER 46
CHAPTER 47
CHAPTER 48
CHAPTER 49
CHAPTER 50
CHAPTER 51
CHAPTER 52
CHAPTER 53
CHAPTER 54
CHAPTER 55
CHAPTER 56
CHAPTER 57
PART THREE
CHAPTER 58
CHAPTER 59
CHAPTER 60
CHAPTER 61
CHAPTER 62
CHAPTER 63
CHAPTER 64
CHAPTER 65
CHAPTER 66
CHAPTER 67
CHAPTER 68
CHAPTER 69
CHAPTER 70
CHAPTER 71
CHAPTER 72
CHAPTER 73
CHAPTER 74
CHAPTER 75
CHAPTER 76
CHAPTER 77
CHAPTER 78
CHAPTER 79
CHAPTER 80
CHAPTER 81
CHAPTER 82
CHAPTER 83
CHAPTER 84
CHAPTER 85
CHAPTER 86
CHAPTER 87
CHAPTER 88
CHAPTER 89
CHAPTER 90
CHAPTER 91
EPILOGUE
ABOUT THE AUTHOR
FATHER OF THE DEAD
Morgan tried to calm the man. “I understand how upset you must be, but I promise you, your sons received expert medical care.”
“My sons are dead, Dr. Connolly.” Kaine’s stony glare never shifted from Morgan’s eyes. She didn’t feel physically threatened, but his intimidating demeanor made her uneasy. It was obvious her words were falling on deaf ears.
Kaine dropped his hands to his sides. His voice never became louder but its added intensity left no possibility of misinterpretation. “I don’t believe you did everything possible. Absent your excuses, the obvious conclusion is that you failed to save the lives of two healthy boys.”
Without waiting for a response, Kaine walked past Morgan. When he got to the doorway he stopped. “If you think this is over, you’re sadly mistaken. You have no idea who you’re dealing with, and if I have anything to say about things, you and this hospital are going down.”
PRAISE FOR
Gary Birken, M.D., and Plague
“Fans of Robin Cook, Patricia Cornwell, and Kathy Reichs are going to want to put Plague on his or her must-read list. The heroine is spunky, intelligent, and intuitive, a combination that makes her an excellent medical detective.”
—Midwest Book Review
Titles by Gary Birken, M.D.
ERROR IN JUDGEMENT
FINAL DIAGNOSIS
PLAGUE
EMBOLUS
CODE 15
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CODE 15
A Jove Book / published by arrangement with the author
PRINTING HISTORY
Jove mass-market edition / December 2009
Copyright © 2009 by Gary Birken, M.D.
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To my parents
To err is human, to cover up is unforgivable, and to fail to learn is inexcusable.
SIR LIAM DONALDSON,
SPEAKING AT THE LAUNCH OF THE
WORLD ALLIANCE FOR PATIENT SAFETY IN
WASHINGTON, DC,
ON OCTOBER 27, 2004
DADE PRESBYTERIAN HOSPITAL
TO: All Officers, Department Chiefs, Chief Nursing Officer.
FROM: Robert Allenby, C.E.O.
SUBJECT: CODE 15s
Listed below is a partial list of the types of medical errors and adverse patient outcomes, termed CODE 15s, which must be reported to the state of Florida’s Agency for Health Care Administration (AHCA) within fifteen days of their occurrence. Please be advised that all medical mistakes that result in patient injury must be reported to this office.
• Death
• Wrong surgical procedure
• Spinal damage
• Brain damage
• Surgery performed on the wrong patient
•
Surgery performed on the wrong site/side
• Procedures to remove foreign objects remaining from surgical procedures
• Surgical repair of injuries or damage from a planned procedure
• Significant medication errors
• Failure to diagnose a life-threatening illness/ injury
PART ONE
CHAPTER 1
DADE PRESBYTERIAN HOSPITAL
NORTH MIAMI, FLORIDA
MARCH 3, 2007
The port wine-colored rash that shrouded Andy Kaine’s body was an undeniable omen of his impending death. Clad in a sterile green gown and wearing a protective plastic face mask, Dr. Morgan Connolly, chief of Emergency Medicine, moved to the head of the stretcher. She motioned to the paramedic who had just transported the critically ill young man to the hospital.
“What’s the story on this kid?” she asked above the cacophony of numerous high-pitched alarms.
“He’s a freshman at Florida International University. His girlfriend found him in his dorm room about forty-five minutes ago. He was completely unresponsive.”
“What were his vital signs coming in?” Morgan asked.
“We had a lot of trouble getting a blood pressure. Maybe it was forty.”
“What about a pulse?”
He shook his head. “We never felt one.”
“When did you start CPR?”
“In his room. We also intubated him,” he said, pointing to the plastic tube that they had placed through Andy’s mouth and down into his windpipe.
Taking particular note of his ashen color and vaporous eyes, Morgan turned to Pam Devlin, the charge nurse. “His blood pressure’s not registering on the monitor. See if you can get one manually.”
“I just did,” Pam answered. “It’s thirty over zero.”
From her new vantage point, Morgan studied the amorphous, punched-out lesions on Andy’s torso. They each wept a blood-tinged straw-colored fluid and, as a group, seemed to be multiplying in front of her eyes. Morgan was quite familiar with the highly contagious strain of meningitis. It was one of the few diseases that instantly filled her with an all-encompassing feeling of doom and helplessness. Morgan took a step back.
Even though she knew a full-blown code blue was almost certainly an exercise in futility, she felt she had no choice.
“We’re going to give this a shot. Continue the chest compressions.” She then pointed to a plastic IV bag suspended from a metal pole. “Open up that saline all the way. Somebody get me a full loading dose of penicillin.”
“He’s crashing,” Pam said, pointing at the flashing red display on the blood oxygen monitor that was in a freefall. “I can’t get a blood pressure.”
The respiratory therapist, who was standing next to Morgan, continued to squeeze the breathing bag. “I’m not getting much air in. His lungs must be filled with fluid.”
Morgan eyes bolted to the cardiac monitor. It showed flatline. “Keep up the chest compressions and give him an amp of epinephrine.”
“Giving it now,” one of the other nurses answered as she injected the medication into Andy’s IV.
“He’s not responding,” Morgan yelled. “Give him another amp.”
“Going in now,” the same nurse answered.
For the next half hour Morgan and the code blue team did everything possible to bring Andy back to life. But his face remained the color of chalk, and his eyes fell deeper into his skull, leaving his pupils widely dilated and hollow.
Finally, Morgan stepped back from the stretcher. The words of her mentor and professor of emergency medicine echoed in her mind with the same sobering effect as they had fourteen years ago when she was an intern: Any physician worth their salt will learn to recognize the difference between a resuscitation and a resurrection.
Morgan pulled off her gloves and noted the time.
“We’re done here,” she announced in a monotone. “Make the time of death ten past nine.”
Morgan stepped away from the bedside and pulled off her sterile gown and mask. She tried, but she couldn’t shift her eyes from Andy’s lifeless face. Over the past ten years she had seen death come in many forms. But the loss of Andy Kaine and what was soon to follow would remain rooted in her memory for many years to come.
CHAPTER 2
In a hush that inevitably follows the unexpected death of a young, healthy person, the nurses and other health-care providers steadily made their way out of the room.
Morgan stayed for a time, eventually finding a seat on a scuffed-up plastic chair. The fact that Andy’s fate was almost surely sealed before the ambulance ever arrived was of little consolation.
Pam pulled up another chair and sat down beside her. “His girlfriend told the paramedics he was fine this morning. She saw him in the library studying for a marine biology exam.”
“Dr. Connolly,” came a hesitant voice from the doorway. “I know this is a lousy time but North Miami Rescue’s on the phone. They’re on scene of a bad car accident and want to speak with you stat about two injured kids.”
Morgan filled her lungs and then let the breath slowly escape.
“What now?” she muttered before turning around and heading out of the room. When she reached the nursing station, the unit secretary handed her the red phone, which was used exclusively to communicate with the paramedics in the field.
“This is Dr. Connolly.”
“This is North Miami Rescue, Doctor. We’re on scene of a motor vehicle accident. We have two pediatric patients who were unrestrained backseat passengers. Their vehicle was broadsided on the driver’s side. It took us twenty minutes to extricate them. We have them on backboards and would like to transport them to your facility.”
“What are their vital signs?”
“Pulse and blood pressure both within normal limits.”
“What’s their neurological status?”
“The younger one’s a little groggy. The older one seems okay. They’re both able to respond to my questions.”
“What are their ages?”
“Nine and seven.”
“Are they having any trouble breathing?” she asked.
“Negative, but the nine-year-old is complaining of some chest pain.”
“Anything else?”
“The seven-year-old is a little pale.”
“Can you identify any major injuries?” she asked.
“Not at this time.”
Knowing that paramedics tend to overreact when assessing injured children, Morgan said, “Both victims have normal vital signs and are breathing without difficulty. Is that correct?”
“That’s affirmative.”
“And both are alert and responding to your questions?” she asked.
“Yes, but we’d like to save some time by transporting them to Dade Presbyterian. We’re less than ten minutes from your facility.”
“Negative. We are not a state-designated pediatric trauma center. Both of your patients are stable. Transport them directly to Ryder Trauma Center per Dade County protocol.”
“Will do. Thank you, Dr. Connolly.”
Morgan replaced the phone and pushed back in her chair. She was just about to dictate a note documenting the events of Andy Kaine’s death when Pam approached.
“You’re not going to believe this,” she said in a hurried voice. “The paramedics are bringing in Andy Kaine’s roommate. He’s already got the rash.”
“How bad is he?”
“They said he’s still breathing on his own but his vital signs were borderline.”
“What’s their ETA?”
“About five minutes.”
“Are the parents here yet?”
“Patient Relations said that the mother is in the Far East on business. I’ll check with them to see if the father got here yet.”
“Let’s use the trauma room,” Morgan suggested.
“It’s already set up.” Pam turned and started to walk away. After a few steps, she stopped and turned around. “There’s someth
ing else you should know. This kid’s not just Andy Kaine’s roommate. He’s his brother.”
Well aware of what she would soon be faced with, Morgan came to her feet. Fearing the worst, but seeking no explanations for the injustice or making any pleas for divine intervention, she simply walked toward the trauma room, ready to do her job.
CHAPTER 3
Waiting for any news regarding the condition of his sons, Mason Kaine, a muscular man with a jutting forehead that overhung narrowly spaced eyes, paced in front of the registration desk.
His apprehension mounting, he finally decided to find a seat among the countless others waiting restlessly for either medical attention or some news of their loved ones. Loosening his tie, he wondered why the hospital felt compelled to keep the emergency room’s waiting room so oppressively hot. Normally he wasn’t particularly sensitive to temperature, but the heat mingling with the foul scent of illness left his stomach in turmoil.
Ten minutes passed. His patience exhausted, he stood up and walked over to the same desk that he had already visited twice. He waited for the triage nurse, a frazzled-looking woman with washed-out and thinning silvery hair, to look up and acknowledge his presence.
“Excuse me,” he began in a measured voice, trying to put aside the irritation on her face, “I’m still waiting for information regarding my sons.”
“As I told you before, Dr. Connolly is very busy. She’ll be out to speak to you as soon as she can. Now, if you’ll just have a seat.” Without waiting for a response, the nurse looked back down at the chart that she had been working on.
Kaine looked down at his watch. “But you told me that the doctor would be out to see me at least—”
She raised her eyes slowly. Stopping after every word, she said, “It’s been a very busy night. We’re asking all family members to bear with us and be as patient as possible.” He watched as she craned her neck to see past him. He didn’t have to turn around to know there was somebody behind him. The nurse, now wearing a scripted smile, said, “Dr. Connolly will be out as soon as she gets a free minute.”