Code 15

by Gary Birken

  “I understand,” he said in a manner that left no doubt in her mind that he would respect her wishes.

  “Can you find someplace safe for that tube of blood?”

  “I know just where to put it,” he assured her. Morgan could feel his eyes probing her. “If you need me, just let me know.”

  “Thanks, John.”

  As she started away, he said. “Your father and I were good friends, Morgan. He was an exceptional physician and an extremely insightful man. If he were here, I’m sure he’d tell you to proceed with extreme caution.”

  CHAPTER 30

  Ben had just finished teaching a one-hour introductory course in instrument flying when his secretary, Lisa, motioned for him to pick up the phone.

  “Who is it?” he asked from across the large classroom he had recently added to his school. Lisa had worked for Ben since the day he opened his medical practice and had come with him when he changed careers. She was indispensable, but not one to embrace a strict professional office environment.

  With a saccharine smile, she wagged her finger at him and in a singsong voice said, “It’s Dr. Connolly. You’d better hurry.”

  Ben pointed at her and then feigned slitting her throat. She covered her face and pretended to shudder in fear.

  He picked up the phone. “Hi.”

  “I just met with John Ackerman. We analyzed the nitroglycerine drip used in the Tony Wallace case. Somebody put a massive dose of protamine in it. I suspect it was intentional.”

  Ben sat down in one of the folding canvas-backed chairs in the front row. “Slow down a sec. What makes you so sure it wasn’t accidental?”

  “The only person who makes up the drip is the anesthesiologist, and that was Mike Quintana. I’ve spoken to Mike on three separate occasions about the case. He’s positive every med he gave and every drip he prepared was fine.”

  “Mike’s a meticulous physician, but he’s also a human being . . . and, if my memory serves me correctly, you’re the one who’s always saying human beings make mistakes. I just don’t see how you can categorically reject the possibility that Mike made an error.”

  “Because for each open-heart case the pharmacy sends the anesthesiologist two vials of protamine. I’ve examined both of them. They were untouched as the day they were shipped from the factory.”

  “I assume Mike made this drip the morning of surgery.”

  “Uh-huh.”

  “Then explain one thing to me. How would anybody, in the middle of a busy open-heart operating room, be able to add protamine to a drip without being seen?”

  “They wouldn’t. But if somebody had snuck into the OR a few hours before the operation . . . say three in the morning when the suite was closed, he could have drained the nitroglycerine bottle and substituted protamine. That way when Mike made up the drip, he would have thought he was adding nitroglycerine to the IV solution when he was really adding protamine.”

  “That sounds a little far-fetched, Morgan.”

  “But it’s possible,” she insisted. “Weren’t you the one who told me to open my mind and treat this investigation as if it were an aviation inquiry?”

  “But why would somebody do that? What would be their motive?”

  It was a question Morgan expected him to ask. “I don’t know,” she told him. “Not yet, anyway.”

  “Aren’t you suppose to meet with Bob Allenby today?”

  “I’m on my way now.”

  “Are you also going to tell him what you just told me?”

  “Bob’s looking for answers. It’s my job to provide them.”

  “I’m sure Bob’s looking for answers, but I think he’s looking for medical explanations. Once you tell him you suspect that we’ve had two Code Fifteens caused by criminal acts . . . well, that’s going to be a tough bell to un-ring. We talked about the fire, aim, ready approach to things.”

  “I appreciate your concern but I don’t see what choice I have. I’m obligated to tell him.”

  “I’ll remember you said that.” Ben stopped for a few moments. He then said, “Listen, I’m flying up to Vero Beach late this afternoon to pick up some parts for one of my planes. Why don’t you come with me? We can talk about your meeting with Bob. “

  “I’ll go if I can fly.”

  “One way,” he told her firmly.

  “What time?”

  “Meet me on the flight line at four.”

  “I’ll be there.”

  Ben came to his feet slowly and walked over to a small table. He tapped the power button on his laptop. Waiting for it to boot up, his mind became preoccupied with Morgan and her meeting Bob Allenby. If he concluded that Morgan was a grief-stricken, stressed-out physician who wasn’t thinking rationally, things could go south for her pretty fast. Ben was sure the first thing Bob would do after Morgan left his office would be to call John Ackerman to confirm her story. But what hadn’t occurred to Morgan was that Bob might assume it was Morgan who had tampered with the drip to give credibility to her conspiracy theories.

  CHAPTER 31

  Morgan stepped off the elevator on the eighth floor and strolled down a long hallway until she reached the corporate offices of Constahealth, Dade Presbyterian’s parent organization.

  She was just about to walk into Bob Allenby’s outer office when her cell phone rang. She checked the caller ID. When she saw it was Kevin, she cringed. She doubted whether he was calling simply to say hello but after listening to the phone ring a couple of more times, she decided to take his call.

  “Hello.”

  “I got your check and just wanted to call and say thanks.”

  Knowing Kevin rarely thanked her for anything, she said, “If you’re calling to ask me for more money, you can just—”

  “Take it easy, Morgan. I’m not calling about money. I told you. In a few months I’ll be swimming in the stuff. And don’t think for a second I’m not going to give you your fair share. We’re still married and the law says everything’s fifty-fifty.”

  Fully understanding his cryptic message, Morgan shook her head.

  “It’s nice to see you’ve become so conversant in Florida divorce law. Look, Kevin, I’m running late for a meeting, so unless there’s something else . . .”

  “Did I remember to mention to you before I left that I’m a couple of months behind on my Mercedes payment?”

  “C’mon, Kevin. I can’t believe you didn’t—”

  “Relax, Morgan. If they call you, just tell them we’re separated and that you don’t know where I am.”

  “That’s a great idea except for one minor detail. The lease is in both of our names.”

  “Just put them off until I get back.”

  “And ruin my credit? I don’t think so. I pay my bills. Have a great trip.”

  “Don’tbe somelodramatic,Morgan.Trytobea littlesupport ive for a change. Maybe we’d still be living together if I hadn’t become exhausted trying to live up to your expectations.”

  All too familiar with Kevin’s canned speeches and lame explanations, Morgan flipped her phone closed. Determined not to let his financial irresponsibility ruin her day, she put her phone back in her purse.

  She continued down the hall and pushed open the large glass door leading to Bob Allenby’s office. Julia, his secretary, was one of the few people in his employ who didn’t quake at the mere mention of his name.

  “Go ahead in. He’s waiting for you,” she told Morgan with a quick wave.

  “What kind of mood is he in?”

  She looked up from her desk. “Well, it’s still pretty early, but I haven’t heard any screaming or the sound of shattering glass coming from his office.”

  “That’s something,” she said, with a quick laugh.

  Morgan knocked on the door, waited a few seconds, and then stepped into Allenby’s dark wood-paneled office. She saw him on the other side of the room, gazing out of his window.

  “Come over here and share this incredible view of Port Everglades with me.”

/>   Morgan crossed the room, taking up a position beside him. Bob was a square-jawed man with brick-like shoulders that he oftentimes joked were necessary to support the weight of the hospital. The chronic puffiness under his closely spaced eyes made him appear older than his fifty-one years.

  She gazed out the huge window. It was a clear day and the deep-water harbor with its massive concrete docks loaded high with cargo bins and tumultuous activity was, as Bob so aptly put it, an incredible sight.

  “How’ve you been?” he asked.

  “Fine. I should have called and thanked you for coming to the funeral.”

  “Your dad and I were very good friends. We accomplished a lot of great things for Presby together.” He looked over at her. “Have the police come up with anything?”

  “Not really.”

  “Let’s have a seat,” he suggested, gesturing toward a small mahogany conference table with four leather chairs around it. Morgan waited to see where he was going to sit and then took the chair across from him. The pressure of being the chief executive officer of Dade Presbyterian for the last fifteen years had taken its toll on him in the form of two stomach ulcers and a blood pressure that would have already given most people a stroke. “I wanted to talk to you about these two unfortunate cases from the Cardiac Care Center. The buzz in the hospital is that you figured out what happened.”

  “The buzz?”

  “It’s a hospital,” he said with a casual shrug. “Word gets around—even to the CEO’s office.”

  Morgan wasn’t surprised that Bob knew something was up. She had been as discreet and diplomatic as possible regarding her inquiries, but as he just implied, hospitals are notorious for their rumor networks.

  After an inward sigh, she said, “I believe I know what happened, but I don’t think you’re going to like it.”

  He regarded her politely. “I appreciate your cautious approach, but I’m running out of time. We have two unexplained and rather serious Code Fifteens. If we don’t come up with some answers pretty soon, we’ll have every inspector from the Agency for Health Care Administration down here with pitchforks and lanterns. If you think you know what happened, I’d like to hear about it.”

  Running out of wiggle room, Morgan said, “As bizarre as this may sound, it looks like Alison Greene died of a cardiac arrest caused by a magnetized cross.”

  Allenby cupped his chin and then stroked his thick mustache. “I’m not a doctor, so I’m unaware of how a magnetized cross could harm anybody.”

  “Magnets can affect pacemakers in many ways. They can even cause a fatal heart arrhythmia. I checked with Mira Ramos and she agrees.”

  “And Mr. Wallace?”

  “He received a medication that made the pump clot off.”

  “You can’t be serious.”

  Morgan took her time to explain what had occurred to Tony Wallace in layman’s terms. When she finished, Bob rubbed his chin and asked, “How could we have made such a colossal series of mistakes?”

  “That’s what I’m trying to tell you, Bob. I’m not sure we can assume these two deaths were unintentional patient errors.”

  Bob’s gaze intensified. Finally and in an unexpectedly calm tone, he said, “What are you trying to say, Morgan?”

  “I think there’s a strong possibility that somebody intentionally tampered with the nitroglycerine bottle and that Miss Greene’s visitor intentionally placed a magnetized cross around her neck knowing it would cause a problem.”

  His tone became patronizing. “Surely, there have to be other, more rational, explanations.”

  “I’ve spent a lot of time on these cases, Bob. If anybody can come up with one, I’m all ears.”

  Bob’s complexion took on a scarlet hue. “Do you have any idea what you’re suggesting?”

  Morgan found herself at a delicate juncture. Raising the possibility the Code 15s were intentionally caused and actually proposing it were quite different. She understood Bob’s astonishment. The Cardiac Care Center had been his brain-child, a project he had shepherded from its inception to the ribbon cutting. The result was the most comprehensive and profitable state-of-the-art heart surgery program in south Florida. To Bob’s credit, his vision had proven to be a booming success.

  Morgan said, “I think you’re going to have to strongly consider that these two patients didn’t die accidentally.”

  With a dumbfounded look on his face, Bob spread his fingers and placed his palms flat on the conference table.

  He cleared his throat twice and then said, “If I report to the Agency for Health Care Administration that there’s a deranged lunatic loose at Dade Presbyterian who’s killing our heart patients, they’ll shut down the Cardiac Care Center faster than a New York minute. As soon as they’ve done that, they’ll probably insist we all admit ourselves to the psych hospital. Do you have any idea of the types of sweeping disciplinary powers AHCA has when it comes to dealing with Code Fifteens?”

  “Of course I do.”

  “If what you’re saying should ever become public, the damage to this hospital would be irreparable. It’s like when somebody gets accused of molesting a child. The accusation’s as bad as the deed. Guilt or innocence doesn’t really matter.”

  “With all due respect, Bob, don’t you think it—”

  “Hear me out,” he interrupted. “I’ve listened to everything you’ve said very carefully, and I truly believe you’ve done an incredible job figuring out how Mr. Wallace and Miss Greene died. But that doesn’t mean they were murdered. Doesn’t it make more sense that their deaths, while tragic, were unintentional medical mishaps?”

  “I don’t believe so. What I do believe is that our first responsibility is to the safety of our patients.”

  “I’m well aware of our responsibilities. What I’m saying is, just because we don’t know exactly how these Code Fifteens occurred doesn’t mean we should go off the deep end and come up with some preposterous explanation that could potentially destroy the Cardiac Care Center.”

  “I’ve spent a lot of time looking at these cases. All I can tell you is that at the moment, it’s the only explanation that makes any sense.”

  Bob leaned back in his chair. His tone became much calmer. His next question came as no surprise. “Have you discussed your suspicions with anybody else?” Before she could answer, he injected, “I hope you haven’t spoken to the police about this, Morgan.”

  She did her best to look appalled. “Give me some credit, for goodness sake,” she told him, wanting to cross her fingers behind her back.

  He stood up and walked back over to his desk. He picked up a stack of pink phone messages and began nonchalantly leafing through them. When he was finished, he folded them in his hand and then casually strolled back toward the conference table.

  “Have you received any grief counseling since your father passed away?”

  Although she was frustrated, Morgan smiled. “No, Bob. Do you think I need some?”

  “I think you’d agree that all of us could use a little help from time to time.”

  “My father’s death and my state of mind have nothing to do with my conclusions regarding these Code Fifteens.”

  “All I’m saying is that with the demands of running the emergency department and the Patient Safety Committee coupled with losing your father, well . . . you’ve been under a lot of stress lately. Maybe you came back to work too soon.”

  Morgan was resolute not to show any outward signs of becoming unglued.

  “I’m fine, Bob. The problem isn’t my emotional well-being. The problem is finding out what really happened to these two patients.”

  “It seems to me you’ve already done that.”

  “I think you know what I mean.”

  “There’s no way I’m reporting these two deaths to the state as some type of criminal act,” Bob said categorically.

  “Excuse me,” Morgan said.

  “It seems obvious that Mr. Wallace was the unfortunate victim of a bizarre but inadvertent
medication error. We’ve seen these types of mistakes before.”

  “And Miss Greene?”

  “How could the nurse have known that the cross was magnetized or that it could result in a serious pacemaker problem? I’m sure her visitor meant no harm. The entire thing was just a peculiar sequence of events that led to a horrible tragedy.”

  Morgan waited a few seconds before asking, “Do you really think the Agency for Health Care Administration is going to believe that?”

  “I think they’re more likely to believe a rational explanation involving systems failures than some outrageous explanation that shifts blame to some imaginary homicidal lunatic.”

  “But you must know that—”

  “The only thing I know is that you and your committee diligently performed a comprehensive root cause analysis for each of these cases and now have rational explanations to explain what happened.” He slapped his hands together and added, “The rest is up to the investigators from AHCA. If they raise the issue of criminal activity . . . well, I guess we’ll have to deal with it. But we’re certainly not going to plant that seed in their suspicious heads.”

  “You just can’t leave it at that, Bob.”

  He shrugged and stood up. “Well, I’ll tell you what. I just did.” He walked her toward his door. “I’d like you to write your reports in a calm, rational, and professional manner. I also need an action plan that I can show the AHCA team, which outlines how these problems will never happen again.” He paused for a moment before going on. “What I don’t need is a screenplay for Steven Spielberg’s next movie.”

  “You may regret this, Bob.”

  “I’m prepared to take that chance. Just call me when the committee’s report is ready so I can have legal review it.”

  Seeing the futility in pursuing the conversation any further, Morgan said, “I’ll call you when we have something.”

  “Good. I’ll look forward to reading it,” he told her, escorting her to his outer office.