To her credit, Joanne Marsh threw herself into making the BCMA system live up to her claim of it being “nearly foolproof.” Albert Cappelli’s sense of having seen it all, as well as his part in the overdosing error, gave him a unique role and a stake in the whole project. When Rob DiPerna espoused the elegance of the program’s design, Cappelli was there to remind him of how things really worked in a busy urban hospital pharmacy. And, as Cappelli readily admitted, elegant design meant nothing when hospital staff put more faith in their own judgment than the judgment of software designers in Kansas City.
After two twelve-hour days, the committee’s work was done. Its bleary-eyed members bade Sarah good night at seven on Friday evening. As they headed off for the weekend, Sarah still had to put the committee’s work-product into a package that would prove compelling to the Arkins and their legal counsel. Harry was coming up with the offer for financial compensation for Ariel’s pain and suffering, as well as for compensatory damages. He was also talking with legal counsel for the heparin manufacturer about addressing their confusing labeling, which had apparently contributed to numerous overdoses throughout the country. It was Sarah’s job to synthesize his work and the work of the committee for the ten o’clock meeting the following Tuesday. She had just one final thing to do before getting down to work, and that was to get together with Dr. Smith.
Though Mess had invited him to join the committee, Dr. Smith begged off, mincing no words about how ridiculous it was to put a doctor’s rear end in a chair for two full days if the hospital was trying to address staffing shortages. However, he did agree to drop in on the deliberations whenever possible. Though his time was short, he was a quick study. And, like Cappelli, he provided a reality check by reminding the committee of the demands of a busy teaching hospital.
Since Mark Arkin seemed to put so much stock in his opinion, Sarah didn’t want Dr. Smith coming to the Tuesday meeting unaware of the committee’s final recommendations. She asked him to come to the conference room after work on Friday evening. To sweeten the deal, she offered to provide a dinner of his choice. Apparently, he was a fan of Thai food, the hotter the better. She got the name of his favorite restaurant and his order. They decided on seven-thirty for the start of their working dinner. After sitting all day, she looked forward to picking up the food herself, rather than having it delivered.
As soon as she exited the hospital, her senses reawakened. The chilly air on her face and the smell of chestnuts from a corner pushcart re-energized her. Even the blast of the cabbies’ horn had a salutary effect. She toyed with the idea of extending her walk before reluctantly heading straight to the restaurant.
* * *
As she approached the conference room, dinner in hand, Sarah was surprised to find Dr. Smith waiting, texting on his phone. Then she remembered he had been on time for his interview on Monday as well. Maybe he was one of the few doctors who were habitually on time, or maybe he was just exhausted and wanted to get it over with. In either case, she was happy he was there. She was more than ready to be done with this last task of the day.
The doctor continued texting as she set out the chopsticks, napkins and containers of takeout. As she headed for the office fridge to get some soft drinks, Dr. Smith put away his phone and picked up a brown bag from under the conference table.
“Can I interest you in a beer?” he asked, holding up a bottle.
Known as a cheap drunk in college and law school, Sarah knew a beer would put her under the table. Still, she was impressed that the doctor had thought to make a contribution to their dinner. “Thanks. Very nice of you to provide drinks.” Then she added, “But, I’m so tired, I think a whole beer will do me in.”
“So I see you’re quite the lush,” he laughed. “Not to worry. I won’t be offended if you don’t finish. But I warn you that I’m a man who can’t stand to see good beer go to waste. I’ll take it off your hands whenever you’re ready.”
They were too hungry and exhausted to face the task at hand. Instead, they dove into their generous portions with nary a word about the committee’s recommendations. They chatted about their off-duty hobbies. It soon became clear they both liked to run and to swim, she at an indoor pool on 90th and he at his alma mater, Columbia. That led to the realization that they had both attended Ivy League colleges and pressure cooker post-graduate schools. Neither had any siblings. And work took up nearly all their waking hours.
Sarah was shocked when she looked up and saw it was past nine. Rick was neither surprised nor chagrined. He was enjoying every minute of getting to know Sarah Abadhi, who wasn’t the least bit chilly once she stopped focusing on work. But the clock snapped Sarah back to attention and the pleasant conversation came to an end as she went over every detail of the remediation plan with the pediatric fellow. At midnight, the night custodian asked how much longer they would be.
When it was nearing one, Sarah was satisfied they had covered all their bases and started packing up her bag. Just as the doctor was cleaning up from their dinner, he received a text message. It was Graciela, the pretty nurse on Seven West whom he’d been texting when Sarah arrived with their dinners. Her shift was over and she was headed toward his apartment.
Extending his hand to Sarah, he said, “You’re one hell of a task master, and I mean that as a compliment.”
Then Rick hightailed it out of the hospital, leftover beer in tow, hoping to beat Graciela home.
CHAPTER FOURTEEN
It was common knowledge at her firm that Sarah’s work ethic, legal mind and enormous billables put her on the fast track to partner. She was at her desk early each morning and stayed into the wee hours with the most wired and macho of the male associates. As she approached her thirty-second birthday, her only break from work came from college friends — now scattered all across the country — her parents, Eva and Joseph and the rest of her small family. After living with a man whose betrayal scarred her more deeply than she cared to remember and dating her share of empty suits, she’d given up looking for a life partner. For Sarah, the only difference between the weekend and the workweek was that she could trade her suits and heels for sweats and sneakers.
This weekend was no exception. From the moment she awoke on Saturday, she focused on fashioning Tuesday’s presentation for its intended audience. Catherine Malloy-Arkin, reputed to be intellectually quick and tough minded, wrote features for a highly regarded business magazine. Her husband’s corporate strategy — leave no competitor standing — was legendary. Raised in a working-class family, the scrappy Mark Arkin had clawed his way to the top. As for the attorney who would accompany them, be it the general counsel of Arkin Worldwide or a malpractice specialist, he or she would be the Arkins’ pit bull, safeguarding the family’s interests. There was no doubt the small audience would be a hard sell. The stakes were enormous, and given the harm done to the helpless newborn, emotions were raw. This was Sarah’s most challenging project to date, and since it was her brainchild, her career might well rise or fall on its outcome.
She took only three breaks during the weekend, spacing them out for maximum stress reduction: one long run along the river, an hour of laps at the pool and a phone conversation with her Bubbe Rivka. Rivka was her mother’s mother, a Lithuanian Jew and a Holocaust survivor. At eighty-six, her frail looks were deceiving. The truth was, she had a spine of steel. She was also one of the few people who could send Sarah into fits of laughter. Widowed for years, she still lived in the same Coney Island high-rise where she’d raised her two children. Sarah rarely had time to trek out to the last stop on the subway line, but she tried to call her grandmother every weekend.
This weekend’s call featured a blow-by-blow account of the latest Oprah show. Rivka recounted the story of a bearded transgendered man who was having a baby with his wife. Apparently, his uterus was intact and his age made him the more fertile of the pair. Rivka was fascinated by the story. She was also fascinated by Oprah, whose rags-to-riches life struck a chord with a woman whose famil
y had emigrated to America with nothing more than two small valises of second-hand clothing.
Rivka adored her granddaughter; Sarah was named after Rivka’s mother, who had been murdered by the Nazis during the war. Rivka thought Sarah was both a shankeit and a mensch, a beauty and a fine human being. Rivka was quick to add that she wasn’t the least bit biased, either.
* * *
The Tuesday meeting was set to take place on neutral turf: an upscale boutique hotel just a block from the Arkins’ Upper East Side brownstone. Sarah got to the hotel hours before the rest of the hospital team, which gave her time to organize the environment to her liking. She arranged the rectangular tables in the shape of a U, so all participants could easily see one another as well as the projection screen. Following the seating chart she had devised, she positioned large, two-sided name cards in front of everyone’s place, including one labeled “Counsel for the Arkin Family.” She set the dozen printed copies of the remediation plan behind her name card and then distributed paper and pens so they were readily available to each of the meeting’s participants.
She took pains to make the room comfortable. The thermostat was set to seventy-two degrees. Sarah adjusted the vertical shades so that the sun wouldn’t blind anyone as the morning progressed. She directed the hotel to offer specialty coffees, espresso and chai before the meeting got underway. She awaited a delivery of French pastries from the Meinigs’ favorite patisserie. Just as she was putting the finishing touches on the room, the tray of tarts, éclairs, scones and petit fours arrived and was placed next to the hot pots of coffee and the bottles of water, juice and soft drinks.
The hospital’s team — less Albert Cappelli — was told to arrive by 9:15 in order to do a final review of the presentation before the meeting got underway. Joanne Marsh, Ted Ainslie, Aimee Sackoff and John Mess arrived together by cab a few minutes early. Rob DiPerna, fresh from LaGuardia, walked in with Harry and Doris, who would be keeping the minutes of the meeting. Dr. Smith, having run from the hospital, came through the door at precisely 9:15. His parka, green scrubs and white sneakers stood in bold relief to the tailored suits and fine footwear worn by the lawyers and administrators in the room.
The team finished its final run-through in less than half an hour and the tension in the room started to rise as everyone awaited the Arkins’ arrival. Mess and Ainslie together paced along the length of the room. Sarah took the opportunity to use the bathroom one last time. When the Arkins and their lawyer walked in at seven minutes past ten, Harry muttered a curse under his breath. The Arkins did not, in fact, bring Larry Heidigger, general counsel for Arkin Worldwide, a guy Harry knew to be someone he could work with. No, the Arkins were represented by Reid Baumgarten, famous for winning eye-popping medical malpractice awards. He was slicker than snot and, thanks to the handiwork of his plastic surgeon and cosmetic dentist, movie-star handsome. Plaintiffs loved him for winning them both vindication and a bundle of money for their troubles. Harry figured they were done for. There was no way Baumgarten would let millions be funneled into hospital improvements in lieu of a fat settlement for his clients.
From the get-go, Harry had thought it best to have Sarah run the meeting. Given his history with Arkin, there was no point in picking that scab. And it was Sarah who knew every last detail of the remediation plan. As people started to take their seats and the hotel waiters took everyone’s beverage order, Harry leaned over and quietly whispered in Sarah’s ear, “Knock ’em dead, kiddo.”
Sarah raised an eyebrow and whispered back, “There’s only one guy in the room I hope to knock dead.” With a little grin, she got up and called the meeting to order.
* * *
Sarah had been deliberate in her seating arrangement. She’d placed the Arkins and their attorney at the base of the U shape created by three tables. To Mark Arkin’s immediate right, at a table perpendicular to the one at which he was seated, was Dr. Smith. Sackoff, Marsh and DiPerna sat to Smith’s right. Harry sat beside the Arkins’ legal counsel and opposite Dr. Smith. Sarah, Doris, Mess and Ainslie were to Harry’s left.
Thinking back on it later, Sarah didn’t know how she remained so cool. She stood in the middle of the room and addressed her remarks to the Arkins, whom she’d previously seen together only in the society page of the Sunday paper. “We appreciate you taking the time to meet with us after the difficult week you’ve experienced,” she began. “We’d like to thank both of you in advance for giving us the opportunity to explain our plan for improvement.”
It was clear they were still suffering the effects of their ordeal. Mark looked haggard, showing every day of his fifty-two years. Catherine Malloy-Arkin had her blond hair pulled back in a ponytail; she appeared tired and wan.
Like the good lawyer she was, Sarah asked a question to which — having checked with Dr. Cho — she knew the answer. “I hope Ariel is doing well?”
“She’s better…so much better,” Catherine said with a little smile.
“That’s wonderful news,” Sarah said, genuinely glad for the child’s recovery.
“Yes, it is. But I want to make it clear at the outset that I don’t want to be away from Ariel for long. Can this meeting be wrapped up in an hour?” Catherine asked, tapping her fingers on the table.
Sarah scanned her fellow committee members and Harry for agreement before responding. “Of course. We understand how anxious you are to get back to Ariel. We’ll complete our presentation within your preferred time frame. To make things more efficient, I suggest that you hold your questions until you hear the entirety of our proposed improvement plan. There are paper and pens available if something comes to mind during the presentation.”
The Arkins and Baumgarten nodded their silent assent.
“First, on behalf of the hospital, I would like to say how sorry everyone is that your baby girl was subjected to a terrible error at the hands of our staff. I personally interviewed everyone involved in your daughter’s care. Each staff member expressed profound regret knowing that Ariel suffered because of our mistake. I want to assure you that this error has had, and continues to have, both personal and institutional ramifications.
“From the institutional perspective, I’d like to emphasize that the intent of the hospital is to leave no stone unturned in its effort to prevent another child from going through what Ariel went through. Its goal is nothing short of the elimination of medication errors. To that end, it assembled this team to create the remediation plan we are about to present. I’d like to introduce the team: Dr. Richard Smith, fellow in pediatric intensive medicine; Aimee Sackoff, director of nursing; Joanne Marsh, director of pharmacy; Rob DiPerna, chief of the design team for Accumeds, the hospital’s computerized medication administration system; Ted Ainslie, hospital vice president for finance and budget; and John Mess, hospital vice president for risk management. Counsel for the hospital is Harry Meinig. I’m Sarah Abadhi, Mr. Meinig’s associate. Also here today from our firm is Doris Ostrom, who will be keeping the minutes for this meeting.”
“Mr. Meinig and I go way back,” Baumgarten interjected. “Nice to see you again, Harry. Too bad it’s under such terrible circumstances.”
Harry didn’t blink. “We can all agree that we’re here today to make sure those circumstances are never repeated. In the interest of time, I suggest we let Ms. Abadhi continue.” Then he gave Sarah the nod to go on.
“Each of our team members will present the proposed changes in their area of expertise. First to present is Aimee Sackoff, director of nursing.” Sarah motioned to Sackoff to begin as she returned to her seat to take charge of the PowerPoint visuals.
“Good morning,” Sackoff started. “I would like to reiterate what Ms. Abadhi said. Our entire nursing staff was shaken to the core by the error that was made in Ariel’s case. However, we believe that something really powerful, really good, may occur as a result of what your baby experienced. As you may know, your daughter’s nurse was working back-to-back shifts last week, due to a staffing shortage.
That nurse is one of our very best, most experienced nurses. We believe that fatigue played a role in her not catching the medication error. We are committed to addressing the problem of fatigued nurses delivering beside care. In keeping with that commitment, we propose to be the first hospital in the city to eliminate mandatory overtime for nurses,” Sackoff said triumphantly, revealing none of her previously expressed reservations about the proposal.
“This is so important,” Sackoff explained, “because we all know that people do their best when they’re not tired. This will be a very costly measure. Mr. Ainslie will be able to give you the specifics on that. But to me, as a veteran nursing administrator, this proposal indicates that the hospital is committed to spending whatever it takes to make mandatory overtime a thing of the past.” She then elaborated on the numbers of new nurses who would be hired, with Sarah showing the graphics to illustrate the increases in staffing. The head of nursing concluded with a brief discussion of contingency plans for times when illness might strike the nursing staff, as had happened during Ariel’s hospitalization.
Sackoff was as concise as she was enthusiastic and, to Sarah’s mind, persuasive. Sarah introduced Joanne Marsh next, keeping her fingers crossed that she would do as well.
“Good morning to you all. Before I explain our plan for improvement, I want to give you my personal, heartfelt apology. The error that harmed your daughter originated in my department. Throughout my long tenure here at the hospital, I’ve made the elimination of medication errors my number-one priority, so when I learned that a brand-new employee in our pharmacy was at fault, I was distraught. Though I know my apology will not put things to right for your family, I want you to know that everyone in my department was heartsick to learn of the error. We have redoubled our efforts to make certain that it never happens again.
Fertility: A Novel Page 8