by Kay Hadashi
“Do you have any questions about tomorrow, Dottie? I’m not your surgeon, of course, but maybe you’re curious about what’s going to happen in the morning?”
“Pop and Josh will be here?”
“They promised to be here before you go in. I might see you in the OR because I have cases to do there also. Anything else?”
Dottie’s eyes were already heavy, so Melanie had Thérèse say goodnight and they left.
“Grandmother is sick, huh, Momma?” the girl asked as they rode home.
“Yes, she is. You understand about how people get sick?”
The girl winced. “Kinda sorta. She gotta be at the hospicable for a while.”
Melanie sighed. “Yep, got to be at the hospicable for a while.”
Chapter Ten
Melanie couldn’t sleep well that night, more worried about Dottie than what she had expected. Even before sunrise, she got up, started the coffeemaker, and went for a run along the beach. After a couple of miles, she turned back. Instead of going straight home, she stopped at her favorite bench near the beach and sat for a quick rest.
“Mom, are you around?”
When she felt several strong gusts of wind in short succession, she decided her mother was near but not close enough to make an appearance.
“Mom, Dottie’s having brain surgery today for a tumor. If you don’t mind, and if it’s at all possible, could you look in on her during the case? It’s in your old neuro room.”
A voice seemed to come on the breeze that blew through. “I hope they’ve done some remodeling since then.”
“Just a couple of years ago. Very nice equipment in there. Honestly, I have no idea what half of it is.”
“I won’t either.”
“You always told me it’s not the equipment, Mom. It’s the hands using it, and the mind making the hands work.”
“You learned that much from me, anyway.”
There was another series of strong gusts and Melanie knew her mother was gone. Leaving the bench, she went home, knowing she had done everything she could, worldly and else wise.
***
Melanie was too busy in the morning with her own cases to say hi to Dottie before she went into surgery. During the break between cases, Melanie tried peeking through the window into Dottie’s operating room while she scrubbed her hands. All she could see was that Dottie’s craniotomy for brain surgery was underway. Somehow, Dottie had been lucky enough to get West Maui Med’s most experienced neurosurgeon, a man near retirement. Dr. Warner had been a new surgeon when Melanie’s mother was still working at the hospital as a neurosurgeon, and he had received some extra training from her. Now, he was viewed as the kindly senior citizen of the hospital that always had a smile for everyone.
The nurse came out to say hi.
“Trinh, I didn’t know you were on today,” Melanie said.
“Actually, Josh came over last night to ask if I’d come in and help with her case.”
“You didn’t have to.”
“I was glad to.”
“How is she?” Melanie asked.
“She’s okay. Scared to death when we took her in, but somehow sedation always wins that battle.” Trinh nodded at the door. “I need to get back to work.”
***
By the time Melanie was done with her scheduled cases, it was well after noon. Dottie’s room was empty and had already been cleaned up, the team long gone, her surgery done. Melanie had patients to check on in the Surgical ICU, and once she was done there, she went to the nearby Neuro ICU to check on Dottie. Before that, she went to the family waiting room to see who was there. Getting close, she heard her daughter’s familiar singing voice. Rounding the corner, she found Pop, Josh, and Thérèse in the waiting room, the two men looking glum.
“Hey there, little girl,” she said to her daughter. She looked at Josh and Pop. “How is Dottie?”
“Not waking up,” Josh said, barely looking up from a spot on the floor he was staring at.
“Momma?” the girl asked, no longer singing.
“Don’t you recognize me?”
Thérèse tilted her head to one side. “Why you wearing pajamas?”
“That’s right. You’ve never seen me dressed like this at the hospital, have you? I change my clothes when I come to work every day.”
With a shrug, the girl went back to singing quietly while playing with her dinosaur, the tail looking to be glued on since the day before.
“How long does it take for her to wake up?” Pop asked.
“Did Doctor Warner talk to you yet?”
“He did. He said Mom would be out for a couple of days,” Josh said.
“That’s my understanding, that most brain surgery patients are kept in medication comas for a while to allow their brain to recover,” Melanie said.
“He wasn’t feeding us a line?”
“No, Josh, not that I’m aware of. Look, the two of you need to start trusting people at the hospital, otherwise this process is going to get a lot more strenuous than necessary.”
“We just met him yesterday. We don’t know anything about him,” Pop said defensively.
“Doctor Warner has been practicing here since my mother was. In fact, she handed her practice over to him. She wouldn’t have done that with just anyone.”
“He’s okay?” Josh asked.
“He’s fine. He’s the most experienced practitioner here.”
Josh motioned for her to go out in the hall with him. “He’s experienced here, but how would he measure up in a real hospital?”
“What do you mean, a real hospital?”
“This place is okay for Maui, I guess. But wouldn’t Mom have better doctors and nurses on the mainland?”
She stepped up to be within inches of his face. “Pardon me?”
“Everybody knows Hawaiian hospitals aren’t as good as the ones on the mainland. I’ve heard the doctors and nurses who work in Hawaii are second-rate and couldn’t get jobs somewhere else. Or they’re just surf bums with jobs.”
“Does that include me?” Melanie pursed her lips, twisting them sideways while giving her response some thought. “Am I one of the second rate doctors, or the surf bum doctor?”
“I don’t know. Because hearing you talk about it, a lot of your patients go to Intensive Care. Or die.”
She cocked her head. “I do surgery on peoples’ hearts, lungs, major blood vessels, on cancer patients, and on critically injured accident victims. There are very few medical centers anywhere in the Pacific Rim that rival the care West Maui Med provides. That started with my mother working here decades ago, and continues with me. And Doctor Warner. And Trinh, who was first trained by the military, and then at one of the best centers on the West Coast. She also came in to take care of your mother on her day off. Did you bother to say thanks before she went home?”
“I didn’t know I was supposed to,” Josh said.
“You asked her for a favor and didn’t bother thanking her? What’s wrong with you?”
“Get off your soap box, Melanie. There’s more to life than the hospital,” he said before walking away.
Melanie’s phone chimed with a text that she was needed in the ER, stat. “Said with a sense of irony.”
***
By Saturday evening, Melanie finally had a break from seeing patients and doing surgery. Taking a tray of food from the cafeteria to her office, she sat at her desk and let out a sigh.
“This job will be the death of me yet.”
She took a bite of her sandwich before turning her attention on the stack of incident reports from Andrew’s office. Seeing they were organized in a simple chronological order, she started at the top with the most recent one. Four hours later, she had a stack of reports related to medications, either missing, outdated meds, or the worst of all, drug administration errors. Unfortunately, she was only halfway through the stack of reports.
“What am I looking for with all these stupid things again?” She looked at several of them. “Oh yeah, med
s in code carts.” She sorted through the reports making new stacks. “Well, there aren’t many of those. The pharmacy really takes good care of med stocks, that’s for sure.”
Something caught her eye after a while.
“What’s this? Somebody from the state health care licensing agency came in a few months ago and did an audit of all pharmacy stock. Somehow, they found a discrepancy in the amount of three meds that had been ordered and delivered but were not found in stock. Those were Fentanyl, Atropine, and Ephedrine. Hmmm. That’s a little more than coincidental. But how much of a discrepancy was there?”
She found incident reports written by pharmacists over missing meds on one occasion, and overstock on another, warranting return of overstock to the pharmaceutical manufacturer. She flipped through a handful of reports, trying to see something that wasn’t immediately apparent.
“What’s wrong with this picture? What am I not seeing? Wait a minute.”
She picked up her phone and called the main pharmacy. Getting one of the techs, she explained what she was doing. She was in luck to get one of the pharmacy techs that did the ordering.
“So, how much ephedrine do you order each month? Does the hospital use much of it?”
“Usually four boxes, sometimes five or six.”
“How many vials are in a box?”
“Twenty-five. They come packed in a small box with paper dividers between them, the whole thing wrapped in plastic to prevent breakage.”
“So, about a hundred vials a month of ephedrine for the entire hospital?” Melanie was making notes as she talked to the pharmacy tech. “I saw in one place that ten boxes were ordered, and twenty more were ordered another time. Why so much at once?”
“Twenty boxes of ephedrine? No, we’d never order that much. That’s almost enough for an entire year,” the pharmacy tech said. “That could create problems with stock outdating before it was used. We do everything we can to prevent that sort of thing.”
Melanie stopped writing. “So, that’s an unusually large amount and with no reasonable explanation of why it was ordered?”
“I can’t think of an explanation. If it’s important, I can send an email to the head pharmacist to ask why so much was ordered in such a short time and get back to you.”
“Please. Is that who orders it? The head pharmacist?” Melanie asked.
“Actually, much of our ordering is contracted to an outside vendor. They send reps in to check our stock and reorder as needed on a weekly basis. We have to maintain some of the meds on our own, but most of the more common stuff is maintained and ordered by an outside vendor. It’s cheaper that way and frees up one of us to do other work instead of constantly checking stock and ordering things. Other parts of the hospital are like that, with sterile supplies and disposable one-time-use-only equipment. You’d have to check with the stockroom and warehouse for all of that, though.”
“I see. But what I’m most curious about are the large orders of ephedrine. What happened to all that ephedrine? One batch was about three months ago and the other larger batch was just last month. Are all those vials of ephedrine just sitting around somewhere?”
“I haven’t noticed an unusually large amount of it. Hold on a second while I check on something.” Melanie could hear typing on a computer keyboard in the background of the call until the pharmacy tech came back on the line. “Yes, I see here in the records that those batches were ordered and delivered but never checked into stock.”
“Why weren’t they checked in?” Melanie asked.
“Well, probably because the pharm tech that received the delivery noticed how large the order was and refused to accept it. That was Francine. She would’ve mentioned it to the pharmacist on duty that day, and the pharmacist would’ve filled out the incident report you’re looking at right now. That should’ve been Leah Kawata.”
Leah was somebody else Melanie had gone to school with as a kid. Even though it was twenty-five years later, she couldn’t see how Leah could possibly be implicated in diversion or drug crimes. “Any idea of who the vendor was that did the ordering?”
“It used to be Bill Fisher, but there was a new one named…” There was silence on the phone for a moment. “…Katie something. I’m trying to read the logbook of visitors. They have to sign in and out and wear a vendor nametag while on premises. Her last name is something like Simmons, Sampson, something like that.”
“Would all of that overstock of ephedrine have been sent back?” Melanie asked.
“Let me check.” There was more typing. “I don’t see anything about a large amount of ephedrine being returned. There were three outdated vials returned, along with a few other outdated meds, but not several boxes.”
“If it was outdated, why not just toss it? Why go through the trouble of returning it?” Melanie asked.
“We get credit for it. Since that outside vendor orders it, anything they order that outdates or is unnecessarily wasted because of them has to be credited back to us. Otherwise, it would get expensive after a while. Honestly, they do a better job of keeping track of what we need and keeping out stocks up to par than we do.”
“Okay, I guess the million dollar question is what happened to all that ephedrine? If it wasn’t checked into hospital stock, and it wasn’t returned, where the heck did it all go?”
“You got me, Doctor. Anything else I can help you with?”
Melanie ground a knuckle into the tic in her eye. “Only if you have a miracle cure for headaches that I haven’t heard about. Otherwise, I don’t know what else to ask. Thanks for your help, though.”
After the call, she photocopied several of the incident reports and made notes on the copies, circling odd items she didn’t quite understand quite yet. On one, she put a yellow sticky note for Detective Nakatani to look at closely. After two more hours of reading reports, she’d had enough. Going to the emergency room, she found it to be quiet. That gave her the chance to make leisurely rounds on her patients. At the very end, she went to Dottie’s ICU cubicle. She found Josh sitting at the bedside.
“How is she doing?”
“She hasn’t woken up yet.”
“I explained about the medically induced coma. From what the nurse said, Doctor Warner is planning to reduce the sedation starting tomorrow morning. That’s a full day early.”
“Does she really need that breathing tube in her throat?”
“She wouldn’t be able to breathe on her own because of the deep sedation.” She gave her husband’s hand a squeeze. “It’s okay, Josh. It’s done all the time. I do it with many of my patients. Through the night, the doses of sedation with be reduced, allowing her to slowly wake up, and in the morning they hold the sedation drugs all together. Once she shows she can breathe on her own and follow commands, they turn off the ventilator and remove the tube. They would keep all that equipment around just in case, but she should be fine.”
“Warner came by a couple of times and said everything went well. Isn’t that what doctors tell everyone?”
“Where do you get that idea?” Melanie asked.
He shrugged. He also seemed demoralized. “I see it all the time on those TV shows. Something always goes wrong.”
“Maybe that’s what happens on TV, but not here at West Maui Med.” She tried making eye contact with him. “Look, we have a policy to be honest with our patients. Remember how blunt Hennessey was with you the other day about her diagnosis? He was being honest, maybe a little mean-spirited in the delivery, but honest.”
“You make it sound like there’s nothing to worry about.”
“There is. Your mother still needs to recover in this acute phase, and then will need several weeks, if not months of physical therapy before she’s completely back to normal. That won’t be easy for her or for the rest of us. But what I’m curious about is why you haven’t asked about the elephant in the room.”
“What’s that?” he asked.
“Her prognosis and what the pathology results are from her tu
mor. I talked with Doctor Warner for a while about your mother. What did he tell you?”
“He was talking about meningioma and how we needed to wait for a few days before getting the final diagnosis from pathology. It sounded bad. Why is the pathologist blowing us off like that making us wait? Don’t you have any pull in this place at all?”
Melanie was tired and her patience was running thin. “Josh, I’m the one who asked Doctor Warner to treat your mother. He even came in on a day off instead of putting your mother on his schedule later next week. I also got the hospital’s best cancer pathologist to come in on a weekend, just to do the preliminary frozen sections of her tumor. They already know it’s a meningioma, which is mostly good news. He also promised to put her tumor at the very beginning of Monday’s schedule and work on it until he’s done everything he can with it. I also got West Maui Med’s best neuroanesthesiologist to provide her anesthesia in the OR.” She stood and looked down at Josh. “Now, I don’t know what else you could possibly want from me or the hospital, but Dottie got the very best neurosurgical, histological, and nursing care that could be found anywhere in the Pacific region. Remember that.”
Melanie left Josh behind at Dottie’s beside. Going out to the waiting area, she found Thérèse looking at a magazine and Pop looking at his phone. She gave Pop a quick wave before sitting with her daughter.
“Momma, look. Somebody in the mazaline look just like you.”
Melanie looked to find a modern advertisement for outdoor adventure clothing from a company she modeled for right after leaving the Air Force, an old image of her rock climbing in Spain. “Oh, yes. She looks just like me, huh? What’s different about her from me?”
“Got blonde hair.” Thérèse looked at her mother’s face. “Kinda younger.”
Melanie sighed. “Yes, a lot younger. Want to know a secret?”
“What secret?”
“Don’t tell anyone else, but that was me a long, long, long time ago.”
“Momma had blonde hair?”
“When I was really young like in that picture.”
Thérèse looked at the advertisement again. “Can I get blonde hair?”