She had to unclench her teeth before she forced the words out. "Buddy, why was that resident alone in there?"
"Well, I might ask the same thing about Luc Nguyn. He was doing the case without staffsupervision until you scrubbed in to check his work. And that's because you trusted him—with good reason." Jenkins sipped from the Styrofoam cup he held."Murray's inexperienced, but he's okay with the routine stuff. I was there with him to get the case started. I was staffing two rooms today because one of the other faculty anesthesiologists is out sick. I popped in and checked on things periodically, and everything seemed to be going fine. It's unfortunate that Murray missed the signs of anaphylaxis until it was wellestablished."He opened his mouth, but closed it again without saying more.
Anna sighed. "I know, Buddy. I shouldn't be taking it out on the anesthesiologist. Luc should have thought of anaphylaxis too. Hey, I should have thought of it. After all, it's ultimately my responsibility. And you know as well as I that doctors can't be right most of the time. We have to be right all the time."
"Never happen," Buddy said. "We all make mistakes. We just have to learn from them and move on."
"Well, I'm not moving on until I get the answer to this one. There was no reason that patient should have had that reaction in the first place."
"Fine. Happy hunting. I'll see you at M&M, and we'll kick it around some more." Buddy lifted his cup in a silent salute, then walked away.
He'd see her at M&M. Not the candy. Anna wished it were. No, this was Morbidity and Mortality Conference, the meeting each month when the staffdiscussed their patients who had suffered adverse consequences from treatment. "Morbidity" sounded so much better than "something went wrong." And "mortality" was more acceptable than "they died." But when it came to assigning blame, there was no sugar coating here.
Anna dreaded the upcoming M&M conference, where the death of Eric Hatley would be discussed. Until then, she intended to keep looking into why he had died. Was it possible that the anesthesia resident had given the wrong medication? Or mismanaged the anesthesia in some way? She kept coming back to the fact that Dr. Murray was inexperienced and on his own.
Or did the blame rest with Luc? A preventable death would leave a black mark, not only on his record but also on his conscience. She'd heard of situations like this that ruined promising careers, sending gifted surgeons into specialties where they could avoid having to make rapid-fire, life-or-death decisions.
Her pager brought her back to the moment. She recognized the number immediately: the chairman's office. She knew what Dr. Fowler wanted to discuss, and it brought more questions to her mind. Would she even be around to look into this case? Or would she be embroiled in something that didn't involve the death of her patient, but rather, the death of her professional career?
Anna squirmed in her chair and tried to ignore the lump stuck in her throat. "Dr. Fowler, why didn't you call and let me know those DEA agents were coming?"
"Because I didn't know. They came by and asked my administrative assistant how to find your office. I never saw them, never knew they were here." Neil Fowler adjusted the knot of his tie, leaned back in his chair, and looked across his desk at Anna. "Tell me what they said."
She took a deep breath and launched into a retelling of her session with Hale and Kramer.
As he listened, Fowler's expression revealed nothing. He'd been chairman of the Surgery Department for ten years—the youngest chairman at the medical center—and had a reputation for being stern but fair. Anna figured he'd seen it all and dealt with it before. Maybe that's why he could appear so calm. But this was all new to her.
When Anna finished, Fowler fixed her with calm, gray eyes."And they told you they'd be terminating your ability to write for narcotics?"
"I'm supposed to receive a special delivery letter tomorrow from the DEA. And they said 'suspended,' not 'terminated.' "
Fowler leaned forward and rested his hands on the desk in front of him. "Anna, I'm not going to prejudge this matter, and I'll try to help if I can. But first, I have to ask you this. Did you write those prescriptions?"
"Absolutely not!" She was surprised at the fervor of her answer. "Sorry. I didn't mean to jump at you. No, I did not write them."
"All right. Here's where we need to go. First of all, before you leave the office I'm going to get Laura Ernst on the phone, and you're going to tell her what just went down."
"Who's she?"
"She heads the legal department at the school. If you end up being charged with something, you'll need your own lawyer. But I want Laura to be aware of this from the get-go."For a second, the corners of Fowler's mouth lifted a fraction."Laura's wound pretty tight, but in a fight you'll be glad to have her on your side."
Anna's brain was moving about a mile a minute. "What about my clinical work? I can't write for any narcotics, but I guess I could get somebody else to sign those prescriptions."
"Uh-uh. I know without asking what the Dean is going to say when he's told about this." Fowler looked at the diver's watch on his wrist. "Which I'm about to do in half an hour."He held up a hand to forestall the words that were on her lips."He's probably going to suggest I suspend you from clinical duties until this is settled."
"Suspended?"
"Doesn't matter what word you use. Actually, the President would probably suggest that I find a way to terminate you, but that's because he's afraid this might bring some bad publicity to the medical center. The Dean's more realistic and a bit less motivated by perception and politics. Be that as it may, I'm pretty sure Dean Dunston is going to feel it would be good for you to be out of sight until this thing is settled and you're cleared. Anyway, don't worry, because you won't be suspended."
She breathed a sigh of relief.
"Well, not as such," Fowler said. "Instead, you're going to take a vacation for a while."
"But I don't have any vacation time coming," Anna said.
"As of this moment, you've suddenly become eligible for a two-week leave for special study and personal enrichment. Don't sweat the paperwork. I can handle that."
"What am I supposed to do during this time? And what happens after that?"
Fowler tented his fingers. "You're supposed to use that superior intellect that made me hire you to figure out how somebody got hold of your narcotics number and 'script pads and started playing Dr. Feelgood. When you do, take that information to the DEA or the Department of Public Safety or whatever agency has jurisdiction, and clear your name."
"What if I can't?"
The chairman removed his wire-rimmed glasses and began polishing them with a spotless handkerchief. When he'd finished, he looked directly at her and said in a low voice, "Have you heard the expression, 'failure is not an option?' "
"Yes."
Fowler nodded once.
The silence stretched on for a long moment. Then the chairman turned his attention to the stack of papers in front of him.
Anna swallowed hard. "I see."
As Anna changed clothes in the women's dressing room, she felt the glances of surgical nurses and female physicians burning into her back like live coals. She was sure that everyone at the medical center already knew about the death of her patient. She was willing to bet that by tomorrow they'd be whispering about something else: that she'd been accused of writing bogus narcotics prescriptions. Maybe Dr. Fowler was right. She should get out of here.
She pulled out of the faculty garage and started toward home, navigating on automatic pilot. Maybe she'd stop at Blockbuster for a movie to get her mind offher problems. Have a quiet dinner in front of the TV, soak in the tub, try to forget for a few blessed minutes. Then a quick mental review of the contents of her refrigerator changed her route. Better stop by the grocery store as well.
Anna wove up and down the aisles of the store with frequent stops to add items, not sure when she'd have time to shop again. Sort of like laying in provisions for a siege, she told herself. On her trip down the second aisle she visited, she noticed the cl
unking sound and the tendency of the cart to pull to one side like a car with a flat tire. By the time she discovered the malfunction, it seemed easier to battle the balky conveyance than unload her groceries into another one. After all, what was one more inconvenience on top of what had already happened? Surely things couldn't get any worse. At least, she hoped that was the case.
When she reached the head of the checkout line, a pimplyfaced clerk with a faint smile on his face but none in his voice began scanning her items. He met her eyes long enough to say, "May I have your Reward Card, ma'am?"
Anna found her keys, buried as usual in the deepest, darkest corner of her purse. The clerk thumbed through the plastic tags until he found the right one. He swiped it several times and finally tossed the keys back onto the counter. "The tag's too worn. Won't scan. What's your phone number?"
She repeated the number to the clerk while she swept the keys into her purse and transferred the last of the items from her cart onto the moving belt. Whether the clerk's heart was in his work, his hands moved swiftly, and in a moment the items were scanned and bagged. "That's $62.48."
Anna had pulled out her wallet along with her keys and was ready with her MasterCard. She swiped it and watched the screen, waiting to confirm the amount and sign. She was still waiting when the clerk said, "Ma'am, swipe it again. I'm getting an error message."
She complied.
"Ma'am," the clerk said, "there's a problem with your card. Do you want to use another one?"
"I only brought this one. What's the matter with it?"
"This account is over its limit. Do you want to write a check? Pay with cash?"
The impatience in the clerk's voice made Anna glance around. The man behind her was shifting from one foot to the other, and the line was building.
"I don't have my checkbook," she said. "And I don't have that much cash. I . . . I'll come back."
She didn't even think about the groceries. All she could think about was getting away from the irritable clerk, away from the exasperated looks of the people behind her in line.
She screeched out of the parking lot, impatient to get home and call the credit card company. There was no way her card was over its limit. Somebody owed her an explanation.
Nick put down the phone and massaged his chin, running his fingers over the scratchy stubble as he thought about the information he'd just been given. Both units of blood received by Eric Hatley were totally compatible with the patient's own blood. The lab director herself had done the cross-matches in duplicate. No question about it. The blood wasn't the source of the allergic reaction that had killed the man.
"Still here?" The morgue technician stood in the open doorway and raised his eyebrows as though to ask, "Why?"
"Yeah," Nick replied. "I want to work on some stuff, and it's a lot quieter over here than in my academic office."
"Right. Those folks in the drawers back there don't make much noise, do they?"
Nick frowned. He understood that when you worked around death all day, making jokes about it was a normal defense mechanism. But it still didn't make him like the practice. He kept quiet and eventually the attendant took the hint and left with a cheery, "Well, it's quitting time. I'm out of here."
His unfinished project stared back at Nick from the computer screen, the cursor accusing him with every blink. He really should finish it today. But first he wanted to let Anna know what he'd found out about the blood. There was no question in his mind that talking with her took precedence over making his chairman happy. Wetherington was never happy anyway, so why worry about it?
Nick opened the faculty directory and dialed Dr. Anna McIntyre's office number. Her administrative assistant answered on the first ring.
"This is Dr. Valentine. I'm trying to reach Dr. McIntyre. Is she there?"
"I'm sorry, Doctor. She's left for the day."
"Oh." Nick looked at his watch. A bit after four. Sort of early in the day for Anna to be leaving, but— "Well, what time does she usually get there in the morning?"
The woman cleared her throat. "I've been told that Dr. McIntyre will be on leave for at least two weeks. Could someone else help you?"
That didn't make sense. The likelihood that a junior faculty member in her first year would have two weeks of accrued leave, let alone be permitted to take it in one block, was about the same as a meteor hitting Neiman Marcus at noon tomorrow. Had the chairman suspended her? Was she in trouble over this patient death? If so, that made his call even more important.
The assistant's voice interrupted Nick's thoughts. "Doctor?"
"Sorry. I guess I could page her."
He started to hang up when he heard a rattle of words and brought the receiver back to his ear. "What was that?"
"I said her pager is sitting on her desk. I saw it just a few minutes ago. I really think she doesn't want to be disturbed."
Nick could feel his temper bubbling to the surface. He shoved it down and tried to keep his voice calm. "All right, could you give me her home number?"
"I'm afraid we can't do that. Why don't I transfer your call to the chairman's office? Maybe Dr. Fowler can help you."
"No, don't bother. Thanks." Nick hung up before she could respond. He didn't want to go through Neil Fowler to contact Anna. And he didn't want to leave a message. It was dawning on him that what he wanted was to see Anna McIntyre again.
He swiveled back to his computer and looked at the screen. He sighed and closed the document. Then he logged on to the Internet. It shouldn't be hard to find Anna.
Being home didn't defuse Anna's anger and frustration. She took the time for a quick shower and a change into more casual clothes. Back in her living room, she pulled a folder from her desk drawer, kicked off her loafers, and slumped into an easy chair with a Diet Coke and the cordless phone, ready to do battle with the credit card company.
She flipped through the folder until she found her last MasterCard bill. She dialed the wrong number once, then navigated a maze of electronic commands, entered her account number, and confirmed her mother's maiden name to an operator who seemed only mildly interested in the process. Finally, she was able to speak to someone about her problem.
"How may I help you?" said the slightly accented voice on the other end of the line.
"My card was declined today because I'm supposedly over my credit limit. I have my last statement right here. I made a payment only a week ago, and I should be nowhere near my limit. Can you tell me what's going on?"
"I'm so sorry." The operator's tone didn't match the words, but Anna figured that she'd settle for action instead of sympathy."Let me pull up your account."
Anna took a long gulp of soft drink while she waited.
"Oh, my."
Anna put down her drink can and sat forward in her chair."What's wrong?"
"Well, it appears that we actually tried to get in touch with you today about your account, but there was no answer at your home number."
For the first time, Anna noticed the blinking red light on the answering machine. "What were you calling about?"
"According to my records, in the past two days there have been numerous charges to your account, and at the present time it's almost two hundred dollars over your credit limit."
"That can't be right."
"No problem," the operator continued, apparently unfazed by Anna's tone. "Your payment history has been good, so if you like, I'm sure we can extend your limit."
Anna felt her heart descend into her shoes. This was defi- nitely not what she needed on top of all her other problems."I don't want my credit limit extended. I want you to remove those charges. They're not mine. I can tell you exactly how much I've used my card in the past week." She fumbled in the folder and withdrew a few charge slips. "I charged gasoline a week ago, then a meal at El Chico, a blouse at Dillard's, and two days ago I bought some things at CVS pharmacy. That's it. That couldn't have put me over my limit. You must have my account mixed up with somebody else's." She heard the panic cree
p into her voice but couldn't stop it.
"I'm sorry, Mrs. McIntyre. Could your husband have made some of these charges and not told you?"
"It's Doctor McIntyre, and I'm not married. I'm the only person with this card."
This time there seemed to be genuine sympathy in the operator's reply. "Oh. I'm afraid what we have here may be a case of unauthorized usage. If you'll hold for a moment, I'll get a supervisor on the line."
Anna found herself automatically saying, "Thank you," before the full import of the operator's words registered."Unauthorized usage?"
"Unfortunately, it's not that uncommon. The supervisor will get more information from you and confirm a security breach. Then she'll cancel your card and arrange to have a new one sent to you by express courier. You should have it tomorrow afternoon. Will there be someone there to sign for it?"
"Yes."
While the saccharin strains of music on hold played in her ear, Anna considered what this meant. It would be an inconvenience to be without her card for a day, but she had a VISA card she could use until the new MasterCard arrived. Being at home to sign for the delivery would be a pain, but she'd work it out somehow. And she was pretty sure she wouldn't have to pay for the things charged to her account by someone else. Clearing up the mess left behind by whoever hijacked her credit card would be a major nuisance, but somehow she'd get through it. The question that stuck in her mind, going round and round without an answer, was how someone had gotten hold of her credit card information. And did this have anything to do with her DEA number being compromised?
Nick looked at the address written in blue ballpoint ink on his left palm, what he'd once heard called the primitive version of a Palm Pilot. It had taken him twenty minutes of computer surfing to dig up a home phone number for Anna McIntyre and only a few clicks after that to uncover the physical address that went with it. Truly, with the growth of the Internet there was no longer any such thing as privacy.
Medical Error Page 3