When Anna turned onto Grand, the neighborhood changed, and she locked her doors. Ahead, on the corner, she saw a onestory, red brick building bearing a sign in faded black letters: Metro Clinical Laboratory. The parking area at the side of the building resembled a road in Afghanistan after a mortar attack. Holes in the concrete threatened her wheels and suspension as she dodged right and left. She brought the car to a halt in the one empty parking space, the farthest from the building.
Anna checked that the car doors were still locked before retrieving her purse from under her seat. Maybe she should check her messages at home before she went into the building. She flipped open her cell phone and noticed the icon that indicated one new voicemail message. Then she remembered.
She'd turned offthe ringer before going into conference with the DEA agents. She changed the setting and pushed the button to retrieve the message.
"This is Nick. Just calling to invite you to have a late lunch with me. Guess you're tied up. Call me when you get this message.I . . . uh, I . . . hey, I really enjoyed our picnic."
Anna leaned back in the seat and wondered how this had happened. A month ago she'd been totally focused on her career. Not much of a social life beyond an occasional date that almost never led to a second one. Now her professional and personal life were on the verge of ruin, but she had two men in her life, either of whom could turn out to be the Mr. Right she'd always hoped would come along.
She started to punch the number to call Nick, who had made it onto her speed-dial list soon after their first meeting. Then she stopped. She really ought to go inside and get this out of the way. She could call him from home or at least from the car after she was safely out of this neighborhood.
Anna unzipped her purse, dropped in the phone, and rummaged around until her fingers identified the tiny canister of pepper spray she'd carried since moving to Dallas. She'd never used it, but today she felt better knowing it was there. She moved the canister toward the top of the purse and left the zipper partly open. Then she unlocked her doors, looped the strap of her purse securely over her head and across her body, and stepped out. She beeped the doors locked once more and looked around her.
A half dozen homeless men crouched against the chain-link fence that formed the far end of the parking lot, next to where she'd left her car. They represented a veritable United Nations of colors and ethnicity, but they shared one characteristic: redrimmed eyes that seemed to stare right through her. The man on the end had a firm grip on the neck of a bottle protruding from a brown paper sack. She watched out of the corner of her eye as he drank, wiped his lips with the back of his hand, and passed the bottle to one of his companions.
Anna dreaded turning her back on these men to walk the seventy feet to the front door. Don't run, she told herself. Just move along. They won't hurt you. She dropped her hand inside her purse and grabbed the pepper spray. Keys in one hand with her thumb on the panic button of the remote, pepper spray canister in the other. Take a deep breath. Start walking.
The walk to the door seemed to take an hour, but she reached it with no consequences worse than a cramp between her shoulder blades from muscles taut as a violin string. Once inside the building, she dropped keys and canister into her purse and looked around for a receptionist.
"Help you?" The Hispanic girl sat behind a scarred desk against the back wall of the foyer. Straight chairs with ripped vinyl seat cushions lined the walls on either side of the room. A coffee table held several tattered magazines and out-of-date copies of two newspapers, the Dallas News and El Sol.
"I'm Dr. Anna McIntyre. I need to speak with your laboratory director."
"May I ask why?" The girl was civil enough, but apparently used to deflecting questions. She probably had her orders. A routine was in place, and any departure from it would present a problem.
"I'd rather discuss it with the director. Is he or she available?"
The girl shook her head. Anna could almost see the gears turning as the receptionist pulled up the appropriate response from her memory bank. "Our medical director is Dr. Gaston. His office is in Fort Worth, but he makes a visit here once a week. He was here yesterday. Would you like to come back next week?"
"Who's in charge here? I mean, right now, on the premises."
"I guess that would be our chief technician."
Anna took a calming breath. "And that would be?"
"Rhonda Brown."
"May I speak with her?"
"May I ask why?"
The dialogue continued like a bad imitation of an Abbott and Costello routine, but eventually the receptionist waved Anna through the door and into the laboratory. She was met there by a stout African American woman dressed in a flowered scrub top and navy scrub pants, the ensemble covered by a crisp white coat.
"Ms. Brown, I'm Dr. Anna McIntyre." Anna extended her hand.
"Pleased to meet you, Doctor. And it's not Ms. It's Miss. Anyway, you can call me Rhonda." She took Anna's hand and gave it a brief, firm shake, while never taking her brown eyes offher visitor. "How can I help you?"
"Is there somewhere we can sit down? This won't take long, but there's a bit of explaining that goes with it."
"Sorry, but I've got tests going and two other techs to supervise. If I can't do it right here, right now, you'll have to come back."
Anna sighed. She'd have to keep it simple, leave out the details, and hope Rhonda went along with her request. She told her about the lab report she'd received and asked if there was any way to identify the woman on whom the test had been run.
"Doctor, more than fifty patients come in here every day."Rhonda pointed to the open door to the waiting room. "Most mornings every one of those chairs is filled. As soon as somebody comes in here for us to draw blood, somebody standing along the wall takes the vacant seat. We check their paperwork, ask them to verify their name and birthday, take the sample and move on. So far as we're concerned, you are who your lab slip says you are."
"Well, can I ask the other technicians? Maybe they remember something."
Rhonda was already shaking her head before Anna finished."Dr. McIntyre, you ever heard of HIPAA?"
Of course, Anna had heard of the Health Insurance Portability and Accountability Act of 1996. Its most important provision, designed to protect patient privacy, had added another layer of paperwork for medical professionals already buried under reams of it. Before any medical information could be revealed, even to a patient's spouse or parent, the proper forms had to be signed. "You're telling me you can't help me because of HIPAA regulations," Anna said.
"I'm telling you that I could get in trouble just by talking to you about this. That patient—the one who told us she was Anna McIntyre—didn't list your name on the HIPAA form she signed."
"But I'm Anna McIntyre. So I can give you permission."
Rhonda shook her head and started to turn away. "Doctor, I've given you more time than I should already. Even if we went through all the legal hassling to get permission to talk about this, I'd still tell you the same thing. All the information we have about these patients is what they give us and what Lola out there at the desk copies offtheir insurance papers. We don't remember their faces or whether they have green hair or a big eye in the middle of their forehead. All I'm looking for is a good antecubital vein. Then, if the patient doesn't faint in the chair, we slap on a bandage, they're out and somebody else fills the spot before it gets cold." The last words were said over her shoulder and by the time Anna framed a reply, Rhonda was looking over a printer strip as it spewed from an automated analyzer.
It was obvious to Anna she'd gone as far as she could go here, with absolutely nothing to show for her efforts except the start of a massive headache. She thanked Rhonda, who acknowledged it with a wave. Anna turned and made her way back into the waiting room where the receptionist—presumably Lola—hardly gave her a glance before returning to her attack on the keyboard of her computer.
Anna spied a water fountain in the corner. She dug two Ext
ra Strength Tylenols out of her purse, and washed them down with tepid water from the fountain. As soon as she got to a better neighborhood, she'd stop at a convenience store and get a Coke. Maybe the caffeine would help get rid of the headache.
In the parking lot, the collection of homeless men had dwindled to three, all leaning against the chain-link fence. The bag-in-a-bottle she'd seen earlier was no longer in evidence. Anna headed toward her car, fighting the urge to run. Easy now. Just like being in the jungle—don't show any fear. Halfway to her car, she pulled her keys from her purse and thumbed the remote.
"Hey, lady. You got any spare change?"
The largest of the trio, a stocky white man, eased offthe fence and began walking toward her. He hadn't shaved in days, and as he got closer, Anna decided he probably hadn't bathed recently either. The other two men didn't move, apparently content to watch the scene unfold.
"I asked if you got any spare change." He was directly between Anna and her car, standing easily with his hands on his hips. His breath smelled of cheap wine and dental decay.
"No. No, I haven't." She tried to move past him, but he moved with her, blocking her way.
"Well, maybe we should just see." He reached out for her purse and tried to wrestle it away from her, foiled for the moment by the strap across her chest.
"Help!" Her screams didn't produce any action from the two observers, who continued to watch with detachment. She tugged at her purse with her left hand, groping wildly for her pepper spray with her right.
The man dropped his hold on the purse and drew back his fist. Anna's hand closed around the spray canister and pulled it free. Her finger was on the button when she felt a jarring pain in the point of her jaw. She caught a glimpse of sky. A loud thud, like a football being punted, filled her head. Then nothing.
Her first thought was that she had to get up. It must be morning. She wasn't sure what she had to do, but she was certain she was late. She started to roll out of bed, only to find that she couldn't move. She was strapped down. And the room was moving—rocking from side to side, bumping up and down. What was going on?
"Just take it easy, miss. Lie back."
The unfamiliar voice didn't reassure her. Just the opposite. She was in some sort of narrow room, and the sound of a siren seemed to be all around her. Where was she? And why couldn't she move? She opened her eyes but the light was dim. Everything was fuzzy, with halos and colored spots making it almost impossible to see anything clearly.
She heard a man's voice, the words faint and echoing as though issuing from a tunnel. "Easy there."
She tried to turn her head but met resistance. A wave of pain drove her back against the bed. What was going on?
"Don't struggle. We have you secured to a stretcher. Your neck's in a collar, in case you hurt it when you fell back on the concrete. Just relax and we'll have you in the Emergency Room in just a few minutes."
She strained to move, but when she flexed her right wrist she felt a sharp prick.
"You have an IV in your arm. Just lie back. We'll be at the hospital soon."
Why was he saying that? What was going on? Another effort to turn her head intensified pain that she thought couldn't get any worse. Her stomach began to churn. She lay back, closed her eyes, and took a deep breath.
"Can you tell us what happened to you?"
The voice was nearer. She opened her eyes, squinted, saw a man bending over her. He was wearing blue coveralls with some type of emblem on the chest. The nameplate over his breast pocket read "Tom."
"Tom." Her voice was raspy. She swallowed and tried again."What happened? Where am I?"
"Hold on. Let me check your vital signs again."
She felt something squeeze her arm to the point of pain, heard a mechanical whir. She bit her lip from the discomfort before the pressure was released with a low hiss. Tom nodded and made a notation on a clipboard he pulled from somewhere behind him. "Okay. Here's what I know. You apparently fell in the parking lot of Metro Labs. Looks like you hit the back of your head. Lost consciousness. One of the technicians stepped outside for a smoke, saw you, and called it in. We just picked you up, and we're headed to the Emergency Room."
"Hey, Tom." A metallic voice came through a speaker above her head. "Baylor's ER says they're swamped. If she's stable, I'm detouring to Parkland."
"Affirmative," Tom replied. "Let's do it."
She squeezed her eyes shut and tried to concentrate. Her head felt as though an air hose was inflating it to three times its normal size. The pain increased with every beat of her heart. When the wail of the siren dipped, she was conscious of a constant roaring in her head. The ambulance—at least, she figured she was in an ambulance—rocked and swayed, bringing with it more nausea. She swallowed hard and willed her stomach to be calm.
Think. Why had she been at that lab—the name had already flown from her thoughts—and why did she fall? As her thoughts went around like a carnival ride, going in a circle with no progress, a more important question intruded. Who was she?
11
AMBULANCE COMING IN, DR. FELL. FEMALE, FOUND UNCONSCIOUS IN A parking lot. Vital signs are stable. The EMT says she's starting to wake up."
Dr. Will Fell looked up long enough from the wound he was suturing to nod at the nurse. Then he bowed over his work, careful to give the same attention to this last stitch as he had to the first one. He could still hear Dr. McIntyre's voice."Resist the temptation to hurry when you're about through. Don't think about the next patient. Think about this one. Every patient should get your full attention until you're finished. That's the only way to practice medicine."
He snipped the ends of the suture and motioned for the aide to apply a bandage. "See that he gets a tetanus shot, wound care instructions, and a follow-up appointment for suture removal in a week to ten days."
Will looked down at the man on the table, a middle-aged Mexican laborer who'd come in with a nasty laceration of his arm from an industrial accident. The man spoke little English, and Will's Spanish was rough, but they'd communicated well enough.
"¿Alguna pregunta? "
The man shook his head. No, no questions. Will figured as much. If the man had any, he probably wouldn't ask them. Keep your head down. Don't call attention to yourself. This was the lesson learned early on. Even if you had your green card, stay away from anyone in authority. Will looked at the technician."Be sure he understands, would you?"
"No problem." The aide reached into a cabinet behind her and pulled out a sheet that contained wound care instructions in both English and Spanish.
Now he could shift his attention to the next patient. As Will stepped into the hall, he began running through a mental checklist of the causes for unconsciousness. Start with the broad categories: traumatic, toxic, metabolic, neurologic, infectious, vascular. Then again, once you broke them down into individual conditions, the number was staggering. In medical school, Will had once competed with several other students to list as many specific causes as possible for unconsciousness. Will had won with two hundred seventy-two.
Well, if she's already regaining consciousness, his job was a bit easier. He'd definitely look for a head injury, probably check some blood chemistries, a toxicology screen, maybe schedule an EEG to see if this was a seizure. Then, like any good diagnostician, he'd see where his findings took him. That's something else Dr. McIntyre instilled in all her residents. For a surgeon, she had a lot of internist in her—always looking deeper into the problem, taking pride in her diagnostic ability. Look closely; don't rush to judgment. He liked what he'd heard her say once. "You're not a technician. You're a doctor. So be a good one. Anyone can learn to cut. A good clinician knows why and when."
Well, Dr. McIntyre, let's see how much I learned from you. Will tapped lightly on the door of Trauma Room Two and pushed through the door. The EMTs were just unloading the patient onto a gurney and giving their report to the nurse. Will took the clipboard from the lead EMT and studied the scribbled notes.
Jane Doe. No ID on her, no purse or wallet at the scene. Vital signs stable. Neuro exam not remarkable—take that with a grain of salt, since a neurological evaluation done in a moving ambulance might not be accurate. The note said there was no odor of alcohol, none of the sweet smell of diabetic ketoacidosis on her breath. Swelling in the occipital region, bruising at the point of the chin, so there was probably some trauma involved. If she'd fallen, that explained the injury to the back of the skull, but why the bruising on the chin? Had she been in a fight? He'd definitely want a CT of the skull.
"Okay, Doc. She's all yours." The EMT turned back to the patient. "Good luck, lady. You're in good hands."
"Thank you," she said.
Will's head snapped up at the sound of that quiet voice. He covered the distance to the gurney in five quick steps, stopping short to look down at the disheveled form of his mentor, Dr. Anna McIntyre. She smiled weakly and said, "Are you a doctor? Can you help me?"
The man looking down at her seemed so young. Was he a doctor? Or was he a nurse or a technician, even an orderly? Had she made a terrible gaffe by calling him "doctor?" No matter. He had a kind face and she sensed somehow that he cared. Maybe he could help.
"Dr. McIntyre?"
Was the young man speaking to another doctor in the room? That name sounded so familiar. Even the room looked familiar. Why? What was going on?
"Please, can you help me?" she said again.
The man leaned over her. He was wearing what looked like gray pajamas, covered by a white coat with words embroidered over the breast pocket. She squinted. Will Fell, M.D.
Medical Error Page 13