Medical Error

by Richard Mabry

  "And as they left, they told me this was an ongoing investigation, so I couldn't talk about it with anyone. I don't know what they can do to me for coming to you like this, but I don't care. It seems to me that you're in trouble, and I want to help."His forced grin held no humor. "After all, that's what friends do. And we are friends. Right?"

  15

  NICK USED A PAPER NAPKIN TO WIPE A SPOT OF GREASE OFF THE CORNER OF his mouth. "So you already knew that Green and Dowling were trying to make a case against you?"

  Anna nodded and pointed to her full mouth. She chewed the last bite of pizza and washed it down with a healthy swallow of Diet Coke. "Yes," she finally said. "Ross and I met with them at the police station earlier today. They must have gone right from our meeting to your office. What was it they said to you? 'Just getting their ducks in a row.' I'd better call Ross and let him know about this."

  While Anna made her call, Nick fought to control his emotions. It seemed to Nick that, slowly but surely, her lawyer was monopolizing Anna's time and attention. His rational mind recognized the need for this, but the little green monster perched on his shoulder continued to whisper in his ear.

  Anna closed her cell phone and dropped it into her pocket."I had to leave a message. He'll call back."

  "I know you need a lawyer in all this," Nick said, "but do you think Ross Donovan is up to defending you? Especially since this has turned into something really serious. I mean, you've told me he's an alcoholic. His drinking broke up his marriage and almost cost him his law license. Won't you let me ask around and find you somebody better?"

  The look in Anna's eyes told Nick he'd gone too far. "The man is a recovering alcoholic," she said. "He's sober and highly motivated to remain that way. As for his competence, his exwife is the chief attorney for the medical center, and she's the one who recommended him. He's done a good job so far, and I don't intend to make a change now."

  Nick threw up his hands in a gesture of surrender. "Okay, okay. I'm sorry." He pushed the empty pizza box aside and reached across the table. Anna hesitated, but finally put her hand out and Nick took it in both of his. "Anything else?"

  Anna pulled her hand back and finished her soft drink."We've got a couple of days, and I don't want to think about this anymore. I have to see Dr. Simpson in the morning, but I should be through by noon. Why don't we get together for lunch in the food court?"

  Nick recognized the invitation as a peace offering, and he grabbed at it like a drowning man latching on to a piece of wood floating by. "Sounds great. I'll be in my office. Come by when you're finished."

  They both stood. Nick reached for the pizza box and paper plates, but Anna said, "I'll take care of all this. You go ahead. I know you have things to do." She began gathering soiled paper napkins. "Thanks for coming by. Of course, I need to tell Ross about this, but I don't want you to get in trouble with the police over letting me know about their visit. I'll ask him to keep your name out of it."

  "Don't worry," Nick said. "I'm not afraid of those guys."

  "Well, you should be. They scare me to death."

  At the door, Nick turned back toward Anna, but before he could say anything, her cell phone chimed the theme from Law and Order.

  "I'm so sorry. That's Ross's ring. I have to take this." Anna pulled the phone from her pocket. "I'll see you tomorrow."

  Nick closed the door a bit more firmly than was necessary and trudged toward his car, wondering if Anna had assigned a special ring to his number as well. If Donovan was Law and Order, what had she given to him—maybe the theme from Friends?

  Ross Donovan leaned back in his desk chair and cradled the phone between his neck and shoulder. He crumpled the Snickers wrapper and tossed it toward the wastebasket, missing by about a foot, before shifting the phone back to his hand."You say that Green and Dowling are checking on Hatley's cause of death. How do you know this?"

  Anna's voice seemed a mile away, as though by talking softly she could lessen the significance of what she was saying. "I can't tell you my source. I promised I'd keep his name out of this. They threatened him if he discussed a case that's under active investigation."

  Ross snorted. "They were throwing their weight around. At this point, they don't even have a case. Besides, how hard would it be for me to find out who signed the death certificate? I'm your attorney. Don't start playing games with me."

  "All right. They went to Nick Valentine. He's a pathologist at the medical center, and during this investigation we've become friends."

  Ross wondered what Anna's definition of "friend" was, but he decided to let it slide for now. "So we know they weren't bluffing when they talked with us. Tell you what. There's a private detective I've used in the past—good man, knows how to find things out without making waves. He has some contacts in the local police department. I may ask him to make a few discreet inquiries."

  Anna's voice got louder. "Is that necessary? I'm not sure I can afford any more fees."

  "He owes me a few favors, so I can probably get him to do a little preliminary digging offthe clock. If it begins to look like we're trying to keep you from being charged with murder . . . at that point I suspect we can work out handling his fees."

  Ross waited for Anna to respond, but there was only silence on the other end of the line. Finally he said, "Anna, are you there?"

  The little girl voice was back again, hushed and fearful. "Yes. I was thinking how simple my life was a couple of weeks ago. I can't help asking God, 'Why? Why me?' "

  Ross shifted in his chair. "If it's any comfort, I've had that same conversation with Him. I've asked the question when I couldn't stop drinking, when my wife divorced me, when I almost lost my license to practice law. Wish I had an answer for you."

  "Oh, there's an answer," Anna said. "But only God has it. Then again—"

  "What?"

  "Maybe you're the answer."

  After the conversation ended, Ross cradled the phone and stared at the ceiling. It was hard enough not to drink. It was hard enough to defend Anna against charges that seemed to worsen day by day. It was hard enough to remain professional in the face of the feelings he was developing for her. Now, out of the blue, she'd told him God might be using him. Ross began to chuckle. Maybe God really does have a sense of humor.

  Mike Simpson opened the chart and fixed her with eyes the color of polished steel. "Anna, how do you feel?"

  The response was automatic. "Fine."

  Simpson shook his head. "No, don't just say 'fine.' You know what I mean. Any headaches?"

  "Some, but Tylenol takes care of them."

  "Vision?"

  "That's all clear now. No fuzziness, no double vision."

  Simpson flipped a page, although Anna knew the checklist was in his head, not on the chart. "Weakness? Incoordination? Falling?"

  "Nope."

  Simpson eased onto the stool at the foot of the exam table on which Anna sat. "How's the thinking? Able to concentrate? I guess you know that's usually the last thing to clear after a severe concussion like you had."

  Anna pursed her lips. If she told the truth—that she could think clearly now—that opened the door for Green and Dowling to put her on the hot seat and grill her some more. But to say otherwise would be a lie. Did God allow a little white lie if it kept her out of jail?

  Simpson saved her. "I see you're having to think about that one, so maybe we'd better not rush it. Let's give it another week before you go back to work. I'll call Neil and let him know. I'm sure he'd want you to be one hundred percent before you get back in the OR."

  Anna swallowed a couple of times, wishing she'd accepted the water the nurse had offered her. "Mike, I . . . I need to tell you something, but it's embarrassing."

  Simpson's expression was neutral as granite. "I think I've heard just about everything at one time or another, Anna, so I doubt that you'll shock me. And it won't go outside this room."

  "You may be getting a call from some detectives who'll want to know whether I've recovered fr
om my concussion. They had me in for questioning, but my lawyer put a stop to it until I was in full possession of my faculties, as he put it."

  "What's this about?"

  "They're accusing me of deliberately giving a patient a drug he was allergic to, then easing up on treating the anaphylaxis so he'd die. They say they're going to charge me with murder."

  Simpson closed the chart, marking his spot with a finger."Well, I just thought I'd heard it all until now. Anna, that's the most far-fetched thing I've ever heard of. What does your lawyer say?"

  "He tells me not to worry, but things seem to be coming at us faster and faster."

  "Who do you have? I can recommend someone if you're not satisfied with this one."

  Anna took a deep breath but still felt like she couldn't get enough air. "It's Ross Donovan."

  Simpson frowned. "Name's familiar. Isn't that Laura Ernst's ex?"

  Anna nodded.

  "Didn't he . . . ? Wasn't there . . . ? I mean . . . He's practicing again?" Simpson rushed on, apparently trying to get past an awkward moment. "I recall Laura telling me once that her husband was a good lawyer. At least, he was then. But let me know if you need another name."

  "Anna, sit down." Neil Fowler half-rose and motioned Anna to the visitor's chair across from his desk. "How are you doing?"

  "Did Mike Simpson call you?" Anna asked.

  "No, but I just got out of surgery." A faint line on Fowler's forehead from the elastic band of a surgical head cover and the wrinkles in his scrub suit confirmed this.

  "Well, he just examined me. He thinks maybe I should be offanother week, because of my concussion."

  Fowler frowned. "I was counting on your coming back to work sooner than that." He pulled a pad toward him and scribbled a note. "I guess I can change around some of the staffing schedules. You take your time and get well."

  He shoved the notepad aside and leaned forward. "Anna, how are things in general? I mean, I got a call from the DEA and they've pretty much cleared you. Your new permit and number should be on your desk when you come back. But how about the other stuff? Your identity theft, for instance."

  Anna ran her hand through her hair. "I haven't had time to deal with that. Now the Dallas police are threatening to charge me with Eric Hatley's murder. They say I gave him a drug I knew he was allergic to, then held back treatment so he'd die of anaphylaxis."

  "That's nonsense!"

  "Not the way they put it together. They say I was supplying him with Vicodin 'scripts, and he'd threatened to go to the police and blow the whistle."

  Fowler seemed calm, but she noticed that his knuckles were white on the arms of his chair. "That's absolutely ridiculous. I hope you have a good lawyer."

  Here we go again. "Yes, Ross Donovan." Anna decided to meet the next comment head-on before Fowler could make it. "He's Laura Ernst's ex. He's had alcohol problems, but he's clean and sober now. I think he's doing a good job."

  Lines creased Fowler's forehead. "Okay, but if you need a recommendation . . ."

  "Thanks, but—"

  "Dr. Fowler! Dr. McIntyre! You're needed in the ER."Fowler's administrative assistant stood in the doorway. "There's been an accident on Central Expressway. An eighteen-wheeler plowed into a loaded school bus, and that started a chain reaction pileup. Multiple casualties are on their way. They need all available surgeons in the ER stat."

  Anna realized at once that she had two choices. She could beg off, citing residuals of her concussion, and buy herself another week before Green and Dowling could get to her. But an extra hand in the ER, maybe in the operating room, could mean life or death for someone. There was really only one choice, wasn't there?

  "I'm on my way." Fowler was already shrugging into his white coat. "Anna, I don't guess you'll be coming, will you? I mean, if Mike told you to take another week off."

  Anna's hesitation lasted only a second more. "No. Looks like you'll need all the help you can get. I'll come too."

  In Anna's experience, the Emergency Room of Parkland Hospital was unlikely to be calm at the best of times. Even at three a.m., the waiting room was often crowded, the cubicles full. Today, the treatment rooms were occupied and the hallways filled with teenagers on gurneys. Will Fell and another junior surgery resident moved quickly from patient to patient, assessing injuries and performing triage.

  Anna edged the door open and took in the scene in the waiting room. A harried security guard struggled to keep a tide of parents, all talking at once, from spilling into the treatment area. A senior nurse waved a stack of clipboards and pleaded, "Please let the doctors do their jobs. Take these forms and give us the medical history on your children. We may need to give them medications, and we need to know if they have any drug allergies." A chill ran up Anna's spine as she recognized that these words would always have added meaning for her.

  She turned back to Neil Fowler, who stood at the junction of two hallways, directing traffic and letting the confusion flow around him like rushing water around a boulder. "What do you want me to do?" she asked.

  He nodded toward a dark-haired, teenage girl who lay moaning at the end of the hall. "Will thinks she has internal injuries, maybe a lacerated spleen. Check her out. If she needs surgery, OR 6 will be ready by the time you get her up there."

  Apparently, the girl's parents had somehow managed to slip into the treatment area. They stood beside her stretcher, holding her hand and murmuring in Spanish. The mother fingered a rosary; the father wiped away a tear.

  Anna grabbed a passing medical student, one she recognized from his recent rotation through her surgery service."Matt, what are you doing right now?"

  The young man seemed relieved to see a familiar face. "Dr. McIntyre. I'm here to help."

  "Okay, then you're mine. Come on. Let's check out this girl. She has one IV running. Start a second one in the other arm, and while you're doing it, draw blood for H&H, 'lytes, crossmatch for six units. Got it?"

  "Yes, ma'am."

  "Ma'am is your mother. I'm either Dr. McIntyre or Anna, depending on how well you do. Now move."

  Matt whispered something to the girl's parents and they moved away, giving him room to work. Anna moved toward the head of the stretcher, looked down at the girl, and said, "I'm Dr. McIntyre. What's your name?" When the girl continued to moan, Anna said, "¿Qué es su nombre? "

  "Her name is Rosa Hernandez." The words were almost whispered, the voice a low baritone with the faintest trace of accent. "And she speaks English, as do we. She's just too frightened to talk."

  Anna turned to face the parents, who now stood at the foot of the gurney. The father took a step toward her, his jaw clenched, tears coursing down his cheek. The woman continued to finger her rosary.

  "Listen," Anna said, "we think Rosa has internal injuries. I may need to stick a needle into her abdomen and see if there's blood there. If there is, that would mean she's had a serious injury and would require emergency surgery. We might have to remove her spleen, sew up a laceration of her liver, even—"

  "Whatever it takes, Doctor." The father's voice was low and intense. "Whatever we need to sign, we will do it." He began to roll up his sleeve. "If you need my blood for her, tell me where to go so they can take it. Just do it."

  "Thank you." She looked at Matt, who was handing offthe tubes of blood he'd drawn to a runner who'd take them to the lab. "Matt, get the Hernandez family to sign a permit for a four-quadrant abdominal tap, exploratory laparotomy, splenectomy, repair of internal injuries. You should know what to include. I'm going to find an empty cubicle and take Rosa in there."

  "What about an MRI or a CAT scan?"

  Anna was already pushing Rosa's gurney away. "Radiology's already overloaded and we can't wait. I'm going to do it the old-fashioned way. Four-quadrant belly tap. Find us when you've finished getting the paperwork done."

  In the exam cubicle, Anna quickly gathered the supplies she'd need. After reassuring Rosa and injecting a local anesthetic, she inserted a long needle into the girl's ab
domen in the right upper quadrant. The first tap yielded nothing. So far, so good. But on the second tap, when she drew back on the plunger the syringe filled with dark blood. Blood in the abdomen. Most likely a ruptured spleen. Maybe a lacerated liver. Perhaps even—please, God, no. Not a tear of the aorta. If that major vessel broke loose, Rosa could bleed to death in a matter of minutes. This was a surgical emergency.

  Matt pulled aside the curtains. "Permit's signed. Hemoglobin's eight, 'crit twenty-five. The chems are cooking."

  "What about—?"

  "They're cross-matching blood for her now. I've asked for a unit of O negative stat, and I'll hang it as soon as it gets here."

  "Okay, let's get her up to the operating room. We're going to OR six. You'll be my assistant."

  16

  ANNA BROKE ALL SPEED RECORDS FOR A QUICK CHANGE INTO SCRUB clothes. Soon she stepped away from the scrub sink, her dripping arms held before her, her mind focused on the operation she was about to perform. "Let's go, Matt. That'll have to do."

  She bumped through the door into OR Six, and then it hit her. This was where it all started—with Eric Hatley's operation and the events that followed in rapid-fire succession, events that now threatened to end her career. Well, she'd go out fighting. The place didn't matter. What mattered was what she did here.

  As she gowned and gloved, Anna studied her surgical team. Karen, the scrub nurse, chose instruments from a sterile pan and arranged them on the green-draped rolling tray that would be placed across the operating table for easy access. Anna nodded to herself. Karen was a battle-tested veteran of the surgical wars, someone who could be depended on not to crack under pressure. But when she saw the circulating nurse, Anna winced. Keisha was a new hire, fresh out of nursing school. Would she panic at a critical moment?

  Matt stepped to his spot across the operating table from her. Below his surgical mask, his Adam's apple moved twice. His shoulders rose and fell, and Anna could hear the sigh. She knew what he was feeling. She'd been there herself once.