by Robin Cook
Lynn remembered a mannequin had been used, not a real patient. Lynn and her classmates had been duly impressed at the demonstration. There hadn’t been any real people involved. The whole back wall of the set had opened and the mannequin had arrived automatically by the use of robotic equipment, placed in the ersatz bed in a matter of seconds, and covered up to the neck with a sheet. At that point all the machinery folded back into the wall and disappeared. The students were told that the immediate family members didn’t see the comings and goings; they were brought in only after the patient was already positioned.
Lynn and her friends had speculated about what the rest of the Shapiro Institute must have been like to enable them to take care of a thousand or so vegetative patients, which is what they had been told was projected to be the average occupancy. They were never given specifics above and beyond told only that automation and computerization made it all possible.
After the mannequin demonstration, there had been a short question-and-answer session run by the individual responsible for the medical student tour. Lynn had asked why families chose to have their loved ones at the Shapiro in the face of such limited visitation. The answer had been simple. It was because the Shapiro’s record of keeping such patients alive was far superior to any other hospital or clinic. The tour guide had gone on to say that in most institutions, up to 40 percent of patients who were comatose from a variety of causes were dead in the first year, whereas the Shapiro had lost no patients in the first year of operation and had lost only twenty-two patients total after six years.
Lynn remembered that Michael had also posed a question, because the mannequin used in the demonstration was outfitted with what looked very much like a football helmet. As a college player himself, Michael was curious. The answer had been that the helmet was a breakthrough technology developed specifically for the Shapiro Institute and that all their patients were equipped with them. It was described as a wireless unit that monitored brain activity in real time and, more important, was also capable of stimulating portions of the brain.
Now, as Lynn approached the hospital elevators, her panic peaked with all these thoughts swirling in her head. She had to do something. She could not allow Carl to be stashed away in such a callous place with contact with her denied. All at once she impulsively decided, no matter what, she would visit him, and not in the restricted-visitation room, staring at him through a plate-glass window. If Carl was to be transferred, she would figure out a way to see him up close and personal. She would need to know exactly what was happening to him and exactly how he was being cared for. She didn’t know how she would manage it, but she would do it.
28.
Tuesday, April 7, 4:45 P.M.
Geez!” Michael complained. “You scared the hell out of me.” Lynn had come up behind him out of his line of sight in the waiting area of the ophthalmology clinic and without warning roughly yanked him out of earshot of the waiting patients. At the time he had been standing off to the side, busily texting her to find out exactly where she wanted to meet up.
“Carl is going to be transferred to the Shapiro,” Lynn blurted out in a forced whisper. The possibility had devolved to a reality in her mind.
“Okay, okay,” Michael soothed. He could immediately appreciate her panic.
“You know what kind of place that is,” Lynn pleaded. Now that she was talking with Michael, the emotion that she had held in check with Erikson threatened to take over.
A quick glance told Michael that a number of patients, who were still waiting to be seen, were taking notice of a young black man talking to a young, distressed white woman. Southern eyebrows of both whites and blacks rose.
“Come with me!” Michael said in a voice that did not brook dissent. He took Lynn by the arm and quickly led her back to an empty exam room and away from prying eyes. Since the clinic was almost over, there were lots of such rooms available. He shut the door.
“You gotta be easy, girl,” he urged. He put his hands on Lynn’s shoulders and looked her in the eye. “You know what I’m saying? You can’t jump the couch now. We got a meeting to go to where we need to be on our game. I don’t know why the dean wants to see us but it sure ain’t to pat us on the back.”
“But . . . ,” Lynn started.
“No buts! Pull yourself together. After the meeting we’ll hash out this Shapiro business. But now we gotta get our shit together and be cool.”
“You’re right,” Lynn said, wiping her eyes with a knuckle. “You’re always right, you bastard.”
“Now, that sounds like the Lynn I know. Listen! We gotta have some sort of a plan.”
“What do you think she is going to say to us?”
“Your guess is as good as mine. Chances are she heard from our new buddy, Benton Rhodes, and knows that we talked to Sandra Wykoff about the Vandermeer case. That’s at a minimum. It stands to reason, considering the time frame.”
“Do you think she is going to accuse us of a HIPAA violation?”
“I hope not, at least not yet. That’s why we need a way to explain how we heard the details about Carl’s anesthesia disaster.”
Lynn nodded. She knew Michael was right and was thankful he was being levelheaded, even if she wasn’t. There had to be a way for them to have heard of the details without violating HIPAA. Obviously the anesthesia ruse wouldn’t hold water with the dean. From the text both of them had received, it was obvious she knew they were on the fourth-year specialties rotation and not taking an anesthesia elective.
“Does the dean know you and Carl were an item?”
“I haven’t the faintest idea,” Lynn said. “I suppose it’s possible, since the dean of students certainly knew.”
“Yeah, but they are such different people. The dean of students is so personable and the dean of the school is so aloof and detached. It’s like they’re from different planets.”
“I have an idea,” Lynn said suddenly. “I could just say that one of the neurology residents told me about the case to show me the doll’s eye reflex. It’s not a lie, just not the whole story. But it rings true. I mean, this is a teaching hospital.”
“That’s a little weak,” Michael said. “Especially if she knows you and Carl were tight. It also begs the question of why you were talking to a neurology resident. But no matter. At least it’s a plan the dean might buy.” He looked at his watch. “The reality is we’re running out of time. This is not the kind of a meeting we should be late to. You got your act together?”
“I think so,” Lynn said. She took a tissue from a dispenser on the exam room countertop and blew her nose. “Let’s get it over with.”
The two students quickly used the connector to get into the main hospital building. The administration offices, including the dean’s offices, were on the first floor. As quickly as they could navigate the crowded main hallway, they entered the administration area through a door with a cut-glass insert. The atmosphere changed abruptly. It was serene, with a carpeted floor and framed original oil paintings on the walls. They passed the hospital administration offices and arrived in the academic area. Here the furnishings were not quite so opulent.
After giving their names to a staid secretary, they took seats. It was three minutes before five.
“We made it,” Lynn said in a whisper.
They ended up having to wait for a quarter of an hour. They didn’t talk after sitting down. The atmosphere was appropriately funereal to fan their fears. Both Lynn and Michael knew the dean of students well but not the dean of the medical school, whom neither had even met.
Lynn tried to relax as Michael appeared to be, but couldn’t for a variety of reasons, mostly centered around the disturbing idea of Carl’s being transferred to the Shapiro and the uncertainty of what they were facing with Dr. English.
“The dean will see you now,” the secretary finally said, gesturing toward the closed door that led into the o
ffice beyond. The two students approached the door, with Lynn slightly in the lead. They shared a glance. Both shrugged. Michael made a fist and pretended to knock in the air. Lynn actually did it. They heard a voice tell them to come in.
In keeping with the general decor in the immediate outer area, Dr. Janet English’s office was attractive but not as over the top as everyone knew the hospital president’s was. There was no mahogany paneling and the artwork was framed prints, not oil paintings. There was a desk and a sitting area for informal meetings. The students approached the desk. There were several chairs, but without being advised otherwise Lynn and Michael remained standing. The dean was finishing signing a stack of papers. After a moment, she looked up. It was obvious from her expression she was annoyed. She didn’t suggest they sit down.
Lynn guessed the dean was somewhere between fifty and sixty. Her complexion was dark. Likewise, her hair was the color of anthracite coal. Through her rimless spectacles, her eyes were like black marbles. If Lynn had been forced to guess, she would have said India was part of the dean’s genealogy.
“I got a major complaint about you,” Dr. English snapped. “You can understand how disappointed I was to learn that two of our best students are causing trouble—students on full scholarship, I might add. And to make matters worse, the trouble was bad enough to involve Dr. Feinberg, the president of the hospital and chairman of Middleton Healthcare. He was upset enough to call me personally to complain.”
There was a pause. Lynn felt an almost overwhelming urge to apologize. She was well aware that the financial support the school had extended to her had been key to her being able to attend medical school. But Michael was as financially dependent as she, and he wasn’t saying anything.
“I was told that you had taken it upon yourselves to question one of our attending anesthesiologists about a recent, very sensitive case. Is this true?”
Both Lynn and Michael started to speak at the same moment, then stopped. Lynn gestured for Michael to talk. She knew he was far better at diplomacy than she, even when she wasn’t as emotionally strung out and sleep deprived as she was now.
“We did talk with Dr. Sandra Wykoff,” Michael said. “But we weren’t, as you say, questioning her. We went to ask her about a case of delayed return of consciousness. As tragic as the case was, we thought that there had to be something for us students to learn.”
“Did you not think of the legal aspects?” Dr. English asked.
Lynn felt herself relax a degree. The dean did not seem to know that Lynn and Carl were romantically involved, which was probably good. Also her voice had moderated. The edge was already gone. It was another reminder for Lynn that Michael was clever at this kind of confrontation. She also noted he was using the King’s English, without the slightest hint of the ’hood.
“As doctors to be, we were thinking more about it from the patient’s perspective,” Michael added.
“I suppose that is commendable from a student’s point of view,” Dr. English said. “But unfortunately there is another aspect. The potential malpractice implications are horrendous when a healthy young man becomes comatose after a simple operation, even when there is no malpractice involved. Such a lawsuit could damage this hospital and affect its ability to take care of thousands of patients. In today’s litigious world, avoiding a lawsuit or controlling it if it does happen in a case like this has to be a prime consideration.”
“We certainly understand that,” Michael said.
“There had been a strict directive from our legal department that no one was to discuss this case.”
“We hadn’t heard that,” Michael said. “But now that we have, we certainly understand and will be cooperative.”
“How exactly had you heard the particulars about this case to begin with?” Dr. English asked.
Michael and Lynn exchanged a quick glance. So far the discussion had been going better than they had anticipated, especially with HIPAA not even being mentioned. But here was the question they feared. Michael nodded to Lynn to take over and try her idea.
“I was talking with the neurology resident on the case,” Lynn began. “He had offered to show me a doll’s eye reflex, which I had never seen before. That was when I had learned the details.”
Dr. English didn’t respond but nodded almost imperceptibly. After a pause she asked, “Did you see the reflex at least? Was it apparent?”
“Yes, I did see it. It was very dramatic.”
“Okay. This is all making more sense to me now. But tell me this: have you two talked about this case with anyone else, like with classmates or anyone besides Dr. Wykoff?”
Lynn and Michael looked at each other and both shook their heads and said no simultaneously.
“Good,” Dr. English said. “As I said, this case is extraordinarily sensitive from a legal perspective. Do not discuss it with anyone!” Dr. English poked a finger at each student in turn to hammer home her point. “If you fail to heed my warning and do discuss it with anyone, anyone at all, I will see to it that you are expelled. Needless to say, being expelled would be a tragedy for both of you, especially this close to graduation. I don’t know how to make it any clearer. I trust you understand the gravity of this?”
“Absolutely,” Lynn and Michael said in unison as if they had practiced the response.
“All right,” Dr. English said. “Let’s move on to another issue.”
Both Lynn and Michael tensed. They thought they were in the clear. Now they weren’t sure. Neither had any idea what was coming.
“When I spoke with the president he said one other thing. As a matter of explanation of your behavior he told me that you two were researching the issue of hospital-acquired morbidity. Is that true, and if it is, why, and why now?”
Lynn and Michael exchanged another glance. A slight nod from Michael encouraged Lynn to answer. “I came across an article recently from Scientific American, which presented some disturbing statistics. It estimated that four hundred forty thousand people die each year in hospitals from mistakes, and that a million leave the hospital with a significant medical problem they didn’t have before they were admitted.
“We were honestly flabbergasted. I mean, we’d heard about the problem during third-year medicine, but we had no idea of the numbers. When we heard about this current case, we thought it was another glaring example and wanted to try to understand how it could have happened.”
Again the dean didn’t respond immediately. She took off her glasses and rubbed her eyes. Then she put her glasses back on and said, “The statistics you quote are sobering. Hospital-acquired infections, or HAI, are the major problem. Did the article point that out?”
“Not specifically,” Lynn said. “It didn’t break the statistics down to specific causes.”
“Well, let me assure you that hospital-acquired infections are the crux of the matter. On a national scale, HAI rates are anywhere from five to ten percent of admissions in the best institutions. In the offending institutions, the rate can go much higher. Do you know what the HAI rate is for Middleton Healthcare hospitals, including this medical center?”
Lynn and Michael shook their heads.
“Let me tell you,” Dr. English said proudly. “Our combined rate is less than two percent.”
“That’s impressive,” Lynn said, and she meant it. Both she and Michael knew that the medical center made a big effort at infection control in many ways, including an active campaign encouraging hand washing and hand sanitizer use in addition to strict control of intravenous lines, respiratory machines, and catheters. Neither was aware of the true extent of the success.
“If you students are interested in hospital morbidity, you should look into nosocomial infection control. That is where you and your classmates could make a difference, not with an isolated case of delayed return to consciousness. Am I making myself clear?”
“Absolutely,” Lynn
and Michael again said simultaneously. Their relief was palpable.
“In fact, I will make it easy for you,” Dr. English said. “I will contact IT and arrange for you both to have access to the hospital’s discharge statistics in our medical center system, provided that you adhere to one major condition: If you are going to talk with anyone outside of our community, particularly the media, I want you to run whatever it is by me first. Is that clear?”
“Absolutely,” the two students reiterated.
“We are justly proud of our success with infection control,” Dr. English continued. “But some of the statistics are not for general consumption. I hope you understand.”
This time both students nodded agreement without verbalizing.
“Good!” Dr. English said. “I will let the president know that you understand now about this unfortunate anesthesia case and the need not to discuss it. I can assure you that it is already being carefully investigated by the Anesthesia Department. If you are interested in hearing about the investigation and what is learned, I imagine I will be able to get the chief of surgery to invite you to the morbidity and mortality session when it will be discussed. Would that be of interest?”
“Absolutely,” Lynn said. Michael nodded.
“Okay,” Dr. English said, looking down at her desk and moving the stack of papers she had signed to the side. “That is all.” Without even looking up again, she reached for her phone and started speaking with her secretary about putting a call through to Dr. Feinberg.