Doing Harm (15 page)

I look at the text page. It’s from Dr. Collier’s secretary, summoning me to an immediate, emergency meeting with him in his office.

Shit.

Here it comes.

I make a feeble effort to straighten out my hopelessly wrinkled white coat, run my fingers over my stubble-covered chin and through my oily, unkempt hair, and grimace into a small mirror fixed to the wall. My eyes are like two overripe tomatoes that have burst. Several red semicircles run in a neat row across the middle of my right cheek, a calling card from my spiral-notebook pillow.

But here’s no time to clean myself up now.

I hurry to Dr. Collier’s office. His summons doesn’t surprise me. Nor does the tone of our meeting, which hovers light-years away from the last one. What a difference one night and two patients—one dead, the other halfway there—make.

This time, no small talk. This time, no posh leather chairs. This time, no job “opportunity.”

This time, I sit trapped in the deep recesses of a low-lying couch in a dark corner of the office, its soft cushions enveloping me like quicksand and pulling me toward the floor. A familiar show tune plays softly overhead from the hidden speakers. “Memories,” I note sourly. From
Cats.

Dr. Collier shuts off the music and steps out from behind his desk. He takes a seat a few feet away, directly opposite me, in a captain’s chair, the black wood of which is polished to a high sheen. He seems to tower twenty feet over me as I sink downward, my butt settling inches above the plush carpeting, my knees reaching up toward my chin. The attendings and residents in our department, most of whom have found themselves sitting in this exact same position at one time or another, refer to this experience as “couch time.”

Dr. Collier is wearing his white coat, surgical scrubs, and a hard expression. His shoes are off, and his feet, clad in argyle socks, are planted firmly on the floor. Two crisp manila files sit on his lap. He doesn’t waste any time.

“Bad day, Steven. Bad day. Frankly, I couldn’t be more disappointed in you.” His tone is glacial.

“Yes, sir.”

“Our department has had an excellent safety record for years, and now you’ve managed to single-handedly turn that around in the space of a single afternoon. Things happen, Steven, but really, this is unacceptable. You of all people should know better.”

“Yes, sir.”

“Now, directly because of your actions yesterday, this department has one dead patient, one critically ill patient, and two potential lawsuits on its hands. On top of that, two of my attending surgeons—highly respected professors at this institution—are fit to be tied. And with good reason, considering what you’ve done to their patients. One of them is already demanding that I fire you immediately.”

I swallow hard.

Larry? Andrews? Which one?
Andrews can be a real prick. God, I hope not Larry. He was pretty pissed, though.

“Yes, sir.”

“Now I have to figure out what I’m going to do with you. First, let’s talk about this radical cystectomy patient who arrested on the floor.”

He opens the first manila folder, gracefully touches the tip of his index finger to his tongue, and starts flipping through the contents. “I’ve read your event note in his chart and reviewed the medication and TPN orders.”

He looks up. “I don’t think you should have put potassium in the TPN solution. I think it was stupid. I think that it showed poor judgment. I’m convinced that it was the potassium that killed him. As far as I’m concerned, instead of giving this unfortunate man potassium, you might just as well have shoved him down an open elevator shaft from the top floor of the hospital. You would have achieved the same result.”

I cringe and stare at the plush carpet underneath his feet.

“Not to mention the fact that, as I understand it, this particular patient’s demise was initiated by his receiving an antibiotic in the operating room to which he was allergic, in direct violation of this hospital’s perioperative patient-safety protocols. Is this true?”

“Well, the anesthesiology resident—”

“Is this true?” he interjects sharply.

“Yes, sir.”

“Fine. Now, since this is a mortality apparently related to a medication error, the hospital is going to do a formal investigation into the cause of death, overseen by the Hospital Safety Committee in coordination with Risk Management.”

Risk Management. The hospital lawyers.

“The family consented this morning to an autopsy, and as per hospital protocol, the TPN solution was saved and submitted to an independent lab for formal analysis.”

The family? What family?
Mr. Bernard never talked about his family, just his girlfriend. But Dr. Collier’s continued verbal body blows distract me from turning that thought over some more in my head.

“Since there is no obvious evidence of overt negligence on your part, just stupidity, the Safety Committee will not be formally investigating you—at least not yet, anyway—just interviewing you to get your version of the events leading up to this sentinel event. I expect you to give them your full cooperation. I want you to remember that the Safety Committee is not your enemy. Its members will simply be ascertaining what happened. You will, of course, comport yourself in a professional manner at all times and answer their questions with absolute candor. Do you understand?”

“Yes, sir.”

“Mmhmmm. All right, then. So there we have the cystectomy patient. Now, with respect to the adrenalectomy patient.” He closes the first folder and opens the second, again dexterously moistening his index finger. “Dr. Lassiter tells me that he specifically instructed you not to perform the adrenal-vein dissection by yourself because of the risk of injuring the IVC—which is exactly what ended up happening. Is that true? Did he really tell you not to perform the dissection until he returned to the OR?” His eyes bore through me like steel drills through Kleenex.

“Yes.”

“Why, then, did you proceed with the dissection?”

“Well, things seemed to be going okay, so I guess I just kept going. I really thought I could handle it by myself, without Lar—without Dr. Lassiter in the room.”

Dr. Collier sighs, closes his eyes, and gently massages the side of his face for a few moments with his right hand, the index and middle fingers moving in slow, circular arcs over his right temple. He stops massaging and, without opening his eyes, shakes his head, his fingers still pressed against his temple. I notice that his eyelids are as deeply tanned as the rest of his body.

“Steven, Steven. I know you’re good with your hands, and confidence in the operating room is not just an admirable trait—it’s a necessary one for any good surgeon. But a truly great surgeon knows his limitations.”

He drops his hand and opens his eyes. The hardness of his gaze has softened a bit around the edges. “Not only were you thoroughly incapable of performing that dissection on your own, you were completely unprepared to handle the catastrophic results of your actions. Your surgical skills simply were not up to the challenge, and as hard as that may have been to admit to yourself, you should have realized that you had reached the extent of your skills and asked for help. Do you understand what I’m saying?”

“Yes, sir.”

“I hope so. Or your surgical career will be extremely short-lived. There is nothing wrong with asking for help when you need it.” He snaps the second file closed. “But you’re young, so for now I’ll give you the benefit of the doubt and chalk your actions yesterday up to your lack of experience.”

He leans back in the chair, crosses his legs, and tents all ten fingers by pressing the opposing tips together, right against left. His eyebrows draw together.

“You know, Steven, we all make mistakes. Especially as young surgeons. And we learn from those mistakes. It’s what surgeons do. That’s how we all improve, both individually and as a field. We’re constantly improving, constantly challenging ourselves, constantly pushing ourselves ahead for the benefit of our patients. Things don’t always quite work out the way we hope and plan. As my own chairman used to say to me back when I was a young surgeon, ‘Robert, good judgment comes from experience, and experience comes from bad judgment.’” He arches his eyebrows. “You certainly showed some bad judgment yesterday, Steven. I hope you learned something from the experience.”

“Yes, sir.”

“It’s a shame that these two unfortunate patients had to become part of your personal learning curve. Especially since these are the kinds of adverse variables that affect our department’s rankings in
U.S. News and World Report.
Mortality data are very important to maintaining our extremely high position on that list, Steven. The events of yesterday are the sort of”—he pauses and momentarily purses his lips before continuing—“
discrepancies
in patient care that can cause us to slip in those rankings. Patients pay attention to that sort of thing these days, Steven—magazine lists and hospital rankings. They shop around and do their research. Patients are not going to want to come to University Hospital and let us care for them if we have a mortality rate significantly higher than that of our competitors. Do I make myself clear?”

“Yes, sir.”

He stares at me then, silent and thoughtful, for what seems a very long time. Not angry at this point, really—just disappointed, as if I’m his sixteen-year-old son, and I’ve banged up the family car, or raided the liquor cabinet with my buddies, or flamed out on my report card. I already feel bad enough about what I did to those patients; Dr. Collier is now making me feel as if I’ve let down my dad, in the worst possible way.

Finally, he asks, “How is the adrenalectomy patient doing today?”

“She’s currently intubated and in the SICU. She had an MI from all the volume loss. She’s also coagulopathic.”

“Mmhmmm.” He nods gravely. “I hope she survives.”

“I hope so, too, sir.”

“Mmhmmm.” He nods once more before smoothly rising from his chair.

Meeting over. With some difficulty, I manage to extricate myself from the cushiony depths of the couch. Dr. Collier walks me to the office door and opens it.

“That’s all for now, Steven. Please keep me updated on this patient’s progress. Also know that I’ll be keeping a direct line of communication open with the Safety Committee. Again, I expect your full cooperation in their investigation.”

“Yes, sir. I understand.” I walk through the door and start to speed away, grateful to be off that couch and out of that office.

“And remember,” Dr. Collier calls to me from his open doorway. I freeze and look back at him.

“I’ll be keeping an eye on you, Steven. We all will.”

He motions to his secretary to follow him into his office. She immediately jumps to attention and scurries into his office, clutching a notepad of legal yellow paper and a pen. The door closes after them.

God, please let her get better. Please don’t let her die.

Please, God. Let her get better.

CHAPTER 7

Wednesday, July 29 to Friday, August 7

But Mrs. Samuelson doesn’t get better.

In fact, she gets worse.

Much worse.

Everything gets worse. One day blurs into the next while Mrs. Samuelson clings to life in the SICU, and the Safety Committee begins its formal inquiry. Work sucks. Each day, I slog through my stuff, going through the motions, starting out each morning with a lead weight in my stomach that just grows bigger and heavier as the day wears on, like a bucket that gets heavier the more you fill it with water.

It seems like everyone in the department treats me differently. Just as Dr. Collier had promised, everyone seems to be watching me. Maybe I’m just being paranoid, of course. But you’re not being paranoid if everyone
really is
out to get you. Right? I can’t shake the feeling that everyone
really is
out to get me.

Andrews screams at me without provocation at least once per day, reminding me how stupid I am and how he will never let me touch any of his patients ever again. I’m also periodically summoned to Dr. Collier’s office, slouching uncomfortably in the couch as Dr. Collier sits regally in his captain’s chair, listening impassively to my updates on Mrs. Samuelson’s condition. I hold out the small hope that the job offer we discussed a few weeks ago to join the faculty will come up again, but it never does.

What hurts more—far more—is Larry’s reaction. He stops talking to me. Completely. He won’t take my calls, ignores me during our departmental conferences, and speaks directly to Luis about his patients, including Mrs. Samuelson. When I show up a few times in the OR to help out with his surgeries, he barely acknowledges my presence and wordlessly performs each operation himself with me standing off to the side, watching. So I stop showing up to his operations, sending Luis to take my place. Depressed and increasingly worried about my future job prospects, I type out a formal letter of apology for what happened and leave it with Larry’s secretary. I don’t receive a response.

Other things are less obvious but no less painful. Although nobody comes right out and says it, I suspect that I’m a favorite topic of conversation among the other residents. Doctors are just as prone to gossip, Machiavellian infighting, and office politics as those in any other profession. In fact, in some ways doctors can be even worse: driven type A’s who are always looking over their shoulders, forever wary of a smarter, more successful, or more devious colleague; ready to pounce on the chance to exploit others’ misfortunes and professional miscalculations to press their own advantage.

I’ve never been particularly close to any of the other residents in our training program, and I think my fall from grace has provided them an opportunity to take me down a few pegs, generating a barrage of small indignities that dog me all day long at work: mostly things like low-toned conversations between residents that abruptly end as I walk within earshot; followed by their knowing smirks as they clap me on the back and smugly ask me how things are going.