It's Nothing Personal (19 page)

“You mean,” asked Jenna, “if it looks like
we’re going to lose?”

“Basically, yes,” replied Nancy.
 
“Some cases are stronger than
others.
 
I’m not saying that we feel
that way about your case right now, but things can and do change.
 
Just so we are clear, the decision to
settle is ultimately yours.
 
We can
give you our input and advice, but neither we nor your malpractice carrier can
force you to settle.”

Jenna asked, “After the discovery process
and all the depositions are taken, then what?”

Jim replied simply, “Then we go to court
next January.
 
Our trial has been
scheduled to last three weeks.”

Jenna sighed.
 
“It’s the gift that keeps on giving.”

Neither of her attorneys replied.
 
There was really nothing either of them
could say.
 
The air in the room was
thick with emotion.
 
Jim finally
asked Jenna if she had any more questions.
 

There were so many things she did not
understand.
 
Jenna felt like a traveller
in a foreign country where every aspect of life was different – the
language, the logic, the customs.
 
She was an uninvited visitor in a world she did not recognize.

“First of all, if this patient is suing St.
Augustine and me together, do we have to coordinate our legal defenses?
 
I don’t see how that would work.”

Jim set his pen down and rested his hands on
the conference table.
 
“Most likely,
if the case ends up going to trial, the jury will be asked to determine the
percentage of liability for each party, Hillary Martin included.
 
For example, they may find that Hillary
Martin is ninety percent responsible, the hospital is eight percent
responsible, and you are two percent responsible.
 
Then whatever amount the jury chooses to
award, if it goes that way, will be applied to each of the three parties
according to their degree of responsibility.
 
You and St. Augustine will both be on
trial together, but not necessarily on the same side.
 
Each party is going to be looking out
for their own best interests.”

Jenna’s eyes bore into Jim’s as she said, “Which
means that, more likely than not, the hospital is going to sacrifice me.”

“They can and probably will try to do that,
at least to some degree,” Jim admitted.
 
“The facts are that Hillary Martin was
their
employee, not yours.
 
They hired a drug addict.
 
We
strongly suspect their background check on Ms. Martin was inadequate, at
best.
 
Otherwise they would have
uncovered truths about her that certainly would have precluded her from being
hired.
 
If Hillary Martin had never
been employed by St. Augustine and had never been permitted to be in the
operating rooms, this whole catastrophe would never have occurred.”

“I have another question,” said Jenna,
wild-eyed.
 
“I know this sounds
irrational, but it really scares me.
 
What about the media?
 
Do you
think I’ll end up in the press?”

“Anything’s possible,” answered Jim.
 
“As you probably know, a case filed
against one of your partners ended up on the front page of the Sunday
paper.
 
Anders just so happens to be
the attorney on that case, too.
 
She
loves the press and uses it to trash and intimidate the doctors she sues.
 
I don’t see any imminent stories coming
out, but it’s something you have to prepare for.
 
You will need to prepare your family, as
well.”

Mental images flashed in Jenna’s head of Mia
going to school and having some other kid say, “Hey, my mom saw your mom on
TV.
 
Did your mom really give some
lady a bad disease?”
 

Not to mention her colleagues.
 
Jenna could easily picture them turning
on her.
 
Goosebumps raised the hair
on her arms as she imagined their critical stares and condemning comments about
her inadequacies and failings.
 

Then there would be the everyday people –
her neighbors, her hairdresser, other parents.
 
Would they go out of their way to avoid
her?
 
Would they also judge her?

Jim had no way of knowing the destructive
thoughts that were running rampant in Jenna’s head, but the expression on her
face spoke volumes.
 
Her skin was as
white as the snow covering the city.

Trying to nudge Jenna back on track, Jim
asked, “Do you have any more questions about the complaint or what to expect as
things move forward?”

“No,” answered Jenna dryly.
 
“I think you guys covered it pretty
well.”
 

“Well then,” Jim continued, “we have copies
of your anesthesia paperwork for Ms. Hollings.
 
If you feel up to it, we would like to
go through it with you.
 
However, if
you’ve had enough for one day, we understand.
 
We can reschedule for later this week.”

Jenna was tired and emotionally
drained.
 
However, the last thing
she wanted was to have to come back tomorrow or the next day.
 

“No, I’m okay.
 
Let’s keep going.
 
I just need five minutes to use the
restroom and call home.”

“Absolutely,” Jim replied.
 
They all stood, and Jenna left the room.

CHAPTER 28

In the restroom, Jenna splashed cool water
on her face.
 
Although it did not
ease her pain, it did help to revive her.
 
She called Tom and told him she would probably be several more
hours.
 
He asked how things were
going, but Jenna did not want to discuss it, certainly not in the women’s
restroom at her attorneys’ office.
 
Jenna hung up with her husband and made her way through the labyrinth of
cubicles back to the conference room.
 

She took her seat, and Jim handed her a
stack of papers.
 

“We would like to go through all your
documentation, piece by piece, so that Nancy and I are sure we understand
everything.
 
Let’s start with your
pre-anesthetic assessment sheet.”

Jenna rifled through the stack of papers
laid out in front of her and found the copy.
 

Jim asked, “As you look at your preop
assessment, is there anything remarkable about Ms. Hollings as a patient?”

Jenna traced her finger over every word and
shook her head.
 
“The patient is
completely straightforward.
 
Ms.
Hollings was young, thin, and healthy.”

Instantly, Jenna was consumed with
self-reproach.
 
Michelle Hollings was healthy
, she thought,
up until the point I injected hepatitis C into her bloodstream.

Next, Jim asked Jenna to refer to the
anesthesia record.
 
Jenna found her
copy and motioned for Jim to continue.

“Can you walk us through this record?
 
It would be particularly helpful if you
could read and explain your notations and abbreviations, the drugs you gave and
why, and Ms. Hollings’ vital signs during the procedure.”

For several minutes, Jenna silently
scrutinized the anesthesia record.
 
She felt a small amount of relief in being the one who understood
everything, rather than the one who understood nothing.
 
At least for now, Jenna was the
expert.
 
She slid her chair closer
to the table and tucked her hair behind her ears.
 

“To start with, I documented that she had a
peripheral IV in her left upper extremity, and it ran well.
 
She was NPO, meaning no food or water,
nothing by mouth, since midnight.
 
The patient was brought to OR 2 and placed in the supine position,
meaning that she was laying on her back on the operating room table.
 
She had a smooth IV induction, which
indicates that I gave her the intravenous medications to knock her out, and
there were no complications.
 
Her
eyes were taped shut, to protect them from inadvertently being scratched.”

Jenna shifted her attention from her
document to her lawyers.
 
Reassured
that they were following her, she continued.

“She was easy to mask ventilate, and her
intubation was uncomplicated and atraumatic.
 
I noted that her arms were extended from
her sides for surgery.
 
Her
extremities were padded, to avoid nerve injury.
 
The last notation I make about the start
of the case is that a warming blanket was placed over her lower body.

“Further down, in the notation section, I
document that at the end of the case, the patient met all the criteria for
extubation.
 
Once the breathing tube
was removed, the patient was taken to the PACU – the recovery room
– in stable condition with supplemental oxygen delivered through a nasal
cannula.”

Jenna’s attorneys furiously scribbled notes on
their copies as she spoke.
 
Jenna
waited for them to catch up.
 
She
was starting to calm down.
 
Going
through her anesthesia record felt safe and familiar.

Jim stopped writing and glanced up at Jenna.
 
“Now I’d like you to look at the
drugs you gave, the corresponding vital signs, and explain Ms. Hollings’
operating-room course.”

Jenna moved her finger along the anesthesia
record.
 
“It looks like Michelle
Hollings got 2 milligrams of Versed in preop, before she got to the OR, to help
her relax.
 
That’s pretty
standard.
 
Apparently, she must have
not have felt much of an effect, because I gave her 2 more milligrams of Versed
in the operating room, before putting her off to sleep.
 

“Her first blood pressure upon entering the
room was 140/80, and her heart rate was 105.
 
That would indicate that she was
probably nervous, which is very common.
 
Then it looks like I induced anesthesia, meaning I knocked her out.
 
I gave her 100 milligrams of Lidocaine,
250 micrograms of Fentanyl, and 200 milligrams of Propofol – Michael
Jackson’s milk.”

Jim and Nancy, caught off guard by Jenna’s
humor, started laughing.
 
Nancy
looked at her client and realized this was the real Jenna Reiner – spunky,
off-color, and down to earth.

Jenna smiled at their appreciation for her
joke and continued.
 

“The last induction drug I gave was 50
milligrams of Rocuronium, a paralytic.
 
Once the patient was intubated, I secured the breathing tube in place with
tape.
 
Then I turned on the Sevoflurane,
which was the anesthesia gas I used to keep her asleep during the
procedure.
 
After induction, her
blood pressure dropped to 90/60, and her heart rate was in the 90s.
 
That’s a very typical response.
 
Most of the anesthesia medications and
the gases used for induction dilate blood vessels and depress the heart to a
certain degree.
 
As a result, most
patients will show a drop in their blood pressure and heart rate.

“Then, it looks like, right at the time of
surgical incision, Ms. Hollings’ blood pressure rose to around 160/90, and her
heart rate increased to over 100.
 
I
gave her 10 milligrams of Morphine and increased the concentration of the gas.”

Jim interrupted, “Why did you switch
narcotics?”

“Morphine lasts longer.
 
I’m sure I figured it would help her
wake up more comfortably.
 
Anyway,
it looks like her blood pressure remained elevated, even after the first dose
of Morphine should have kicked in.
 
I administered another 5 milligrams and further increased the concentration
of Sevoflurane.
 
After that, her
blood pressure came down to around 100/50, and her heart rate dropped into the
90s.
 
Her vital signs stayed in that
range for the rest of the case.

“During the surgery, Ms. Hollings also
received some anti-nausea medications and an antibiotic.”

“Do you see any evidence that she didn’t
respond to the Fentanyl you gave at the beginning of the case?
 
What I’m getting at is whether it looks
like she got Fentanyl or saline?” asked Nancy.

Jenna studied the chart closely.
 
Looking at Nancy, Jenna replied
honestly, “I would say, based on this record, Ms. Hollings responded
appropriately to the Fentanyl.
 
She
dropped her blood pressure following intubation, which is a very stimulating
and painful event if a patient is inadequately anesthetized.
 
There is nothing in my documentation
that leads me to believe that what I injected wasn’t Fentanyl.

“It’s not uncommon to see patients require
additional narcotics once the surgical incision has been made.
 
After intubation, there’s a period of
about ten minutes where the patient is being positioned and prepped.
 
Since none of that is painful, you often
see their blood pressure and heart rate decrease as the vasodilating effects of
the gases and medications are unopposed.
 
At the time of incision, the noxious stimulus causes the patient to
release adrenaline, and their blood pressure and heart rate increase.
 
Not every patient needs additional
narcotics at the time of surgical incision, but it’s not uncommon, either.”