Medical Error (13 page)

Anna was still processing the chairman's remarks, adding the knowledge to the mental card file she maintained on management of complications, when it hit her. Fowler hadn't looked directly at her since she'd taken her seat. Not at any time during lunch. When he polled the faculty for comments on the previous case, he'd passed over her. It was as though she weren't there. Was this the way it was going to be until she could clear herself of the suspicion that hung over her like a cloud?

Her initial hurt gave way to grim determination. She wasn't about to be kept in limbo until those guys at the DEA found out who was using her information. And as for the Dallas Police, if Green and Dowling were typical examples, she wasn't sure she'd trust them to find a lost dog. They'd probably fine the owner for failing to keep it on a leash. No, she was going to become more actively involved in the process. And she planned to start right after M&M.

Anna's reverie was interrupted when she heard Fowler say, "Luc, how about Mr. Hatley?"

Anna pulled a blank three-by-five card from the bunch she kept in the pocket of her white coat. As Luc related the events of Hatley's case—his emergency admission, the surgery, the measures taken to replace blood loss and combat the infection that was sure to follow the colon injury—she jotted notes, all the while wishing that she could be the one making the presentation. But it was protocol that the resident on the case detail what happened and what went wrong. After that, the attending was free to speak up, defending where necessary and accepting any criticism alongside the resident.

As Luc wound down the presentation, Anna found her toes tapping in a nervous dance under the table. She picked up her soft drink can, found it empty, and longed for something to counteract the sandpaper-like feeling in her throat.

Anna was trying to organize her thoughts when the door at the back of the room opened, and the anesthesiologist Buddy Jenkins slipped in. He eased into one of the empty chairs along the far side of the room. His eyes met Anna's. Although his expression was carefully neutral, Anna knew what was behind it. Don't try to hang any of this on my resident . . . or on me. Well, she couldn't blame him. She'd probably do the same thing if she were in Jenkins's place. Besides, Nick had pretty well convinced her that the young anesthesia resident's only error had been failing to make the diagnosis early on. But then, neither she nor Luc had picked up on it either. They'd depended too much on that incorrect history, had been too complacent.

"Okay. Dr. McIntyre, your comments?" Fowler's tone conveyed neither approval nor censure.

Anna cleared her throat. "Luc's summarized things pretty well. He put first things first, treated the shock and stopped the bleeding. His repair of the perforated bowel was perfect. Since there was considerable fecal spillage into the abdominal cavity, antibiotic coverage was important." She lifted her eyes from her notes and looked directly at Fowler. "We've already been reminded today how it's possible to have a good surgical result compromised by an infection, and in this case the risk of fatal sepsis was significant. It's unfortunate that, even though we had good information that Mr. Hatley should tolerate the Omnilex, he suffered a severe anaphylactic reaction."

"Who decided on Omnilex? You or Luc?" The speaker was Linda Farley, new to the surgery faculty, fresh out of her training. Anna was pretty sure that Linda felt the medicine practiced here in Texas could never compare with what she'd learned in Boston at Peter Bent Brigham Hospital, in the shadow of Harvard.

"Luc felt, and rightly so, that Omnilex gave the best coverage in this situation. I agreed."

Linda was like a dog trying to wrest a bone away from a rival. "But if there was any antibiotic allergy, especially to penicillin, Omnilex was almost certain to produce anaphylaxis —which it did."

"I realize that, but—"

"Let's move on." Fowler's voice was calm, but there was no mistaking the way he was taking command of the situation."There are a lot of 'what ifs,' but in the final analysis, I think there's nothing to be gained by exploring them. We can conjecture all day about how this would have turned out if you'd chosen a safer but less effective antibiotic, or if the anesthesia resident had picked up on the anaphylaxis earlier and started treatment."

Anna saw Jenkins stiffen. If Fowler saw it, he didn't react. He was already closing the chart and opening the next one."Luc, you and Dr. McIntyre made the right clinical decision based on the information available to you. Unfortunately, there was a bad outcome."

Fowler pulled a sheet of paper toward him and began reading a series of announcements, but Anna had already tuned him out. It was over. She took several deep breaths but still felt claustrophobic. She saw Jenkins slip out, and she wanted desperately to do the same. Unfortunately, the way everyone was packed into the conference room, it would have drawn attention she didn't want. As Fowler continued to speak, Anna uncrossed her legs and put both feet flat on the floor. She rested her hands on the arms of her swivel chair, ready to push up and make a quick exit when the conference finally came to an end. She'd made it through this test. But she knew there were more to come.

Nick looked around the cafeteria. It was two-thirds full of medical school staff— administrative assistants, students, residents and faculty—but he and Anna had managed to score a table with no neighbors nearby. Besides, the buzz of conversation was better than a white noise machine for protecting them from eavesdroppers.

His call had caught Anna as she was walking into her office after the conference. It took some persuasion on his part, but she finally agreed to meet him here so they could talk while he grabbed a late lunch. Thus far, she'd been about as talkative as the Sphinx—although a whole lot prettier.

"You didn't bring up the new information about Hatley?" Nick took a bite of hot dog and wiped the corner of his mouth with a paper napkin.

Anna shook her head. "I was going to mention that I'd found out he was penicillin-allergic. I figured if I didn't say something about it, Fowler would. I mean, I'd already told him about my visit with Hatley's mother. But he moved things along before I could bring it up. I got the impression he was trying to get the discussion over with." She sipped her iced tea."Maybe he was trying to protect me. Or maybe he was trying to protect the department."

"He knows that Hatley's mother told you he was penicillinallergic. But does he know about the second Eric Hatley?"

"He learned about it when he and I met with Laura Ernst and the dean," Anna said. "But I'm pretty sure none of them is going to spread that knowledge around. I was afraid that Will Fell, the resident I talked with about the fake Hatley, would be at M&M today and mention it, but he wasn't. One of the residents told me that Will just got offa twenty-four-hour shift in the ER, and I'm pretty sure he's in dreamland right now."

"So it's not common knowledge that Hatley died because someone stole his identity." Nick took another bite of hot dog and chewed thoughtfully, parsing the implications of what they knew so far. He washed the food down with coffee, wincing as the hot liquid hit his tongue. Anna shoved her iced tea toward him. He scooped out a piece of ice with his spoon and rolled it around in his mouth before continuing. "And you don't want anyone to know yet that you've caught on about the identity theft?"

"I'm not sure how they tie together, but I keep getting the feeling that what happened to me—the credit cards, the DEA number—and what happened to Hatley are linked. I don't know how or why, but if they are, then whoever stole my information had to get it someplace, and I'm betting it was—"

"Here at the medical center," Nick said. "And you don't want to tip your hand while you investigate?"

"Right. I figure it has to be someone around here who has access to my personal stuff." She lifted her glass and drank."When you change into a scrub suit in the dressing room, what do you do with your wallet?"

Nick's hand went to the hip pocket of his scrub suit. He felt the reassuring bulge. "I put it in my pocket. I keep my change and keys in my white coat, and the wallet goes on my hip. I'm used to feeling it there, where it's safe."

"Exactly. Now think of what a woman does. No woman— at least none that I know—wants to walk around with a bulge in her hip pocket." She held up the small clutch that had been sitting on the table. "Most of the female doctors and nurses around here have either a fanny pack or something like this that they can drop into the pocket of their white coat when they need it. But you don't wear a fanny pack under your surgical gown, and there's no place for a purse there, either. So our valuables end up in a drawer of our desk or in a locker in the dressing room."

"And you think someone got into your purse and stole your credit card information. Maybe got your DEA number off the ID card you carry." Nick pulled out his wallet and flipped through the plastic holders until he came to a small folded blueand-white card headed Controlled Substance Registration Certificate. "Do you carry yours in your wallet?"

"I do, but probably for a different reason than you do. I'll bet you don't write many prescriptions."

Nick nodded assent. "Not as a pathologist, no. Just occasionally, for friends or family."

"Have you ever written for a controlled substance?"

"One of my buddies wrenched his knee last Friday afternoon playing football. I wrote him for enough Tylenol with codeine to carry him through the weekend until he could see his regular doctor." Nick made the connection quickly. "And I had to look in my wallet to check my DEA number."

"Right. On the other hand, I write prescriptions all day, and I have my number memorized."

"Do you carry your card?" Nick asked.

"I do, but for a different reason. I don't want it lying around where someone could get hold of it. I always thought it was safest to have it in my purse." Anna wadded up her napkin and shoved it into her empty glass. "Guess I was wrong."

7

A
S THOUGH IN RESPONSE TO SOME UNHEARD SIGNAL, THE CAFETERIA BEGAN to empty. Office workers sighed and marched back to their desks. Doctors gulped their lunches and headed for surgery or clinics. Medical students snatched up their books and drifted out in groups of two and three, trading stories of terrible lecturers and fascinating patients.

Anna looked at her watch. "I should go." She pushed back her chair and grabbed her purse.

"What's on your agenda for this afternoon?" Nick asked.

Anna wasn't sure she had a firm plan. And if she did, should she share it with anybody? Even Nick?

"I smell rubber burning." Nick grinned. "Does it require that much thought to tell me what you're up to?"

"Sorry." She created interlocking rings with the condensate on the bottom of her empty glass. "I'm not sure I have a plan, other than to snoop around and hope I can recognize a clue if I stumble across it."

"Not much of a plan, but better than nothing I guess," Nick said. "How about dinner later tonight?"

Anna gave him full marks for persistence, but tonight she wanted to be alone. She moved aside a stray strand of hair. "Sorry, Nick. Really, all I want is to pick up some fast food on my way home, sink into a bubble bath, and fall asleep reading the book that's been on my bedside table for a month."

Nick nodded his understanding. "So, tomorrow?" He paused."No, wait. That's Saturday. I'm covering pathology tomorrow, and I don't want to interrupt our time together if I get called back. Sunday?"

Anna felt the shadow of an idea form. The more she thought about it, the more she liked it. What could it hurt to ask?

"Is the question too hard for you?" Nick asked. "Need to check your Palm Pilot? Trying to decide if we can be alone without a chaperone?"

"No," Anna said. "Just thinking. Sunday would be fine. What did you have in mind?"

"That's usually my only day to sleep in. How about brunch? Then we can play it by ear. A movie, walk around in the West End, maybe go out to the Arboretum?"

Anna tried to hide her grin, but was afraid it showed in her eyes, if not on her lips. "Are you flexible about those plans?"

"Sure. What do you suggest?"

"Come by my apartment about ten-thirty Sunday morning. Go to church with me. Then we can have lunch and decide how we'll spend the rest of the day."

To his credit, Nick only hesitated for a few seconds. "Sure. What's the dress code?"

"Whatever you're comfortable wearing. Most men wear sport shirts. There are some in jeans. You'll see a smattering of coats and ties, mainly the older members."

"What about you?"

She grinned. "I'll be wearing a dress, but I don't think that's a good look for you. I'd stick with a sport shirt and slacks."