Medical Error (15 page)

"So take some for biopsy. Culture, histology, special stains. I'll make sure all that gets done. Why do you need an answer during surgery?"

"Nick, I've got a bad feeling. Of course, we'll send specimens for all that stuff, but while we're in there I need to be sure this isn't some type of malignancy. It may alter what we have to do."

Frank called it a bad feeling, and Nick didn't argue. After all, he'd experienced and responded to those same gut feelings. A layperson might call them hunches. For a doctor, Nick figured they were the result of disparate facts, stored in some far recess of the frontal lobe, laced together by the subconscious. So here he was, spending his Saturday morning with his eye glued to a microscope.

Nick examined the section of node under low power magnifi cation: definite inflammatory changes, but nothing to suggest a cancer. Then his eye was drawn to one area in particular. He scanned it yet again. The pattern was unique, and the diagnosis fit the clinical picture. Just one more thing to con- firm it. Quickly, he swiveled the lens to a higher power. Yes, definitely a non-caseating granuloma. And there was another one. And another.

"What've you got, Nick?" The voice over the intercom was tinny, but still plainly identifiable as Frank's. He was an excellent surgeon, but not known for his patience. Nick knew from experience that Frank had a true "surgeon's mentality." Figure it out, cut it out, move to the next case.

"Let me look at a couple more sections, but I think I've got something for you."

"Is there a malignancy in those nodes?" Frank asked.

"Nothing that I've seen. Let me ask you. What did this kid's chest X-ray look like?"

"Nothing special," Frank said. "One radiologist thought his hilar nodes were prominent, another one said it wasn't anything."

"Did you do a serum calcium?"

"I don't recall. Probably. We did a full chem panel." There was a pause and the sound of voices in the background. "Read those numbers offto me, would you?" Another pause. "Say that again?"

"What was it?" Nick asked.

"It's 11.2."

"So it's elevated."

"I suppose we attributed it to dehydration," Frank said.

"Nope. He's got sarcoid."

"Are you sure?"

"I'll check out the permanent sections first thing Monday morning, and you'll want to do some more lab work. But, yes, I'm sure. No malignancy. If you get him on steroids pretty quickly, you're going to save him from a bunch of problems."

Frank was quiet for a moment. "And if we'd missed it—"

"But you didn't. Send me some more nodes, including a couple that aren't in formalin so I can get TB cultures. But it's sarcoid, I'm sure."

"Thanks, Nick. Good pick-up. I appreciate you coming in this morning."

Nick stretched to ease the ache in his back. After he thanked the pathology tech and promised to put in a good word with Dr. Wetherington on Monday for a new microtome and cryostat, Nick ambled offtoward the surgeons' locker room to change. He stopped in the lounge and drew a cup of coffee. After one look at the mud-like consistency, he decided to wait and visit the Starbuck's downstairs on his way out.

He was standing at his open locker when he heard a noise behind him. Nick turned and saw a man in the uniform of a security guard, standing before a locker on the other side of the room, struggling to insert a key. "Help you?" Nick asked.

"Oh, I need to get into this locker. Dr. Morgan thinks he forgot his wallet when he left last night. He called and asked that someone get it and put it in his office. He'll pick it up later this morning."

The guard finally managed to get the locker open. He swept his hand across the top shelf and frowned. Then he stood on tiptoe and reached to the very back of the shelf. The expression on his face changed to one of triumph, and he pulled out a wallet. "Got it. No wonder he forgot it. Stuck way in the back there."

"How did you get the locker key?" Nick asked.

The guard unsnapped a huge ring of keys from his belt and held it up. "Oh, we have master keys to all the lockers up here. Every once in a while someone has to get into their locker after hours, and they don't have their key."

Nick didn't bother asking the man how he was going to leave the wallet in Dr. Morgan's locked office. He'd already figured that out. What he wondered was how many people were on the security staffof the medical center, and how often that ring of keys got passed around. He hated the prospect of telling Anna that her list of suspects had just expanded.

8

A
NNA AWOKE SATURDAY MORNING, FILLED WITH A SENSE OF FUTILITY. HOW long had it been since her world started to fall apart? A month? A year? No, less than a week. She felt like that guy in Greek mythology—the name escaped her—who was doomed to roll the boulder up the hill. Every time he made a little progress, it rolled back. That was her, no doubt about it. It seemed as though every time she tried to solve one of her problems, another one cropped up.

She considered those problems, one by one. She had new credit cards, but she didn't know who had been using her old ones. She'd eventually clear her credit history, but she was sure it would be a time-consuming and frustrating process. She'd learned why Eric Hatley suffered a fatal reaction to a medication he should have tolerated, but in the process she'd been hit with the news that Hatley's mother was filing a malpractice suit. And when it came to finding out who was responsible for the narcotics prescriptions that bore her name and DEA registration, not only had she made no headway, the harder she looked, the more people she found who could be responsible.

She was a doctor, not a detective. Why was she the one doing all this looking anyway? She heaved a sigh. She was doing it because until she was no longer under suspicion by the DEA and the police she was a woman without a profession. She wanted to practice medicine, to teach, to get her life back. If she wanted that sooner rather than later, she'd better stop sitting here at the breakfast table drinking coffee and feeling sorry for herself. Even though it was Saturday, she should be doing something. Unfortunately, she had no idea what that was.

"Might as well run some errands. I can't foul that up," she muttered under her breath.

Anna rinsed out her coffee cup and set it beside the sink to drain. It took her only a few minutes to make out a grocery list. After that, she'd go by the cleaners, fill up her car, and try to catch up on all those little things she'd let slide recently. She knew that none of this would get her any closer to clearing her name with the law, but at least she could feel as though she'd accomplished something by the end of the day.

The last time she picked up groceries, she drove out of her way to shop in another part of town. Her first inclination was to do the same thing and avoid the grocery store where the pimply-faced clerk had sent her running out the door by announcing to her and the world that her credit card was over the limit. Then she made a decision. No minimum-wage store clerk was intimidating her. She'd walk into that store with her head held high, buy a cart full of groceries, and pay for them with one of her brand-new credit cards.

Anna relaxed when she entered the store and scanned the faces of the checkers. No, he wasn't here. Maybe that was a good sign. She went up and down the aisles, loading her cart, ducking her head to avoid the glances of the shoppers around her. Then she realized that no one but her had any notion of what had happened here a few days ago. And even then, it hadn't been her fault.

The shortest line was in front of a checker Anna knew by sight but not by name, a middle-aged woman with a slightly distracted look behind her corporate smile. She scanned each item, bagged it all with practiced ease, and announced, "Fortytwo fifty- three."

Anna cringed a bit when she swiped her new card. Her heart thumped as she watched the display announce, "Awaiting approval." Ten seconds. Fifteen. No, this couldn't be happening again. "What's the problem?" she finally asked.

The checker said, "Let me see that card, Hon." The woman swiped it on the scanner above her register's keypad. She frowned. She swiped it in the other direction. Another frown. She turned the card over, looked at the front, and her frown turned into a look of triumph.

"What?" Anna said.

The checker pointed to a small sticker Anna had managed to ignore. "See this, Hon? This is a new card. When you get it, you have to call this number and have the card activated. That keeps somebody from stealing it out of your mailbox and using it." She handed the card back to Anna. "Got another one?"

Anna remembered that she'd done exactly what the woman described when her new MasterCard arrived, and she'd used that card ever since. When this VISA card arrived, she'd filed it away in her wallet, intending to activate it later. Then she'd forgotten. Today, she'd pulled out the card for the first time, not realizing her error until it was too late.
Way to embarrass yourself again, Anna.

She tucked the not-yet-active card back into a slot in her wallet and swiped her MasterCard. When the "Approved" message popped up, along with a space for her signature, Anna realized she'd been holding her breath. She took in what seemed like half the air in the room, wondering how long it would take for her pulse rate to slow down again. Who was it that said of life's reverses that whatever didn't kill you just made you stronger? If that was the case, she'd already gotten a lot stronger. She hoped her strengthening process was about over, but a little voice inside her warned that there was probably more to come. Anna's grandmother would have called it "second sight." Nick probably would tell her it was an acceptance of Murphy's Law. Whatever it was called, Anna felt distinctly uneasy as she wheeled her cart out of the store, afraid of what might be next.

Once she'd stowed her grocery purchases, hung up her dry cleaning, and tossed her credit card receipts on the desk for filing later, Anna sat down with the phone and called the number indicated to activate her VISA card. The whole process took five minutes, four of which were spent listening to an operator telling her how important it was for her to purchase a plan that would notify all her credit card companies if her cards were lost or stolen. Anna told the operator thank you very much, and declined the coverage.

She still felt as though she should be doing something. Maybe her attorney had talked with the DEA or the police by now. She didn't know how fast lawyers worked. And would he be in his office on Saturday? If she'd been presented with a difficult medical problem, she knew she'd worry with it until she was on top of it, weekend or not. Maybe he operated under the same philosophy.

Well, she was paying Ross Donovan, so why should she be afraid to call him? Anna found his number, making a mental note to program it into her cell phone's memory, punched the keys, and waited. One ring. Two. Three.

"Ross Donovan." The response was a bit brusque, but not antagonistic. Sort of like, "Hey, I'm trying to get some work done here and hate to stop to answer the phone." Anna knew the feeling.

"Mr. Donovan, this is Dr. Anna McIntyre."

The tone of the response brightened appreciably. "Hi, Dr. McIntyre. You know, we're going to be working together for a while. I'm Ross. May I call you Anna?"

"Sure."

"So was there something you need? I'm afraid I haven't—" Anna heard a muffled thud. "Hang on, I just managed to shove a stack of papers offmy desk." A minute passed before the attorney was back on the line. "Sorry. Is there something I can do for you?"

"I wondered if you'd called those policemen." Anna searched her memory, and finally the names popped up. "Green and Dowling. Are they still intent on proving that I'm part of some sinister narcotics ring?"

"I left a call for them yesterday. One was in court, the other was off. They may try to call me this weekend. Once I've talked with them, I'll get back to you. But, as I told you yesterday, if you're innocent, you have nothing to worry about."

Anna wished she could believe that. "What about the DEA?"

"Again, I left messages for both Hale and Kramer. No return call yet. If they're reasonable, I should be able to get you a new DEA permit fairly quickly. There's no doubt that the prescriptions are forgeries. The only question is how someone got your number, matched it with your other information, and started using it to write false prescriptions."

That brought up a question Anna had wondered about."Could they have picked a number at random, and by chance it matched mine?"

He chuckled. "Sorry, didn't mean to laugh at you. Yeah, they could have picked a number, and the chances of it matching yours are the same as a roomful of monkeys producing the works of Shakespeare. No, whoever's behind this had to know what name went with the number."

"Don't pharmacists check that against some kind of directory or list?"

"Not usually."

"So it still comes down to someone who knew both my name and number."

"Yep," Donovan said. "If I were you, I'd think about someone you work with as the most likely suspect. Maybe we can point the police toward the real criminals and get them off your back."