Medical Error (2 page)

Jeffsnapped out a couple of requests to the circulating nurse before turning back to Anna. "He's getting hard to ventilate. Do you think we might have overloaded him with fluid and blood? Could he be in pulmonary edema?"

"I want your staffdoctor in here now! Let him evaluate all that. We've got our hands full." Anna snatched a scalpel from the instrument tray and sliced through the half-dozen sutures Luc had just placed. "Deavor retractor." She shoved the curved arm of the instrument into the edge of the open wound and tapped the medical student's hand. "Hold this."

Anna grabbed a handful of gauze sponges, expecting a gusher of blood from the abdomen. There was none. No bleeding at all within the wound. So why was the blood pressure dropping?

"Pressure's down to almost nothing." The anesthesia resident's voice was strained. "And I'm really having trouble ventilating him."

Dr. Buddy Jenkins, one of the senior anesthesiologists, pushed through the swinging doors. "What's going on?"

Anna gave him the short version. "Blood pressure's dropping, pulse is climbing. We've gone back into the belly, but there's no bleeding. And there's a problem ventilating him."

Jenkins moved his resident aside, then slipped a stethoscope under the drapes and listened for a moment. "Wheezes. And no wonder. Look at his face."

Anna peeked over the screen that separated the patient's head and upper body from the operative field. Her heart skipped a beat when she saw the swelling of the lips and the red blotches on the man's face.

"It's not blood loss," Jenkins said. "He's having an anaphylactic reaction. Most likely the blood. Did you give him an antibiotic? Any other meds?"

Anna's mind was already churning, flipping through mental index cards. Anaphylaxis—a massive allergic reaction, when airways closed offand the heart struggled to pump blood. Death could come quickly. Treatment had to be immediate and aggressive.

"He had two grams of Omnilex," Luc said. "But his old chart showed—"

Jenkins was in action before Luc stopped speaking. "I'll give him a cc. of diluted epinephrine by IV push now, then more in a drip." He turned to the anesthesia resident. "Get that ready—one milligram of epinephrine in a hundred milliliters of saline."

"Luc, you two close the abdominal wound," Anna said. "I'm going to break scrub and help Dr. Jenkins."

Jenkins handed her a syringe. "Give him this Decadron, IV push. I need to adjust the ventilator."

Anna injected the contents into the patient's intravenous line. She said a quick prayer that the epinephrine and steroid would turn the tide, that they hadn't been too late in starting treatment.

The team battled for almost half an hour, at first gaining ground, then losing it steadily. Finally, Jenkins caught Anna's eye. They exchanged glances. There was no need for words.

She sighed and stepped away from the table. "I'm calling it."Her voice cracked. "Time of death is 11:07."

Luc let the instrument he'd been holding drop back onto the tray. Jenkins picked up the anesthesia record and began to scribble. Murray, the anesthesia resident, turned back to his supply table and started straightening the mess. The medical student looked at Anna. She nodded toward the door, and he slipped out of the room. She didn't blame him. This was probably the first patient he'd seen die.

Anna tossed her gloves and mask into the waste container. She shrugged, but the tension in her shoulders gripped tighter."Any idea why this happened? The blood was supposed to be compatible. He'd tolerated Omnilex before. What else could have caused it?"

No one offered an answer. And she certainly had none. But she intended to find out.

The OR charge nurse directed Anna to the family room, where she found Hatley's mother huddled in a corner, twisting a handkerchief and occasionally dabbing at her eyes. The room was small and quiet, the lighting was soft, and the chairs as comfortable as possible. A box of tissues sat on the table, along with a Bible and several inspirational magazines. Soft music playing in the background almost covered the hospital sounds drifting in from the nearby surgical suite.

Anna whispered a silent prayer. She'd done this dozens of times, but it never got any easier. She knelt in front of the woman. "Mrs. Hatley, I have bad news for you."

Anna stumbled through the next several minutes, trying to explain, doing her best to make sense of a situation that she herself couldn't fully understand. When it came to the matter of permission for an autopsy, Anna wasn't sure of the medicolegal situation here. Hatley had died after being shot, but his injuries weren't the cause of death. Would she have to call the County Medical Examiner and get him to order one? The weeping mother solved the problem by agreeing to allow a postmortem exam.

There was a light tap at the door, and the chaplain slipped into the room. "I'm sorry. I was delayed." He took the chair next to Mrs. Hatley and began speaking to her in a low voice.

Anna was happy to slip out of the room with a last "I'm so sorry." Outside, she paused and took several deep breaths.

It took another half-hour for Anna to write a chart note, dictate an operative report and final case summary, and change into clean scrubs. She was leaving the dressing room when her pager sounded. The display showed her office number followed by the suffix "911." A "stat" page—respond immediately.

As she punched in the number, Anna wondered what else could possibly go wrong today. "Lisa, what's up?"

"Dr. McIntyre, there are two policemen here. They want to talk with you. And they say it's urgent."

Nick Valentine looked up from the computer and grimaced when he heard the morgue attendant's rubber clogs clomping down the hall. The summons he knew was coming wasn't totally unexpected. After all, he was the pathologist on autopsy call this week, which was why he was sitting in this room adjacent to the morgue of Parkland Hospital instead of in his academic office at the medical school. But he'd hoped for some undisturbed time to get this project done.

The attendant stuck his head through the open door. "Dr.Valentine, you've got an autopsy coming up. Unexpected death in the OR. Dr. McIntyre's case. She asked if you could do it as soon as possible. And please page her before you start. She'd like to come down for the post." The man's head disappeared like that of a frightened turtle. More clomps down the hall signaled his departure.

There was nothing new about an attending wanting a postmortem done ASAP. You'd think they'd realize there was no hurry anymore, but that didn't seem to stop them from asking. At least she was willing to come down and watch instead of just reading his report. Nick turned to the shelf behind his desk and pulled out a dog-eared list headed "Frequently Needed Pager Numbers." He ran his finger down the page. Department of General Surgery. Anna E. McIntyre, Assistant Professor. He picked up the phone and punched in her number. After he heard the answering beeps, he entered his extension and hung up.

While he waited, Nick looked first at the pile of papers that covered half his desk, then at the words on his computer screen. He'd put this offfar too long. Now he had to get it done. To his way of thinking, putting together this CV, the
curriculum vitae
that was so important in academics, was wasted effort. Nick had no interest in a promotion, didn't think he'd get one even if his chairman requested it from the dean. But his chairman wanted the CV. And what the chairman wanted, the chairman got.

The phone rang. Probably Dr. McIntyre calling back.

"Dr. Valentine."

"Nick, this is Dr. Wetherington. Do you have that CV finished yet?"

"I'm working on it."

"Well, I need it soon. I want you to get that promotion to associate professor, and I have to be able to show the committee why I've nominated you. Don't let me down."

Nick hung up and rifled through the pile on his desk. Reprints of papers published, programs showing lectures delivered at medical meetings, textbooks with chapters he'd written, certificates from awards received. His professional résumé was pitifully small, but to Nick it represented the least important part of his job. What mattered most to him was what he was about to do—try to find out why the best efforts of a top-notch medical staffhad failed to save the life of some poor soul. If he did his job well, then maybe those doctors would be able to snatch some other patient from the jaws of the grim reaper.

His phone rang. "Dr. Valentine, are you about ready?" the morgue attendant said.

Nick looked at his watch. Almost half an hour, and Dr. McIntyre hadn't responded to the page. He hated to start without her, but he might have to. "Give me another ten minutes."

While he waited, Nick figured he might as well try to make Dr. Wetherington happy. Now, when did he deliver that paper before the American Society of Clinical Pathology? And who cared, anyway?

Anna's administrative assistant met her at the doorway to the outer office. "Dr. McIntyre, I didn't know what to do."

"That's all right, Lisa. I'll talk with them." Anna straightened her white coat and walked into her private office, where two people stood conversing in low tones. Lisa had said, "Two policemen," but Anna was surprised to see that one of them was a woman.

The man stepped forward to meet Anna. "Doctor McIntyre?"

Anna nodded.

He pulled a leather folder from his pocket and held it open for her inspection. Anna could see the gold and blue badge pinned to the lower part of the wallet, but couldn't read the words on it. The card in the top portion told her, though. It carried a picture beside the words, U.S. Drug Enforcement Administration.

Lisa had been wrong. These people were from the DEA, not the police. Still, an unannounced visit from that agency made most doctors sweat. You never knew when some innocent slip might get you into trouble.

The man flipped the credential wallet closed. "This won't take long."

"Good. I've just finished an emergency case, and I still have a lot to do." Anna moved behind her desk and sat.

"Your chairman said you'd give us as much time as we need."

Anna glanced pointedly at her watch. "Well, have a seat and let's get to it. What do you need from me?"

The man lowered himself into the chair, his expression slightly disapproving. His partner followed suit. "We have some things we need for you to clear up."

"Could I see those credentials again?" Anna said. "Both of you."

They obliged, laying the open wallets on the desk. Anna pulled a slip of notepaper toward her and began copying the information, occasionally glancing up from her writing to match the names and faces on the IDs with the people sitting across from her. The spokesman was Special Agent John Hale, a chunky, middle-aged man wearing an off-the-rack suit that did nothing to disguise his ample middle. Anna thought he looked more like a seedy private eye than an officer of the law.

The woman, the silent half of the pair so far, was Special Agent Carolyn Kramer, a woman who reminded Anna of a California surfer, complete with perfect tan and faultlessly styled short blonde hair. The resemblance stopped there, though. Kramer's eyes gleamed with a combination of intelligence and determination that told Anna she'd better not underestimate the woman. Kramer wore a stylish pantsuit that had probably cost more than Anna made in a week. How could a DEA agent have money for an outfit like that?

Anna handed the badge wallets back to Hale and Kramer."All right, how can I help you?"

Hale pulled a small notebook from his inside coat pocket and flipped through the pages. "Doctor, recently you've been writing a large number of Vicodin prescriptions, all of them for an excessive amount of the drug. Can you explain that?"

"I don't know what you mean," Anna said. "I'm pretty sure I haven't written any more Vicodin 'scripts than usual, and I certainly haven't changed my prescribing practices."

Hale nodded, stone-faced. "What are those practices?"

"I prescribe Vicodin for postoperative pain in many of my patients, but always in carefully controlled amounts, usually thirty pills at a time. By the time they've exhausted that first prescription, I can generally put them on a non-narcotic pain reliever. It's rare that I refill a Vicodin 'script."