Medical Error (27 page)

"Rosa Hernandez. Fourteen years old. Exploratory lap, splenectomy. She's on her third unit of blood, just finishing her second bottle of Ringer's. Vitals are stable." As he gave his report to the nurse in the surgical Recovery Room, Dr. Murray's voice carried an authority Anna hadn't heard in it before. "Call me if you have any questions."

Anna wiped her palms on her scrub suit before offering her hand to Murray. "You did a nice job."

"Thanks, Dr. McIntyre." She noticed that his palms were still moist, but his handshake was firm. "I'm going to see if Dr. Jenkins needs my help in room four."

Anna watched him walk away. She knew that surviving the challenge of cases like this one supplied the building blocks of confidence that helped make a mature physician. She flashed on her own such experiences. She'd heard it said that to be a good trauma surgeon you had to be fearless. Her own opinion was that a little healthy fear never hurt. It was the doctors who were overconfident and thought they could do no wrong who always seemed to get into trouble.

"Dr. McIntyre?" Matt's voice at her elbow brought Anna out of her daydreaming.

"Yes, Matt?"

"I've handwritten an op note. I guess you'll dictate the formal one. Do you want to write the orders?"

Speaking of performing well under fire, Matt had done well also. She might as well let him spread his wings a bit more."Why don't you write the orders, then show them to me? I'll sign offon them. While you do that, I'll talk with the family."

The Hernandez family was huddled together in a corner of the surgery waiting room. Anna tried to put a smile on her face as she approached them. She knew the anxiety, the empty feeling in the pit of the stomach that came when the doctor walked toward you with news that could wreck your life forever. She'd experienced it herself when her father was in Intensive Care after his stroke. No high-stakes poker player ever tried to read the face of his opponents with any more intensity than Anna did that day. But it was only when the doctor looked down at Anna and her mother and began, "I'm sorry" that the news became obvious. She'd vowed that, if she had good news to convey, it would be evident to the family as soon as she walked through the door.

"Is she all right?" Mrs. Hernandez looked up at Anna, her anguish and pain reflected in her eyes.

Mr. Hernandez sat grim-faced and stoic, obviously prepared to hear the worst and support his wife if the dread words were uttered.

"Rosa is fine." Anna had more to say, but the words were cut offwhen Rosa's parents jumped to their feet and embraced, first each other and then her.

"Thank you, Doctor." Mrs. Hernandez wrung Anna's hand."Thank you for saving our daughter."

"Why don't you sit down and let me explain what we found?" Anna pulled up a chair so she'd be at eye level with Rosa's parents. "The force of the crash ruptured her spleen. We controlled the bleeding, then removed the spleen. It's a fairly common operation, sometimes done as an elective procedure for people with certain types of blood disorders. She'll function fine without it. We've replaced most of her blood loss, and she'll be able to build up the rest on her own."

They both began to speak at once. Anna held up a hand. "I'll answer all your questions, but first let me get back in and look at Rosa. She'll be in the Recovery Room until she's awake and stable. Either I or one of my staffwill look in on her a couple of times a day, and the nurses will notify us immediately if there's any change in her condition. Why don't you wait here? The nurse will come and get you when it's okay for you to see her."

Back in the recovery room, she found Matt writing in Rosa's chart. "How're you doing?"

"I think I've got it covered," he said. "See what you think."

She took the chart and scanned what Matt had written. It all looked good.

"Do you agree with the morphine pump for pain?" Matt asked. "I can change it to IM Demerol if you want to." He lowered his voice. "Some of the older staffstill like that, but I figure you—"

It felt so good to be back in action that Anna had almost forgotten her problems. Now one of them came roaring back at her. Whether it was the look on her face or the way she shoved the chart back toward him, Matt's voice trailed off. "Dr. McIntyre?"

"Why don't you get Dr. Fowler to sign offon this?" Anna said.

"Did I do something wrong?"

"Matt, someone stole my DEA number and has been writing 'scripts for narcotics. I've had a hard time convincing the authorities to clear me, and even though they're supposed to have issued a new DEA number, I'm not sure the process is complete. Right now, I think it's best that someone else sign offon an order that involves narcotics."

Anna couldn't read Matt's expression. Did he believe she was unjustly accused? Was he sympathetic or suspicious? Was she justifying herself in his eyes or feeding the rumor mill she knew existed in the medical center?

"I'd heard a little about that," he said. "And I think you ought to know that none of us ever thought you did anything wrong."

As though embarrassed by his statement, Matt looked down at the chart. "I'll get Dr. Fowler to sign offon this."

"Thanks, Matt. I appreciate it."

"Thank you for letting me help. I'm applying for a surgery residency here at the medical center. Would you mind if I listed you as a reference?"

"I'd be honored," Anna said.

"Look, Glenn. You need to come clean on this one." Ross Donovan watched a drop of his sweat hit his desk blotter. He loosened his tie and moved the phone to his other hand. "I saw your name on the label. I know you're involved in this some way. I can make sure you go down for it, or I can try to keep you out of it. But I can't help you unless you tell me everything."

"Ross, you gotta believe me. I didn't think I was doing anything wrong. Honest." The last word came out like a strangled call for help.

The lawyer waited for more, but all he heard was heavy breathing. Okay, now it got tricky. How far could he push the man? "Tell you what. When's your next meeting?"

The answer came without hesitation. "Tonight at eight. The basement of St. Barnabas Church on McKinney."

"Okay, I know where that is. I'll be parked around the corner at seven-thirty. Find me and get in the car."

"You won't—?"

"I won't tell your employer about this. At least not yet. But I want the whole story. And you'd better level with me. If I find out you're lying, all bets are off."

After he hung up, Ross sat for a moment with his eyes closed. This was crunch time. If this meeting tonight worked out, he might be close to solving Anna's problems. Of course, if it didn't, he could be in big trouble, trouble that could have the police on him like fleas on a dog. It was times like this that had driven him to depend on courage in a bottle.

Ross pulled out the bottom drawer of his desk and probed without looking, ignoring everything else in the drawer, until his fingers found what he wanted. He pulled out a bottle and put it on the desktop. "Your Honor," he said, in his best courtroom voice, "I call to the stand Mr. James Beam. Mr. Beam is an old friend, one who has been with me through many difficult times."

Ross reached once more into the drawer and withdrew a glass. He held it up, and the rays of the noon sun passing through it cast a rainbow on the opposite wall. A bottle and a glass, companions he'd known for a long time. And oh, how he'd missed them.

One drink—one drink wouldn't hurt, would it? He knew what it would be like, could almost taste the smooth liquor rolling across his tongue, feel the burn as it hit his stomach, anticipate the feeling that followed. He uncapped the bottle and filled the glass almost to the brim.

Some ex-smokers carried a pack, testing their willpower and daring themselves to quit. Most didn't, though, because they knew that sometime, somewhere, they'd succumb to temptation. Stress, fatigue, even hunger were the enemies of the addict, whether their drug of choice was nicotine, alcohol, or narcotics.

Ross had decided to keep his stash intact, to test his willpower. His AA sponsor tried to talk him out of it. "Don't be around alcohol. Don't be around people who drink. Don't go into bars. Avoid cocktail parties. All you need is the opportunity, because believe me—the craving will always be there. Always."

If he ever needed some Dutch courage, though, now was the time. Ross was pleased to note that the surface of the amber liquid in the glass didn't move when he held it up. His hands hadn't always been this steady. He had things under control now. No problems.

He wasn't sure how long he sat there glass in hand, staring at the half-full bottle of bourbon. Then he walked to the window and raised the glass in a toast. To sobriety . . . or to oblivion?

Yesterday, he'd gone to an AA meeting and said, "I'm Ross. I'm an alcoholic, and I have ninety-nine days." If he went to a meeting tomorrow, would he be awarded a hundred-day chip? Or would he be saying, "I'm Ross. I'm an alcoholic. Yesterday I fell offthe wagon."

He took a deep breath, then another. Finally, he turned away from the window. At the desk, he put the glass down next to the bottle and stared at them as though they were a magic crystal ball, holding all the answers to his questions. Would bourbon rule him for the rest of his life? In a single motion he swept both glass and bottle offthe desk into the wastebasket. He heard the tinkle, smelled the fumes.

He shrugged. The cleaner would take care of the trash he'd created. Nothing could clean up the mess he had been about to make of his life.

Ross grabbed his coat and briefcase and left the office, not totally sure where he was going but knowing that wherever it was, he'd get there sober.

17

N
ICK TOOK HIS FRUSTRATION OUT ON HIS CELL PHONE WHEN ANNA FAILED to show. She had promised to come by his office and have lunch with him after her appointment with Mike Simpson. Nick had planned his day carefully so he'd be free for lunch, had even picked out a place off- campus where they'd have a little privacy. He'd gotten up enough courage to say some serious things to her, but now it was as though the earth had opened up and swallowed her.

When he hadn't seen or heard from her by one in the afternoon, Nick started calling. Her administrative assistant said Anna wasn't in and hadn't come into the office all day. Was there a message? Nick said he'd try elsewhere. No message.

Anna's machine at home picked up on the first ring, so he figured there were already messages waiting for her. Nick hung up without adding one of his own. When a call to her cell phone came up dry, he swallowed hard and decided to leave a message. He hated that. Voicemail messages were so sterile and impersonal.

He worked to keep his voice neutral—no urgency, no begging."Anna, this is Nick. I thought we had planned on lunch. Give me a call when you get this. I—" He bit back the rest of his message and hung up.

Nick began to picture scenarios to explain why Anna was out of touch. Had Mike found a problem this morning? Maybe Anna had developed a late consequence of her head injury. What if she had a chronic subdural hematoma? At this moment, could she be suffering through the claustrophobic experience of an MRI? Was she once more lying in a hospital bed, or—oh, please, God, no—was she being prepped for surgery?

Nick's temples throbbed. He pulled a bottle of Advil out of his desk drawer and washed two tablets down with cold coffee. Of course, there was another possible scenario. He'd shoved this one into the back of his mind, but it kept creeping forward to stick its tentacles into his consciousness and stir his thoughts into unease. Had those two Dallas police detectives, Green and Dowling, brought her in for more questioning? He could picture her, sitting in an interview room being buffeted by questions and looking to her attorney for help. That last thought made him cringe. He knew Anna had confidence in Donovan, but Nick wasn't sure she should depend on an alcoholic, even if he was dry, or sober, or whatever AA called it.

"Dr. Valentine, call for you on line one." The voice on the intercom snapped Nick out of his thoughts before they could spiral downward any further.

He lifted the receiver. "Dr. Valentine."