Richard Mabry - Medical Error

Anna stood quietly by as the emergency room clerk explained to a young Latino boy that his father would be seen as soon as possible. The boy nodded gravely and rattled offthe translation so rapidly that Anna, who prided herself on being able to communicate in that language, couldn't follow the Spanish. The father grimaced, clutched his stomach for a moment, then shrugged in resignation and edged back toward a seat in the crowded waiting room.

When the clerk was free, Anna stepped up to the desk."Shirley, what doctor's running the ER today?"

The woman turned with a start. "Oh, Dr. McIntyre. I didn't see you standing there. I thought you were on vacation."

Anna leaned over and dropped her voice. "News travels fast around here. Yes, I'm on a leave of sorts, but there's something I need to. .. I have to get some information from one of the doctors for the project I'm working on. Who's the Pit Boss today?"

Shirley ran her hand through blonde hair that Anna was willing to bet didn't start out that color. "That would be Dr. Fell."

"Do you know if he's tied up right now?"

"I think he just slipped back for a cup of coffee." Shirley pointed the way.

Anna nodded her thanks and headed for the break room. Just being in the Emergency Room made her pulse quicken, as she relived memories of her own time as "Pit Boss"-the second-year surgery resident charged with overseeing the ER at Parkland Hospital, arguably one of the busiest in the nation. The pressure was tremendous, but the opportunity to hone one's clinical judgment and skills was almost unlimited.

She recalled the time when one of the senior staffsurgeons had found her sobbing in the ER break room at the end of her shift. He'd put a gentle hand on her shoulder. "What's wrong, Anna?"

She told him about her feverish struggle to save the victims of a horrible crash on North Central Expressway. In the end, the only survivor was a three-year-old child, left orphaned when his mother, father, and older sister died. "I did all I could. And it wasn't enough."

The doctor had eased into the chair beside her. "If you've given it all you had, don't blame yourself when you lose the battle. You can't die with them, you know. If you do, who'd take care of the next one?"

Anna gave a little shudder as she recalled that advice. She'd recently had a patient die-one who should still be alive right now-but for the moment she needed to put any thought of guilt and blame aside. She needed to do something positive. She'd start by questioning the doctor who'd treated the "other" Eric Hatley.

"Dr. McIntyre, what brings you down here? I thought you were on leave." Dr. William Fell was slumped on the couch, sipping from a Styrofoam cup. He started to stand, but Anna waved him back.

"Will, I'm glad you're on duty today. I need to know what you remember about this patient." She held out the emergency room file she'd taken from Nick's office.

He flashed a grin. "Hey, this was two weeks ago. I can't remember the patients from yesterday."

"It's really important. Look at your note. Tell me if it rings a bell."

Will scanned the scrawled note. "Matter of fact, I do recall this guy. In the first place, if you notice the time stamp, he showed up here at two a.m. with a chief complaint of a sexually transmitted disease. I'd just stretched out to take a nap when they woke me. I gave him a pretty good tongue-lashing for picking that time to come in for something like that. Know what he said?"

Anna shook her head.

"Said that he knew we wouldn't be as busy at that time of the morning, and he was up anyway." Will flipped back to the cover sheet. "I remember telling him that, since he had private insurance, he should have gone to his regular doctor during normal hours. He blew me offand asked me if I was going to treat him. I did a quick exam, confirmed my diagnosis with a lab test, and gave him an IM antibiotic. Told him to make a follow-up appointment, but you know they never do. End of story."

"Can you recall what he looked like?"

"Vaguely. Twentyish black male. Taller than me, quite a bit thinner."

"Remember anything else about him?"

Will closed his eyes and Anna could almost hear the wheels turning. "Sorry, nothing stands out. Is it important?"

"Not really, I guess."

"What's this about?"

"The man's name came up in connection with another case, and I'm following up on it," Anna said. "We may have gotten a couple of patients with the same name mixed up. But you didn't do anything wrong, so don't worry about it. Thanks."

"I'll walk out with you," Will said. "It's time for me to get back to work."

They stopped in the hall and Anna put her hand on Will's arm. "Hang in there. It's a tough rotation, but it's worth it- sort of like putting iron into a fire to temper it."

As she started down the hall, Anna couldn't help wondering whether the problems that plagued her right now would temper the iron of her resolve or shatter it.

"Hi, Lisa. I'm picking up some things. Pretend I'm not here." Anna ducked into the sanctuary of her office before her administrative assistant could reply.

She scanned the mail and rummaged through the papers in her "In" box. Nothing that couldn't wait another day. And if things didn't get straightened out pretty soon, none of it would matter anyway. Anna unzipped the backpack she used as a briefcase and pulled out a manila folder bulging with the documents to duplicate. She was still shuffling the papers, deciding how many copies she'd need, when Lisa appeared in the doorway.

"Dr. McIntyre, I know you said to pretend you aren't here, but there are two detectives out there, and they want to speak with you."

Anna decided she was getting entirely too experienced at meeting with members of the law enforcement community."Have you looked at their credentials?"

Lisa nodded. "Yes. They're with the Dallas Police."

Anna squared her shoulders. "Very well. I'll talk with them."

Lisa paused with her hand on the doorknob. "I want you to know that I think this whole mess with narcotics numbers and forged prescriptions is ridiculous. Nobody in the department thinks you did anything wrong."

"Thank you," Anna said. "I guess you'd better send them in."

The moment the two men-one white, one African American-came through the door, Anna decided she would have pegged them as policemen without any advance warning. Not just because of the wardrobe-off- the-rack sport coats, slightly rumpled dress shirts, shoes obviously chosen for comfort rather than style. No, it was a subtle presence that said, "I'm in charge and I've got my eye on you."

Anna held out her hand. "May I see your credentials?" She left the men standing while she sat and carefully examined their badges and identification cards. She jotted down their names and badge numbers, adding them to the sheet she'd started for the DEA agents.

Lamar Green was a burly African American with a shaved head and what looked to be a permanent scowl on his face. His whole demeanor said, "Don't mess with me."

Burt Dowling was a rail-thin white man with a pronounced five o'clock shadow and thinning dark brown hair. Whereas Green seemed to jangle with nervous energy, Dowling appeared to observe the world with a touch of disappointment through hooded eyelids.

She handed the credentials back and motioned the men to the two chairs across from her desk. "How may I help you?"

Green pulled a notebook from his pocket but didn't open it. Instead, he fixed her with a glacial stare. "Doctor, we need to ask you some questions about all the prescriptions you've been writing for large amounts of narcotics."

Anna fought to control her temper. "I believe you mean that some prescriptions bearing my DEA number and forged with my signature have turned up. I'm unaware of any evidence that even vaguely suggests I'm anything but a victim in this situation."