Richard Mabry - Medical Error

"Don't you want a retainer or something first?"

He waved away the question. "The TV shows always talk about giving your attorney a dollar to make the relationship formal. If Laura sent you, I suspect we can work out financial arrangements. I assure you that I'll consider anything you tell me to be privileged, even if you decide not to hire me."

Anna digested this and decided it made sense. "One more thing before we get started. Why did Ms. Ernst recommend that I consult you, and in the same breath say that you're a liar and a cheat?"

"The short answer, I guess, is that I am… or at least, I was. I lied to her and cheated on her. That was before our divorce."

Anna tried to conceal her surprise. Well, she wasn't hiring a husband. She needed a lawyer. "And I guess when I asked her for the name of a lawyer, she had to call to see if you were free to accept me as a client?"

Donovan grinned, and two dimples flanked the Pecklike cleft in his chin. "Nope, she called to see if I was out of rehab."

Anna wheeled into what was probably the last open spot in the faculty parking garage and hurried across the campus. She didn't want to be late for the Morbidity and Mortality Conference, especially today, when she might well have center stage. She wished she'd had time to accept Donovan's lunch invitation, though. He'd left the invitation open, and she might end up having a working dinner with him, depending on how things progressed.

Once she'd gotten past the preliminaries with Donovan, she'd been impressed by his incisive questions and sound counsel. They'd settled on a payment schedule she could meet. He'd advised her to have no more contact with the DEA or the police, assuring her that he would handle all that.

Anna stopped at her office long enough to toss her purse into a desk drawer and snatch up her white coat. The Surgery Department conference room was packed with doctors. The faculty members sat in upholstered swivel chairs scattered at intervals around the long conference table. Third- and fourthyear resident physicians ringed the table, occupying lightly padded wooden side chairs without arms. The more junior residents were scattered around the periphery of the room in plastic shell chairs guaranteed to keep them uncomfortable and awake for the proceedings.

A few medical students, easily identifiable by their short white coats and worried looks, sat together in one corner, trying to avoid being noticed, or even worse, called on. Anna figured that some were here to learn, but most were in attendance because general surgery was a required rotation they had to pass.

The long white coats of the faculty were starched and pristine, in contrast to those of the residents, which ranged between slightly wrinkled and grungy. Although scrub suits seemed to be the uniform of the day, some of the male faculty members wore dress shirts and ties. Anna had chosen a simple white blouse and black skirt, trying for a professional look beneath her white coat. She would have preferred to remain anonymous throughout the entire conference, something she knew was impossible, but she had no intention of calling attention to herself through her choice of clothing.

Neil Fowler moved aside the remains of his box lunch and pulled a stack of papers toward him. Like a ripple around the table, the residents and staffphysicians put aside their food. Most conversations died away, some chopped offin midsentence. Anna felt the few bites of ham and cheese sandwich she'd been able to choke down trying to push their way back up. She gulped the last of her Diet Coke.

"Let's get this month's M amp;M Conference underway. We'll start with cases from the junior residents. Shelly?" Fowler took a handkerchief from his pocket and began to polish his glasses, his gaze directed to the far corner of the room. Although two of the medical students exchanged glances, apparently wondering if the chairman's attention was wandering, Anna knew better. She'd attended more than fifty of these conferences, first as a resident and for the past years as a faculty member. Neil Fowler wouldn't miss a word that was said.

After the first presentation, Fowler swept his eyes around the room, focusing one by one on the faculty members, inviting comments. A couple of the more senior faculty had a few words about the management of the case. Each agreed that the morbidity-in this case, a severe postoperative infection that kept the patient in the hospital an extra week-might have been avoided had certain things been done differently. Fowler closed the discussion by mentioning a specific antibiotic that would likely have been more effective. "Moving on. Tim?"

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 amp;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."