Richard Mabry - Medical Error

"Uh… yes, sir."

"Deep tendon reflexes brisk and equal. Pupils reactive to light. No papilledema. Sensation intact. So she was neurologically intact?" Simpson turned from the computer screen and fixed him with cold gray eyes. "But she had amnesia. That's abnormal. It's not a physical sign, but recall that one of the elements-the first element-of a good neurologic is whether the patient is oriented to time, place, and person. She isn't, so her neurologic is abnormal. Never mind her pupillary reactions and deep tendon reflexes. So you were right. You had to get the CT." The faintest hint of a smile flickered on Simpson's lips."Fell, you're a good doctor. Dr. McIntyre told me once she had high expectations for you. When you know you're right, don't back down. But remember one thing. In our profession, good isn't enough. We have to be perfect."

Will nodded. "So you agree she has no evidence of a subdural?"

"Just a concussion."

"And the amnesia? Should I get a psychiatry consult?"

Simpson shook his head. "Transient global amnesia. A rare consequence of head trauma, especially if there's significant associated psychological stress. I'm betting that within the next few hours she'll start remembering things. By tomorrow, maybe the next day, she should be fine."

"Will all her memory come back?"

Simpson shrugged. "Most of it. Generally these patients don't remember anything about the precipitating event. Other than that, yes, it all comes back to them."

"Do you want her hospitalized for observation?"

"Admit her to my private service with the diagnosis of head injury, rule out subdural hematoma. Neuro signs every hour. You know the drill. Get an MRI of the head tomorrow to make sure she isn't developing anything else. I'll see her before I leave this evening. If anything comes up before then, page me."

"Good morning, Will." Anna pulled the covers up to her chin. It wasn't so much a matter of modesty. Goodness knows that had gone out the window along with her clothes when the nurses replaced them with a hospital gown. And she dreaded looking in a mirror. One of the ICU night nurses had taken pity on her and scared up a hairbrush and lipstick, but Anna still felt-and probably looked, she guessed-like a Halloween leftover.

"Morning, Dr. McIntyre." Will was freshly shaved, his scrub suit and white coat were clean and unwrinkled, but the dark circles under his eyes told a different story.

"Will, you were in here offand on all night. Weren't you supposed to go offduty last evening?"

Will suddenly found her chart very interesting. He didn't look up as he said, "Well, I decided to hang around here last night."

"There was no need for that. Dr. Simpson came by last evening. He brought the on-call neurosurgery resident with him and briefed him on my case. You should have gone home for some rest."

"Oh, I snatched a few naps in the call room. No big deal."

Anna decided not to pursue a subject that was obviously an embarrassment to Will. Instead, she asked, "So, what's the plan?" She grinned. "I mean, I think I know what the plan should be, but I still have some holes in my memory right now."

Will seemed on firmer footing now, talking about something clinical. "Your neuro signs are stable, so we-I mean, Dr. Simpson-will let up on the frequency of checking those. You're scheduled for an MRI this afternoon. If things go well, we can get rid of that IV this evening and start letting you eat and move around."

"And how long before Mike lets me go home?"

"Maybe another day or two. And I'm pretty sure he'll want you on limited activity for a week or so."

Something that had been gnawing at the back of Anna's mind began to burrow forward into her conscious thoughts. She had gone to that laboratory for a reason. All the pieces of the puzzle hadn't put themselves together in her addled brain, but she had the sense that she needed to get back to whatever she was doing. Soon.

Will hesitated for a moment before reaching down and touching her hand, carefully avoiding the IV snaking into the vein just above her wrist. "I've got to go back on duty in the ER, but if you need anything, just have the nurses page me."

"Thanks, Will."

Anna appreciated Will's obvious concern for her. She was independent enough to think she didn't need his help, but it was nice to know it was there. Then she realized that there were a couple of men in her life who'd already shown her that they cared. And she should probably contact both of them.

That led to another thought. Her cell phone. Where was it? The answer came back quickly, and with it another set of problems reared its head. Her cell phone was in her purse. And her purse? The last she'd seen of it, a derelict was tugging it away from her. Purse. Cell phone. Wallet. Identification. Cash. Credit cards. All gone. And her car? What were the chances it was still parked where she had left it? There was so much to deal with. But not now. Not yet. Instead, she closed her eyes and began to do the only thing she felt well enough to do. She prayed.

Nick Valentine frowned at the ringing phone. What now? He wasn't on call, so this couldn't be a frozen section or an autopsy. He was current on all his dictation, not just the pathology reports-he was scrupulous in keeping current with those-but even the academic and administrative material. The long-delayed curriculum vitae was on Dr. Wetherington's desk, putting an end to almost daily phone calls asking for that piece of material. No, Nick's desk was clean, and his conscience was clear. So why couldn't he have a moment's peace to finish this journal article he'd been trying to read for the past month?

"Dr. Valentine." Nick noticed that he hadn't been completely successful in keeping the annoyance out of his tone, and a glimmer of guilt flitted across his mind.

"Nick?" The voice was a little weak but he recognized it immediately.

"Anna! Where are you? Are you all right? I've been trying to reach you since noon yesterday."

"It's sort of a long story. Right now I'm at University Hospital. They've just moved me out of the ICU and into a room. If you want to come by, I'll-"

"I'm on my way. What room?"

Nick rushed down the warren of corridors from his office at the medical school to the University Hospital, his mind churning. ICU? What had happened? Was Anna going to be okay? He arrived at the elevators but decided they were too slow. He took the stairs two at a time. He paused at the door to her room long enough to slow his breathing, wondering if his pounding heart was a consequence of the stairs or a signal of the emotion he felt. He tapped on the door.

"Come in."

The response was faint, the voice almost unrecognizable. Nick opened the door. What he saw brought the same feeling as his first- and last-roller-coaster ride. His stomach dropped, his pulse raced, and he wanted to turn back the clock and start over. Anna lay with eyes half-closed, lifting her hand a few inches in greeting before letting it fall back on the covers. The bruise on her jaw was a palette of green and blue, a stark contrast with the pallor of her skin. Her red hair was tousled, and her green eyes had none of their usual snap and sparkle.

Nick scanned the monitors recording Anna's vital signs, and he relaxed a bit when he saw the values. He covered the distance to the bed in three long strides. "I've been so worried about you."

"I'm sorry. I guess-" She swallowed with visible effort."Could I have a sip of water?"

Nick wondered if it was okay to let her drink. She still had an IV in, but there was a Styrofoam pitcher of water on the bedside table, and a flexible straw sat in a half-full glass beside it. He held the water for her, supporting her head with his other hand. She managed three small sips.

"Thanks," she said. "You must be wondering why I didn't call sooner."