Richard Mabry - Medical Error

Nick stepped back from the autopsy table, pressed the pedal under his right foot, and spoke into the microphone hanging near his head. "No other abnormalities noted. The balance of findings will be dictated after review of the histopathology specimens and the results of the toxicology tests. Usual signature. Thanks." He turned away from the body and gestured to the morgue assistant to close the incisions. "I'll be in the office if you need me. Thanks for your help."

Nick removed his goggles and stripped offhis mask, gown, and gloves. He was standing at the sink outside the autopsy room, drying his hands, when he heard footsteps hurrying down the corridor toward him. He turned to see a woman approaching. The attractive redhead wore surgical scrubs, covered by a white coat. As she neared him, he could make out the embroidered name above the breast pocket: Anna McIntyre, MD. She stopped in front of him, and the set of her jaw and the flash of her green eyes told Nick she was in no mood for light banter.

"Dr. McIntyre?"

She nodded.

"Nick Valentine. I paged you, but when you didn't answer I had to go ahead and get started. Sorry."

She waved away his apology. "No, it's my fault. I couldn't break free to answer your page. What can you tell me?"

"Why don't I buy you a cup of coffee and I'll tell you what I've found so far? If we go to the food court, we can get away from the smell down here."

She hesitated for a few seconds. "Okay. Lead the way."

It seemed to Nick there was a Starbucks on every corner of every major city in the U.S. Most important to him, however, was the one here in the basement of the Clinical Sciences Building at Southwestern Medical Center. As he waited to order, he sniffed the rich aromas that filled the air. The smell of coffee never failed to lift his spirits. Maybe it would do the same for the woman who stood stoop-shouldered beside him. For most doctors, caffeine was the engine that helped propel them through long days and longer nights. Maybe all she needed was a booster shot.

When they were seated at a corner table with their venti lattes, Nick filled her in on his findings at the autopsy he'd just completed. "That's about it," he concluded. "I'll sign the death certificate with the preliminary cause of death as anaphylaxis due to an unknown cause."

"But you won't have a final diagnosis until-"

"Right. I'll review the tissue samples and the results of the toxicology screen, but I doubt that we'll find anything there. I'll have some tests run on the blood samples I took, and maybe that will help us. I'll need to research whether there's a good blood test for a drug reaction or latex allergy. The long and short of it is that we may never know the real reason he developed anaphylaxis and died."

"I hadn't even thought of latex allergy," she said. "But that's pretty rare, isn't it?"

"Less than one percent of the population. Seen in people chronically exposed to latex: surgeons and nurses, industrial workers, patients with lifelong indwelling catheters." He felt himself slipping into his lecture mode and made an effort to pull back. "I mean, we could talk about all these uncommon things, but I'll bet you learned the same thing in medical school that I did. When you hear hoof beats-"

"Think horses, not zebras." She managed a tiny smile. "Yes, I know. So we should concentrate on the blood or the antibiotic. If it was the blood, there's a problem in the blood bank because he got one unit of unmatched O negative, which should have been okay, and one unit that was supposedly compatible by cross-match."

"The residuals in both bags of blood are being re-typed and cross-matched against your patient's blood as we speak. We'll know the answer by the time we finish our coffee." He drank deeply from his cup. "Don't you think an antibiotic reaction is the most likely cause?"

She took a sip of coffee. "Probably, although I hope not. Choosing an antibiotic wasn't a routine matter, because we didn't know if Hatley had any drug allergies. The resident- one of our sharpest ones, by the way-thought he'd see if we could get the information another way. He had medical records check for a previous visit for the patient. They found a recent emergency room visit by the patient where he tolerated Omnilex. Since that antibiotic's the best choice to cover spillage from a perforated bowel, I agreed with Luc when he ordered it."

"But-"

"I know. If you give that drug to a patient who's allergic to it or to penicillin, their reaction is likely to be severe-like this one. But I thought, since we had that history of tolerance, it was okay." She blinked hard. "I should have known better. Should have made him use a different drug."

Nick sensed he was treading on thin ice here. Maybe he should change the subject. Besides, he wanted to know more about this woman. "You know, I've seen you in the halls, but we've never actually met. Did you train here?"

She hesitated before reeling offwhat had apparently become a stock answer. "Raised in Oklahoma. Graduated from med school in North Carolina. Duke, actually. Lucky enough to get a surgery residency here at Parkland, and when I finished I was offered a faculty position in the Surgery Department. I've been here a little less than a year now."

Nick held up a hand, palm out. "I know better. You don't get a surgery residency here because you're 'lucky.' You get one because you're good. Let me guess. AOA at Duke?" If Anna was Alpha Omega Alpha, she must have been in the top ten percent of her class.

"Right. But I don't guess it's enough to be bright if you foul up and cost a patient his life." She drank from her cup, and Nick noticed that she swallowed several more times after that.

Nick was barely aware of the activity around him, the ebb and flow of people, the sounds of pagers punctuating dozens of conversations. All he saw was Anna. She was one of the most attractive women he'd encountered in quite a while. But he was certain there was more to this trim, green-eyed redhead than striking good looks. Right now she was focused on medicine-it was obvious she cared a great deal about her patients, and this loss hit her hard-but Nick had a sense that in a different setting she'd be fun to know. And he intended to see if he couldn't arrange that. Anna shifted in her chair. He couldn't let her leave yet.

"Wait a minute," he said. "Aren't you curious about me at all? There may be a prize if you can answer all the questions later."

Did he see the ghost of a grin? "Sure. Why not? What's your story-the Reader's Digest version?"

Nick moved his cup aside and leaned forward with his elbows on the table. He wasn't sure how much longer he could draw out their time together, but he was determined to give it his best shot. "My roots are Italian. Named for my grandfather. He was Nicolo Valentino when he got offthe boat, changed his name when he got his citizenship. I'm Nicolo the Third." He ticked offthe points on his fingers. "Worked my way through premed at Texas Tech. Got into the med school there by the skin of my teeth. Managed to get a residency in pathology here at Southwestern. When I finished, they had an opening in the department." He held out his hand, palm up, fingers spread, thumb tucked under. "So here I am-four years in the department, still an Assistant Professor. Up for promotion now, and I suspect that if I don't make it they'll cut me like a dead branch from a tree."

Nick's last sentence rang a faint alarm bell in his head. He had to finish that project or the chairman would be royally ticked off, but it only took Nick a second to put that chore out of his mind. He was sitting with the most beautiful woman he'd ever met. He wanted to get to know her better, and he intended to keep her here as long as possible, even if it meant incurring Dr. Wetherington's wrath.