Peter Clement - Mortal Remains

Obviously they had an opening, he thought, knowing many posts went unfilled these days since HMOs were making the healing profession less attractive than an MBA. But she also must have impressed the admissions board as much as she was in the process of wowing him. They wouldn’t take just anybody.

He was about to put the papers away when he spotted the correspondence regarding her rural rotation. It was dated November 6, two weeks ago exactly, requesting the program director to allow her to switch her slot so as to do her rural training period as soon as possible. To facilitate the change, she’d even foregone her own vacation. Her manning the wards at the time the hospital would be most short of house staff was her offer, not the insistence of the director.

I’m flattered, he thought. He proceeded to file everything where he’d be able to find it again when her three months were up and it was time to fill in the evaluation forms. But from the looks of her, he could have filled them out now. It would be A+ right across the board.

He tried to get through another few letters, but once more his thoughts turned to Bessie McDonald and ways of inducing a coma.

Within minutes he was arguing with the head nurse of the geriatric wing at NYCH, insisting they check their short-acting insulin supplies to see if any were missing.

11:00 A.M.

Medical Records,

New York City Hospital

“Dr. Garnet,” Lena Downie whispered at his shoulder, “it’s the call you’ve been expecting from Dr. Collins.”

Finally! he thought, following in Lena’s wake as she led him to a phone behind the front counter. She had the rolling gait of a female John Wayne.

“Melanie?”

“Earl! Sorry I didn’t get back to you earlier, but I’ve been up to my ass in crocodiles with budget meetings last night and rounds this morning-”

“Hey, don’t apologize. I’ve been there many times.”

“What can I do for you?”

“Bessie McDonald, a former patient of yours, is the woman whose M and M report was in Kelly’s file. Mark said he spoke to you about it Sunday night, but didn’t have the name yet.”

“Bessie? Well, my, God. That’s a weird coincidence. I knew she’d had a relapse two weeks ago. The nurses on her floor notified my office that she was found comatose one morning at 4:00 A.M. I’d even dropped in for a long overdue visit the day before, and she was fine – well, you know how these things go. I just assumed she must have thrown another embolus. But it was her chart Mark asked about? This is really strange. Do they know what happened to her?”

“The CT shows no infarcts, so it’s probably metabolic, but-”

The sight of Lena hovering nearby interrupted him. “I need to talk with you in private,” he said instead.

“Sure. I’ve got rounds until five. How about we meet at my apartment? I can make us a pitcher of the best martinis you ever had, and we can discuss whatever you want with no interruptions.”

“Sounds good.”

She gave him the directions.

Back at his desk, he returned to what he’d been doing since morning – reexamining Bessie’s old records from 1974 to the present. The reason? Tanya Wozcek had gotten him thinking the worst. Yet he’d gone over everything a second time and still couldn’t find a single entry that suggested an error in her management back then. At least not the kind that gets written down.

So he’d gone searching through the rest of her old charts, checking subsequent admissions to see if she had any tendency to develop any transient metabolic states that might have spiked her digoxin level, yet been missed in ‘seventy-four because they came and went: things like renal failure from dehydration; side effects of other medications; interactions with those drugs – he looked for them all.

The result? Nothing.

That left only two other possibilities: the sort of accident that occurs in the syringe, a nurse drawing up too much digoxin – or what Janet had suggested, a deliberate overdose. Given that the same woman now lay in a coma, also unexplained, tilted him toward the latter.

However, the records here only went up to the admission under Melanie four years ago, the one Tanya had mentioned. The more recent entries would be in her active chart on the floor. Should he go back upstairs and poke through them too? He glanced at his watch and saw it was nearly 1:00 P.M. He might as well, to be complete. After all, he had the rest of the afternoon before Melanie got off duty. He could also try to reach the people whose resident numbers were on the old M and M reports, if the teaching office could track them down for him. Who knew what bizarre piece of information one of them might remember that would prove useful?

Before closing the chart, he took a final glance through the clinical notes Melanie had written at the time of the first embolus, refreshing his memory about what had been done so he could more easily pick up the threads of the patient’s story when he got to the floor.

Precise, to the point, and clear, they documented why she had thought McDonald’s symptoms were the result of a clot, not a bleed, and warranted immediate thrombolitic therapy. Earl was impressed. The symptoms and signs distinguishing one from the other were subtle. In his own ER he’d seen seasoned neurologists dither over similar cases, then not insist as authoritatively as they should have for an immediate CT, thereby wasting precious minutes. Not Melanie. “Eyeball to needle time” as the residents called it, or the duration from when they first saw the patient to the infusion of a clot buster, had taken three-quarters of an hour, which meant she hadn’t squandered a second in making her own diagnosis and getting radiology to prove it. “Well done, Melanie,” he said under his breath.

As he walked out the door, Lena gave him a frosty good-bye, making it clear she hadn’t appreciated his denying her a chance to eavesdrop.

That same day, Tuesday, November 20, 1:15 P.M.

Hampton Junction

“Iread your transcript today,” Mark said to Lucy, as they shared a late lunch of soup and salad at his kitchen table. “No wonder you handled yourself so well with my patients.”

She chuckled, with her mouth full of lettuce. “My past was no secret, if you’d read your mail lately. That’s quite a pile on your desk.”

“It’s a bad habit of mine, avoiding mail. All I seem to get is forms, bills, and professional questionnaires. I hate paper-maze stuff.”

“Join the paperless society and use e-mail.”

“I did. That gave me even more junk to deal with, so I canceled it.”

“I’m surprised. You being way out here yet not wired-”

“Oh, I’m on the net and have necessary passwords that let me access labs and X-ray departments to get test results.” He knew he sounded defensive, but he didn’t want this sophisticated, world-traveled lady to think he was a hick.

“It’s just that I never met anybody in America who doesn’t have e-mail,” she said.

He grinned and held out his arm. “Want to touch me to see if I’m real?”

She laughed, skewering what looked like half a head of Romaine with her fork and toasting him with it.

“Tell me about where you were stationed with Médecins du Globe ,” he said, figuring he’d mangled the pronunciation.

Her smile vanished. “I’m afraid it was the grand misery tour, from Papua New Guinea tribal wars to refugee camps in Somalia, Rwanda, Bosnia, and Albania.”

There was hardness in her voice that told him she didn’t want to talk about it. “I can only imagine what you’ve seen,” he said, after casting about for something to say. It sounded lame.