Robin Cook - Harmful Intent

"How did you become the scapegoat?" Kelly asked. "What happened to the other doctors and the hospital? Weren't they sued?"

"They were all dropped from the case," Jeffrey explained. "I had a brief problem with morphine a few years back. Standard story: it was prescribed for a back injury I suffered in a bike accident. During the trial, they suggested that I'd mainlined some morphine shortly before I came on the case. Then someone found an empty via] of.75% Marcaine in the disposal of the anesthesia machine I was using-.75% Marcaine is contraindicated for obstetric anesthesia. No one found the.5% vial."

"But you didn't use.75%, did you?" Kelly asked.

"I always check the label of any medication," Jeffrey said. "But it's that type of reflex behavior that's hard to specifically remember. I can't believe I used.75%. But what can I say? They found what they found."

"Hey," Kelly said. "Don't start to doubt yourself. That's what Chris started to do."

"Easier said than done."

"What is.75% Marcaine used for?" Kelly asked.

"Quite a few things," Jeffrey said. "Whenever you want a particularly long-acting block with little volume. It's used a lot in eye surgery."

"Had there been any eye cases in the OR where your accident occurred or any operations that might have required.75% Marcaine?"

Jeffrey thought for a moment. He shook his head. "I don't think so, but I don't know for sure."

"It might be worth looking into," Kelly said. "It wouldn't have much legal import, but if you could explain the.75% Marcaine, at least to yourself, it would go a long way in helping rebuild your confidence. I really think that where malpractice is concerned, doctors need to be as diligent in guarding their selfesteem as thef are in preparing their court cases."

"You're right about that," Jeffrey said, but he was still thinking about

Kelly's questions regarding the.75% Marcaine. He couldn't believe that no one had thought to ask about cases prior to Patty Owen's in the same OR. He sure hadn't thought of it. He wondered how he'd go about inquiring now that he didn't enjoy the access to the hospital he once had.

"Speaking of self-esteem, how's yours?" Kelly smiled, but Jeffrey could tell that despite her apparent lightheartedness, she was dead serious.

"I have the feeling I'm talking to an expert," Jeffrey said. "Have you been reading a bit of psychiatry on the side?"

"Hardly," Kelly said. "Unfortunately, I learned about the importance of self-esteem the hard way, by experience." She took a sip of tea. For a moment she was lost in her own sorrowful reverie, staring out the bay window at the overgrown garden. Then, just as abruptly, she snapped out of her momentary trance. She looked at Jeffrey, without her smile. "I'm convinced it was through low self-esteem that Chris committed suicide. He couldn't have done what he did if he felt better about himself. I just know it. It wasn't the fact of the tragedy that pushed him over the edge. It certainly wasn't guilt. Chris was like you, in that he had nothing to feel guilty about. It was the sudden erosion of confidence, the damage done to how he thought about himself, that made Chris take his life. People have no idea how sensitive even the most accomplished doctors are to the impact of being sued. In fact, the better the doctor the more it hurts. The fact that the suit is baseless has nothing to do with it."

"You're so right," Jeffrey said. "Back when I heard that Chris had killed himself, I was astounded. I knew what kind of man he was, what kind of doctor he was. Now his suicide doesn't astound me at all. In fact, from where I sit now, I'm surprised more doctors sued for malpractice aren't drawn to it. In fact, I tried it last night."

"Tried what?" Kelly asked sharply. She knew what Jeffrey meant but she didn't want to believe it.

Jeffrey sighed. He couldn't look at her. "Last night I tried to commit suicide," he said simply. "I came within an inch of doing the same thing that Chris did. You know, the succiny1choline and morphine trick. I had the

IV running and everything."

Kelly dropped her cup of tea. She lunged forward and, grabbing Jeffrey by his shoulders, she shook him. The Miove startled him. She caught him completely unaware.

"Don't you dare do such a thing. Don't even think about it!"

Kelly was glaring at him, still clutching his shoulders. Finally Jeffrey mumbled that she needn't worry, since he'd lacked the courage to go through with it.

Kelly shook him again, reacting to his comments.

Jeffrey didn't know what to do, much less say.

Kelly kept shaking him, her passions inflamed. "Suicide is not courageous," she said angrily. "It is the opposite. It's the cowardly thing to do. And it's selfish. It hurts everyone you leave behind, everyone who loves you.

I want you to promise me that if you ever have thoughts of suicide again, you'll call me immediately, no matter what time of day or night. Think of your wife. Chris's suicide filled me with such guilt, you have no idea. I was crushed. I felt that somehow I had failed him. I know that's not true now, but his death is something I'll probably never get over completely."

"Carol and I are getting a divorce," Jeffrey blurted.

Kelly's expression softened. "Because of the malpractice suit?"

Jeffrey shook his head. "We'd planned it before all this started. Carol was just nice enough to put it off for the time being.,,

"You poor man," Kelly said. "I can't imagine trying to deal with being sued for malpractice and a breakup of a marriage at the same time."

"My marital problems are the least of my worries," Jeffrey said.

"I'm serious about your promising me you'll call before you do anything foolish," Kelly said.

"I'm not thinking..."

"Promise!" Kelly insisted.

"All right, I promise," Jeffrey said.

Satisfied, Kelly got up and cleaned up the mess that she'd made when she'd dropped her teacup. As she picked up the pieces of broken china, she said:

"I wish more than anything that I'd had the slightest indication of what

Chris had been plan-

ning. One minute it seemed that he'd been full of fight, talking about the anesthetic complication being secondary to a contaminant in the local, the next minute he was dead."

Jeffrey watched Kelly as she threw the shards of china away. It took a few moments for her last words to sink in. When she returned and took her seat again, Jeffrey asked, "What made Chris think of a contaminant in the local anesthetic?"

Kelly shrugged. "I haven't the faintest idea. But he seemed to be genuinely excited about the possibility. I encouraged him. Just before that he'd been depressed. Very depressed. The idea of a contaminant gave him a real boost.

He spent several days poring over pharmacology and physiology textbooks. He made lots of notes. He was working on it the night he... I'd gone to bed.

I found him the next morning with an IV in place, the bottle empty."

"How awful," Jeffrey said.

"It was the worst experience of my life," Kelly admitted.

For an instant, Jeffrey envied Chris, not because he'd succeeded where

Jeffrey had failed, but because he'd left behind someone who obviously loved him so deeply. If Jeffrey had followed through, would anyone be that sorry about it? Jeffrey tried to shake the thought. Instead, he considered the notion of a contaminant in the local anesthetic. It was a curious thought.

"What kind of contaminant was Chris thinking about?" Jeffrey asked.

"I really don't know," Kelly answered. "It was two years ago, and Chris never did go into much detail about if. At least not with me."

"Did you mention his theory to anybody at the time?"

"I told the lawyers. Why?"

"It's an intriguing idea," Jeffrey said.

"I still have Chris's notes," Kelly said. "You're welcome to see them if you'd like."