Code 15

by Gary Birken

“I don’t need an autopsy to confirm the obvious. The woman fell from her bike, ruptured her spleen, and I missed it. It’s as simple as that.”

  “Nothing’s as simple as that.”

  “I’m responsible. We’ll have to report this to the state as a Code Fifteen,” Morgan said, feeling emotionally drained. “That poor woman. She told me she was a single mom with three kids. She had no other family. What in God’s name is going to happen to those children?”

  “We have a great team of social workers. I’m sure they’ll take care of everything. You didn’t do anything wrong,” Justine assured her again. Morgan barely heard Justine’s words. Her mind was reeling, trying to understand how she could have made such a huge mistake. Finally, she stood up and made her way back to the nursing station. On the brink of tears, she struggled to collect herself.

  Morgan took a measured look around the emergency room. Everybody around her, including those who had just helped in trying to save Faith Russo’s life, was already busy at work attending to new patients. It was as if it was just another busy Friday night and nothing out of the ordinary had happened. The strange irony was that Morgan had been guilty of the same type of unemotional response herself many times in the past. But tonight was infinitely different. The feeling of being directly responsible for another human being’s death had shaken her to the core.

  CHAPTER 38

  DAY TWELVE

  At nine a.m. Monday morning, Morgan walked through the gleaming metal doors that accessed Dade Presbyterian’s morgue.

  It had been a long, wearisome weekend. She had spent most of Saturday wallowing in guilt, self-doubt, and remorse. Ben had gone out of town and although she had spoken to him a few times, she decided to wait until he returned to tell him what happened. As soon as he landed on Sunday, he came to her apartment bearing Thai takeout for dinner.

  At first, Morgan had difficulty sharing her dismay with him regarding what had happened. As she expected, Ben was supportive and insightful. He reminded her that no physician was immune to poor patient outcomes. He also pointed out that missed diagnoses and errors in treatment were inevitable, especially if one chose to be an emergency room doctor. The only way to get back on track was to be introspective about what had occurred, lick your wounds, and show up for your next shift. Ben’s pep talk was sufficient to renew her confidence, raise her spirits, and make her more comfortable about the prospect of getting back to work. Equally important was that she was now questioning not only the events surrounding Faith’s death but her own accountability as well.

  Typical of most hospitals, Dade Presbyterian’s morgue was a dreary, featureless room with cement block walls, gray countertops, and a scuffed linoleum floor. Directly in the middle of the room, bolted to the floor, was a long stainless-steel table. The table was brightly illuminated by two overhead surgical lamps.

  Morgan walked across the room and grabbed one of the white plastic bunny suits from the top of a large stack. Holding it in front of her, she stepped into its legs, pulled it up over her shoulders and zipped it up the front all the way to her neck. When she entered the autopsy room, the chief of Pathology, Everett Canfield, was putting on his gloves.

  Canfield was a chronically cranky man who had lost his smile more years ago than anybody could remember. With shaggy eyebrows and crusty skin, he ran the pathology department with no imagination. Morgan wasn’t alone in her belief that the only thing saving his job was his twenty-five years of service and his close personal friendship with Bob Allenby. Influential in hospital politics, he was one of the few members of the medical staff that Morgan had locked horns with on more than one occasion. Based on their history, she assumed he didn’t hold her in high esteem.

  She watched in silence as he stepped up to the table. His only acknowledgment of her presence was a fleeting glance and a cursory nod. His assistant handed him a scalpel and with one steady stroke, he made an incision from the top of Faith’s breastbone all the way down past her umbilicus. For all his pomposity, Canfield was an adept and experienced pathologist.

  While joking with his technician, he divided the muscle layers of Faith’s abdominal wall.

  “Okay, let’s have a look,” he said, using a scissors to incise the last thin layer that separated him from Faith’s abdominal cavity. The instant he opened it, there was a huge gush of old, dark blood. Based on the ultrasound findings from the emergency room, Morgan was hardly surprised.

  “Let me have the suction,” he told the technician. He then plunged the plastic sucker deep into Faith’s abdomen and removed the remaining blood. Most of it was liquid, but some of it was in the form of huge clots, too large for the sucker. Shaking his head, he reached his cupped hand into her abdominal cavity and began scooping them out.

  “Every drop of blood she has is in her abdomen,” the tech said. “She never had a chance.”

  Canfield never looked up. “It’s no wonder she’s dead,” he stated in a condescending voice. When there was no more blood, he slid his double-gloved hand to the upper right part of the abdomen. “The liver’s fine—no cracks, lacerations, or contusions.” He then moved to the left side, reached up toward the diaphragm and curled his fingers around her spleen. He pulled it gently forward so he could examine it.

  “How does it look?” Morgan asked trying to peer over his shoulder.

  “Like an elephant sat on it. It’s shattered into a dozen pieces. This is undoubtedly the cause of death.”

  “Are you positive?” Morgan asked.

  With raised eyebrows, he answered, “I doubt she was born this way. Obviously, this woman sustained a major blunt force to her abdomen and bled to death from a pulverized spleen. This is not exactly the brain-breaker case of the month.”

  Morgan took a step back and folded her arms. She doubted whether Canfield had read Faith’s entire medical record.

  “This woman was seen twice the night she died,” Morgan told him. “The first time she came in she complained of knee pain. Her pulse and blood pressure were normal, and her abdomen was completely normal. We checked her out thoroughly and discharged her. Less than an hour later, she returned in cardiac arrest with an abdomen full of blood. How do your findings explain that?”

  “Do you really want me to answer that?”

  “I wouldn’t have asked if I didn’t,” she said, undaunted by his insulting innuendo.

  “Denial and ego aside—you missed her ruptured spleen the first time you saw her.”

  “I don’t think so,” Morgan insisted, pointing to the spleen. “She told us her bike accident occurred hours earlier. Anybody who had sustained an injury like that would have bled to death within minutes.”

  “I’m an educated man, Dr. Connolly. I call them as I see them. I don’t rely on tea leaves, crystal balls, or a Ouija board. If I’m standing under a bridge and I hear hoofbeats, I think of horses, not zebras.”

  “What’s your point?”

  “There is no point. I’m simply saying I can’t say with complete accuracy how long it will take somebody with a crushed spleen to bleed to death. What I can say with certainty is that I’ve been around a long time, and I’ve seen plenty of overconfident young physicians show up in my morgue and deny the obvious—even though it’s staring them right in the face.” He reached for a larger scissors. “As painful as this is for you, Doctor, the woman died of an undiagnosed ruptured spleen.”

  “With all due respect, you weren’t in the ER when they brought her in. If you had been, your opinion might—”

  “My opinion would be the same.” He then added nonchalantly, “Don’t be too hard on yourself. The ability to objectively assess your patient outcomes takes some physicians years to acquire.”

  The tech snickered, which further infuriated her. Looking at Canfield’s smug face, Morgan wondered what in the world made him think he knew anything about treating patients. The only patients he ever dealt with were already dead.

  Seeing no reason to debate the issue with him, Morgan unzipped her bunny
suit and headed for the exit. She was almost to the door when something suddenly occurred to her. She turned around.

  “Was she pregnant?”

  Canfield shifted his attention to the pelvic organs for a moment, examined the uterus, and said, “It doesn’t appear so.” He looked up with an inquisitive expression. “What the hell difference would it make if she were pregnant or not?”

  “I was just curious. I appreciate you allowing me to attend the autopsy, Dr. Canfield. I’ll look forward to reading your report as soon as it’s dictated.”

  “You’ll get the second copy. I had a call from Bob Allenby earlier. He’s first in line. Evidently, you’re not the only one who’s quite eager to see my report.”

  Feeling her anger swell even further, Morgan gave serious consideration to telling Canfield what she thought of his offensive disposition. Instead, she simply shook her head, turned back around, and again started back for the exit. Just as she was about to go through the door, she heard Canfield and his assistant trying to muffle their laughter.

  CHAPTER 39

  Still fuming over the way she’d been treated by Canfield, Morgan sat by herself in the doctor’s dining room nursing a cup of jasmine tea.

  She looked up for just long enough to see Ben making his way toward her table with a tray heaped high with food. He set his tray down and took the seat across from her. Morgan looked at her own tray, which contained only a modest fruit plate.

  “How can you eat so much?” she asked.

  He plucked a napkin from a metal dispenser and spread it on his lap. “And good morning to you, Dr. Connolly.”

  “Sorry. Good morning.”

  “How are you feeling?”

  “Mentally or physically?”

  He shrugged. “Take your choice.”

  “Let’s see. I’m only vomiting every other morning now. My clothes are all starting to get tight and, even though I know it’s too early, I think somebody kicked me last night.”

  “All good things,” Ben said, spreading a mound of grape jelly on his toasted bagel. “I assume you went to the autopsy.”

  “I just came from there. “

  “Who did it?”

  “That jerk, Canfield.” Morgan watched as Ben stirred the third packet of sugar into his coffee. When he reached for the fourth, she snatched it from his hand. “I’ll tell you what. Let’s give your pancreas a break this morning.”

  “Now there’s the Morgan Connolly I know and love. What did the autopsy show?”

  “A belly full of blood and a fractured spleen,” she said with a quick shake of her head.

  “You sound surprised. I thought that’s what you were expecting.”

  “I guess a small part of me was praying for something else.”

  “C’mon, Morgan. ER medicine’s a tough specialty. It’s easy to miss things.”

  “That’s just the point. I don’t think I missed anything.”

  He looked across the table at her with circumspect eyes, dabbed the corner of his mouth, and said, “That’s not what you’ve been saying all weekend.”

  “I know.”

  “Isn’t it possible the diagnosis wasn’t obvious the first time you saw her? I’m not a trauma surgeon but I seem to recall that injuries to the spleen can sometimes be tricky to detect.”

  “The subtle ones maybe, but not the massive type that killed this woman. I saw her spleen this morning. It was shattered beyond recognition. There’s no way she could have had a bike accident in the middle of the afternoon and then sauntered into our emergency room at eleven o’clock looking like a rose. She never would have lived that long.”

  “If you’re not disputing Canfield’s findings regarding the cause of death, then the only possible explanation for this woman’s death is that her injury occurred soon after you discharged her.”

  “Which is precisely what I think happened. I’ve been thinking about this case nonstop since you left last night. I’m starting to realize that there are a lot of inconsistencies regarding what happened.”

  “For instance?” Ben asked.

  “For one, she told me she didn’t want an X-ray because she was pregnant. I asked Canfield to check. She wasn’t pregnant.”

  “Did you do a pregnancy test on her?”

  “The second time.”

  “And?”

  “It was negative.” Morgan said.

  “Maybe she wasn’t sure about being pregnant. The other possibility is she was simply wrong.”

  Morgan shook her head. “She was definite about it. She told me she’d already had her first visit with an obstetrician.”

  “So she was lying. There are dozens of reasons why she might have lied to avoid an X-ray.”

  “Give me one.”

  “Maybe she was phobic about radiation or just in a hurry to get out of the ER.” Ben removed his glasses and set them down next to his tray. “I guess the question is: What difference does it make if she was pregnant or not—or what her reasons were for not wanting an X-ray?”

  Morgan pushed her tray forward, giving her just enough room to rest her hands on the table. She leaned in. “About forty-five minutes after I discharged her, the unit secretary received a call from a man. He said he saw a woman in our parking lot wobbling as she got into her car. He then asked the secretary to call security and inform them.”

  “I assume this turned out to be your patient.”

  Morgan nodded.

  Ben massaged the bridge of his nose and then replaced his glasses. “Well, if she was bleeding internally and going into shock, it’s quite possible she could have been unsteady.”

  “But when she left the emergency room, she was fine. Does it seem reasonable that in the time it took her to get from the ER to her car, she bled into a shock from an injury that occurred twelve hours earlier?”

  Ben waited for a group of nurses to walk by and said, “Were there physical signs at the autopsy indicating a severe blow to the abdomen?”

  “Canfield made note of a bruise on her abdomen under her left rib cage. I saw the same thing when the paramedics brought her in.”

  “How can you be so certain it wasn’t there the first time you examined her?”

  “Because I checked her belly thoroughly. There were no bruises of any kind on her abdominal wall. I even made a note of it on the chart.”

  Ben regarded her intently for a few seconds before asking, “Was there evidence of a sexual assault?”

  “None.”

  “Since I’m sure you spoke with them, what did security say? Did they think she was robbed?”

  “The guard who found her said she was slumped over the steering wheel. He found her purse undisturbed on the backseat.” Morgan checked Ben’s eyes for a reaction. From the look on his face, she suspected he knew where she was headed. “When a woman drives alone, she puts her purse on the seat next to her—not in the back. If her purse was on the backseat, I’d bet anything there was somebody sitting next to her.”

  “Every square inch of the hospital’s under video surveillance. Why don’t you ask security to see if there’s anything on their tapes?”

  “I thought of that. Unfortunately, the ER lot’s a temporary one. Apart from a golf-cart patrol every couple of hours, there is no other surveillance. The other interesting thing is when they brought her in she wasn’t wearing her knee brace. One of the guards found it hanging over the top of the Dumpster.”

  “Maybe she found it uncomfortable.”

  “Or maybe she never needed it in the first place,” Morgan said. She then leaned over her tray and said in just above a whisper, “I don’t believe this woman ever fell off a bicycle. I don’t believe she suffered any injury at all that day. I think she was faking the whole thing and had some other reason for coming in that night.”

  “For instance.”

  Morgan held up both hands. “I don’t have the first damn idea why she would put on a charade like that.”

  Ben’s focus changed when he noticed Morgan’s face was
the color of chalk. “Are you okay? You look terrible.”

  She covered her mouth with her fingers. “I may have spoken too soon about the morning sickness.”

  “Do you want to—”

  “I’ll be fine in a minute,” she assured him. “This case will definitely have to be reported to the state as a Code Fifteen. As the treating physician, I’m going to be right in the middle of an AHCA investigation.”

  “I wouldn’t worry about that,” Ben said. “You have an exemplary record. This woman’s death, while tragic, is an incident, not a pattern.”

  She tossed Ben a cautionary look. “I’m not sure AHCA will view things quite as charitably as you are. Canfield’s autopsy report will be an important part of their inquiry. If the state concludes that I missed the diagnosis and negligently discharged Faith Russo from the emergency room, they will consider this case a wrongful and preventable death.” Morgan shook her head slowly. Ben could see she was struggling not to lose her composure. “Faith Russo was a young, healthy woman with three children. There’s no predicting what disciplinary action they could take against me.”

  Ben said, “You’re looking at the absolute worst scenario.” The words were barely out of his mouth when Morgan grabbed her tray, pushed her chair back in, and stood up.

  “I’ll give you a call later,” she said. “Are we on for dinner?”

  “Sure. You pick the place.”

  Ben watched her leave the cafeteria. What concerned him the most was that he knew Morgan was right about AHCA. They would almost certainly open an inquiry into the Faith Russo case, and it was equally probable she would fall under intense scrutiny.

  Even if Morgan were exonerated, the investigative process alone would be an embarrassing nightmare that would haunt her for months. Trying to cope with such an investigation would be tough enough under normal circumstances—trying to do it in the early part of a pregnancy would be a daunting challenge.

  CHAPTER 40

  DAY FOURTEEN

  From his wooden deck and under a warm sun, Gideon sat on his white slat-back rocking chair, gazing at his garden.