Code Blue

by Richard MD Mabry

  "After the incident, I spoke with the hospital's chief of staff. It appeared to be a medication error, and I subsequently relinquished care of the patient to one of my colleagues, an internist."

  Cathy could hear keys clicking as Ferguson called up her file on his computer. She marveled at how quickly the world had shifted from filing cabinets stuffed with paper to a computer processor small enough to fit into a briefcase, yet with the capacity to hold the information contained in several libraries.

  "I have your account here," Ferguson said. "It appears that you are indeed covered by us. Your limits are rather low, though. What is the amount named in the suit?"

  Cathy thumbed through the thick document to be certain, although the number was one she was unlikely to forget. "One million dollars plus costs."

  "Ummm, that's well above your coverage level. But you practice in Texas and there's a cap on damages. The million is probably a negotiating figure." More clicks. "Tell you what. Please photocopy everything you have and send it to me by express courier. Don't discuss the case with anyone.I'll have our attorneys look it over, and we'll see where we go from here."

  "There's one thing you should know. I've seen the original prescription at the pharmacy. It's not the one I wrote. It's been tampered with."

  "Can you prove that?"

  "Not directly, no. But—"

  Ferguson's reply was firm and not nearly so reassuring as his earlier words. "Doctor, we have to base our decisions on things we can prove. And it's not our business to spend our resources investigating shadowy plots against our insured.Frankly, if your case isn't strong and we can negotiate the litigant down to a reasonable sum, it's often prudent to settle these things. We'll simply have to see."

  A rush of anger made Cathy's blood boil. "I thought your primary duty was to protect me. That's why I've been paying premiums."

  Unlike Cathy, Ferguson didn't raise his voice. She guessed that after he hung up he'd have about a dozen more conversations like this today. Her case wasn't special to him—but it was to her.

  "Our primary duty is to stay in business while discharging our obligations. We'll do everything we can to protect you, but that does not involve tilting at windmills, especially if the windmills seem stronger than our lances. Now leave it to us. I'll look forward to receiving your records soon."

  "Wait! What if I want my own attorney?"

  Ferguson cleared his throat. "You have that right. It would be at your own expense, of course, and we'd expect full cooperation and an open exchange of information with whomever you choose."

  "That's fine, so long as it works both ways. I'll send the records."

  There was a gentle tap at the door. Cathy hung up the phone and called, "Come in."

  Jane stuck her head through the door. "Your first patient is here. Are you ready?"

  Cathy took a deep breath. This was something she'd been forced to learn early in her medical training—keeping several balls in the air without dropping one. She couldn't afford any more slipups.

  "Be sure his lab reports are on the chart. Put him in a treatment room, get his vital signs, and let him know I'll only be a few minutes." As Jane turned to leave, Cathy added, "Please close the door behind you. I have one more call to make."

  Will laid his napkin beside his empty plate, pushed his chair back from the table, and said, "I didn't know you were such a good cook. If I'd known that, I'd have chased you harder and insisted you marry me."

  Cathy tried to maintain a poker face while deflecting the compliment. "In medical school, I shared an apartment with two other girls. We took turns cooking, and I learned in selfdefense.Otherwise, they'd have thrown me out."

  She rose to clear the table, and Will immediately pitched in. They stacked the dishes in the sink, then moved into the living room.

  "You have a nice little apartment here," Will said. "Cozy.Decorated in early packing boxes, with accents by Home Depot."

  Cathy laughed. "I'm embarrassed. I've been here more than two months, but so far I've only unpacked enough to get me by." She pointed to the coffee table in front of the sofa where they were sitting. "But I did take your advice and dig that out."

  Will picked the Bible offthe table and opened it to the flyleaf. "Your parents gave you this Bible. It must be a nice reminder of them."

  "Not really. My folks went to church as a matter of course, and they took me along, also as a matter of course. But we were never really what you'd call religious."

  Will thumbed through the pages. "You know, since I was raised as a preacher's kid, I had no real choice about attending church. When I went offto college, I let church and religion slide. I guess a lot of kids do. But I eventually realized an important part of my life had gone missing. That's when I came back to the church, back to God." He laid the Bible gently on the table. "I hope you can do the same. It would help during the tough times."

  Cathy drew a deep breath. "Speaking of tough times . . ."

  She took him through the story of Milton Nix's neardeath, how she'd been able to save him, only to find that the cause of the problem was an overdose of the medication she'd prescribed. Cathy told him about being served with papers for a malpractice suit and about her conversation with her malpractice carrier. "But I finally got Jacob Collins to let me see the prescription that he has in his files. And it's not the one I wrote!"

  "How do you know?"

  "The day Milton Nix came in, I couldn't find my pen, so he gave me a couple with the bank's name on them. I used one to write his prescription, but I tossed them in a drawer right after that and found one of my own pens to use for the rest of the day."

  "So?"

  "Milton's pen had blue ink in it. I always write with a pen that has black ink. The printing on the prescription in Jacob Collins's pharmacy was black."

  Will drummed his fingers on the table. "I think I see where this is going," he said.

  She had no trouble following his reasoning. It was the same chain of logic she'd developed.

  "Someone got hold of your original prescription. They changed the numbers, made a photocopy of the altered prescription so the changes wouldn't be so obvious, cut out the paper to the original size, and that's what's in the file."

  "Exactly."

  "So how could they have altered the prescription without it being obvious?" he asked.

  "I've thought about that. Let me show you." Cathy pulled a blank sheet of paper toward her, picked up a pen, and printed "DIGOXIN, .125 mg." She held up the pen like a magician calling attention to the next trick, then made a zero that encompassed the decimal point and the number one. After she inserted another period before the two, the prescription called for "DIGOXIN 0.25 mg." Next she wrote "1 TAB Q DAY." It was fairly easy to make a slightly crooked "2" out of the "1." She squeezed a terminal "S" after "TAB" and the job was complete.

  Will nodded. "And I guess there's no way to get another look at the prescription in Jacob's files without a subpoena now that litigation has started. Think back to what you saw.Did it look like this?" He pointed to the alterations.

  "I think so." She pursed her lips. "Of course, there's no one to confirm that I wrote that prescription with a blue pen except Mr. Nix."

  "And, since he's suing you we can't look to him for help."Will crossed his legs and leaned back with his hands behind his head. "Let me be lawyerly, if that's a word. It seems to me that you have a couple of courses of action. You can leave this in the hands of your malpractice carrier, let them settle the suit, which sounds like what they're leaning toward. Or you can take it upon yourself to investigate and gather the information to defend yourself." He bent forward to look directly at her. "Realize that if you choose the latter course, you're not only battling this lawsuit, you're going up against someone who had little enough regard for life that they almost killed one of your patients. Don't you think it might be a little dangerous for a woman to play detective like that?"

  "Dangerous for a woman?" Cathy stared back at Will until he blinked. "Why
just for a woman?"

  "I mean . . ." Will stammered.

  "I'm not a frail flower, Will Kennedy. You should know that. I'll fight this all the way."

  Will threw his hands up in mock surrender. "Okay, I give.I know you're a fighter. I remember that black eye you gave Billy Dendy back in sixth grade."

  "He had it coming. He wouldn't stop pulling my hair."She smiled and it turned into a laugh, probably the first one she'd had in months. "Anyway, can I retain you to help me? I don't know my way around the legal system, and it doesn't appear that my carrier's lawyers are interested in fighting the case."

  "Of course, I'll help you. But, for the sake of argument, what would be so bad about settling?"

  Thinking back to the hair-pulling in the sixth grade, Cathy slowly twirled a strand of her hair. "It would raise my premium for the next several years, assuming the company would still cover me. It would be a tacit admission of guilt. It would give the credentials committee at the hospital grounds to rescind the privileges I've fought so hard to get.In a town this size, the news would spread like smallpox, and my patient base would drop to zero before the end of the month. And, most importantly, it would give whoever altered that prescription the satisfaction of succeeding at my expense." She dropped the hair and blew to move it away from her mouth. "So, will you take the case?"

  "Consider it part of the retainer you've already paid."

  "Will, that dollar was just a token. I appreciate the way you helped with the car accident, but this will take a lot more time, I'm afraid. I can't pay much, but I'm sure I can pay you a reasonable fee over time."

  Will set both feet on the floor. He reached out and took her hand, and her heart started beating faster. Whoa, this was no time to rekindle old feelings. She tried to compose her features into a perfect poker face.

  "Let's barter some more," he said. "Have dinner with me two nights a week, come to church and lunch afterward with me every Sunday, and cover my expenses for phone calls and such. The rest we'll call pro bono."

  "Tell you what," Cathy countered. "I'll have those dinners with you if you'll let me cook them. And they'll be working dinners. I'll pay all your expenses plus a five hundred dollar initial retainer. I can afford that, I think."

  Will nodded. "And church, with Sunday lunch afterward?"

  "When it includes your mother's fried chicken? That's a no-brainer. It's a deal."

  Cathy stood at the exam room sink drying her hands when she sensed Jane standing behind her. She finished, tossed the paper towels in the waste container, and leaned against the sink. "What's up?"

  The nurse's voice was as hushed as an acolyte's in a cathedral."Dr. Harshman's secretary called."

  Cathy supposed that even the mention of Arthur Harshman inspired awe throughout Dainger's medical community. Awe, sometimes mixed with fear. She determined not to let him have that effect on her. "What did she want?"

  "Emma Gladstone's surgery is scheduled for next Wednesday morning. First case on the schedule, 7:30 a.m.Dr. Harshman wants you to meet him in the surgeons' lounge at 7:00 a.m. to go over details."

  "I'll bet he does." Cathy made no effort to keep the sarcasm out of her voice. "What he wants to do is grill me about the surgery: anatomy and technique and all the details I had to memorize when I was a senior medical student.He's angry that Emma Gladstone insists on having me present during the surgery, and he plans to do his best to make me so miserable that I back out."

  Jane apparently decided to let the topic drop. She waited a couple of moments before pulling a second pink message slip from the ones in her hand. "Dr. Bell called. He wants you to call him back this morning."

  "Okay. What about the rest of those calls?"

  "Same as usual. Insurance companies wanting more information before they'll pay our claims. I've done all I can, but for these you'll have to talk with the medical directors and justify the charges."

  Cathy's shoulders sagged. Growing up, she'd seen her father as a hero—a surgeon who saved people's lives, a man admired in the community. There had always been money in the household. For some reason, she had pictured this as the pattern for her practice as well. Apparently, she'd been wrong. Dreadfully wrong. Money was tight. And she certainly wasn't getting much respect, either from her colleagues or from patients like Mr. Phillips. That triggered a memory.

  "Did Mr. Phillips ever call back for a follow-up appointment? Or write to have copies of his records sent to another doctor?"

  "Nope. I guess he's too busy to take care of himself."

  Unfortunately, the old adage held true in medicine. You can lead a horse to water— Cathy shrugged. "I'll be in my office." She took the pink slips and the charts that went with them and headed offto do battle with the insurance companies.On the way, she tossed her soiled lab coat into the hamper and shrugged into a fresh one, nicely pressed and starched. Maybe she'd feel better if she looked professional while she made the calls.

  Cathy couldn't believe that Marcus would have anything good to say. She'd talk with the insurance companies first.An hour later, her coat and psyche both a bit wrinkled, she hung up and tossed the last of the charts into her "out" box. She'd received promises to review all the claims and possibly—just possibly—issue supplemental checks for the balances due. Ah, the romance of medicine.

  "Let's see what Marcus wants," Cathy murmured. She dialed the number and leaned back, wishing she could put her feet on the desk as she'd seen so many male colleagues do. But she was determined to project a professional image, even when alone in her office.

  She endured a full two minutes of music on hold before she heard Marcus say, "Thanks for calling back."

  "No problem. What's up?"

  "I wanted to give you a heads-up and remind you to be at the Morbidity and Mortality Conference tomorrow at noon."

  Warning bells clanged in Cathy's head. "You mean to discuss the Nix case? Can't do it, Marcus. Milton Nix has filed a malpractice suit."

  "I'm sorry to hear that, but we still have to review it. That's hospital policy. When the inspectors come around for our accreditation visit, they look at all those records. I don't want them to find that we didn't discuss that one. It would look like we're making an attempt to hide our mistakes."

  "Discussing that case in front of the medical staffwould guarantee that the details would be all over town by sundown.If the malpractice action goes to trial, there's no way we could get a fair jury pool." Cathy thought for a moment."Tell you what. You and I and Dr. Baker have talked about it. Why don't you write up a memo and put it in the M&M records with the gist of our discussion and a note that the case is under litigation."

  Marcus cleared his throat. "I'm not sure I can do that."

  "Look, I really need your help here. I'm not asking you to sweep anything under the rug. Just keep the records sealed until this action is settled. Will you do that for me?"

  There was silence for a long moment, and Cathy wondered if Marcus had hung up. Then he said, "Okay, I'll do it."He paused. "I realize you're having a tough time right now.How about having dinner with me tonight? Relax a bit. Cry on my shoulder if you want to."

  She needed Marcus's support, and dinner with a colleague would be a nice change. But she hesitated once again. Was it still because she was wary of getting close to a man? Or had Marcus's behavior at the credentials committee meeting tipped her offthat he might not always be the ally he purported to be? She wondered if he wasn't really in the camp of the doctors who wanted her gone. And there was also her relationship with Will, though she wasn't sure where that was going.

  "Thanks, but I have plans." Of course, those plans were Lean Cuisine in front of the TV, maybe a pint of Cherry Garcia ice cream, and a hot bath, but she figured she didn't owe Marcus a detailed explanation. Let him think what he wanted.

  The yellow legal pad was filled with almost undecipherable scrawls. In contrast to the careful printing of her prescriptions, Cathy's notes to herself were hastily scribbled words and symbols, marching helter-skelter in
all directions, sometimes connected to other thoughts by lines that gave the whole thing the appearance of a drunken spider's web. She'd eaten her microwaved dinner, at least some of it, although she couldn't recall what it had been. Now she sat cross-legged on the sofa with a pint of ice cream slowly melting on the coffee table in front of her. She couldn't make sense of the who and why and how of the prescription that nearly killed Milton Nix.

  Cathy looked up as she heard footsteps climbing the stairs outside, followed by a rapping on the door. She detoured to the mirror to check her appearance. Comfortable old sweats, bare feet, blonde hair pulled back and held by an elastic band, face scrubbed free of all makeup. Unless it was the UPS deliveryman, she was in trouble.

  It wasn't the deliveryman. It was Will Kennedy, a bouquet of fresh flowers in one hand, a briefcase in the other.

  He stepped through the door. "I take it that this evening is informal."

  What a total idiot she was. Of course, this was supposed to be the first of the working dinners for her and Will. A dinner she was responsible for cooking.

  "I . . . That is, you have to . . . I'm so sorry. I completely forgot."

  Will smiled the same smile that had melted her heart when she was younger—a smile that touched her as she never thought a man could do again. "I sort of figured that.And I'll bet you've eaten." He didn't wait for an answer. "No problem. I'll just order pizza. Shall we set up on the kitchen table?"

  An hour later, Will looked at Cathy across the remnants of a pepperoni pizza and said, "I've enjoyed my dinner with you even if Pizza Hut did the catering, but I guess it's time to go to work. First, I need you to sign these forms. I'll send one copy to your malpractice insurer so they'll know I'm on board as your personal attorney. Since the suit's already been filed, I can schedule discovery depositions."

  "You'll have to educate me," Cathy said. "Discovery?"

  "We have the opportunity to subpoena witnesses and ask them questions under oath. Not just Nix and his wife, but anybody who might have knowledge pertaining to our case.So who should that be?"