Code Blue

by Richard MD Mabry

  Anna whispered a silent prayer. She'd done this dozens of times, but it never got any easier. She knelt in front of the woman. "Mrs. Hurley, I have bad news for you."

  Anna stumbled through her explanations, doing her best to make sense of a situation that she didn't fully understand.When it came to the matter of permission for an autopsy, Anna wasn't sure of the medico-legal situation. Hurley had died after being shot, but his injuries weren't the cause of death. Would she have to call the County Medical Examiner and get him to order one? The weeping mother solved the problem when she agreed to allow a post-mortem exam.

  There was a light tap at the door, and the chaplain slipped into the room. "I'm sorry. I was delayed." He took the chair next to Mrs. Hurley and began speaking words of comfort in a low voice.

  Anna was happy to slip out of the room with a last, "I'm so sorry." Outside, she paused and took several deep breaths.

  It took another half-hour for Anna to write a chart note, dictate an operative report and final case summary, and change into clean scrubs. Her pager sounded just as she left the dressing room. The display showed her secretary's number followed by the suffix "911." A "stat" page—respond immediately.

  As she punched in the number, Anna wondered what else could possibly go wrong today. "Lisa, what's up?"

  "Dr. McIntyre, there are two policemen here. They want to talk with you. And they say it's urgent."

  Nick Valentine looked up from the computer and grimaced when he heard the morgue attendant's rubber clogs clomping down the hall. He'd half-expected a summons.After all, he was the pathologist on autopsy call this week, which was why he was sitting in this room adjacent to the morgue of Parkland Hospital instead of in his academic office at the medical school. But he'd hoped for some undisturbed time to finish his project.

  The attendant stuck his head through the open door. "Dr.Valentine, you've got an autopsy coming up. Unexpected death in the OR. Dr. McIntyre's case. She asked if you could do it as soon as possible. And please page her before you start. She'd like to come down for the post."

  The man's head disappeared like that of a frightened turtle.More clomps down the hall signaled his departure.

  There was nothing new about an attending wanting a post-mortem done ASAP. You'd think they'd realize there was no hurry any more, but that didn't seem to stop them from asking. At least she'd volunteered to come down and watch instead of simply reading his report. Nick turned to the shelf behind his desk and pulled out a dog-eared list headed "Frequently Needed Pager Numbers." He ran his finger down the page: Department of General Surgery. Anna E. McIntyre, Assistant Professor. He picked up the phone and punched in her number. After he heard the answering beeps, he entered his extension and hung up.

  While he waited, Nick looked first at the pile of papers that covered half his desk, then at the words on his computer screen. He'd put this offfar too long. Now he had to get it done. In his opinion, putting together this CV—the curriculum vitae that was so important in academics—was wasted effort. Nick had no interest in a promotion and didn't think he'd get one even if his chairman requested it from the dean.But his chairman wanted the CV. And what the chairman wanted, the chairman got.

  The phone rang. "Dr. Valentine."

  "Nick, this is Dr. Wetherington. Do you have that CV finished yet?"

  "I'm working on it."

  "Well, I need it soon. I want you to get that promotion to associate professor, and I have to be able to show the committee why I've nominated you. Don't let me down."

  Nick hung up and rifled through the pile on his desk.Reprints of papers published, programs showing lectures delivered at medical meetings, textbooks with chapters he'd written, certificates from awards received. His professional résumé was pitifully small, but to Nick it represented the least important part of his job. What mattered most to him was what he was about to do: try to find out why the best efforts of a top-notch medical stafffailed to save the life of some poor soul. If he did his job well, then maybe those doctors would be able to snatch some other patient from the jaws of the grim reaper.

  His phone rang again. "Dr. Valentine, are you about ready?" the morgue attendant said.

  Nick looked at his watch. Almost half an hour, and Dr.McIntyre hadn't responded to the page. He hated to start without her, but he might have to. "Give me another ten minutes."

  While he waited, Nick figured he might as well try to make Dr. Wetherington happy. Now when did he deliver that paper before the American Society of Clinical Pathology? And who cared, anyway?

  Her secretary met Anna at the doorway to the outer office. "Dr. McIntyre, I didn't know what to do."

  "That's all right, Lisa. I'll talk with them." Anna straightened her white coat and walked into her private office, where two people stood, conversing in low tones. Lisa had said, "two policemen," but Anna was surprised to see that one of them was a woman.

  The man stepped forward to meet Anna. "Doctor McIntyre?"

  Anna nodded.

  He pulled a leather folder from his pocket and held it open for her inspection. Anna could see the gold-and-blue badge pinned to the lower part of the wallet, but couldn't read the words on it. The card in the top portion told her, though. It carried a picture beside the words U.S. Drug Enforcement Administration.

  Lisa had been wrong. These people were from the DEA, not the police. Still, an unannounced visit from that agency made most doctors sweat. You never knew when some innocent slip might get you into trouble.

  The man flipped the credential wallet closed. "This won't take long."

  "Good. I've just finished an emergency case, and I still have a lot to do." Anna moved behind her desk and sat.

  "Your chairman said you'd give us as much time as we need."

  Anna glanced pointedly at her watch. "Well, have a seat and let's get to it. What do you need from me?"

  The man lowered himself into the chair, his expression slightly disapproving. His partner followed suit. "We have some things we need you to clear up."

  "Could I see those credentials again?" she said. "Both of you."

  They obliged, laying the open wallets on the desk. Anna pulled a slip of notepaper toward her and copied the information.When she'd finished, she looked up to match the names and faces on the IDs with the people sitting across from her. The spokesman was Special Agent John Hale, a chunky, middle-aged man wearing an off- the-rack suit that did nothing to disguise his ample middle. Anna thought he looked more like a seedy private eye than an officer of the law.

  The woman, the silent half of the pair so far, was Special Agent Carolyn Kramer, a woman who reminded Anna of a California surfer bunny, complete with perfect tan and faultlessly styled short blonde hair. The resemblance stopped there, though. Kramer's eyes gleamed with a combination of intelligence and determination that told Anna she'd better not underestimate the woman. Kramer wore a stylish pants suit that probably cost more than Anna made in a week. How could a DEA agent have money for an outfit like that?

  Anna handed the badge wallets back to Hale and Kramer."All right, how can I help you?"

  Hale pulled a small notebook from his inside coat pocket and flipped through the pages. "Doctor, recently you've been writing a large number of Vicodin prescriptions, all of them for an excessive amount of the drug. Can you explain that?"

  "I don't know what you mean," Anna said. "I'm pretty sure I haven't written any more Vicodin scripts than usual, and I certainly haven't changed my prescribing practices."

  Hale nodded, stone-faced. "What are those practices?"

  "I prescribe Vicodin for post-operative pain in many of my patients, but always in carefully controlled amounts, maybe thirty pills at a time. By the time they've exhausted that first prescription I can generally put them on a nonnarcotic pain reliever. It's rare that I refill a Vicodin script."

  Apparently, it was Kramer's turn in the tag-team match.She picked up a thick leather folder from the floor beside her chair, unzipped it, and extracted a sheaf of papers he
ld together by a wide rubber band.

  "Would you care to comment on these?" Her soft alto was a marked contrast to Hale's gruffbaritone.

  Anna's eyes went to the clock on her desk. "Will this take much longer? I really have things I need to do."

  Kramer seemed not to hear her. She held out the bundle of papers.

  "Okay, let me have a look." Anna recognized the top one in the stack as a prescription written on a form from the faculty clinic. She pulled it free and studied it. The patient's name didn't stir any memory, but that wasn't unusual. She might see twenty or thirty people in a day. The prescription read:

  VICODIN TABS

  DISP. [#100]

  SIG: 1 TAB Q 4 H PRN PAIN

  At the bottom of the page, three refills were authorized.The DEA number had been written into the appropriate blank on the lower right-hand corner.

  Anna squinted, closed her eyes, then looked again. There was no doubt about it. The DEA number was hers. And the name scrawled across the bottom read: Anna McIntyre, M.D.

  "Can you explain this?" Kramer asked.

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