Off the Record

by Jill Elizabeth Nelson

  The site put up by the Agency for Health Care Research and Quality was a gold mine. She was able to look at many quality-of-care markers, including trends in adverse events brought about by medical errors state by state over the past decade. Tennessee stacked up consistently a little below average in the number of errors compared to other states in the nation up until the last couple of years. At that point, the statewide rate began to creep above the national average. Not alarmingly high and possibly only a swing on the pendulum, but certainly disturbing.

  Kate narrowed her search to the Chattanooga Health System. She scanned the numbers and graphs and caught her breath. Were there enough careless workers in the system to account for this spike in medication and procedural errors?

  The health-care workers must have been aware of these statistics. No wonder Nurse Pritchard was so touchy about the subject of medical errors. But she was even more defensive about the resident chart. Was paperwork more important to her than people? Or maybe the charge nurse was the common factor between the two. Did she cover her own mistaken chart entry by stealing it out of the record? Carolyn Pritchard was in the thick of the incident with all the access she needed to handle the problem any way she wanted.

  Kate shook her head. If that was the answer, then the Orchard Hill incident would be an isolated event, but these health-care-quality studies flagged a trend. There had to be an underlying cause to produce these statistics on adverse events in the Chattanooga system. That didn’t mean Nurse Pritchard wasn’t involved, or even the mystery lady from the administration; just that there was something more far-reaching going on than a single cover-up.

  But could charts and medication errors connect with Loretta’s medical-bill problem? If anyone tracked patients in the Chattanooga Health System affected by errors in processing charges, would this same spike in incidents show up? Maybe there was some kind of referral glitch from one system to another that resulted in the wrong patient getting bills from Minnesota. A wispy notion of a connection between med errors and billing mistakes flitted through Kate’s mind, and she chased after it.

  “You’re going to laser a hole with your eyes right through that computer screen.”

  Livvy’s voice broke Kate’s concentration, and she lost the thought. She puffed out a breath hard enough to disturb the bangs on her forehead. “Take a look at this.” She pointed at the health-care information.

  Her friend leaned over and let out a low whistle. “Doesn’t look too hot for us, does it?”

  “I’ve always believed we get great medical care around here, but this upswing in mistakes is scary. There must be a reason for it. I wish I could see more specific information about the individual errors so I could look for commonalities. But that sort of thing isn’t available for public consumption.”

  “Then I guess we’ll just have to work with the information we can get.”

  Kate turned to her friend with a gasp. “What did you say?”

  Livvy took a step backward. “I don’t know. What did I say?”

  Kate rose with a thin chuckle. “You’re being helpful as usual.”

  “I am?”

  “You said the word information. It’s the idea I was searching for when you showed up behind me.”

  “You’ll have to explain if I’m going to follow your logic.”

  Kate spread her hands. “Don’t you see? What happened to Mrs. Kraemer was based on wrong information. And this other problem—”

  “The one you can’t tell me about?”

  “Right. That issue is also about wrong information.”

  Livvy stared at her. “But where did the bad info come from?”

  “That, Livvy Jenner, is the million-dollar question.”

  AFTER BATTING AROUND IDEAS with Livvy for a little while longer, Kate arrived home around midmorning. She changed into old jeans and a T-shirt and put on her gardening hat and gloves. With a rake, a weeding knife, and a trowel in hand, she slipped out the sliding-glass doors into her backyard. Since yesterday’s clouds failed to carry out their threat of rain, Kate suspected that the soil would be mellow enough to yield up the weeds, yet firm enough to be ready for seed. Weeds today, then seed tomorrow, God willing. She smiled and leaned into her job of digging and pulling in the fertile black earth.

  Her mind went back over what she’d learned the previous afternoon and that morning at the library—and what she hadn’t. She’d tried calling Loretta last night when the diner would have been closed, but no one had answered. Where could Loretta have been or wasn’t she answering her phone? The diner owner wasn’t much of a social butterfly. It was usually either work or home for her. She’d try again that evening to contact her. She didn’t want to bother her at work.

  She’d considered calling Lucy Mae with an update the previous night too but had finally decided against it. What could she tell the poor woman who was still distraught over her mother’s condition? She hadn’t learned anything to prove Carla’s claim about the missing medication order one way or another. For all she knew at this point, the young nurse might be lying. End of story. Just because Carla had made a good impression didn’t give Kate any evidence worth presenting to Lucy Mae—or anyone else, for that matter.

  After a while, the sun began to bake Kate’s head through her hat, and she glanced at her watch. The hands were nearly aligned on twelve, and Paul had said he’d be home for lunch. He often ate out with a Faith Briar member or someone from the community, but he didn’t have plans today.

  Kate jumped up and tugged off her gloves, leaving them with her tools. She’d be back to make more headway after the noon meal.

  In her tiny kitchen, she washed her hands, then pulled out sliced deli turkey, lettuce, tomatoes, cheese, and condiments from the refrigerator. Working on the L-shaped counter, she put together thick sandwiches on slices of whole-grain bread. A potato salad she’d made while Paul was at his meeting the night before would offer a nice side dish. She was just setting the food on the table when he walked through the front door.

  He stepped into the kitchen and gave her a peck on the cheek, then headed for the table. “Gardening?” He nodded toward the knees of Kate’s jeans.

  She laughed. “Can’t hide anything from you.”

  “It’s a gorgeous day. I don’t blame you for taking advantage of it. If I hadn’t hired out the yard work at the church already, I’d be tempted to tackle some spring raking and landscaping myself just to get out of the office.”

  “Tough day?”

  “I came in at two minutes after nine because I stopped to talk to the grounds man, and that got me a time’s-a-wastin’ lecture from Millie right off the bat.” He shook his head with a smile.

  Kate chuckled. The church secretary’s obsession with schedules was legendary.

  They took their places at the table, and Paul offered a prayer of thanks, then dove into his sandwich.

  “For being stuck inside, you sure worked up an appetite.” Kate passed him the potato salad.

  “The phone was so busy, I actually got a lot done this morning.”

  Kate stared at him. “That statement seems contradictory.”

  One side of Paul’s mouth lifted. “The calls were for Millie.”

  Kate put her sandwich down on her plate. “People called the church office to talk to your secretary?”

  “From what I could make out”—he waggled his fork at her—“she’s appointed herself some kind of a spokesperson for the Call of Duty campaign Joe is launching on behalf of the blood drive. She’s been issuing broad hints to me that I should throw a pitch for the ‘duty to donate’ into my Sunday message.”

  Kate took a sip of her lemonade and let the sweet-tartness slip down her throat. “Renee’s recruited me as a Telephone Encourager. That’s all well and fine, but I hope neither of them thinks we’re going to take sides.”

  “I’m a little concerned that people might get divided into factions over an event where they should be working together.”

  Kate sigh
ed. What a distressing thought. “Joe and Renee mean well.”

  Paul swallowed a mouthful and patted his lips with a napkin. “Yes, they do. I just hope their efforts end well.”

  Half an hour later, Paul headed back to the church after helping with the dishes, and Kate returned to her gardening. With the afternoon sun wrapping warm arms around her, she was dirty and sweaty again in no time.

  “Ka-ate! Where are you?”

  At the shrill call, Kate sat up on her haunches. “I’m in the backyard, Renee.”

  A few moments later, the older woman stood outside the chain-link fence. She waved a set of papers in her right hand while cradling her tiny Chihuahua over her left elbow. “I suspected you must be home since your car is in the driveway.”

  Kate pulled off her gloves and went over to the fence. “Hi, Renee. Hi, Kisses.” She scratched the teacup Chihuahua between the ears and received a lick on the wrist and an enthusiastic bark in response.

  “I’ve brought your calling list,” Renee said, looking Kate up and down with a curl of her upper lip.

  “I thought as much.” She smiled at the petite woman dressed in crisp tan slacks and a pink silk blouse. As usual, every hair was in place.

  “Do you like doing that?” The older woman flapped the papers at the disturbed earth.

  “Gardening? Yes, I find it relaxing.”

  “But you’re dirty, and you’re usually so...well...put together.”

  “Why, thank you.” Kate laughed. Coming from Renee, that was a high compliment. “Come on into the yard. I’ll serve lemonade on the patio.” She nodded toward the black wrought-iron table and chairs on the small cement slab outside.

  While her guest came in through the gate, Kate gathered up her gardening supplies and placed them on the cement patio slab. She’d put them away in the garage after Renee left. Then she went inside, washed up in the bathroom, and ran a comb through her hair. A few minutes later, she stepped outside, carrying a pitcher of lemonade and a pair of glasses on a tray.

  Renee was seated at the table. The sheaf of papers was secured beneath her small handbag, and Kisses was running around the yard. The little dog yipped with delight when he saw Kate, trotted up to her, and sniffed her tennis shoes, then scampered off across the lawn.

  “Little Umpkins enjoys spring as much as the rest of us,” Renee cooed.

  “It’s a lovely time of year.” Kate inhaled a deep breath of clean mountain air scented with dogwood blossoms from the tree on the nearby hillside. She poured lemonade into the glasses and handed one to her guest.

  Renee accepted the glass but placed it in front of her without taking a sip. “Thank you, but I really shouldn’t have stayed. I have many stops to make today.”

  Kate grinned. “You found plenty of Telephone Encouragers?”

  “Oh yes,” Renee responded with a confident flick of her hand. “Arletta Walner—the event is in her school, you know—Betty Anderson, Dot Bagley, Eli Weston, and Morty Robertson, to name a few. Oh, and Sybil Hudson too. The manager of the Hamilton Springs Hotel ought to have good influence, I would think.” She sent Kate an arch smile. “People are excited to get involved.”

  Kate nodded. “It’s a good cause.”

  “You said it! But that stiff-necked old coot is making it all about duty instead of a privilege.” Renee sniffed. “You have no idea what a frustration it is to be paired up with a man who can see no one’s point of view but his own.”

  Kate bit her tongue against the impulse to bring up a comparison about two peas in a pod. It takes one to know one probably wouldn’t go over very well. “It’s important for people working together on a project to find ways to understand each other.”

  “We understand each other perfectly well.” Renee lifted her hands. “But he’s too stubborn to admit that promising a little pampering along with a deed well done is more appealing to people than dry old obligation. So we’ll just have to prove it to him, won’t we?” She winked and nodded.

  Kate raised a palm in protest. “Now, Renee, I don’t regard this project as—”

  “Ooh, Kisses, sweetie!” Renee lunged from her chair and scuttled across the lawn. “Stop digging in the dirt.” She scooped up the little dog and brushed at his paws. “Pretty soon you’ll look like Kate.” The woman headed back toward the table.

  Suppressing a smile, Kate rose. “Would he like a doggie treat? I have a few left from the last time he stayed with us.”

  “You can send the treats along with us. I need to get on the move. I’m on a mission to deliver all the calling lists this afternoon. Here you go.” She tugged the papers from beneath her bag. “I’m sure you’ll get right on it.”

  Kate took them, then glanced down at the handwritten list of names and phone numbers. “You put a lot of work into this.”

  “No effort is too great to get the message out.” The older woman beamed. “The script is at the back. Take it as a guide on how to approach people from the proper perspective.” She leaned forward and gave Kate’s arm a conspiratorial pat.

  Maybe Kate needed to make herself more clear. “I’m happy to do this, but you must understand—”

  Kisses barked and wiggled in his mistress’ grasp. “Little Umpkins is anxious to get going. Toodles.” Renee fluttered her fingers and walked toward the gate. “Why don’t you bring the treats out to my car?” she said over her shoulder.

  Frowning, Kate took the list inside and laid it on the dining-room table. She got the little bag of doggie treats from one of the yellow cupboards in the kitchen and went out the front door to the curb. Renee was seated in the driver’s seat of her vintage pink Oldsmobile.

  She rolled down her window as Kate approached. “Kisses thanks you.” She received the bag and patted Kisses at the same time.

  Kate leaned close to the window. “Renee, my focus in helping with this project is encouraging people to donate blood. I’m not going to make an issue about their motive.”

  Renee snapped her fingers. “Exactly! I’m glad you’ve got the vision. Be sure to tell them that it’ll be the best donating experience they’ve ever had. And if that doesn’t get our numbers over the top, you just wait. I have a surprise tactic in the works.”

  Kate couldn’t stop the sigh that escaped. “A surprise tactic?”

  Renee chuckled. “The old buzzard won’t know what hit him. I’ll unveil it when the time is right. Don’t worry. We’re going to win!” She put the car in gear.

  Kate barely stepped away in time to spare her toes as Renee gave her vehicle the gas. Planting her hands on her hips, Kate watched the pink car fade down Smoky Mountain Road. Paul’s concern about division in the town was taking clearer shape by the minute.

  Chapter Eleven

  Troubled, Kate cleaned her gardening supplies and put them away. Then she took a quick shower. While her hair dried, she sat down at the table with Renee’s list. The names were all familiar, but one jumped out at her.

  Loretta Sweet.

  It had to be a God thing that Loretta’s name wound up on her call list. Now she had a better excuse to contact her than just a generic “Hi, how y’all doin’?” Maybe a conversation about the blood drive would provide an opening to encourage the Country Diner’s owner to confide in her about the medical bills without betraying that LuAnne had already told her about the problem. Definitely a prospect for prayer.

  Kate silently talked to God about Loretta while she performed some routine housekeeping, including a load of laundry. She eyed several other piles of clothes waiting their turn, but a stained-glass project called to her. The laundry could wait. She turned on her heel and went into the spare bedroom that had been transformed into her stained-glass studio. As she worked, she prayed for Carla Trexler and her children, as well as for Mrs. Kraemer’s recovery. The cuckoo clock in the hallway signaled her that it was time to make supper, so she stowed her equipment away in the proper racks and bins and then headed to the kitchen.

  She took down one of her Mauviel copperware skillet
s from the ceiling hook and set it on a stove burner. Still in prayer mode over the medical error situations, she chopped and sautéed onions, browned hamburger, and boiled pasta.

  Kate wasn’t sure why, but a feeling kept niggling at her that the two incidents were related somehow. But what could an elderly resident in a Chattanooga assisted-living facility and a hale and healthy business owner in Copper Mill possibly have in common? The puzzle occupied her as she used the food processor to blend whole tomatoes, garlic, celery, and herbs into a sauce and then heated it in a copper pan.

  Both issues had to do with medical care and both involved wrong information, but that’s where the obvious similarities ended. Kate stirred her ingredients together and stuck the casserole in the oven. If only this mystery were as simple as following a recipe. Add a dash of this, throw in a little of that, and, voilà, a delicious dish. Obviously, she didn’t have all the facts collected to make any sense out of this rash of medical mistakes. She was convinced there must be some missing ingredient out there just waiting to be found.

  OVER SUPPER, she told Paul about Renee’s visit.

  “A surprise tactic?” His forehead scrunched. “I can’t imagine what that would be.”

  “With Renee, it’s bound to be something extravagant and unexpected.” She spread her arms in a large gesture.

  Paul laughed. “She is a creative woman.”

  “And determined to prove to Joe that her approach is best.” She leaned closer to her husband. “What should we do about it?”

  “Right now?” He forked up a large bite from his plate. “We should enjoy this terrific casserole.”

  “You mean we wait.”

  “We wait. We eat. You have a better idea?”

  Kate groaned. “That’s the hardest part, you know.”

  “What? The waiting or the eating?”

  She backhanded his shoulder, and he laughed around a mouthful of food.

  After the dishes were done, Paul resumed reading his book. Kate picked up her call list and flipped to the last of the three pages where Renee had attached her canned script. The lines read like an ad promoting the blood drive in the same terms as a spa. Kate smiled at one of the supposedly alluring statements: “Following the donation, you’re invited to unwind and rejuvenate in a cafélike atmosphere, while being served savory snacks and beverages.” Words like luxurious and pampered drew a laugh...only it wasn’t funny.