Code Blue pft-1

by Richard L Mabry

  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 amp;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?"

  "I guess the first people we need to subpoena are the ones who might have had access to the prescription." Cathy flipped several pages and found the chart she'd made. "Here's the list."

  Will came around and read aloud over her shoulder."Milton and Gail Nix. The two pharmacists: Jacob Collins and Lloyd Allen. Anyone else?"

  "Not really. And I don't see Mr. Nix playing fast and loose with his own heart medicine."

  "We're working on the premise that it was done to hurt you. Who in this group doesn't like you?"

  "How about asking if there's anybody in town who does like me?" Cathy heard the self-pity in her voice and hated it."I thought Milton Nix wanted me to do well enough in my practice to pay offmy note at the bank." She gave a sarcastic laugh. "But now he's suing me."

  "Any problems with Gail Nix?"

  "Not that I know of."

  "Lloyd?"

  "No."

  "Jacob?"

  Cathy recalled her last conversation with the pharmacy owner. He'd seemed a bit too pleased when he had said, "I suspect it will be an important piece of evidence in the near future."

  The hairs on the back of her neck bristled. "Yes, I think Jacob has to be a suspect."

  9

  Cathy watched Jane escort the morning's last patient to the front and begin the checkout process. Ten o'clock and she was through for the morning. At this rate, she wondered how much longer she could maintain her practice.

  She slumped down behind her desk and brushed her hair out of her eyes. Might as well tackle some more of the paper-work that never seemed to end. Cathy had just added her signature to the last insurance form when Jane tiptoed in with a bulging manila folder.

  "Here are the checks for you to sign." Jane's sad eyes conveyed a message that was confirmed when Cathy opened the folder.

  She thumbed through the checks: withholding tax, answering service, cell phone, office phone, supplies, rent, Jane's salary. The check on the bottom of the stack was the monthly salary Cathy had allotted herself-not much- just enough to cover her living expenses. Then she looked at the adding machine tape clipped to the front of the folder and compared it with her bank balance. She shoved the last check across the desk. "Here, rewrite this check for half that amount."

  Jane shook her head. "This is the second month in a row that you've reduced your salary check."

  "I knew going in that it would take some time to get the practice on a good financial footing. Eventually my practice will grow. Someday those insurance claim checks will start coming in. In the meantime, the boss is the last person to get paid. That's simply the way it is."

  Cathy picked up her pen and signed the top check in the stack. She looked up when she heard the office door open."Jane, do we have someone else coming in this morning?"

  "Not until after lunch. Let
me check."

  Cathy couldn't quite hear the mumbled conversation in the waiting room. In a couple of minutes, just as she signed the last check, she heard Jane's voice again.

  "Come on in here and lie down. I'll get the doctor."

  Cathy was out of her chair in time to meet Jane in the hall. "What's going on?"

  "Mr. Phillips. Severe chest pain, difficulty breathing. Sweating and weak. Probably having that MI we predicted."

  "Let's see."

  Phillips lay on the examination table, his complexion as pale as the sheet beneath him. Large drops of sweat dotted his forehead. His coat lay rumpled on the floor. He'd loosened his tie and unbuttoned the top buttons of his shirt, but his chest heaved as he struggled for air.

  Cathy rolled the portable oxygen tank out of the corner, turned the valve to start the flow, and cinched the plastic mask over Phillips's face. "Jane, give him an aspirin to chew and swallow. Then call 911. We need them here-fast. After that, call the hospital and alert them that we're coming in."

  While Jane gave Phillips the aspirin, Cathy slipped a blood pressure cuffon his arm. His pressure was 116 over 70. Down from his previously high pressure, but not in shock- yet. Pulse 84 and a bit thready. Just what she'd expect with a myocardial infarction. She pulled the man's shirt open the rest of the way and applied her stethoscope to his bare chest. She frowned at what she heard: S3, a third heart sound. A classic sign of an early MI.

  "Mr. Phillips, I think you're having a heart attack." She applied the leads for an EKG as she talked. "I'll check an electrocardiogram to see how severe it is. We'll transfer you to the hospital as soon as the paramedics get here. Are you with me?"

  Phillips nodded weakly but did not speak. The muscles in his temple were knotted, and Cathy could hear his teeth grinding.

  Jane bustled in. "EMTs are on their way."

  "Give him a nitroglycerine to hold under his tongue."Cathy's eyes never left the EKG tracing. Rhythm stable. Slight ST segment elevation. A few isolated T waves flipped. Still early, probably no damage to the heart muscle yet-if she worked fast.