"Who decided on Omnilex? You or Luc?" The speaker was Linda Farley, new to the surgery faculty, fresh out of her training. Anna was pretty sure that Linda felt the medicine practiced here in Texas could never compare with what she'd learned in Boston at Peter Bent Brigham Hospital, in the shadow of Harvard.
"Luc felt, and rightly so, that Omnilex gave the best coverage in this situation. I agreed."
Linda was like a dog trying to wrest a bone away from a rival. "But if there was any antibiotic allergy, especially to penicillin, Omnilex was almost certain to produce anaphylaxis —which it did."
"I realize that, but—"
"Let's move on." Fowler's voice was calm, but there was no mistaking the way he was taking command of the situation."There are a lot of 'what ifs,' but in the final analysis, I think there's nothing to be gained by exploring them. We can conjecture all day about how this would have turned out if you'd chosen a safer but less effective antibiotic, or if the anesthesia resident had picked up on the anaphylaxis earlier and started treatment."
Anna saw Jenkins stiffen. If Fowler saw it, he didn't react. He was already closing the chart and opening the next one."Luc, you and Dr. McIntyre made the right clinical decision based on the information available to you. Unfortunately, there was a bad outcome."
Fowler pulled a sheet of paper toward him and began reading a series of announcements, but Anna had already tuned him out. It was over. She took several deep breaths but still felt claustrophobic. She saw Jenkins slip out, and she wanted desperately to do the same. Unfortunately, the way everyone was packed into the conference room, it would have drawn attention she didn't want. As Fowler continued to speak, Anna uncrossed her legs and put both feet flat on the floor. She rested her hands on the arms of her swivel chair, ready to push up and make a quick exit when the conference finally came to an end. She'd made it through this test. But she knew there were more to come.
Nick looked around the cafeteria. It was two-thirds full of medical school staff— administrative assistants, students, residents and faculty—but he and Anna had managed to score a table with no neighbors nearby. Besides, the buzz of conversation was better than a white noise machine for protecting them from eavesdroppers.
His call had caught Anna as she was walking into her office after the conference. It took some persuasion on his part, but she finally agreed to meet him here so they could talk while he grabbed a late lunch. Thus far, she'd been about as talkative as the Sphinx—although a whole lot prettier.
"You didn't bring up the new information about Hatley?" Nick took a bite of hot dog and wiped the corner of his mouth with a paper napkin.
Anna shook her head. "I was going to mention that I'd found out he was penicillin-allergic. I figured if I didn't say something about it, Fowler would. I mean, I'd already told him about my visit with Hatley's mother. But he moved things along before I could bring it up. I got the impression he was trying to get the discussion over with." She sipped her iced tea."Maybe he was trying to protect me. Or maybe he was trying to protect the department."
"He knows that Hatley's mother told you he was penicillinallergic. But does he know about the second Eric Hatley?"
"He learned about it when he and I met with Laura Ernst and the dean," Anna said. "But I'm pretty sure none of them is going to spread that knowledge around. I was afraid that Will Fell, the resident I talked with about the fake Hatley, would be at M&M today and mention it, but he wasn't. One of the residents told me that Will just got offa twenty-four-hour shift in the ER, and I'm pretty sure he's in dreamland right now."
"So it's not common knowledge that Hatley died because someone stole his identity." Nick took another bite of hot dog and chewed thoughtfully, parsing the implications of what they knew so far. He washed the food down with coffee, wincing as the hot liquid hit his tongue. Anna shoved her iced tea toward him. He scooped out a piece of ice with his spoon and rolled it around in his mouth before continuing. "And you don't want anyone to know yet that you've caught on about the identity theft?"
"I'm not sure how they tie together, but I keep getting the feeling that what happened to me—the credit cards, the DEA number—and what happened to Hatley are linked. I don't know how or why, but if they are, then whoever stole my information had to get it someplace, and I'm betting it was—"
"Here at the medical center," Nick said. "And you don't want to tip your hand while you investigate?"
"Right. I figure it has to be someone around here who has access to my personal stuff." She lifted her glass and drank."When you change into a scrub suit in the dressing room, what do you do with your wallet?"
Nick's hand went to the hip pocket of his scrub suit. He felt the reassuring bulge. "I put it in my pocket. I keep my change and keys in my white coat, and the wallet goes on my hip. I'm used to feeling it there, where it's safe."
"Exactly. Now think of what a woman does. No woman— at least none that I know—wants to walk around with a bulge in her hip pocket." She held up the small clutch that had been sitting on the table. "Most of the female doctors and nurses around here have either a fanny pack or something like this that they can drop into the pocket of their white coat when they need it. But you don't wear a fanny pack under your surgical gown, and there's no place for a purse there, either. So our valuables end up in a drawer of our desk or in a locker in the dressing room."
"And you think someone got into your purse and stole your credit card information. Maybe got your DEA number off the ID card you carry." Nick pulled out his wallet and flipped through the plastic holders until he came to a small folded blueand-white card headed Controlled Substance Registration Certificate. "Do you carry yours in your wallet?"
"I do, but probably for a different reason than you do. I'll bet you don't write many prescriptions."
Nick nodded assent. "Not as a pathologist, no. Just occasionally, for friends or family."
"Have you ever written for a controlled substance?"
"One of my buddies wrenched his knee last Friday afternoon playing football. I wrote him for enough Tylenol with codeine to carry him through the weekend until he could see his regular doctor." Nick made the connection quickly. "And I had to look in my wallet to check my DEA number."
"Right. On the other hand, I write prescriptions all day, and I have my number memorized."
"Do you carry your card?" Nick asked.
"I do, but for a different reason. I don't want it lying around where someone could get hold of it. I always thought it was safest to have it in my purse." Anna wadded up her napkin and shoved it into her empty glass. "Guess I was wrong."
7
AS THOUGH IN RESPONSE TO SOME UNHEARD SIGNAL, THE CAFETERIA BEGAN to empty. Office workers sighed and marched back to their desks. Doctors gulped their lunches and headed for surgery or clinics. Medical students snatched up their books and drifted out in groups of two and three, trading stories of terrible lecturers and fascinating patients.
Anna looked at her watch. "I should go." She pushed back her chair and grabbed her purse.
"What's on your agenda for this afternoon?" Nick asked.
Anna wasn't sure she had a firm plan. And if she did, should she share it with anybody? Even Nick?
"I smell rubber burning." Nick grinned. "Does it require that much thought to tell me what you're up to?"
"Sorry." She created interlocking rings with the condensate on the bottom of her empty glass. "I'm not sure I have a plan, other than to snoop around and hope I can recognize a clue if I stumble across it."
"Not much of a plan, but better than nothing I guess," Nick said. "How about dinner later tonight?"
Anna gave him full marks for persistence, but tonight she wanted to be alone. She moved aside a stray strand of hair. "Sorry, Nick. Really, all I want is to pick up some fast food on my way home, sink into a bubble bath, and fall asleep reading the book that's been on my bedside table for a month."
Nick nodded his understanding. "So, tomorrow?" He paused."No, wait. That's
Saturday. I'm covering pathology tomorrow, and I don't want to interrupt our time together if I get called back. Sunday?"
Anna felt the shadow of an idea form. The more she thought about it, the more she liked it. What could it hurt to ask?
"Is the question too hard for you?" Nick asked. "Need to check your Palm Pilot? Trying to decide if we can be alone without a chaperone?"
"No," Anna said. "Just thinking. Sunday would be fine. What did you have in mind?"
"That's usually my only day to sleep in. How about brunch? Then we can play it by ear. A movie, walk around in the West End, maybe go out to the Arboretum?"
Anna tried to hide her grin, but was afraid it showed in her eyes, if not on her lips. "Are you flexible about those plans?"
"Sure. What do you suggest?"
"Come by my apartment about ten-thirty Sunday morning. Go to church with me. Then we can have lunch and decide how we'll spend the rest of the day."
To his credit, Nick only hesitated for a few seconds. "Sure. What's the dress code?"
"Whatever you're comfortable wearing. Most men wear sport shirts. There are some in jeans. You'll see a smattering of coats and ties, mainly the older members."
"What about you?"
She grinned. "I'll be wearing a dress, but I don't think that's a good look for you. I'd stick with a sport shirt and slacks."
Anna stood in the doorway to the outer office and watched her administrative assistant, Lisa, pound the keys of her computer into submission. Surely by now rumors of all kinds circulated through the department. Although Lisa had already voiced her support, Anna's stomach did a flip- flop as she wondered what kind of reception she'd get from others on the staff.
Lisa's smile seemed genuine. "Dr. McIntyre. It's good to see you. Are you back at work now?"
Anna forced a smile in return. "No, just here to clean out my mail and check my messages. I'm going to close my door. Buzz me on the intercom if it's urgent. Otherwise, pretend I'm not here."
Safely hidden in her office, Anna shoved her purse into a desk drawer and covered it with a file folder. Did that make it safer from prying eyes and searching hands? She grimaced as she realized how ineffective her attempts at security had been in the past. Then again, old habits die hard.
Anna tossed her white coat onto the chair on the other side of her desk and dropped into her swivel chair. Next she heeled offher shoes and shoved them under the kneehole of the desk where she could slip them back on if someone came in. She leaned back, ran her fingers through her hair, and willed her shoulder muscles to relax. M&M was over. One hurdle down, lots more to go.
The always-efficient Lisa had her mail and messages sorted into neat piles centered on her blotter. Anna started by signing operative reports, summaries, and professional letters. Then came the patient information: tissue reports, lab and X-ray, referral summaries. She initialed them all and dictated a few chart notes and instructions for Lisa to pass on to her clinic nurse. The ease with which she'd been able to slip back into her professional persona and forget her other problems didn't surprise her. Her colleagues often kidded that Anna wouldn't notice the start of World War III if she were struggling with a diagnostic problem.
When she was satisfied she'd dealt with the most urgent matters, Anna slipped her feet into her shoes and opened the office door. "Lisa, I'm going down to the break room to get a soft drink. May I bring you something?"
"Oh, no thank you. I was just there for some coffee." Lisa gestured to the Styrofoam cup on her desk.
Anna, like all the other faculty members, generally left her office door open, assuming that her administrative assistant would be at her desk to guard against unwanted visitors. Now Anna saw the fallacy in that assumption. The assistants were away from their desks several times a day: coffee, restroom breaks, trips to the supply room, lunch. Anna closed her office door behind her and waited until she heard it click before she left.
Once she returned to her desk, Diet Coke in hand and shoeless again, Anna decided to tackle her stack of journals before it reached a critical stage and toppled over. She was marking an article with a Post-It note and a scribbled reminder when she heard noise in the outer office. Voices chattered in the hall. A file cabinet closed. Anna looked at her watch and nodded a silent understanding of what was going on. The assistants were leaving. No doubt, Lisa was even now retrieving her purse and preparing to make a quick exit.
Even though they didn't punch a time clock, the administrative assistants came and went with a regularity that was unwavering: In the office by eight a.m. Half an hour for lunch in staggered shifts, with the phones always forwarded for uninterrupted coverage. Out the door by four-thirty. In another ten minutes or so, all the department offices would be empty.
By quarter to five Anna should have the whole department to herself. Then she could nose around the offices without interruption or the need for explanation. She wasn't sure what she'd find, or even what she was looking for, but she was determined to try. She dawdled at her desk for another fifteen minutes, and when she emerged the office staffers were long gone. Of course, the doctors were still in clinic or the operating room and would be for another hour or more. The cleaning people wouldn't come in until later. Now was the time for Sherlock McIntyre to prowl. Anna wished she had Nick, her own private Watson, at her side so she could bounce ideas offof him. That is, if she had any ideas.
It wasn't dark, and Anna knew that there were other people in the building, but still the deserted hallways and offices felt creepy as she wandered systematically through them. Nothing struck her. No one came by and whispered, "I stole your personal information." She had no inspirations. Maybe this detecting was more difficult than it seemed on TV.
Then Anna glanced into the office complex shared by two doctors, Joe Leach and Allen McClay. The outer office was vacant, and their assistant's desk was unoccupied. Dr. McClay's office door was closed, but the door to Dr. Leach's inner office was open. Anna was sure both those doors had been closed when she walked by earlier. She edged into the outer office.
Through the open door of Dr. Leach's office, she heard drawers opening and closing. Someone was in there. Maybe Leach had finished his surgery and was rummaging for something in his always disorganized files. She tiptoed closer just as her chairman, Neil Fowler, emerged from the office with a file folder tucked under his arm. He closed and locked the door before he looked up and saw Anna.
If he was startled, Fowler didn't show it. "Hi, Anna. I thought things went fairly well at M&M, didn't you? I hope you don't think I was cutting you off, but I was afraid that Linda was about to launch into a harangue on how they used to do things in Boston, and I didn't want to give her a chance."
Anna knew she should probably agree and move on. Don't take a chance on antagonizing the chairman. But instead, she said, "Dr. Fowler, what were you doing in Joe's office?"
Fowler held up the file folder. "I needed some of the data he's collecting for a paper we're writing together."
"But how did you get in? I passed by here earlier and his door was locked."
He pulled a ring of keys from his pocket, jingled them, and grinned. "Master key for all the doors in the department. I'm the chairman. Remember?"
Anna made some conversational gambit—she wasn't even sure it made sense—and retreated back to her office. She closed the door and leaned against the desk. Of course the chairman would have a master key. She hadn't even thought of that. But how many more were floating around the department? She could hear it now. "Hey, Neil. Let me borrow your key. I need to get into my office, and I forgot mine." Then a quick wax impression—wasn't that the way they did it in the mystery novels? —and pretty soon locked doors presented no challenge.
She chided herself for letting her suspicions run wild. It was hard enough to think that an assistant might yield to the temptation to lift a few prescription pads and copy down a doctor's DEA number in order to turn it into cash or satisfy personal needs. But would another physician do that? No,
surely not. On the other hand, she couldn't rule out that possibility.
Well, she'd learned something anyway. Probably more than she wanted to know. And the pool of suspects was larger than ever.
Anna closed the chart and tossed it into the rolling wire cart beside her, on top of all the others that were to be refiled. She shrugged her shoulders, flexed her fingers, and wiggled her toes. She felt as though she'd gone five rounds with a welterweight fighter. She was sore, discouraged, and painfully aware of her shortcomings.
The room was quiet except for an occasional muttered curse as a resident or staffphysician struggled to complete long overdue dictation. The Medical Records Department might seem to be a minor cog in the operation of a large medical center like Southwestern, but Anna realized how much power the records staffwielded. How many times had she waited while a misfiled chart was located? How often had she hurried over to this basement room to sign charts and do dictation so her name would come offthe dreaded "suspended" list—unable to operate or even admit patients until she'd completed the paperwork that seemed ready to bury her and her colleagues at any minute?
This time she'd come here voluntarily to wade through the charts of almost a hundred patients in search of a clue to the identity of the person who had co-opted her name and DEA number. And it had been a total bust. The names were just that—names. She'd been able to remember a few cases, put faces and scenarios with them, but that hadn't helped. Even though some of her patients weren't the type of people she'd want to go out for coffee with, she couldn't picture any of them being involved in a scheme to produce hundreds of forged narcotics prescriptions.
Medical Error Page 9
