Medical Error

by Richard Mabry

  Anna shoved the phone out of the way and turned her attention to the pile of unopened mail on the desk. Might as well take care of that. After all, this was supposed to be a catch-up day. The first two envelopes she opened informed her, in what would have been hushed and respectful tones if the letters could have delivered their message aloud, that she'd been preapproved for credit cards with a limit far above her reasonable purchasing power. She tossed them in the trash, but while she opened her bill from the phone company a disturbing thought hit her. She retrieved the two discarded sheets and systematically ripped them into tiny pieces. She opened her fist and loosed a small snowstorm into the wastebasket, thinking that she really needed to buy a paper shredder—today.

  The next three pieces of mail were bills, and Anna dutifully put them aside in a stack next to her checkbook. She'd pay them this afternoon. Her credit was more important to her than ever, and she wasn't about to let these go unattended.

  She picked up the next envelope and was about to apply the letter opener to it when the phone rang. The caller ID showed an unfamiliar number. Who could be calling her? Someone from the medical center? She was effectively suspended from clinical duties. There was no way that Fowler would be in his office today. She thought of Nick and felt an unexpected flutter.

  "Hello?"

  "Hey, Anna. How's your Saturday going?"

  Anna wasn't sure whether she appreciated or resented the chipper tone of Nick's voice. "I think the expression is 'rowing against the tide.' I've already spent half the day and don't feel as though I've accomplished anything worthwhile. How about you? Aren't you on call?"

  "Yep. Had to go in for a frozen section this morning, but things are quiet now. Have you had lunch?"

  Anna looked at her wrist and discovered she'd left her watch on her bedside table, not an unusual action for her on a day off."Is it that time already?"

  "My stomach tells me I'm at least half an hour late for lunch." Nick paused, apparently for effect. "I knew it. Mickey's little hand is on the twelve and his big hand is on the six. How about having lunch with me?"

  "What about your being on call?"

  "No problem," Nick said. "Things are quiet now, and there shouldn't be anything I can't put offfor an hour or so. Why don't I show up with some deli treats? We can picnic in your living room. Guaranteed good weather. No flying or crawling critters to interfere."

  Anna hesitated. Their relationship seemed to be moving a little fast. Didn't she have enough to worry about? Then again, she liked having Nick around, so what was the problem? "Okay. How long before you're here?"

  "Does this answer your question?"

  The sound of her doorbell ringing was simultaneous with a fainter version in the phone receiver. She laughed. "Pretty sure of yourself aren't you, Dr. Valentine?"

  "Pretty confident, Dr. McIntyre. Besides that, I knew when I bought it that if you weren't home or—perish the thought— turned me down, the food wouldn't go to waste."

  Anna rose and started toward the door, dropping the unopened mail on the coffee table along the way.

  Nick shifted the wicker basket from his left hand to his right. The woman at the deli had sold him the picnic hamper for what she'd termed a bargain price, probably because he'd spent so much on the food in it. He wasn't sure what made him think he could make this crazy idea work. After all, he'd told Anna only yesterday that he'd be tied up today. She probably had her day all planned out—a day without him. But after doing the frozen section, after hammering out the stack of stuffon his desk that he'd put offfor a week, he found that he missed her. He wanted to talk to her, be with her, even smell the floral scent of her shampoo. The way he felt about her . . .it was different than anything he'd ever felt about a woman. And he liked it.

  The front door swung open and Anna stood there smiling at him. She was dressed casually: simple skirt and blouse, sandals. Her red hair was pulled back with a band that matched her green eyes. "You're just full of surprises, aren't you?"

  "I like to keep you guessing," Nick said. He hefted the basket."Can I put this down somewhere? I think the lady at the deli threw in some lead weights when my back was turned."

  Anna beckoned him in. "Sure. Bring it into the living room. We'll set up a picnic on the coffee table."

  Nick pulled a red checked cloth offthe top of the basket and handed it to Anna. "When Nick Valentine brings a picnic, he brings everything except the ants."

  "Where did you get all this?" Anna asked. "Red checked tablecloth, picnic hamper, goodies. This is like something out of a movie."

  Nick shrugged an "it was nothing" gesture. "I'd heard about this little deli in Highland Park. Family owned, been there for years. I decided to pick up a couple of sandwiches and call you to see if you wanted to share them with me." He shrugged. "I ended up buying all this."

  "It's wonderful. But there's so much food."

  "As I told you, any leftover food won't be wasted. As for the basket and tablecloth, maybe you can keep them for our next picnic."

  Nick wondered why he'd said that. It sounded brash, assuming that there'd be more picnics, more time together. Don't rush her. Take it easy. Be cool.

  Anna scooped a pile of mail offthe coffee table. "Let me clear this offso I can spread the cloth." Two letters on the bottom of the pile slipped from her grasp and fell to the floor.

  Nick set the basket on the floor and stooped to retrieve the mail. "Let me get those." One letter had landed address side up, and his eyes brushed across the return address: Metro Clinical Laboratories. "This looks like a lab report."

  Anna smoothed the wrinkles from the cloth and began to pull items from the hamper. "Oh, that's probably mine. I had my annual physical a couple of weeks ago. I suppose my doctor ordered some kind of new test that the lab at the med center wasn't set up to do yet, so he sent it to an outside lab."

  Nick frowned, but hurried to erase it before Anna looked up. "You know, I'm in the pathology department. If there's a test out there that we can't run, I haven't heard about it."

  "Well, Dr. Pathologist, in that case, why don't you open it and see what it is? And if I have trouble interpreting the results, I've got an expert on hand."

  Nick fumbled with the envelope. "Are you sure, Anna?" There was no levity in his voice now. "This is confidential stuff.Look." He held out the envelope and pointed to the large red letters in the lower-right-hand corner: CONFIDENTIAL.

  "I don't mind if you know my cholesterol or my triglyceride or whatever. Go ahead. I almost have our picnic set up, and I don't want to stop."

  Nick ran his finger under the flap and pulled out a single sheet of paper. He scanned the results with a practiced eye. Then he looked at the top of the page and double-checked the name and address of the patient. Finally, he asked, "What's your date of birth?"

  "Why do you ask?"

  "Just making sure this is really your report."

  For the first time, Anna looked up. "July seventh."

  "That matches." Nick said. "Did your doctor talk with you about ordering any unusual tests?"

  "Nick, you're scaring me," Anna said. "What is it?"

  He handed the report to her. "You'd better see this yourself."

  Anna put down the loaf of sliced sourdough bread she was holding and looked down at the report in her hand. "Why did Dr. Reed order these? And why were they sent to a lab outside the medical center? The names of the tests are vaguely familiar, but I can't quite place them."

  Nick eased onto the sofa and patted the cushion beside him."Anna, sit down."

  She sank into the seat, the picnic forgotten. "I don't understand," she said.

  "Let me take your questions in order." Nick's voice was quiet, his tone sober. This wasn't the Nick who'd walked in her front door a few moments ago, the one who made her perk up. He'd changed. And it wasn't good. "First, Dr. Reed must have ordered these tests because he had reason to suspect a serious illness."

  "What kind of—"

  "I'll get to that. Second, he pro
bably sent them to an outside lab because he was being considerate. By and large, our lab personnel at the medical center are professionals. They respect patient confidentiality. But sometimes they let things slip. He didn't want this information to get out."

  Anna took a deep breath. She couldn't recall feeling this way since she waited for the dean's office to post the list of those who'd passed their courses and would receive their MD degree. When the list went up, she almost turned away without reading it. She ached to know the verdict but was afraid of what she'd see.

  "Anna, are you okay?" There was concern in Nick's voice."Can I get you something to drink?"

  "No, I'll be fine. Go on." Anna tried to swallow, to move her heart out of her throat as she waited for the other shoe to drop.

  "You're right about the tests. You don't deal with them every day, but I do." Nick held up the paper. "If this first one is positive, it's followed up by another. If that one is positive, they do a third. If they're all three positive, then we do a confirmatory test. Even then, some clinicians insist on a fourth assay as sort of a fail-safe. If that's positive, there's no doubt."

  "What are you saying?"

  It seemed to Anna that Nick shrank back a bit. "You're HIV positive."

  She felt as though someone had slammed a fist into her gut."That can't be true."

  "They ran all the tests," Nick said. "To be sure. After all, this is an area where false positives and false negatives can be disastrous."

  Anna shook her head, as though trying to dislodge what she'd just heard. "No, no. I mean, there's no way I could be HIV-positive." She stopped, trying to figure out how to couch her reply. "I haven't had any exposure."

  "Sure you have." Nick's tone was neutral, nonjudgmental."You've been in patient contact for what? At least the last three years of med school, three or four more in residency, then in practice. Didn't you ever notice a hole in your glove during surgery? Maybe you had a little cut on your hand at the time but paid no attention to it. Did you accidentally stick yourself with a needle? Sure you've had exposure. It doesn't take sexual contact to contract AIDS. Blood exposure to non-intact skin will do it."

  Anna felt the initial adrenaline rush of fear fading. Think logically, she told herself. Think about it. Once more she looked at the report, this time a lot more carefully. Studied it as though her life depended on it, which in a way, it did. She moved past the lab values themselves, and concentrated on the heading of the report.

  That was her name, her date of birth. She didn't know her insurance number offhand, but she was willing to bet the designation at the top of the page was correct. Her home address was right, down to the added four digits after the ZIP code, numbers that Anna never could remember. And she could see why her doctor might have had the report sent to her at home, to protect her privacy. But why would Gary . . . wait a minute! The name of the requesting doctor wasn't Gary Reed. And the address wasn't the faculty clinic on Harry Hines Boulevard. No, the order came from Dr. Khalid Mahmood. The facility was the Metro Medical Center on Grand Avenue. This test was sent to the lab by what Anna often heard called a Doc- In-The Box, a walk-in clinic, one located in one of the more depressed parts of Dallas.

  "Nick, I found it. I know what happened," Anna said.

  "You mean you know how you were exposed?"

  "No. I mean I think I know how this test was done using my name and insurance information."

  She saw the doubt in his eyes, knew he was probably thinking she'd gone somewhere she wasn't known to have the test done. How was she going to convince him that she was an innocent victim? And why did she care so much about what he thought?

  Anna handed the report to Nick and watched his face as he took the paper. He didn't look down at it. He looked at her, like he was giving her a lie detector test with his eyes. Finally, he lowered his gaze and tapped the top portion of the report."Anna, this is your name. Your address. The fact that the test was done at an out-of-the-way clinic doesn't change that."

  She shook her head. "Can't you see? The same thing's happened to me that happened to Eric Hatley. Someone's using my identity to get medical care. They got hold of my insurance information and used it the same way they used my credit cards and DEA registration. This is just another part of the identity theft."

  "It makes sense, I guess. I want to believe you. But these test results—"

  "Besides the fact that I know these aren't my tests. Think about it logically. It came from another clinic. That implies that I was trying to keep the results a secret. If that were my intent, would I have asked you to open the envelope? No, I'd have made sure the envelope stayed hidden while you were here. Hey, I'd have opened it myself the moment it arrived."

  She watched Nick's frown deepen, then gradually fade."Okay, I see what you mean. But let's say this isn't your test. What can you do about it?"

  "I've got an idea. It's crazy, but so is everything that's happened to me so far."

  Nick handed the report back to Anna. "What's that?"

  Anna began to pace. "I've been thinking about the credit theft and the narcotics thing separately. They're not. I've had a vague feeling they were related, but now I think they're part of something a lot bigger. Someone—we don't know who—got hold of all my personal information. They either used it themselves or passed it on to other people. If I trace one of these incidents back to the source, I've got my answer."

  "You keep saying that you're going to do this," Nick said."What happened to the 'we' that we talked about? Did I get thrown offthe team?"

  Nick was right. Her problems seemed to be piling up faster than she could deal with them by herself. "You're right. Two heads are better than one. We'll brainstorm this and figure out our next move." She surprised herself by reaching out for Nick's hand. "But you do believe me, don't you?"

  Nick took the offered hand and squeezed, and his expression changed. "Yes, I believe you. I don't understand it all, but we'll figure it out." He dropped her hand and pointed to the forgotten picnic, now all laid out. "But can we do it while we're eating? After all, low blood sugar hinders the thinking process. Isn't that right, Doc?"

  Anna relaxed as she saw that Nick had apparently accepted her innocence. "Sure," she said. "Let's eat."

  The picnic, once it started, involved more eating than talking. Anna found that the afternoon's events hadn't blunted her appetite. "My compliments to your deli," she said, wiping mustard from her lips with a paper napkin.

  "Thank you. I think—"

  A pager went offand they both jumped. Anna's hand went to her waist in an automatic gesture that ended in frustration when she recalled that her pager was still on her desk at the medical center. She wasn't on call. No one wanted her.

  Nick thumbed the button, looked at the display, and frowned. "Gotta call in. Okay if I use your phone?" When he hung up, the frown had turned to a look of disgust. "I have to go back to the medical center. There's a medicolegal autopsy they want done ASAP."

  "Go on. I'll clean up here."

  "Should I come back when I've finished?" The look on his face made it clear that he wanted to do just that.

  "Can I take a rain check? I'm beat. And there's nothing either of us can do about any of this before Monday." Anna wrapped the remaining two sandwiches and a handful of cookies in one of the napkins and shoved them at Nick. "Take these with you. You're more likely to want them than I am. And thanks for the picnic. I enjoyed it."

  When Nick stopped at the doorway, Anna thought he might be about to turn back and kiss her. Would she let him? The question became moot when he said, "I've enjoyed it too. Don't forget. I'll be by at ten-thirty in the morning."

  She closed the door, leaned against it, and replayed the scene in her mind. If the question of the lab report hadn't come up, would the afternoon have ended differently? She wondered.

  9

  ANNA AWOKE BEFORE THE ALARM SOUNDED. SHE LOOKED AT THE CLOCK, tried to recall what day it was, struggled to define the feeling at the back of her consciousnes
s that something was supposed to happen today. It had nothing to do with work—she was still on unofficial suspension. It was . . . Sunday. And Nick had agreed to attend church with her.

  She kept reminding herself that she should be cool. Nick was a friend, nothing more. She didn't have time or space in her life for anything else, certainly not with everything swirling around her. But she did her makeup with extra care. Then she spent an unusually long time in front of her open closet door. Anna didn't have a lot of clothes—her budget was far from limitless—but she'd bought wisely, choosing good quality things that set offher red hair, green eyes, and pale complexion. She finally chose a simple green dress.

  At ten-fifteen she started fidgeting. By ten-thirty she was checking her watch every fifteen seconds. At ten-forty, her phone rang.

  "Anna, this is Nick. I'm so very sorry."

  She felt as though she were on a roller coaster that had just started to drop. He was going to cancel. She'd scared him offby asking him to go to church with her. "That's okay, Nick."

  "No, you don't even know what I'm apologizing for. I got a call this morning from George Race. He's the pathologist on call today, and his daughter is being christened this morning. The doctor who was supposed to cover for him got sick, and he needs me to work—at least until noon."

  Anna felt her heart start beating again. She was a doctor. She could understand a situation like this coming up. It had nothing to do with her invitation to church. "Of course you have to cover for him, Nick. I'd be disappointed if you didn't."

  "I'll be through at noon. Can we still have lunch together?"

  Anna rummaged through the notes scattered on the coffee table in her front room. There it was. "I can do better than that. Some friends are having a party this afternoon. There'll be food there."

  "Will I know any of these people? Are they doctors? Neighbors? What?"

  Anna gripped the phone a bit tighter. Better tell him the truth. "It's a group from our church. They're a lot of fun. And there'll be tons of good food."