Medical Error

by Richard Mabry

  "Dr. McIntyre? Don't you know who I am?"

  "I'm sorry. Should I? I mean, I can't even recall my own name, so I guess it's okay that I don't know yours."

  He turned and gave orders to the woman beside him. Some of the words made a vague sort of sense, but the memories they triggered seemed as disconnected as the pieces of a jigsaw puzzle just dumped from the box. And when she tried to put them together, all it did was make her headache worse.

  The doctor turned back to her. "I'm going to examine you. Just try to relax. First of all, follow my finger with your eyes." As the examination went on, there were times when she seemed to know instinctively what was coming next. Most of the time she was right. What could that mean?

  The doctor shoved his stethoscope—she wondered how she knew that was what it was called—into the pocket of his white coat. "We're going to take a bit of blood for some lab work. Then the nurse here is going to take you to X-ray for some studies of your head. After that, I'll be back to talk with you some more."

  "But you haven't answered my question. Can you help me?"

  "Of course," he said. But she could see the doubt in his eyes.

  The voice on the phone was neutral, the greeting brisk. "Dr. Simpson."

  "Sir, this is Will Fell. I'm a surgery resident in the Parkland ER."

  "Yes, I know. You're the Pit Boss. What do you need?"

  Will guessed that when you were the chief of a busy neurosurgical service you didn't spend much time in social niceties or idle chitchat. He swallowed hard, more nervous than he'd ever been while presenting at Grand Rounds. "Sir, I need you down here. We—"

  "Whatever this is, why can't one of the neurosurgery residents handle it?"

  "Dr. Simpson, I think I need a faculty presence. Dr. Anna McIntyre was just brought in to the ER. She apparently sustained some head trauma and lost consciousness. She's awake now, but she's amnesic—not just for the event, it's global amnesia. She's getting a CT of the head right now. I did a neuro exam, and I think it's normal, but—"

  "I'm on my way. Meet me in radiology."

  Twenty minutes later, Will sat beside Mike Simpson, chairman of the Department of Neurosurgery, watching the man study the images on the computer screen in front of them.

  "What do you see?" Simpson asked.

  Will squinted, wondering what he'd missed. To him, this was a normal CT of the head. No midline shift, no masses, nothing. What had Simpson seen that he hadn't? "Sorry, sir. It all looks normal to me."

  Simpson nodded. "Right. Now why did you get this scan?"

  Oh, boy. Will steeled himself for the chewing out that was coming. Every test, especially one with a hefty price tag, required justification. "Well, she had physical evidence of trauma to the head. I wanted to rule out a subdural hematoma. That's a surgical emergency."

  "But did she have neurologic signs?"

  Will felt drops of sweat coursing between his shoulder blades. "Uh, well, I wasn't sure."

  "You're a second-year resident. You've probably done hundreds of neuro exams. What did you think about this one?"

  Will squared his shoulders. "I thought it was normal. But this is a faculty member and I thought—"

  "You wanted to be sure. And that was a good decision. But did you think her neurologic exam was normal?"

  "Uh . . . yes, sir."

  "Deep tendon reflexes brisk and equal. Pupils reactive to light. No papilledema. Sensation intact. So she was neurologically intact?" Simpson turned from the computer screen and fixed him with cold gray eyes. "But she had amnesia. That's abnormal. It's not a physical sign, but recall that one of the elements—the first element—of a good neurologic is whether the patient is oriented to time, place, and person. She isn't, so her neurologic is abnormal. Never mind her pupillary reactions and deep tendon reflexes. So you were right. You had to get the CT." The faintest hint of a smile flickered on Simpson's lips."Fell, you're a good doctor. Dr. McIntyre told me once she had high expectations for you. When you know you're right, don't back down. But remember one thing. In our profession, good isn't enough. We have to be perfect."

  Will nodded. "So you agree she has no evidence of a subdural?"

  "Just a concussion."

  "And the amnesia? Should I get a psychiatry consult?"

  Simpson shook his head. "Transient global amnesia. A rare consequence of head trauma, especially if there's significant associated psychological stress. I'm betting that within the next few hours she'll start remembering things. By tomorrow, maybe the next day, she should be fine."

  "Will all her memory come back?"

  Simpson shrugged. "Most of it. Generally these patients don't remember anything about the precipitating event. Other than that, yes, it all comes back to them."

  "Do you want her hospitalized for observation?"

  "Admit her to my private service with the diagnosis of head injury, rule out subdural hematoma. Neuro signs every hour. You know the drill. Get an MRI of the head tomorrow to make sure she isn't developing anything else. I'll see her before I leave this evening. If anything comes up before then, page me."

  "Good morning, Will." Anna pulled the covers up to her chin. It wasn't so much a matter of modesty. Goodness knows that had gone out the window along with her clothes when the nurses replaced them with a hospital gown. And she dreaded looking in a mirror. One of the ICU night nurses had taken pity on her and scared up a hairbrush and lipstick, but Anna still felt—and probably looked, she guessed—like a Halloween leftover.

  "Morning, Dr. McIntyre." Will was freshly shaved, his scrub suit and white coat were clean and unwrinkled, but the dark circles under his eyes told a different story.

  "Will, you were in here offand on all night. Weren't you supposed to go offduty last evening?"

  Will suddenly found her chart very interesting. He didn't look up as he said, "Well, I decided to hang around here last night."

  "There was no need for that. Dr. Simpson came by last evening. He brought the on-call neurosurgery resident with him and briefed him on my case. You should have gone home for some rest."

  "Oh, I snatched a few naps in the call room. No big deal."

  Anna decided not to pursue a subject that was obviously an embarrassment to Will. Instead, she asked, "So, what's the plan?" She grinned. "I mean, I think I know what the plan should be, but I still have some holes in my memory right now."

  Will seemed on firmer footing now, talking about something clinical. "Your neuro signs are stable, so we—I mean, Dr. Simpson—will let up on the frequency of checking those. You're scheduled for an MRI this afternoon. If things go well, we can get rid of that IV this evening and start letting you eat and move around."

  "And how long before Mike lets me go home?"

  "Maybe another day or two. And I'm pretty sure he'll want you on limited activity for a week or so."

  Something that had been gnawing at the back of Anna's mind began to burrow forward into her conscious thoughts. She had gone to that laboratory for a reason. All the pieces of the puzzle hadn't put themselves together in her addled brain, but she had the sense that she needed to get back to whatever she was doing. Soon.

  Will hesitated for a moment before reaching down and touching her hand, carefully avoiding the IV snaking into the vein just above her wrist. "I've got to go back on duty in the ER, but if you need anything, just have the nurses page me."

  "Thanks, Will."

  Anna appreciated Will's obvious concern for her. She was independent enough to think she didn't need his help, but it was nice to know it was there. Then she realized that there were a couple of men in her life who'd already shown her that they cared. And she should probably contact both of them.

  That led to another thought. Her cell phone. Where was it? The answer came back quickly, and with it another set of problems reared its head. Her cell phone was in her purse. And her purse? The last she'd seen of it, a derelict was tugging it away from her. Purse. Cell phone. Wallet. Identification. Cash. Credit cards. All gone. And h
er car? What were the chances it was still parked where she had left it? There was so much to deal with. But not now. Not yet. Instead, she closed her eyes and began to do the only thing she felt well enough to do. She prayed.

  Nick Valentine frowned at the ringing phone. What now? He wasn't on call, so this couldn't be a frozen section or an autopsy. He was current on all his dictation, not just the pathology reports—he was scrupulous in keeping current with those—but even the academic and administrative material. The long-delayed curriculum vitae was on Dr. Wetherington's desk, putting an end to almost daily phone calls asking for that piece of material. No, Nick's desk was clean, and his conscience was clear. So why couldn't he have a moment's peace to finish this journal article he'd been trying to read for the past month?

  "Dr. Valentine." Nick noticed that he hadn't been completely successful in keeping the annoyance out of his tone, and a glimmer of guilt flitted across his mind.

  "Nick?" The voice was a little weak but he recognized it immediately.

  "Anna! Where are you? Are you all right? I've been trying to reach you since noon yesterday."

  "It's sort of a long story. Right now I'm at University Hospital. They've just moved me out of the ICU and into a room. If you want to come by, I'll—"

  "I'm on my way. What room?"

  Nick rushed down the warren of corridors from his office at the medical school to the University Hospital, his mind churning. ICU? What had happened? Was Anna going to be okay? He arrived at the elevators but decided they were too slow. He took the stairs two at a time. He paused at the door to her room long enough to slow his breathing, wondering if his pounding heart was a consequence of the stairs or a signal of the emotion he felt. He tapped on the door.

  "Come in."

  The response was faint, the voice almost unrecognizable. Nick opened the door. What he saw brought the same feeling as his first— and last—roller-coaster ride. His stomach dropped, his pulse raced, and he wanted to turn back the clock and start over. Anna lay with eyes half-closed, lifting her hand a few inches in greeting before letting it fall back on the covers. The bruise on her jaw was a palette of green and blue, a stark contrast with the pallor of her skin. Her red hair was tousled, and her green eyes had none of their usual snap and sparkle.

  Nick scanned the monitors recording Anna's vital signs, and he relaxed a bit when he saw the values. He covered the distance to the bed in three long strides. "I've been so worried about you."

  "I'm sorry. I guess—" She swallowed with visible effort."Could I have a sip of water?"

  Nick wondered if it was okay to let her drink. She still had an IV in, but there was a Styrofoam pitcher of water on the bedside table, and a flexible straw sat in a half-full glass beside it. He held the water for her, supporting her head with his other hand. She managed three small sips.

  "Thanks," she said. "You must be wondering why I didn't call sooner."

  "That's not important. I'm just glad you're okay. At least, if they've moved you out of ICU, I guess you are. What happened? What can I do?" Nick had to stop the questions from pouring out. It appeared that Anna was all right now. That was all that mattered.

  "I couldn't call you," she said. "I didn't even know my own name for a while."

  He sank into the chair at her bedside and covered her hand with his. He felt her flinch and pulled back. "Sorry."

  "No, that's okay. Actually, it's nice. Just watch the IV."

  He took her hand once more, this time more gently. "I think you'd better tell me about it."

  It took a while for Anna to relate the story. Several times she paused, apparently searching to recapture events. "My memory's coming back now," she concluded. "I don't remember exactly how I got hit on the head, but we've sort of pieced together that I was mugged. And there are still a few areas that are sort of fuzzy around the edges."

  "So you're going to be okay?"

  "Mike Simpson says I'll be fine, although he wants me to take it easy for at least the next week." She grimaced. "I think I'm probably going to push that, though. As soon as he turns me loose, I want to pick up where I left off. . . if I can figure out exactly where that was."

  A shadow passed across Anna's face and she turned her head away. She freed her hand from Nick's and wiped a tear from the corner of her eye.

  "What's the matter?" he asked.

  "I just thought of all the things I have to do. The mugger got my purse, with my phone, my wallet, driver's license and credit cards, everything. I can't do anything until I take care of that."

  "Let me help," Nick said. "I can—"

  There was a light tap on the door and it swung open. Nick turned to see a heavy-set black woman, a sweater thrown over her dark blue scrub suit, tiptoe into the room. "Dr. McIntyre?"

  Anna looked puzzled for a moment. Then Nick saw her expression change, and she said, "Miss . . . Miss Brown? Have I got it right?"

  "That's right, Rhonda Brown. You've got a good memory for names and faces."

  "Not recently, but that seems to be getting better." Anna indicated Nick. "This is Dr. Nick Valentine."

  Nick exchanged handshakes with the woman and offered her his chair.

  "Can't stay. I sneaked away from the lab and whenever I'm gone, everything turns to— Well, it gets bad. Got to get back and keep things running." She hesitated, and Nick could tell she was nervous about something. "Look, you need to know something. I'm the one who called the medics. I sneaked out for a smoke just in time to see a wino struggling to get your purse away from you. He decked you, I screamed, and he dropped your purse and ran. I stuck my head in the door and yelled for the receptionist to put down her magazine and call for an ambulance. Then I went back outside to wait with you until the paramedics rolled up. That's when I decided to disappear. Didn't want to be involved, you know?"

  "Thank you for calling for help," Anna said.

  "Well, that was the least I could do. I kept thinking about that story I learned in Sunday school. You know, the Good Samaritan? All I could think of was 'They passed by on the other side.' I couldn't do that."

  "I'm glad you gave me the chance to thank you in person," Anna said. "I know it was hard for you to come."

  "You don't know the half of it." Rhonda reached into the shopping bag that dangled from her hand and pulled out a purse. "I didn't trust that gang that's always hanging around in the parking lot. So I grabbed this before they could snatch it and run. Everything's still there: your cell phone, credit cards, driver's license, cash. I even scooped up your car keys and put them in here." She held out the purse.

  Anna took it with trembling fingers. "You don't know how much this means to me. Thank you."

  Rhonda shrugged. "At first, I figured the money in this would buy me a new pair of Reeboks, with enough left over for lunches next week. But that's the other half of that Good Samaritan story. That guy not only helped out the man who'd been robbed. He paid the innkeeper to take care of him. Besides, I don't need new sneakers, and I'm on a diet."

  12

  THAT'S SUCH A RELIEF," ANNA TOLD NICK AFTER RHONDA LEFT. "AT LEAST I don't have to worry about canceling my credit cards and getting a new driver's license. And my house key is on that ring along with my car keys. I don't like to think about what someone could have done with that."

  Nick frowned. "Anna, I wish you'd let this drop. Sure, somebody stole your identity. We can see that. But trying to find out whose behind it can only get you hurt. You—"

  "Hold on." Anna held up one hand, careful to choose the one without an IV. "According to Miss Brown, the reason I'm here in this bed is because I was mugged by a derelict who wanted my purse so he could buy another bottle of Thunderbird. It could just as easily have happened on my way to work or the grocery store."

  "All right. I guess I can accept that. But I still worry about you. So would you be careful? And would you let me help?"

  Maybe Nick's expression of concern and offer of help came from a sense of duty. But there seemed to be genuine affection ther
e as well. And that brought up the question of how she felt about Nick. Were her feelings for him platonic? Or was something more developing? No, there was too much to think about and her brain wasn't up to it. Not yet, at least.

  She realized Nick was still waiting for an answer. It seemed easier to acquiesce than argue. "I'll be careful. And once I'm out of here, I promise we'll talk about what I . . . what we need to do next."

  Once Nick was gone, Anna dumped the contents of her purse onto the bedside table and began to go through them. She opened her wallet and held her breath, letting it out when she saw both her new credit cards still in place, along with her driver's license and two very special cards: a wallet-sized ID card confirming her Texas medical license and another with her DEA permit number on it. She would need to be extra careful with those in the future, although short of putting them in a vault she wasn't sure how to protect them.

  Anna thumbed through the bills in the wallet, wishing that Rhonda Brown had taken the reward she'd offered. "Nope," the technician said. "I did it because it was the right thing to do, not for money. You just do something good for somebody someday. That'll be enough."

  Her cell phone was clipped to an inside pocket of the purse, and Anna was surprised to see that it still held a charge. The display also showed twelve missed calls and eight voicemail messages. She scrolled through the log and saw that, along with six messages from Nick, she had two from Ross Donovan.

  She listened to Nick's messages first. There was a definite progression in their tone. The first was a casual invitation to lunch, the next call expressed regret that they hadn't been able to get together, and a third asked if he could see her that evening. The fourth, fifth, and sixth demonstrated his worry when he was unable to contact her at her office, at home, or via her cell phone. Yes, no doubt about it. Nick cared for her. But she wasn't ready to answer the question of how deep her feelings for him ran. Not now. Not with all this hanging over her.

  She moved to the messages from Ross Donovan, wondering if her reluctance to think about a commitment to Nick had something to do with this other man who'd come into her life. The first was fairly businesslike: "Anna, this is Ross Donovan. I enjoyed lunch with you. I think our meeting with the DEA went fairly well. I suggest you call your chairman tomorrow to make sure Hale notifies him that you're in the clear with the agency. I'll see what I can do to get the Dallas police offyour back now. Keep in touch."