Under the Knife

by Tess Gerritsen

  This was the proverbial one percent, the moment of terror every anesthesiologist dreads.

  It was also the worst moment in Kate Chesne’s life.

  As panic swirled around her, she fought to stay in control. She injected vial after vial of adrenaline, first into the IV lines and then directly into Ellen’s heart. I’m losing her, she thought. Dear God, I’m losing her. Then she saw one brief fluttering across the oscilloscope. It was the only hint that some trace of life lingered.

  “Let’s cardiovert!” she called out. She glanced at Ann, who was standing by the defibrillator. “Two hundred watt seconds!”

  Ann didn’t move. She remained frozen, her face as white as alabaster.

  “Ann?” Kate yelled. “Two hundred watt seconds!”

  It was Cindy who darted around to the machine and hit the charge button. The needle shot up to two hundred. Guy grabbed the defibrillator paddles, slapped them on Ellen’s chest and released the electrical charge.

  Ellen’s body jerked like a puppet whose strings have all been tugged at once.

  The fluttering slowed to a ripple. It was the pattern of a dying heart.

  Kate tried another drug, then still another in a desperate attempt to flog some life back into the heart. Nothing worked. Through a film of tears, she watched the tracing fade to a line meandering aimlessly across the oscilloscope.

  “That’s it,” Guy said softly. He gave the signal to stop cardiac massage. The intern, his face dripping with sweat, backed away from the table.

  “No,” Kate insisted, planting her hands on Ellen’s chest. “It’s not over.” She began to pump—fiercely, desperately. “It’s not over.” She threw herself against Ellen, pitting her weight against the stubborn shield of rib and muscles. The heart had to be massaged, the brain nourished. She had to keep Ellen alive. Again and again she pumped, until her arms were weak and trembling. Live, Ellen, she commanded silently. You have to live….

  “Kate.” Guy touched her arm.

  “We’re not giving up. Not yet….”

  “Kate.” Gently, Guy tugged her away from the table. “It’s over,” he whispered.

  Someone turned off the sound on the heart monitor. The whine of the alarm gave way to an eerie silence. Slowly, Kate turned and saw that everyone was watching her. She looked up at the oscilloscope.

  The line was flat.

  * * *

  KATE FLINCHED AS an orderly zipped the shroud over Ellen O’Brien’s body. There was a cruel finality to that sound; it struck her as obscene, this convenient packaging of what had once been a living, breathing woman. As the body was wheeled off to the morgue, Kate turned away. Long after the squeak of the gurney wheels had faded down the hall, she was still standing there, alone in the O.R.

  Fighting tears, she gazed around at the bloodied gauze and empty vials littering the floor. It was the same sad debris that lingered after every hospital death. Soon it would be swept up and incinerated and there’d be no clue to the tragedy that had just been played out. Nothing except a body in the morgue.

  And questions. Oh, yes, there’d be questions. From Ellen’s parents. From the hospital. Questions Kate didn’t know how to answer.

  Wearily she tugged off her surgical cap and felt a vague sense of relief as her brown hair tumbled free to her shoulders. She needed time alone—to think, to understand. She turned to leave.

  Guy was standing in the doorway. The instant she saw his face, Kate knew something was wrong.

  Silently he handed her Ellen O’Brien’s chart.

  “The electrocardiogram,” he said. “You told me it was normal.”

  “It was.”

  “You’d better take another look.”

  Puzzled, she opened the chart to the EKG, the electrical tracing of Ellen’s heart. The first detail she noted was her own initials, written at the top, signifying that she’d seen the page. Next she scanned the tracing. For a solid minute she stared at the series of twelve black squiggles, unable to believe what she was seeing. The pattern was unmistakable. Even a third-year medical student could have made the diagnosis.

  “That’s why she died, Kate,” Guy said.

  “But— This is impossible!” she blurted. “I couldn’t have made a mistake like this!”

  Guy didn’t answer. He simply looked away—an act more telling than anything he could have said.

  “Guy, you know me,” she protested. “You know I wouldn’t miss something like—”

  “It’s right there in black and white. For God’s sake, your initials are on the damn thing!”

  They stared at each other, both of them shocked by the harshness of his voice.

  “I’m sorry,” he apologized at last. Suddenly agitated, he turned and clawed his fingers through his hair. “Dear God. She’d had a heart attack. A heart attack. And we took her to surgery.” He gave Kate a look of utter misery. “I guess that means we killed her.”

  * * *

  “IT’S AN OBVIOUS case of malpractice.”

  Attorney David Ransom closed the file labeled O’Brien, Ellen, and looked across the broad teak desk at his clients. If he had to choose one word to describe Patrick and Mary O’Brien, it would be gray. Gray hair, gray faces, gray clothes. Patrick was wearing a dull tweed jacket that had long ago sagged into shapelessness. Mary wore a dress in a black-and-white print that seemed to blend together into a drab monochrome.

  Patrick kept shaking his head. “She was our only girl, Mr. Ransom. Our only child. She was always so good, you know? Never complained. Even when she was a baby. She’d just lie there in her crib and smile. Like a little angel. Just like a darling little—” He suddenly stopped, his face crumpling.

  “Mr. O’Brien,” David said gently, “I know it’s not much of a comfort to you now, but I promise you, I’ll do everything I can.”

  Patrick shook his head. “It’s not the money we’re after. Sure, I can’t work. My back, you know. But Ellie, she had a life insurance policy, and—”

  “How much was the policy?”

  “Fifty thousand,” answered Mary. “That’s the kind of girl she was. Always thinking of us.” Her profile, caught in the window’s light, had an edge of steel. Unlike her husband, Mary O’Brien was done with her crying. She sat very straight, her whole body a rigid testament to grief. David knew exactly what she was feeling. The pain. The anger. Especially the anger. It was there, burning coldly in her eyes.

  Patrick was sniffling.

  David took a box of tissues from his drawer and quietly placed it in front of his client. “Perhaps we should discuss the case some other time,” he suggested. “When you both feel ready….”

  Mary’s chin lifted sharply. “We’re ready, Mr. Ransom. Ask your questions.”

  David glanced at Patrick, who managed a feeble nod. “I’m afraid this may strike you as…cold-blooded, the things I have to ask. I’m sorry.”

  “Go on,” prompted Mary.

  “I’ll proceed immediately to filing suit. But I’ll need more information before we can make an estimate of damages. Part of that is lost wages—what your daughter would have earned had she lived. You say she was a nurse?”

  “In obstetrics. Labor and delivery.”

  “Do you know her salary?”

  “I’ll have to check her pay stubs.”

  “What about dependants? Did she have any?”

  “None.”

  “She was never married?”

  Mary shook her head and sighed. “She was the perfect daughter, Mr. Ransom, in almost every way. Beautiful. And brilliant. But when it came to men, she made… mistakes.”

  He frowned. “Mistakes?”

  Mary shrugged. “Oh, I suppose it’s just the way things are these days. And when a woman gets to be a—a certain age, she feels, well, lucky to have any man at all….” She looked down at her tightly knotted hands and fell silent.

  David sensed they’d strayed into hazardous waters. He wasn’t interested in Ellen O’Brien’s love life, anyway. It was irrelevant t
o the case.

  “Let’s turn to your daughter’s medical history,” he said smoothly, opening the medical chart. “The record states she was forty-one years old and in excellent health. To your knowledge, did she ever have any problems with her heart?”

  “Never.”

  “She never complained of chest pain? Shortness of breath?”

  “Ellie was a long-distance swimmer, Mr. Ransom. She could go all day and never get out of breath. That’s why I don’t believe this story about a—a heart attack.”

  “But the EKG was strongly diagnostic, Mrs. O’Brien. If there’d been an autopsy, we could have proved it. But I guess it’s a bit late for that.”

  Mary glanced at her husband. “It’s Patrick. He just couldn’t stand the idea—”

  “Haven’t they cut her up enough already?” Patrick blurted out.

  There was a long silence. Mary said softly, “We’ll be taking her ashes out to sea. She loved the sea. Ever since she was a baby…”

  It was a solemn parting. A few last words of condolence, and then the handshakes, the sealing of a pact. The O’Briens turned to leave. But in the doorway, Mary stopped.

  “I want you to know it’s not the money,” she declared. “The truth is, I don’t care if we see a dime. But they’ve ruined our lives, Mr. Ransom. They’ve taken our only baby away. And I hope to God they never forget it.”

  David nodded. “I’ll see they never do.”

  After his clients had left, David turned to the window. He took a deep breath and slowly let it out, willing the emotions to drain from his body. But a hard knot seemed to linger in his stomach. All that sadness, all that rage; it clouded his thinking.

  Six days ago, a doctor had made a terrible mistake. Now, at the age of forty-one, Ellen O’Brien was dead.

  She was only three years older than me.

  He sat down at his desk and opened the O’Brien file. Skipping past the hospital record, he turned to the curricula vitae of the two physicians.

  Dr. Guy Santini’s record was outstanding. Forty-eight years old, a Harvard-trained surgeon, he was at the peak of his career. His list of publications went on for five pages. Most of his research dealt with hepatic physiology. He’d been sued once, eight years ago; he’d won. Bully for him. Santini wasn’t the target anyway. David had his crosshairs on the anesthesiologist.

  He flipped to the three-page summary of Dr. Katharine Chesne’s career.

  Her background was impressive. A B.Sc in chemistry from U.C., Berkeley, an M.D. from Johns Hopkins, anesthesia residency and intensive-care fellowship at U.C., San Francisco. Now only thirty years old, she’d already compiled a respectable list of published articles. She’d joined Mid Pac Hospital as a staff anesthesiologist less than a year ago. There was no photograph, but he had no trouble conjuring up a mental picture of the stereotypical female physician: frumpy hair, no figure, and a face like a horse— albeit an extremely intelligent horse.

  David sat back, frowning. This was too good a record; it didn’t match the profile of an incompetent physician. How could she have made such an elementary mistake?

  He closed the file. Whatever her excuses, the facts were indisputable: Dr. Katharine Chesne had condemned her patient to die under the surgeon’s knife. Now she’d have to face the consequences.

  He’d make damn sure she did.

  * * *

  GEORGE BETTENCOURT DESPISED doctors. It was a personal opinion that made his job as CEO of Mid Pac Hospital all the more difficult, since he had to work so closely with the medical staff. He had both an M.B.A. and a Masters in public health. In his ten years as CEO, he’d achieved what the old doctor-led administration had been unable to do: he’d turned Mid Pac from a comatose institution into a profitable business. Yet all he ever heard from those stupid little surrogate gods in their white coats was criticism. They turned their superior noses up at the very idea that their saintly work could be dictated by profit-and-loss graphs. The cold reality was that saving lives, like selling linoleum, was a business. Bettencourt knew it. The doctors didn’t. They were fools, and fools gave him headaches.

  And the two sitting across from him now were giving him a migraine headache the likes of which he hadn’t felt in years.

  Dr. Clarence Avery, the white-haired chief of anesthesia, wasn’t the problem. The old man was too timid to stand up to his own shadow, much less to a controversial issue. Ever since his wife’s stroke, Avery had shuffled through his duties like a sleepwalker. Yes, he could be persuaded to cooperate. Especially when the hospital’s reputation was at stake.

  No, it was the other one who worried Bettencourt: the woman. She was new to the staff and he didn’t know her very well. But the minute she’d walked into his office, he’d smelled trouble. She had that look in her eye, that crusader’s set of the jaw. She was a pretty enough woman, though her brown hair was in a wild state of anarchy and she probably hadn’t held a tube of lipstick in months. But those intense green eyes of hers were enough to make a man overlook all the flaws of that face. She was, in fact, quite attractive.

  Too bad she’d blown it. Now she was a liability. He hoped she wouldn’t make things worse by being a bitch, as well.

  * * *

  KATE FLINCHED AS BETTENCOURT dropped the papers on the desk in front of her. “The letter arrived in our attorney’s office this morning, Dr. Chesne,” he said. “Hand delivered by personal messenger. I think you’d better read it.”

  She took one look at the letterhead and felt her stomach drop away: Uehara and Ransom, Attorneys at Law.

  “One of the best firms in town,” explained Bettencourt. Seeing her stunned expression, he went on impatiently, “You and the hospital are being sued, Dr. Chesne. For malpractice. And David Ransom is personally taking on the case.”

  Her throat had gone dry. Slowly she looked up. “But how—how can they—”

  “All it takes is a lawyer. And a dead patient.”

  “I’ve explained what happened!” She turned to Avery. “Remember last week—I told you—”

  “Clarence has gone over it with me,” cut in Bettencourt. “That isn’t the issue we’re discussing here.”

  “What is the issue?”

  He seemed startled by her directness. He let out a sharp breath. “The issue is this: we have what looks like a million-dollar lawsuit on our hands. As your employer, we’re responsible for the damages. But it’s not just the money that concerns us.” He paused. “There’s our reputation.”

  The tone of his voice struck her as ominous. She knew what was coming and found herself utterly voiceless. She could only sit there, her stomach roiling, her hands clenched in her lap, and wait for the blow to fall.

  “This lawsuit reflects badly on the whole hospital,” he said. “If the case goes to trial, there’ll be publicity. People—patients—will read those newspapers and it’ll scare them.” He looked down at his desk. “I realize your record up till now has been acceptable—”

  Her chin shot up. “Acceptable?” she repeated incredulously. She glanced at Avery. The chief of anesthesia knew her record. And it was flawless.

  Avery squirmed in his chair, his watery blue eyes avoiding hers. “Well, actually,” he mumbled, “Dr. Chesne’s record has been—up till now, anyway—uh, more than acceptable. That is…”

  For God’s sake, man! she wanted to scream. Stand up for me!

  “There’ve never been any complaints,” Avery finished lamely.

  “Nevertheless,” continued Bettencourt, “you’ve put us in a touchy situation, Dr. Chesne. That’s why we think it’d be best if your name was no longer associated with the hospital.”

  There was a long silence, punctuated only by the sound of Dr. Avery’s nervous cough.

  “We’re asking for your resignation,” stated Bettencourt.

  So there it was. The blow. It washed over her like a giant wave, leaving her limp and exhausted. Quietly she asked, “And if I refuse to resign?”

  “Believe me, Doctor, a resignation will lo
ok a lot better on your record than a—”

  “Dismissal?”

  He cocked his head. “We understand each other.”

  “No.” She raised her head. Something about his eyes, their cold self-assurance, made her stiffen. She’d never liked Bettencourt. She liked him even less now. “You don’t understand me at all.”

  “You’re a bright woman. You can see the options. In any event, we can’t let you back in the O.R.”

  “It’s not right,” Avery objected.

  “Excuse me?” Bettencourt frowned at the old man.

  “You can’t just fire her. She’s a physician. There are channels you have to go through. Committees—”

  “I’m well acquainted with the proper channels, Clarence! I was hoping Dr. Chesne would grasp the situation and act appropriately.” He looked at her. “It really is easier, you know. There’d be no blot on your record. Just a notation that you resigned. I can have a letter typed up within the hour. All it takes is your…” His voice trailed off as he saw the look in her eyes.

  Kate seldom got angry. She usually managed to keep her emotions under tight control. So the fury she now felt churning to the surface was something new and unfamiliar and almost frightening. With deadly calm she said, “Save yourself the paper, Mr. Bettencourt.”

  His jaw clicked shut. “If that’s your decision…” He glanced at Avery. “When is the next Quality Assurance meeting?”

  “It’s—uh, next Tuesday, but—”

  “Put the O’Brien case on the agenda. We’ll let Dr. Chesne present her record to committee.” He looked at Kate. “A judgment by your peers. I’d say that’s fair. Wouldn’t you?”

  She managed to swallow her retort. If she said anything else, if she let fly what she really thought of George Bettencourt, she’d ruin her chances of ever again working at Mid Pac. Or anywhere else, for that matter. All he had to do was slap her with the label Troublemaker; it would blacken her record for the rest of her life.

  They parted civilly. For a woman who’d just had her career ripped to shreds, she managed a grand performance. She gave Bettencourt a level look, a cool handshake. She kept her composure all the way out the door and on the long walk down the carpeted hall. But as she rode the elevator down, something inside her seemed to snap. By the time the doors slid open again, she was shaking violently. As she walked blindly through the noise and bustle of the lobby, the realization hit her full force.