Deadly Errors (8 page)

Michelle coated another fry. “Get real, Doctor Pollyanna. I’ve seen the bumper sticker … Shinola happen. It’s Murphy’s basic rule, the one all the other Murphy’s rules derive from: if something can go wrong, it will.”

He mentally ran the protocol again, searching for a way to go wrong. “But the way this is set up, something
can’t
go wrong.”

The anesthesiologist sat back with a smirk. “And how, dear boy, can that be? Something can
always
go wrong. Believe me, I know.”

Intuitively, he knew Michelle was probably right. He just couldn’t see how. “Okay, let’s walk through this again. The patient’s MRI is sent to the Principle Investigator at University of Pittsburgh with the targeted area overlaid on the images. The PI’s radiation boys determine the dosage, it’s double checked, then sent back here electronically where it goes into the patient’s chart automatically. It’s only after I double-check the dose that Larry’s given treatment. It’s all done by computer. No chance for human error.”

“Right. No chance of
human
error. But what about computer error?”

He considered this suggestion a moment. “I dunno … the protocol is supposed to be infallible.”

Michelle threw up both hands. “Okay, okay, you made your point. The
protocol
is inviolate. But what about someone else? Couldn’t someone else change it?”

“Impossible. Only the treating physician can do that. That’s me. And I can guarantee you I didn’t.”

“I realize that. What I’m suggesting is a hacker.”

Tyler thought about this a moment. “Jesus, Med-InDx’s made a point of absolute security that that possibility didn’t even cross my mind. Huh!” Made sense.

Michelle smirked again. “Absolute security? Just like Microsoft?”

“Good point.”

“So what are you going to do about it?”

The question triggered a cascade of thoughts. “Shit, Shellie, I just realized … this would classify as a sentinel event. Which means whatever the cause of Larry’s problem, I need to report it to NIH and our administration. First thing in the morning, too.”

“Oh dear, that probably means JCAHO too.” JCAHO—the body charged with accrediting hospitals.

Wrong treatment dosage
, Tyler mused. Exactly the types of mistakes electronic medical records are supposed eliminate. But how could this one happen?

“Holy shit!”

Tyler snapped back out of thought. “What?”

“I just thought of something. Did you ever know Robin Beck? The ED physician?”

“No. Why?”

“Now that I think about it, she had something similar to this happen. Hold on, let me see if I can get my facts straight.” Michelle pressed her fingertips against both temples and closed both eyes. A moment later her eyes popped open. “Okay, I think I got it straight.” She sat back in the booth, hands folded on the table. “She injected a patient with a whopping dose of insulin. The only problem was, the patient wasn’t diabetic. She swears the chart unmistakably showed the patient on a combo of regular and long-lasting insulin.”

“Jesus. What happened?”

“Patient died.”

A finger of nausea stabbed Tyler’s gut. He thought of Larry.

“Now that I think of it, there was another one too …” Michelle snapped her fingers. “Okay, yeah, yeah … a nurse—what was her name?—gave a GI bleeder a couple units of mismatched blood. Patient ended up having a mondo transfusion reaction and boxed.”

Tyler smoothed out a napkin, removed a garish purple and blue drug company ballpoint pen from his white coat. “You remember the nurse’s name now?”

Michelle paused to think a moment. “Gail Walker? Yeah, Gail Walker.”

Tyler wrote that down. “And the other doctor’s name is Beck? Robin Beck?”

“Right.”

“How’d you know about this? You know them personally?”

“No. Just heard about them.”

“Where?”

Michelle shrugged. “Doctors’ lounge I guess.”

Typical
, he thought. With no office to tend to or patients to see, when not sleeping a case, most gas passers hang around the lounge drinking coffee and taking the pulse of the medical center. They become the staff ’s CNN. Want to know which hospital administrator is having an affair? Ask your favorite anesthesiologist. Want to know what line items are being cut from the budget next year, ditto.

“How long ago did these complications happen?”

“Oh man, you would have to ask that, wouldn’t you. Let’s see.” Michelle’s brow furrowed, accenting penciled eyebrows. “You know what, I can’t honestly remember. Last fall, I think. It’s been a while. I know that much.”

“Both of those sound exactly like the kind of screw ups EMRs are supposed to prevent.”

“My point exactly. Which makes a pretty good argument for a hacker diddling the system, doesn’t it?”

Tyler groaned. The thought of Larry’s brain being irreparably damaged by some pimpled face techno-geek made him almost vomit. “What happened? I mean those cases must’ve been investigated, right?”

Michelle looked up surprised, as if not having considered this angle before. “You know, I don’t really know. I do know that Beck was slapped with a huge malpractice suit. Ten million’s the word on the street. Other than that …” she shrugged.

Tyler glanced at his watch. “I’m going to call the Med-InDx tech.”

Just then Tyler’s beeper began chirping. It displayed the recovery room number followed by 911—meaning an emergency. “Jesus, here we go … the ICU.”

Michelle waved him away. “Go ahead. Answer it. I’ll call the technician for you. You want to meet tonight, right?”

Tyler nodded and pushed out of one side of the booth as Michelle did the same.

When he answered the page a moment later the nurse told him, “Dr. Mathews, you better come quickly. Your patient just blew both pupils and stopped breathing. He’s getting ambued now.”

T
YLER MADE IT from the basement cafeteria to the second floor recovery room in record time. Gasping for air, he pulled up alongside a respiratory tech squeezing the black AMBU bag connected to the tube into Larry’s lungs. Larry’s eyelids were wide open, both pupils so large and black only a thin rim of green iris showed.

“Shit,” he murmured. Then, to one of the nurses hovering, “Call CT, tell ’em I want a stat scan.”
He bled into that resection
, was his first thought.

The nurse glanced up from the computer keyboard. “Figured that’s what you’d ask for. Already called. A transporter’s on the way.”

Tyler grabbed the head of the bed, started pushing. “Don’t have time for that. I’ll take him myself.”

O
NE BY ONE Tyler watched black and white images fill the oversized GE monitor as he scrolled the CT series once again. Through the lead-impregnated glass window his peripheral vision caught the recovery room nurse, the CT tech, and the respiratory tech transferring Larry’s supine body from the scanner to the recovery room bed.
Larry’s body
, he mused, already preparing his emotions for the eventuality he saw in the scan.

“Where do you want him to go?”

Tyler glanced up at another recovery room nurse who had entered the room undetected. He knew the guy, an ex-corpsman, if memory served correctly. “Take him up to ICU.” It would be better to have the family see him there than in the recovery room. Besides, the recovery room nurses had finished their shift by now and were closing down the unit until tomorrow morning’s cases started rolling in. “But before you do, I want another look at his pupils. I’ll be out in a minute.”

“Thanks.” The ex-corpsman moved off to help the others.

Tyler returned his gaze to the huge blood clot filling most of the area where Larry’s brain should be.
Return to surgery and evacuate the clot?
Why? Larry was, by now, brain dead. Beside, getting in and out of Larry’s head a second time without the clot reaccumulating was about as likely as winning the Lotto. No, he had nothing left to offer the poor kid.

Tyler wondered what sort of hopeful dreams the prospect of a life without seizures had spawned in Larry Childs’s imagination.
Probably included a raft of trivial daily activities most of us take for granted
, he supposed. Conveniences and privileges that allow independence. A driver’s license. Employment. Being able to sit in a theater without fear of soiling himself or having moviegoers goggle in horrified interest at a convulsion. Gone now, all of them.

Suddenly Tyler’s shoulders seemed twenty pounds heavier as the fatigue from operating and the depression of seeing his effort fail seeped through his bones. He thought of the family downstairs—waiting, unaware of this terrible complication, still holding out hope for Larry’s survival.

His beeper started chirping. He called the unfamiliar number.

“Tyler, Michelle. Got hold of that technician for you. I told him what we’re thinking—the hacker and all? He doesn’t believe it. Thinks we’re full of shit. Much as said I’m crazy. Claimed it’s impossible for anyone to penetrate their security. Bottom line is there’s no way he’s coming back tonight to even discuss it. Said he’d meet me tomorrow at the latte stand.”

“Which one?”

“The one in the cafeteria.”

“Thanks.” He almost hung up before realizing he needed more information. “Oh, what time?”

“Seven.”

“You going to be there?”

“Probably not. Depends on whether I’m finishing up a case or not.”

“Got it. What’s his name?”

“Jim Day.”

W
EARILY TYLER ROLLED back and pushed out of the task chair. For a moment he stood, hand on the chair back and sucked a deep breath before palm wiping his face. He stepped into the scanner room and over to Larry. For a moment he studied his half-opened eyes. Believing only in the reality his own senses provide, Tyler had no idea what clerics conceptualized when speaking of a person’s soul. He doubted it was some sort of metaphysical energy packet that, at the moment of death, levitated from the lifeless body into Heaven or dropped into the abyss of Hell. What he knew for certain was there came a time in the dying process when an immeasurable sign of life vanished from a person’s pupils. He’d witnessed it too many times to not believe in it. He had never known a patient to survive once that light disappeared. It had vanished from Larry’s eyes sometime within the past few hours.

He told the nurses, “You can take him up now. I’ll go talk with the family.”

T
YLER FOUND LARRY’S family occupying a waiting room corner where the three of them had set up a small camp. A rumpled thermal blanket piled on one end the couch, newspaper sections stacked on the other. Latte cups strewn over a commandeered coffee table, two club chairs liberated from nearby. A priest with basset-hound eyes stood silently to Mrs. Childs’s left. Tyler assumed he was from their parish. This time of evening the large surgery waiting area was deserted except for a middle-aged couple across the room in adjoining chairs, apparently watching CNN Headline News. Tyler suspected they would eavesdrop on this interchange in hopes that any forthcoming bad news might lessen their odds of the same.

A second after eye contact, Leslie Childs, Larry’s older sister and self-appointed family spokesperson and legal counsel, jumped up from the couch but stayed put. The parents’ heads snapped toward him but they remained seated. All three pairs of eyes zeroed in on him. Tyler dropped down on the couch next to Leslie so as to speak directly to her parents, even though he expected her to dominate the conversation.