First Chapter
Michael had tried to be supportive when he'd gotten over his initial surprise at my declaration, assuring me he was certain I'd acted reasonably, but his reassurance hadn't helped. Even when he looked at my notes on her chart from the previous day's visit and said he couldn't see how he'd have acted any differently, I replied, "Given what happened, I should have kept her."
"On what grounds?" he challenged. "A little bit of temperature? Look at the resident's workup. For once we can be thankful about their habit of ordering too many tests. Apart from a slightly elevated white count and a sodium of one-thirty-three, everything else was normal, including the physical exam. Christ, the guy even ordered a chest X ray, which frankly I wouldn't have done. From his note, apparently there wasn't much on that either."
"A bit of COPD from smoking, and a minimal horizontal line in the lower right lung we thought was either old scar tissue or atelectasis," I interjected, précising the report from memory. We were huddled in a quiet corner of the nurses' station, a large central room with huge windows looking out on the rest of the department. I kept watching over Michael's shoulder for ambulances in triage or new patients in the surrounding bed areas, but for the moment the city of Buffalo had given us a breather and ER was quiet. Our residents seemed to be handling whatever few cases the nurses had brought in. "Obviously that little mark was the start of infection and was a lot more significant than we thought," I added, sounding pathetically morose even to myself.
"Bullshit!" Michael said, loud enough for anyone in the station to hear. A young medical student looked up from her computer screen, but no one else paid him any mind. He immediately lowered his voice, but not his intensity. "If a radiologist says that film suggests anything more than what you called it, he's a liar. No one could predict that little mark was brewing into what she had today, certainly not without a previous film to compare it to--which, by the way, makes me wonder why she came here to St. Paul's instead of the staff health service at University Hospital."
"She was on vacation, St. Paul's was closer to her home, and she said she didn't like everybody at work knowing her business anyway," I answered, only giving part of the reason. In fact she had phoned in ahead of time and found out I was on call. "I work with his wife," she'd announced at triage, putting everyone on the defensive. She'd increased the level of discomfort even further by proclaiming, "And my son's the chief technician for the labs at her hospital." By the time she'd done the same routine with the resident who'd initially assessed her--browbeating him into ordering more tests than he might normally have asked for--anyone who went near the woman resented her. I only learned all this from the clerks and nurses after I'd sent her home. But I'd already taken my own dislike to Phyllis Sanders.
"I know Janet, Dr. Garnet," had been her greeting when I'd appeared at her bedside to review her case with the resident.
Dr. Janet Graceton is my wife, an obstetrician at University Hospital. I met people all the time who announced they knew her, had had their children delivered by her, thought the world of her, but this had been different. I felt I'd had my chain yanked.
"I've heard so much about you as well," she'd continued in a high whiny voice. Sitting up in her hospital gown, her arms crossed in front of her chest, her gray hair pulled tightly back into a bun, she'd seemed rigid, held in. She'd forced a smile, but it had looked like a reproach as her forehead frowned while her lips turned up. All the while her eyes seemed to say Are you going to disappoint me too?
I'd resented her immediately and had been particularly repulsed by her attempt to use her acquaintance with Janet to manipulate me.
When she'd told me her son's position and then added, "He's worked with your wife too, you know," I'd barely kept the irritation out of my voice. Go do your wheedling for special treatment in someone else's ER, I'd been thinking while explaining she'd nothing much wrong with her.
"How long did you say she'd been sick?" Michael asked, snapping me back from my thoughts.
"Only a day," I answered, trying to keep my words steady and not sound defensive. "She'd had a slight headache when she woke up that morning, then the temperature and diarrhea."
"It doesn't sound like much to bring a nurse into ER. I wonder if she chose Saint Paul's over her own staff health service because they had her number there and knew she was a malingerer?"
"Maybe," I answered, not admitting that was exactly what I'd suspected as I'd firmly insisted she could go home. "Obviously she wasn't malingering this time."
Michael gave me a smile and clapped his hand warmly on my shoulder. "You made a solid call, Earl, given what was there. Hey! After all your years in the pit, you of all people should know you can't beat yourself up over every disease that turns nasty." He finished signing off his part of today's resuscitation, handed Sanders's chart back to me, and added, "When this case is reviewed, everyone will agree with me." He then strode briskly out of the station and over to where a new ambulance case had been rushed into triage.
He'd meant to support me, but the mention of a case review unleashed once more the sense of dread I'd been trying to control. All unexpected return visits trigger investigations to identify possible slipups. I'd instigated the mandatory checks myself when I'd first become chief over eight years ago. But not all physicians at St. Paul's Hospital had appreciated my setting up an arena where their errors were dissected and laid bare for critical scrutiny. Whenever I had a case on the schedule, more than a few of these doctors turned up hungry to settle old scores. This time they might have a point. As I signed off my own notes, my memory of yesterday's encounter kept playing over and over. Had my resentment at the woman made me miss something?
Copyright © 1999 by Baskerville Enterprises, Ltd.
