Deadly Medicine (28 page)

Abby was so different, and Ward was refreshed by her optimism, by the pure joy she found in simple things like the sun setting over the trees behind her cabin or the flowers exploding in her garden. Looking at things with Abby, Ward felt like she was seeing in color again for the first time in a very long time.

The strangest thing for Ward was the way it was all becoming so clear to her now. None of her friends had ever liked Jess. They’d tolerated her, for Ward’s sake, but had no real connection to her. Ward had always thought her friends had been lacking, but as she stepped away and the video of her life with Jess came into focus, she realized how self-centered and demanding Jess had been. At times, which were coming more frequently now, Ward had to remind herself why she’d ever loved Jess in the first place.

“Why. Are. You. Smiling?” Abby asked.

Ward felt herself blushing, thankful Abby couldn’t read her mind. “I suspect I’m just happy.”

Abby leaned forward and put her papers onto the table, then set her glasses atop the pile. “It’s legal, you know,” she said softly.

“Are you happy?” Ward asked, afraid of the answer. It was too soon to ask for more from Abby. Too soon after her breakup with Jess. But their relationship felt good, and right, and she was beginning to dread packing up her car and heading south when her time in the mountains was over. She didn’t want this to end. So what if she was going back to Philly? Her ER schedule allowed flexibility, enough to spend at least a few days a week with Abby. If Abby wanted the same thing. If Abby wanted her.

A smile danced across her face. “I am.”

“Are you ready to talk about August?”

“I am not,” she said, but nothing but a light air carried her words. She was teasing.

“We’re running out of July,” Ward said simply and, closing her eyes, leaned into the cushion of the couch, allowing the buttery soft leather to engulf her.

Abby’s response reached across the couch to her, across the fear and anxiety and uncertainty, and erased them all. “It’ll always be July, Ward. If we want it to be.”

Ward couldn’t keep her eyes closed. She needed to see Abby, to look at her. Their eyes met. “It seems so fast. We hardly know each other. But—”

“We know everything we need to, don’t we?”

“I know that I like everything about you, and I want more.”

“I like the sound of that, Ward. I want more too. And Philly isn’t so far away that we can’t work something out. We both have cars and free time. Let’s not worry about it, okay? Let’s just see what happens. Is that what was troubling you?”

Ward looked at her, confused. “Huh?”

“Before this conversation. What were you reading?” Abby nodded toward the computer perched on Ward’s lap.

“Oh, that,” she said, drawing out the words into three syllables before turning her attention back to her laptop and the pile of notes she’d made. “What do you think the odds are of developing a venous air embolus from insertion of a central line?”

Abby stared, her face contorted into a look of confusion.

“You know what a central line is, right?”

Between her childhood with two physician parents and her career as an administrator, Abby evidently understood a good deal about medicine. Sometimes Ward forgot Abby didn’t actually practice.

“A big IV inserted into the heart?”

Ward had to suppress her smile. Abby had conceded to August, and just the thought was thrilling. Now she looked so adorable as she tried to maintain her professional image.

“Close. A big IV inserted into a big vein that goes into the heart.”

Abby waved a dismissive hand in Ward’s direction. “Close enough. What about it?”

“So, when you’re injecting medication into an IV, there’s always a chance of injecting a little bit of air. What are the chances of injecting enough air that it causes harm?”

Abby bit her lip and shrugged. “One in a million.”

“I think that’s close. It’s one in eight hundred catheters placed.”

“That seems kind of high.”

“Actually, it’s not. Since central lines aren’t so common, it’s a rare occurrence.”

Abby still looked confused, but it didn’t matter. Ward’s next point was even more profound. “So what do you think the odds are of dying from an air embolus created during insertion of a central line?”

Abby held out her manicured hands in surrender, an annoyed look on her face. “One in a million?”

Ward reached out and tickled her. “I’m about to state something profound and you’re not taking this seriously.”

“Well, then state it, and quit torturing me with trivia questions.”

Ward backed off, but not before placing a kiss on Abby’s nose.

“Okay, let me put it this way, so you can understand the significance of what I’m saying. In my career, over ten years of practicing in the ER, I’d guess I’ve inserted a couple hundred lines. So about twenty a year. To have a fatal embolus, I’d have to insert twelve thousand lines. I’d need to practice for six hundred years.”

Abby was quick to reply. “Wow,” she said, and then she was quiet, thinking. “Or you’d have to be very unlucky.”

Ward grew somber. “Yes, Abby. There’s a lot of luck in medicine, both good and bad.”

“So Hawk could have done everything right, been a perfectly good doctor who had bad luck.”

“Yes, exactly,” she said, then laughed. “I don’t know. I’m just not sure how air accidentally ended up in the vein. A little air is explainable. You can have a little mixed into the fluid getting injected, and the doctor wouldn’t even notice unless he checked carefully.”

“So it would be an oversight?”

Ward bit her lip as her mind raced, trying to figure it out, picturing IV tubing and fluids and syringes. How could a large volume of air accidentally get into the vein? “Well, that’s the confusing part. I can understand missing a small volume of air. Less than a CC. Half a CC probably could get by without noticing. But a fatal bolus of air would be huge. Like a big syringe full. I don’t know how that happens without someone noticing.”

“So someone injected a syringe full of air into this child’s heart and didn’t know it?”

Again, Ward shook her head. “I’m not sure, Abby. But the air had to get in there somehow.”

“Why would you inject air? Is there any medical reason? Don’t you need air?”

Ward shook her head. “You’d never inject air. The air we need—oxygen—goes into the lungs and gets absorbed in tiny amounts into the blood. Air injected into the vein acts like a clot. It forms a blockage and shuts down the circulation.”

“So what do you think? How did this happen?”

“I don’t know? Maybe from the IV tubing?” Abby looked confused, so Ward elaborated. “There’s air in the tubing, just like in a hose. Before you connect the tubing to the IV, you run fluid through it. That flushes the air out.”

“So it could really just be bad luck, and we don’t need to make any changes to our protocols.”

Ward sighed. She didn’t know what to think. Perhaps Hawk had neglected to flush the tubing but was too afraid to admit his mistake. That would go along with what she knew of him, learned through the rumor mill. He was uncaring and unremorseful. Why would he admit to a mistake? Ward wasn’t sure if she should tell Abby that Hawk had taken care of the tubing himself. She wasn’t so sure it was important, but perhaps it was.

“There’s one more thing. Normally, when a central line is placed, the doctor focuses on the doctor parts—prepping the skin, setting up the sterile field, inserting the needle into the right place. The nurse opens the fluids and connects the tubing. But in this case, Hawk did it all. He took care of the tubing.”

“So no matter how the air got in there, it was Hawk’s fault,” Abby observed.

“Yep.”

“Even if it only happens once every six hundred years, it still happens, right? So perhaps we should create a protocol that only nurses flush tubing.”

Ward shrugged.

“What?”

“I’m beginning to think Dr. Hawk is…not a good person.”

Ward turned to face her, and she knew her own expression matched the somber one Abby wore. Then Ward did something she’d never done before. She talked badly about a colleague.

“It’s just talk, Abby, you know? I’ve been following him around since March. That’s when I started with the company. And at every hospital, the ER staff makes little comments about him. No one blatantly accuses him of malpractice, but they’ve certainly hinted at it.” She thought of Erin. “It was also suggested he’s quite indifferent to the fates of his patients.”

Abby nodded, her look still closed, as she seemed to search carefully for words. “I have to listen to the gossip, Ward. It’s my job, to know everybody’s business. But I have to decide what’s bullshit and what’s real. And as the product of two physicians, I’m very hesitant to pass judgment on medical errors. But you’re reviewing these cases because those same questions were raised here, not just by the ER staff, but by the medical staff as well. And you know when doctors question one of their own, it warrants a closer look. I didn’t want these cases to wait until Dick Rove comes back.”

“Really?” Ward asked, surprised. “I got the feeling that every doctor on staff perceives the peer-review process as a witch hunt.”

Abby chuckled. “Well, if you were looking at one of the staff physicians, I’d say that’s true. They’d defend each other to the death. But Hawk was an outsider and therefore fair game. Notice that no one pointed a finger last night except when Ham Jarrod said he didn’t like Hawk.”

“Scapegoat?” Ward asked.

Now Abby sighed. “I don’t think so, but I guess it’s possible. That’s why your opinion is so important. You’re neutral.”

“I don’t know if I have an answer for you, Abby. I don’t think we’ll ever know what happened to Hailey Conrad. I just can’t help feeling like I’m missing something important.”

“Like what?”

Ward glared at her. “If I knew that…No, seriously. I have a bad feeling about Hawk, but I really don’t have any proof of malpractice. An air embolus is an acceptable complication of central line insertion. Even if it’s rare, it does happen.”

“Okay, we have an answer then. Remember our mission—we’re not pointing fingers, right? We’ll use the information you’ve gathered to make everyone smarter. Set up a protocol for insertion of lines, perhaps a check list to make sure tubes are flushed and syringes are checked for air.”

Ward felt all warm and fuzzy inside. Abby really was good at what she did. “Case closed, then.” Ward quickly typed up recommendations for the insertion of central lines and sent the document to Abby via e-mail.

“I have two more cases to go. Can I use your computer to pull up the files?”

Since they’d been outed at the meeting, using Abby’s secure connection to access patient records was no longer a concern.

“Of course.”

Abby logged in using her password, then handed her laptop to Ward, who logged in to the medical-records section.

She pulled up the chart on the tenth patient under review. This was a sixty-year-old heart-attack victim, with a terribly abnormal EKG. He’d died shortly after arriving in the ER. Ward spent half an hour reading notes and labs, noting times that orders were given and completed. Perhaps Dr. Hawk had done something inappropriate in the man’s care, but if he had, Ward couldn’t tell by reviewing the chart. Jeff Jacoby had been seen promptly, had an EKG and chest X-ray within minutes of arrival, was quickly given aspirin and the correct dose of clot-buster drug, but had suffered a cardiac arrest and died anyway. Hell, Hawk had gone so far as to mix up the clot-buster and administer it himself. It sucked, but nothing else could have been done to save the poor man.

Hawk was really a hands-on doctor, Ward noticed. In every case she’d reviewed, the nurses’ notes indicated that he had performed procedures that were normally the nurse’s responsibility. Probably just his training. Many inner city hospitals where residents train are inadequately staffed, placing the burden of nursing and janitorial duties on the residents. The habits learned then often stayed, and she’d seen many doctors inject their own medications and start their own lines. None to the extent Hawk did, though.

Ward told Abby her findings and noted the look of relief on her face. “Finished, then?” she asked, with a twinkle in her eye.

Ward frowned. “One more to go,” she said, and began reading the next chart. She was only a few paragraphs into it when she experienced an eerie sensation of déjà vu, and before she’d finished, her mouth had gone dry. Kim Sparks was a forty-year-old diabetic who’d been vomiting for several days and become lethargic at home. She perked up when the paramedic gave her an IV shot of sugar, but shortly after arriving in the ER she was found dead in her room.

“Fuck,” she whispered. This was the patient Erin had told her about. Her friend’s mom. Only that woman had died in February, in another hospital fifty miles away, where Dr. Edward Hawk was working at the time. It sounded just like Frieda’s neighbor, too. He’d died just before she met Frieda. Ward couldn’t help wondering if Hawk had been his doctor. She suddenly felt clammy, found it hard to swallow. These cases were too bizarre and too similar to be a coincidence.

“Did you find something?” Abby asked.

“This is really strange,” Ward said as she relayed her thoughts. Then she stared into the distance as she tried to recall the details. At the time she’d talked to Erin, she hadn’t been too concerned about it; she’d simply been trying to make peace with Erin and offer her some solace. And she knew nothing about Frieda’s neighbor.

“Who’s Erin?”

“She’s a nurse I worked with a few months ago. She was really upset over the death of one of her patients. It was the same history as the patient who died here last month. The woman came in with a low blood sugar, seemed to be doing fine, and was found dead in her room.”

“Isn’t that very unusual? Like more than one in a million?”

Ward could see that Abby wasn’t kidding, just trying to get a handle on the information she was sharing. “I’d bet it’s even steeper than that.”

Ward met Abby’s gaze, saw the question there, and answered before Abby could put it into words. “Yes, Abby. It was Dr. Hawk’s patient.”