Fertility: A Novel (11 page)

“Mr. Meinig and I go way back,” Baumgarten interjected. “Nice to see you again, Harry. Too bad it’s under such terrible circumstances.”

Harry didn’t blink. “We can all agree that we’re here today to make sure those circumstances are never repeated. In the interest of time, I suggest we let Ms. Abadhi continue.” Then he gave Sarah the nod to go on.

“Each of our team members will present the proposed changes in their area of expertise. First to present is Aimee Sackoff, director of nursing.” Sarah motioned to Sackoff to begin as she returned to her seat to take charge of the PowerPoint visuals.

“Good morning,” Sackoff started. “I would like to reiterate what Ms. Abadhi said. Our entire nursing staff was shaken to the core by the error that was made in Ariel’s case. However, we believe that something really powerful, really good, may occur as a result of what your baby experienced. As you may know, your daughter’s nurse was working back-to-back shifts last week, due to a staffing shortage. That nurse is one of our very best, most experienced nurses. We believe that fatigue played a role in her not catching the medication error. We are committed to addressing the problem of fatigued nurses delivering beside care. In keeping with that commitment, we propose to be the first hospital in the city to eliminate mandatory overtime for nurses,” Sackoff said triumphantly, revealing none of her previously expressed reservations about the proposal.

“This is so important,” Sackoff explained, “because we all know that people do their best when they’re not tired. This will be a very costly measure. Mr. Ainslie will be able to give you the specifics on that. But to me, as a veteran nursing administrator, this proposal indicates that the hospital is committed to spending whatever it takes to make mandatory overtime a thing of the past.” She then elaborated on the numbers of new nurses who would be hired, with Sarah showing the graphics to illustrate the increases in staffing. The head of nursing concluded with a brief discussion of contingency plans for times when illness might strike the nursing staff, as had happened during Ariel’s hospitalization.

Sackoff was as concise as she was enthusiastic and, to Sarah’s mind, persuasive. Sarah introduced Joanne Marsh next, keeping her fingers crossed that she would do as well.

“Good morning to you all. Before I explain our plan for improvement, I want to give you my personal, heartfelt apology. The error that harmed your daughter originated in my department. Throughout my long tenure here at the hospital, I’ve made the elimination of medication errors my number-one priority, so when I learned that a brand-new employee in our pharmacy was at fault, I was distraught. Though I know my apology will not put things to right for your family, I want you to know that everyone in my department was heartsick to learn of the error. We have redoubled our efforts to make certain that it never happens again.

“To that end, we propose an intensive training program for every staff member who handles medications. Never again will a novice pharmacy technician — such as the young man I fired last week for causing your daughter’s heparin overdose — step one foot in the pharmacy until she or he is completely conversant in the computerized medication administration system we adopted just days before Ariel’s hospitalization.”

Baumgarten interrupted. “Would have been nice if you’d done that before my clients’ baby entered your hospital.”

Marsh was not cowed. “We agree with you. We thought our training was sufficient, but clearly, we were mistaken. However, we aim to correct our mistake, and Mr. DiPerna here,” she motioned to her right, “will explain to you in detail how we aim to make the system as fail-safe as is humanly possible.” With that, she handed off the presentation to the chief designer of the BCMA system. He piggy-backed on what Marsh had said, making a point-by-point case for massive, onsite tech support from his firm. In addition, the BCMA system would be redesigned to add audible alarms when scans did not match. DiPerna closed by saying that such a plan would further reduce the probability of an error such as the one that had affected Ariel Arkin.

Finally, Ted Ainslie explained the cost of all the proposed improvements in staffing and training — over ten million dollars in the first year alone. Maintaining high staffing levels among nurses, and providing training for all new hires, would cost at least as much in each subsequent year. Projected out three years, the bill would top thirty million dollars.

It was Sarah’s job to conclude the presentation. Taking the floor once again, she looked directly at the Arkins. “In closing, I want to emphasize the seriousness of the hospital’s commitment to eliminate medication errors. We are on a mission. Although we have no power over the pharmaceutical company, we have initiated talks with the heparin manufacturer about a redesign of the labeling for their products in order to eliminate the type of mix-up that occurred in Ariel’s case. Those discussions are part and parcel of our overarching goal: that no other patients suffer as Ariel did from a mistaken dosage or from an incorrect medication. We are willing to fund that effort despite, as Mr. Ainslie just illustrated, its eight-figure price tag. And, to guarantee our good faith, should you agree to our remediation plan, we propose that it be monitored for compliance by a neutral third party — mutually agreed upon — for the life of the agreement, that is to say, three years.”

Sarah took a sip from her lukewarm latte and continued. “Of course, we want to address the pain and suffering Ariel experienced because of our error. We are offering your daughter a monetary settlement of five hundred thousand dollars as compensation for the trauma she experienced.”

Sarah had no sooner announced the figure than she heard Baumgarten remark in a stage whisper, “You’ve got to be kidding.”

She’d anticipated that reaction from the Arkins’ representative and remained calm and measured in her presentation. “Though her response to treatment has been so encouraging, giving us all great hope that Ariel will make a full and complete recovery, our settlement has contingencies built in for remedial therapies through age twenty-one in the event of physical or cognitive damage associated with the medication error.” Sarah saw Catherine shudder.

She was nearly done. She looked down at her watch: five minutes to eleven. At that point she knew it was time to open the floor to the Arkins and their counsel. “I understand that you are anxious to get back to Ariel. However, I want to give you every opportunity to ask questions about what you just heard.”

Baumgarten went first. “Very nice presentation. We appreciate your efforts to prevent another little baby from suffering the way Ariel did. Jesus, you guys nearly killed her. So it’s nice that you don’t want to kill off any other babies who come in with a simple staph infection. We appreciate that. We really do. But how does your plan do my clients any good? The harm has already been done to their little one. Five hundred thousand? Why, that’s chump change. You know that, Harry,” he said, turning his attention to Meinig.

Harry could see the storm clouds rolling in. God bless Sarah. Her idea of admitting guilt was a logical strategy given the damning evidence of hospital culpability, but it looked like Mark was aiming to play hardball. He had to try to salvage the plan. “Reid, what I know is that we’d all like something good to come out of what was nearly a catastrophic error. Thank God the error was caught immediately and Ariel was given state-of-the-art treatment by Dr. Smith here and the rest of the medical team. We all hope and pray that she’s going to be okay. But as important as making sure she’s okay, we want to make sure her ordeal brings about something positive. That’s the thrust of our proposal. And we hope you and your clients will give it some thought. That’s all we’re asking — that you give it serious thought.”

Mark had sat stock still throughout the presentation while his wife took copious notes. His face was blank, betraying nothing but fatigue. When he broke his silence, he turned toward Dr. Smith. “My good Dr. Smith. I haven’t heard squat from you. What’s your impression of this so-called ‘plan for remediation?’ Is it worth a rat’s ass? I’m interested in hearing what you think. I know you work for the hospital, but I also know you’re not afraid to call things as you see them. After all, you called me an asshole when I was being an asshole. Not too many people have ever done that and lived to tell the tale. So I figure you’ll level with me. What’s your take on what you just heard?”

Harry winced when he heard that Dr. Smith had called Mark an asshole to his face, though he couldn’t agree more. He wondered where he had gotten the balls to do that. The same question crossed the mind of nearly everyone else in the room. Not Sarah, though. She found herself suppressing a little smile.

Rick colored when he was reminded of the scene in the baby’s room — when the father was yelling and he couldn’t think straight as he tried to counteract the effects of the overdose.

“Sorry about that, Mr. Arkin. Things were happening pretty quickly at that moment. I apologize for losing my cool.”

“I don’t give a crap about that. You saved my daughter’s life. By my lights, you’re a straight shooter. Is this plan the real deal? That’s all I’m asking.”

Rick had had his share of moments in the sun. He’d been a two-sport varsity athlete in high school. He’d won academic honors in college. Beating out the competition, he’d been appointed pediatric chief resident. Now he was in one of the country’s best fellowship programs in pediatric intensive care. But nothing had prepared him for this. He thought for a moment and then sat up a bit straighter in his chair.

“You want the truth, Mr. Arkin? All right, here’s the truth as I see it.”

The members of the hospital team held their breath when they realized a sixty-grand-a-year fellow decked out in scrubs and sneakers might well hold the hospital’s fate in his hands.

“Mr. Mess here will confirm that I just about fell out of my chair when I heard that the hospital was going to take responsibility for the error. Frankly, such honesty is a rare occurrence, Mr. Arkin, and I was happy to hear the hospital was willing to do the right thing. We doctors and nurses — and all the staff — we’re just people. We’re not automatons. We do our best — and believe me, I work with the very finest people in the field — and despite that, we sometimes make mistakes. Believe me, nobody woke up that morning and said to themselves, ‘Oh, gee, maybe I’ll injure a little baby at work today.’ Just the opposite. The people I work with are driven by the desire to help kids get better. But despite that, a series of circumstances allowed well-meaning people — highly competent people — to deliver an overdose to your baby.

“I’ve reviewed this plan at length. Ms. Abadhi had me going over it with a fine-tooth comb. I would have to conclude that, using your terminology, this is ‘the real deal.’ It’s a good-faith, comprehensive effort to address the circumstances that allowed good people to make a terrible mistake. If it’s implemented, I believe it will go a long way toward helping competent, well-meaning doctors, nurses and pharmacists do their very best for each of our patients, and will get us as close as we can to eliminating medication errors at the hospital.”

It was as though every person on the hospital team exhaled at once. The man in the scrubs and sneakers had spoken, giving the plan his seal of approval. Harry thought that after that ringing endorsement, it was possible they might still have a shot at convincing the Arkins to bypass the malpractice route. It depended on how great their desire was for vengeance, since it was clear they didn’t need a cent from the hospital. Baumgarten would be key on that point, emphasizing the need to “teach those bastards a lesson,” or some such tripe. The question was, would they accept the remediation plan as proof that the lesson was learned?

Catherine had stopped her note-taking to look directly at Dr. Smith. “Thank you, Dr. Smith. As is obvious, we put a great deal of faith in your opinion. My husband and I appreciate your assessment of the hospital’s proposal.”

Baumgarten, who would have liked to put a sock in the doctor’s mouth, cut Catherine off before she could say another word. “Yes, thank you, Dr. Smith. And thank you all for your presentation this morning. My clients and I will be getting back to you after a thorough review of your proposal. I’m assuming, Ms. Abadhi, that you’ve prepared a document for us to review?”

“Yes, of course, Mr. Baumgarten.” She got up and handed each of them a copy.

“I really have to get back to Ariel now,” Catherine said as she stood up to leave. “You’ve given us a lot to think about.”

“My clients and I will be going over their options. We’ll get back to you,” added Baumgarten.

Sarah tried to get a read on Mark, but his face revealed nothing. She had given it her all. Everyone did their part during the presentation, none more than Dr. Smith. Time would tell whether their efforts would pay off.

CHAPTER FIFTEEN

As each day passed with no word from the Arkins or their attorney, Sarah grew more on edge. With Thanksgiving coming up, word from the Arkins would likely be further delayed. She decided to distract herself by spending the holiday at her parents’ house in Westchester. During the big feast, Bubbe Rivka regaled her children and grandchildren with tales of romantic intrigue at the Brighton Beach Senior Center, but Sarah was too worried to enjoy her grandmother’s storytelling. That night and the next, she slept poorly in her childhood room.

If she’d been a fly on the wall at the Arkin home, she might have enjoyed her Thanksgiving more. Daily life changed after the Arkins brought their baby home from the hospital. Mark lingered in the mornings, not leaving for work until ten. He was back for dinner each night by six. His company had always been his reason for living, but now all he cared about was Catherine and Ariel. He forced himself to show up at the office and put on a good front, so people wouldn’t think he was losing his edge. He knew they’d take advantage, just as he would if he sensed a weakness in someone else. But the truth was, all he really wanted to do was stay home with Catherine and help her take care of their daughter. He even changed a diaper or two.