Fertility: A Novel (2 page)

CHAPTER TWO

Dr. Richard Smith must have been numb from exhaustion. There was no other way he’d miss the tall, attractive brunette coming in the hospital’s main entrance as he was on his way out. But even a renowned ladies’ man required sleep, and this ladies’ man was anxious to get home and collapse. It was 8:24 a.m. and he’d been on duty since noon the day before. So much for his scheduled twelve-hour shift. This was Monday, his day off — funny how schedules became meaningless when a baby was bleeding out. Shit. He hoped that when he came back the next day, that baby would still be alive and, just as important, that she hadn’t suffered irreparable harm at the hands of her so-called health care providers.

Rick Smith loved being a fellow in pediatric intensive care medicine. He’d been a decent student in med school, but had really hit his stride during his pediatric residency, when his tenacity in dealing with the very sickest patients won him notice. He was like a dog with a bone, unable to rest until he got to the bottom of what laid his patient low. Then he was relentless in his efforts to beat back the illness and return the child to a normal life. If his patient suffered a trauma by accident — or sometimes at the hands of a cruel adult — he was like a highly skilled craftsman restoring a work of art after an assault. He was a funny combination: carefree player on his rare days and nights off, and driven perfectionist the rest of his waking hours.

As he walked to his apartment he kept thinking about that baby, blood oozing even through the pores of her skin. With an overdose so large, it was nothing short of a miracle that she had stayed alive long enough for the antidote to kick in. He had a hunch she was a fighter. He had worked on babies whose spirits were so well defined that he marveled at their drive and, for lack of a better word, attitude. This baby was one of those. After only fourteen days of being on the planet, she already knew what she wanted and what she didn’t. It could make a kid a pain in the ass, but for survival purposes, it was a real plus. Maybe she came by it honestly; the tabloids routinely portrayed her old man as a royal hard ass. From what Rick could see as he worked through the night, Mark Arkin was just a normal dad, scared that his kid wouldn’t pull through, probably making private deals with his maker to save her life.

Just as he put his key into the deadbolt lock of his apartment door, his phone rang. It was the hospital. Shit. He’d made sure to bring the house staff up to speed — on the overdose case in particular. What the hell could they want now? He let it go to voice mail. Once inside he pulled off his clothes, peed, brushed his teeth and headed for bed. But then he thought better of it. Maybe he should just answer the call and get it out of the way. He called the number back.

“This is Dr. Smith on what’s supposed to be my day off. This had better be good.”

“Dr. Smith, this is Nancy Howland, Julie Bonner’s assistant. Ms. Bonner asked me to let you know that you’ll be needed for a meeting with the hospital’s attorney today. The meeting is in reference to the Arkin infant’s case.” She attempted to sound authoritative while remaining pleasant. She knew how the fellows and residents guarded their limited time off.

“And who might Julie Bonner be?” he asked, making no attempt to hide his annoyance. Clearly, the hospital was getting its ducks in a row for a lawsuit while an eight-pound infant was fighting to stay alive. He was not alone in finding the bean counters and lawyers infuriating in the face of the life-and-death struggles that made up an average day in his department.

“Ms. Bonner is the hospital’s vice president for public relations. She is assisting the risk management office and the attorneys in their investigation of the child’s treatment. Every person involved is being interviewed today.” Nancy Howland knew she had to stand her ground. Bonner had made it clear there would be no excuses accepted — even if a car service had to drive the staff member to the hospital for the interview.

“Well, that’s just dandy…what’s your name? Nancy? I’ve been on call since noon yesterday. I haven’t had any sleep in over twenty-four hours. And as much as I’d like to help you, I’ll be spending today between the sheets. Alone, I might add.”

Howland knew she had to persevere and get him in for an interview, or Bonner would have her head on a platter. His address was displayed on her computer screen right above his phone number — he lived just a couple of blocks away. She decided to make a deal. “I understand completely, Dr. Smith. The interviews will be conducted throughout the day, and I am scheduling you last. We’ll expect you at 4:30. That will give you a chance to catch up on your rest.”

Rick was too tired to argue. And that would give him at least a semblance of a night’s sleep. “That’s very thoughtful of you, Nancy,” he said, his voice heavy with sarcasm. “I am so glad you’re taking my needs into account in this investigation. And will you be scheduling me another day off this week to make up for today?”

Howland wasn’t getting into that rat’s nest. She replied sweetly, “I’m sorry to say I have no authority to make those decisions or I’d be certain to give you another day off.” She paused, waiting to see if he’d make another smart comment. Relieved when he didn’t, she wrapped things up. “We’ll see you at 4:30 in room 700.”

Rick’s fatigue led him to surrender. Had he some sleep under his belt, he would have kept up the repartee. Who knew? Maybe Nancy was a babe. And even if she wasn’t, maybe she’d be an eager and enthusiastic partner, which held a charm of its own. But for now, all his desires were folded into his need to lie down and close his eyes. He hung up, set his alarm for 4:15 and got into bed. In less than a minute he was breathing slowly and rhythmically, enveloped in the rapture of long-deferred sleep.

CHAPTER THREE

Mark Arkin awoke that Monday morning with his arm around his wife. He and Catherine had succumbed to their exhaustion on a loveseat in the family lounge of the pediatric intensive care unit — the PICU. They’d been up with Ariel much of Saturday night as she fussed with what looked to be a nasty diaper rash. It was the nanny’s day off, so they consulted the pile of baby books Catherine had amassed during her pregnancy. Then they applied ointment and kept her dry, but got no relief from the baby’s incessant crying until four on Sunday morning. When she awoke around seven, the crying began again.

Mark Arkin didn’t remember anything like this from when he had been married to Linda. Maybe that’s because he had rarely been at home during their children’s first years — or, for that matter, their later ones. He had never had any qualms about the long hours he kept. There had been no way to scale his industry’s mountain while attending parent-teacher conferences and soccer games.

This time was different, though. Mark had never thought he’d be one of those fools — an
alter kocker
in his mother’s parlance — who left a perfectly good wife for a new, younger model. He had been too busy amassing his fortune to chase skirts. Besides, he had been satisfied with Linda — who was both nice-looking and highly competent at running the family, the houses and their social life without any help from him. But when he met Catherine Malloy during an interview for an article she was writing for
Fortune
on his meteoric rise from the streets of Flatbush, he fell hard. At forty-seven he found himself besotted by the thirty-year-old natural beauty.

It took a year of pursuit, including a legal separation from Linda, before Catherine would even entertain the idea of going out for a drink. She refused to sleep with him until his divorce was final for over a year — something about the “one-year rule” that she had heard from a radio psychologist. The titan of real estate was powerless to sway her. The truth was, her unavailability added to her allure. Mark was fifty years old before he finally won Catherine over. And here he was, two years later, married to the woman he was crazy about, and scared that their baby would die fifteen days after taking her first breath.

As he sat on the loveseat, a terrifying thought crept into his consciousness: The nightmare with Ariel was retribution for what he’d done to Linda and their kids. But that was absurd. At the very least, it presumed some sort of balance in the universe, or, more improbable still, a wrathful god evening up the score. He had always pegged the notion of a “supreme being” as a scam, a way to keep the little people in line. He made big decisions every day, consequences be damned. When he walked away from his family, he had silenced the small but persistent inner voice of reproach by being generous. Linda got the houses in Scarsdale and the Hamptons, as well as alimony for the rest of her life. The kids got liberal child support until they were out of school, when their trust funds would kick in. Mark couldn’t help but pat himself on the back, thinking that most first families would thank their lucky stars to get such munificent treatment from a husband and father who moved on in his life.

Still, here he was with Catherine. Through the night she had alternated between uncontrollable sobs and gentle crying until he finally persuaded her to try to sleep. It was his first victory at calming her, and he did it by telling her that if she got some rest, she would be in better shape to care for Ariel in the morning. Even as he made the case for sleep, he wondered if he was full of crap. Would Ariel even be alive in the morning? It was beyond him to understand how she could live to see another day after such an assault to her tiny body.

Try as he might, he couldn’t shake the idea of retribution. What was happening to them and to their baby was too monstrous to be a random accident. For the first time since he was in grade school, he felt guilt. It was a sickening feeling. And the tears that fell silently on Catherine’s hair frightened him as much as anything that had happened over the past day and night.

CHAPTER FOUR

Julie Bonner’s office was nothing if not efficient. When Sarah returned to the conference room adjacent to John Mess’s office, Nancy Howland, Bonner’s assistant, was waiting for her. Howland informed Sarah that the pharmacist who’d filled the order and the baby’s nurse, Joyce Hilker, would be coming in for interviews. Howland had left messages for the pediatric fellow, Dr. Smith, and the attending physician, Dr. Cho. She asked if Sarah wanted to interview the licensed practical nurse that had been teamed with Joyce Hilker on Sunday. Sarah thanked Howland for taking initiative and told her to contact the LPN as well as the charge nurse for the floor. She figured she could fit all of them in — and in cases like these, time was of the essence. She had to interview each of the major players before they had a chance to think too carefully about a cover, or to coordinate their stories.

After she and Doris Ostrom got themselves set up in the conference room, Sarah thought about how she could use the time before her first interview at 9:30. She decided to lay eyes on the pharmacy to see how orders were dealt with via the new computerized system. She asked Howland for directions and then suggested she let the pharmacy know Sarah was on her way.

* * *

The hospital pharmacy was actually smaller than she had imagined, but it hummed with what appeared to be the well-coordinated activity of about a dozen people in white jackets. Double doors led to the outpatient pharmacy, staffed by another four workers. Within the pharmacy there were row upon row of open shelves with more medications than Sarah had ever imagined possible. There was also a walk-in cooler for the medications that had to be kept refrigerated. As Sarah scanned the clean, well-lit room, a blond, middle-aged woman wearing a white jacket and white clogs approached.

“You must be the attorney Julie’s office just called about. I’m Joanne Marsh, head of the hospital’s pharmacy,” she said, extending her hand. “Glad to meet you.”

“I’m Sarah Abadhi,” she said, shaking hands with the head pharmacist. Sarah noticed the Pharm.D. following Joanne Marsh’s name on her ID tag, indicating her doctorate in pharmacology.

“Please, let me know how I can be of help in your investigation. This is the type of error I’ve spent my career trying to prevent. Believe me when I say I’m eager to know how this mistake happened.”

Sarah was taken by her frankness and her straightforward demeanor. “I thank you in advance for your cooperation. It’s clear that it’s in everyone’s interest to keep errors like the one that occurred yesterday to a minimum. You could help me by demonstrating how a doctor’s order is processed by the pharmacy. I’d like to familiarize myself with the system.”

“I’d be happy to. We put our Bar Code Medication System — BCMA —– into operation just last week. We have orders constantly arriving on our system. Let me take you through the entire process from arrival of the order to departure through the pneumatic tubes.”

Marsh was as efficient as she was confident when explaining the system. She used the first order of the incoming computerized requests as an example. “Let’s see. A doctor on Four North has requested Effexor XR, 150 mg, for an eighty-nine-year-old female patient. I’ll bring up the patient’s profile to see what other medications she’s taking. As you can see on the screen, there are no possible drug interactions, so we can fill the script without calling the floor to speak with the patient’s nurse.”

Then Marsh walked Sarah over to unit five of the large array of freestanding, open shelves and, using a stepstool, brought down from the highest shelf the large, brown, bubble-sealed Effexor capsules. Returning to the computer terminal, she scanned the bar code on the Effexor package and printed out a label with the patient’s name and ID number, the prescribing doctor’s name and ID number, the dosage and the date. Once the label was affixed to the cardstock portion of the Effexor packaging, the head pharmacist indicated on the screen that the order was filled. Before five minutes had elapsed, the order was put into a clear plastic capsule that would wend its way through the pneumatic tubes to Four North and the eighty-nine-year-old woman awaiting her antidepressant medication.