Fertility: A Novel (4 page)

“And where was the infant at this point?”

“She was in her crib.”

“And had you or anyone on the floor administered any medications to her?”

“The ER had started an IV for fluids. But we were still awaiting the clindamycin and heparin.”

“And what time did you leave the baby’s room to page the lactation specialist?”

Hilker thought a moment. “I really can’t say exactly. I would guess it was around 4:15 or 4:30.”

“Were you successful in paging the specialist?”

“Yes. She answered her page within just a few minutes. She said she would be at the baby’s room in fifteen minutes — which was amazing, considering it was a Sunday. I thought to myself that at least that baby and mother had caught a little break.”

Cletus Jackson interrupted. “Joyce, remember to just state the facts as you remember them.” Sarah couldn’t tell if the nurse appreciated the union rep’s advice or found it a put-down. She nodded once and then waited for Sarah’s next question.

“At what point did the heparin and clindamycin arrive on the floor?” Sarah inquired, drawing the circles of her questioning closer to the actual target of the investigation.

“Well, that was the thing. The pharmacy technician actually brought the two orders right up to the floor. He said the new computer system had a glitch and wasn’t cooperating. The doctor had ordered them ‘stat’ so he ran them up to the floor himself.”

Sarah couldn’t help but think of Joanne Marsh’s demonstration of the apparently foolproof system. “Is that an unusual thing for the pharmacy to do?”

“It happens from time to time, but it’s fairly unusual. I thought the pharmacy tech was going the extra mile and I told him so.”

“At what point were the clindamycin and heparin administered?” Sarah set her sights for the bull’s eye.

Hilker looked at her union rep. Jackson nodded and the nurse proceeded, looking down at her hands. “I immediately gowned up and brought the meds into the baby’s room. I told the father that Dina Geissinger, the lactation specialist, would be in to see them very shortly. The mother was still sitting in the chair. She had the yellow paper gown covering her breasts and she was weeping. The dad was pacing around the room and talking to someone on his cell phone very quietly — almost in a whisper.”

“And where was Dr. Smith at this time?”

“Dr. Smith was no longer in the room.”

“And when were the clindamycin and heparin administered?” Sarah asked.

At this point tears began streaming down Hilker’s face. She got a tissue from her purse and shook her head in resignation. “When I checked on the baby, she woke up with a start and began to cry. Both of the parents came to the crib to try to calm her down, but the truth was, they were so upset I’m not certain they were much help. I checked that both of the meds had the correct patient name. Then I hung the clindamycin from the IV stand and connected it to the catheter. As I was about to flush the IV with heparin, Dina Geissinger came into the room for the consultation.”

Sarah interrupted her. “I understand the new computer medication system has bar codes that have to be scanned at every point. Did you scan the drugs before administering them?”

Still looking at her hands, the nurse explained what had happened next. “I attempted to scan the medications. The clindamycin scanned, no problem. But the heparin wouldn’t scan. I remembered that the pharmacy tech said they were having a problem with the new system so I figured it was just a glitch. The system only started last Monday and we’re all learning as we go. As I said, I visually checked the patient’s name and medication name.”

“And what about the dosage?”

Hilker looked up from her hands and stared directly into Sarah’s eyes. “The label looked correct — 10 units per milliliter.”

“So what did you do then?”

“I flushed the intravenous line with the heparin to keep it patent — open.”

“Who was in the room at this point?”

“As I said, the parents and Dina Geissinger. But then the three of them left for an examining room. I checked the IV one more time before I took off my gown and gloves and left the room. The baby had fallen back to sleep by the time I returned to the nurses’ station.”

“Do you recall the time you left the baby?”

“Yes, it was five o’clock. I remember because I knew the cafeteria would be open and I could get a takeout dinner to get me through until nine. Of course, with all that happened after I came back from the cafeteria, I never got to eat that dinner.”

CHAPTER SIX

Joyce Hilker’s blow-by-blow account of the events that followed her return from the cafeteria stirred both dread and awe in Sarah. The mother’s screams brought Hilker running into the baby’s room, where she found her wailing, “Oh my God, oh my God, help my poor baby.” The nurse was joined by Dr. Smith, who immediately diagnosed the overdose and started treatment to reverse its devastating effects.

Hilker finished telling her story fifty minutes after she began. If the nurse had looked tired at the start of the interview, she was drained when it was done. Sarah thanked her for her cooperation. She also thanked Cletus Jackson, shaking hands with them both as she saw them out. Then the agnostic Sarah offered up a silent thank you. The union rep had not, in fact, prevented the nurse from giving what appeared to be a thorough account of the events of the previous night.

As she’d listened to Hilker’s description of the quick response of the medical team, particularly the work of the pediatric fellow, Sarah wondered what it would feel like to have the skills and knowledge to save a person’s life. Since her last boyfriend had taken a walk rather than entertain the thought of marriage, she had made work the center of her universe. Harry handpicked her to be his protégée last year and gave her more responsibilities than most associates — these interviews being a prime example. She knew she had a good shot at continuing to rise through the ranks of her firm. But she had no idea what it would feel like to prevent someone from dying. She had to be satisfied with protecting hospitals and their staffs from frivolous malpractice suits so that they could engage in their life-saving work. But it was clear that if this family decided to file suit, it would be anything but frivolous.

She had just a couple of minutes before her next interview. How a mistake of such magnitude could occur was still an open question. From the scene described by the nurse — the frantic parents, the concurrent infection in the mother, the extra five hours tacked onto her shift — Sarah could imagine how an error could be made. She had to wonder if the nurse had really seen 10 units on the vial of heparin. Had it been mislabeled? And if so, who was responsible — the hospital pharmacy or pharmaceutical company? If it wasn’t mislabeled, had Hilker checked the dosage as she said she had? Could she have misread it due to fatigue? And why didn’t the computer system work? Were glitches really being experienced? Joanne Marsh led Sarah to believe the system was foolproof. Did the staff agree? She made notes to herself on all of her queries and was finishing the last one just as a pert, slim woman in her early twenties knocked on the open door. She introduced herself as Tracy Petersen, the LPN summoned by Nancy Howland. Sarah welcomed her into the conference room, showed her to a seat and excused herself, telling the young woman and Doris that she’d be back in a minute.

Sarah wanted to lay eyes on the heparin vial, and the sooner the better. She made a beeline for John Mess, who was in his office adjacent to the conference room.

“Excuse me, John. Where is the heparin vial that was used for the baby?”

“Actually, I have it.”

“May I see it?”

“Of course, Sarah.”

He got up from behind his large, cherry desk and walked to a closet next to the built-in bookcases. He opened the door to reveal a waist-high safe. Kneeling down, he entered several digits on the keypad, and the door opened. On the top shelf was a plastic zip-top bag. He handed it to Sarah. In the bag was a vial with a handwritten label showing the Arkin baby’s name and ID number, her doctor’s name and ID number, the date of dispensing and dosage of heparin: 10 units/mL. The label looked clear enough. However, when the vial was turned a bit there was a blue label from the manufacturer that read: Heparin, 10,000 USP units/mL. Clearly, Hilker never noticed the discrepancy. She handed the plastic bag back to Mess.

“Thanks. There appears to be some inconsistency in the labeling.”

“Unfortunately for us, there does, indeed.”

“I hope to get to the bottom of that by the time I finish up this afternoon. Having a picture in my mind of the medication is a big help. Thanks. I’d better get back; I have someone waiting for me now.”

Sarah found Tracy Petersen and Doris chatting amiably about the weather and how they both hated it turning cold so early in the season. Doris was such a pro. She knew exactly how to put people at ease — not only in interviews such as this one, which were often fraught with tension, but at their frenetic, high-stress office as well. She was one of the few people at the firm who looked up from working to welcome Sarah when she arrived five years earlier. They hit it off from the start and Sarah always enjoyed teaming with her. Doris was the only one at work who could make Sarah’s dimples show, a point Doris was only too happy to tease her about.

Sarah gave her standard introduction and then asked Petersen some questions to get a sense of her relationship with Joyce Hilker. Apparently, they had worked on the same floor for the last couple of years and were often paired together by the charge nurse, Jeannie Lopez. In Petersen’s estimation, Hilker was a great nurse, maybe the best she’d worked with. She was also a great teacher, a plus for an LPN studying to become a registered nurse.

Clearly a fan of her partner and mentor, Petersen would likely hesitate to cite any faults or past errors. Sarah knew she would have to tread carefully when she went down that road in her questioning.

“Yesterday Joyce Hilker was supposed to finish her shift at 4 p.m. What was your schedule?” Sarah inquired.

“Well, lately I’ve been doing a noon-to-midnight shift. I know some people don’t like getting out of work that late, but it works for my boyfriend and me,” the nurse volunteered. “He gets off work at 11:30 and picks me up right at the front of the hospital. But this weekend I was just trying to get some overtime, so I took an extra shift yesterday, 7 a.m. to 4 p.m.”

“Were you asked to extend your shift yesterday?”

“Oh, yeah. We were really shorthanded. That stomach flu hit a lot of us. I had it two weeks ago and I wouldn’t wish it on my worst enemy. Anyway, yes, Jeannie — the charge nurse — asked if I would do back-to-back shifts. I didn’t really want to because I’m on today at noon. But I could see she was really desperate so I said okay. Plus, the extra money always comes in handy.”

“What was your interaction with the Arkin baby when she was admitted?”

“Joyce did the admission by herself because I was busy with another patient.”

“Is that the usual procedure?” Sarah asked.

“Well, if we can, we like to introduce ourselves to the patient and the family together, but yesterday we were very busy and, like I said, short staffed,” Petersen explained.

“So when did you start working with the Arkin infant?”

“The first time I came to the baby’s room was when I answered a call that came into the nurses’ station. When I got there, Joyce was at the door and she told me to get Dr. Smith right away.”

“And what did you do?”

“Well, luckily he was at the nurses’ station entering some orders into the computer. I told him Joyce wanted him in the isolation room — and that sooner rather than later would be better from the look that Joyce had given me. I know that sounds kind of pushy, talking to a doctor that way, but Dr. Smith is a good guy,” Petersen said, smiling and nodding her head for emphasis.

Another vote for Dr. Smith. “And did you accompany the doctor into the baby’s room?” Sarah asked.

“No. I had plenty to do and Joyce didn’t ask for my help — just Dr. Smith’s. We hadW a lot of very sick kids on the floor yesterday — I mean really sick — so there was no way I was going where I wasn’t needed. Believe me when I tell you I had plenty else to do.”

“When did you next assist Joyce with the Arkin baby?”

Petersen started twisting her light brown hair around her finger. She hesitated a minute and then began her version of the events of the prior night. “I think it was around 5:30 when all hell broke loose. I was with a little guy who was on a ventilator when I heard the screams and then the code alert. I realized it was the new admission’s room, so I put on a gown and gloves and went in.”

“Who was in the room at the time?”

“Let me see. Dr. Smith, Joyce, Jeannie Lopez and the parents. The mother was screaming, I mean hysterically. It wasn’t until I looked at the baby that I understood what was making her act so crazy. God, I’ve never seen anything like that — blood coming from everywhere. Dr. Smith told me to get the parents out of the room. I mean the doctor can’t think straight when people are screaming at him. So I did my best to get them out of there.”

“What did you say?” Sarah was anxious to hear what this twenty-something LPN could have said to tear Mark Arkin away from his hemorrhaging infant.

“Well, I said just what I said to you. I told them the doctor couldn’t do his best for their baby with them so upset — that he had to be able to work. The best way for them to help was to give the doctor space. The father started shouting at me, saying he wasn’t going anywhere, that he wasn’t going to leave his kid alone for a moment with such…incompetents. Yeah, that was the word he used, incompetents. Then Dr. Smith yelled at the father.”

Sarah was intrigued. “What did he yell at the father?”

Petersen seemed to hesitate for a moment and her cheeks flushed. “You have to understand how bad things were. I don’t want to get him in trouble.”

“It’s best if you just tell me how things went. I understand it was an extremely stressful situation, Tracy,” Sarah assured her.