Fertility: A Novel (7 page)

“That it is,” Sarah said as she and Doris simultaneously took their lipsticks from their purses and each applied a new coat. “I think that will have to do for our beautification, Doris. We’d better head back just in case that Dr. Smith is on time. I know,” she smiled, making her dimples show, “it’s a long shot, but we can hope, can’t we? The faster he gets in, the faster you can go home.”

“Frankly, I can’t wait to go home. I’m gonna put my feet up, have a glass of merlot and do my best to put what I’ve heard today behind me.”

* * *

The women’s hopes were realized just a few minutes later when a panting man entered the conference room and introduced himself as Rick Smith. He looked like something the cat had dragged in: unshaven, his dark hair tousled, his blue jeans and Columbia sweatshirt having seen better days. If he had the look of someone who had just rolled out of bed, it was because that’s exactly what he had done — just minutes earlier. He’d run all the way to the hospital.

“Would you like some coffee, Dr. Smith?” Sarah asked.

“No thanks,” he said, begging off. “I’m hoping to go back to sleep after we’re done here.” Seeing the quizzical look on the lawyer’s face, he added with some impatience, “Look, I was on from noon yesterday until after eight o’clock this morning. I’m behind on my sleep and this interview isn’t helping.”

“I am very sorry we had to call you in today,” Sarah responded. “I’ll be as quick as I can so you can get your much-deserved rest.” She started the digital recorder and made her standard opening. “The hospital is investigating the medication error that occurred yesterday in the case of the infant Ariel Arkin.”

“Damn well better investigate it. Someone nearly killed that baby,” the doctor said.

Sarah was taken aback by his blunt, albeit correct, assessment of the situation. “The hospital is eager to find out how the error occurred, as I’m sure you are, Dr. Smith.”

“It’s obvious how it occurred. Someone from the pharmacy screwed up. They sent heparin with a thousand times the potency I ordered.”

“Yes, that seems clear, but I’m investigating the circumstances that allowed that error to be made, particularly given the fact that the BCMA system is in operation.”

“Yeah, so much for that. We’ve been hearing for months how the BCMA was going to make medication errors a thing of the past. Guess that particular emperor has no clothes.”

Sarah was eager to hear more. “How so, Dr. Smith?”

“Isn’t it obvious? Even with all the scanners in place, the infant nearly bled to death from an enormous overdose.”

“Do you have an idea as to how that could have happened?” Sarah was particularly interested to hear his answer since he had played no role in the overdose and had no reason to try to cover his rear.

The pediatric fellow sat slumped in the armchair, his head resting on his hand. He was either very relaxed or dead tired. “How did it happen?” he asked incredulously, suddenly coming to life. “Someone wasn’t doing their job, that’s how. The manufacturer clearly labeled the vial “10,000 units.” Hard to miss all those zeroes — even without a scanner,” he said impatiently.

“Apparently the labels for the 10- and the 10,000-unit vials of heparin are nearly an identical shade of blue. It appears that contributed to the mix-up,” Sarah explained.

“What, people can’t read now? We go by colors? What is this, preschool?”

Sarah was impressed by his forceful condemnation of those responsible for the overdose. She was still looking for the part of him that engendered fondness in the people who worked with him. Perhaps his high expectations for patient care were part of his appeal. And, truth be told, he’d likely clean up nicely. Little doubt about that, Sarah thought, before getting back to the business at hand.

“I can understand your intolerance for this type of error. But it appears there were circumstances that contributed to people making the mistake. One factor appears to be that the hospital was short staffed because of the flu going around. The newness of the BCMA may also be a factor.”

“Look, I have some sympathy for the nurses — and all the floor staff, for that matter. People are being asked to work back-to-back shifts and they’re exhausted. And it’s not just because of the flu that’s going around. Understaffing is a constant problem here. As far as bedside care goes, the administrators are trying to run this place on the cheap. As for the computer system, which I’m sure cost the hospital a bundle, trouble-free it’s not. It rejected scripts from me without reason several times this past week. I know a lot of people have found it to be a thorn in their side.

“That being said,” Dr. Smith continued, “do you have any idea what happened to that little baby yesterday? It was disastrous. There’s no other word for it. I spent an entire night trying to undo the horror caused by simple carelessness. That baby did not have to suffer this trauma. She
shouldn’t
have suffered this trauma. So if you think I have, what did you call it, an ‘intolerance’ for the error, you’re goddamned straight I do. I am intolerant of an error that could inflict so much harm on a helpless infant.”

Doris coughed. Maybe she had a tickle in her throat, but Sarah took it as a signal that she was impressed by the rumpled doctor’s passionate advocacy for his patient. Sarah couldn’t take her eyes off him. His unvarnished appraisal was both helpful and refreshing. Maybe that’s what people enjoyed about him. There was no bull from Dr. Smith.

“I appreciate your assessment of the conditions that may have contributed to the baby being harmed. I am certain this will be cold comfort, but many of the people with whom I’ve spoken today are stricken with a deep sense of remorse. No one wanted this terrible error to happen.”

“Well, I know Joyce Hilker is a wreck about this. She’s a great nurse; don’t get me wrong. She trusted the pharmacy’s label on the heparin. And she should have been able to trust it. If the pharmacy had done its job correctly, she would never have administered a near-lethal dose of heparin to her patient. But as it stands, she’s got to live with the knowledge that she nearly killed a baby.”

Sarah thought this would be a good time to get Dr. Smith’s take on the rollout of the system lauded by Joanne Marsh. “To what degree, Doctor, would you say the staff believes in the efficacy of the BCMA system?”

“You want the truth?”

“I do.”

“So far, I’d say the BCMA has been more trouble than help. If the company who sold the system had flooded the hospital with their own people to debug it as we rolled it out, maybe we would have had a better first week. But that didn’t happen. I know that I overrode it when it rejected perfectly appropriate scripts. I can’t speak for the others, but I wouldn’t be surprised if they did the same.”

Bingo. The system had problems. Help was scarce. Maybe most importantly, people hadn’t bought into the BCMA. Hence, Alejandro Avila’s reluctance to believe the scanner’s error message and Albert Cappelli’s override of the system with his handwritten label. Joyce Hilker had followed suit, chalking up the failure to scan as a system failure. Sarah would guess Dr. Smith, Avila, Cappelli and Hilker were not alone in responding to the “foolproof” system by blowing it off. In this particular case, however, had everyone involved not overridden the BCMA, Ariel Arkin would likely be healing nicely from the staph infection that brought her to the ER, and the pediatric fellow sitting next to Sarah would be enjoying his day off.

Sarah could see the guy was beat, but there were still some bases to cover. In the event the baby didn’t survive, there would be a further investigation into how the staff had responded to the error. So she asked the pediatric intensivist to describe his efforts to stabilize the baby. She knew she could get much of what he had to say from the baby’s chart, but she figured she couldn’t be too careful. Dr. Smith complied in painstaking detail. When he was done explaining how he had labored through the night to save the child, she shook his hand and thanked him for his help in the investigation.

For Rick Smith’s part, he hightailed it back to his apartment and the lure of at least another couple of hours of shuteye. As he left the interview, he toyed with the idea of checking on Ariel Arkin, but he knew that if he went up on the floor, he’d get sucked in for hours. Instead, he jogged home and thought about that good-looking attorney. She was a little uptight, but a beautiful woman. No doubt about that. Once in his apartment, he quickly pulled off his sweatshirt and jeans and got back into bed. He thought about how he wouldn’t object to spending a little time alone with that lawyer — and then he was out like a light.

* * *

After Doris headed home, Sarah gave John Mess and Julie Bonner a verbal summary of her findings. She emphasized that it was more complicated than just the careless error of a novice pharmacy tech — the story Joanne Marsh had tried to sell earlier to Mess. Sarah told them they would have her written report in the morning. They were both happy — no, ecstatic — to share news on the baby’s condition. Her vitals were strong and her infection retreating. She was responding to stimuli appropriately for her age.

After a day filled with graphic accounts of so ghastly an event, Sarah was relieved to know there was reason to hope that little Ariel Arkin might recover.

CHAPTER ELEVEN

Sarah worked until the wee hours of the morning on her report. It shouldn’t have made any difference that the injured baby had a powerful father, but knowing the big guns Mark Arkin could aim at the hospital did, in fact, make her even more meticulous than usual. She paid particular attention to writing up her highly strategic — some might say daring — recommendations. She planned to share her work with Harry in the morning. If, after hearing her out, he didn’t think she’d lost her mind, they would go to the hospital together to deliver her report to John Mess and Julie Bonner.

She knew she was sticking her neck out on this one. Until now she’d been the ideal protégée on every project, doing what Harry would have done had he had the time or inclination. She read him like a fortune teller reading a palm and often knew his preferences without him offering a hint of direction. That was why he’d plucked her out of the pool of associates and made it his business to groom her for partner.

But this time was different. Her recommendations were based on what she thought was right for all involved, but she knew they might incite an infamous Meinig tantrum. She was willing to chance it, though. If she could persuade Harry to her way of thinking, she had a feeling they could neutralize the “cluster fuck” and actually do some good at the same time.

* * *

Another morning without time for a swim or a run. Sarah was in the office by seven, putting the finishing touches on her report. She handed it over to Harry for his review just before eight. He muttered to himself as he read her findings about how Alejandro Avila’s initial error had not been caught — and why. The report was as much an indictment of the hospital’s staffing policies and half-baked implementation of the BCMA system as it was of Avila, Albert Cappelli and Joyce Hilker, at least one of whom, under different circumstances, might have caught the error. Leaving nothing out, Sarah slammed the pharmaceutical maker for marking such vastly different doses of heparin with a nearly identically colored label.

When Harry turned to the last page of her report — her recommendations — she held her breath. He kept reading, gesticulating with his hands, raising his eyebrows and muttering to himself. She had prepared herself for an explosion, but all Harry said when he was done was, “Are you sure about this, Sarah?”

“Yes, I am. I think this is the best way to go.”

“Well, it’s a risk. But I’ve heard about some other cases that were handled this way with good results. I’ll back you up on this, Sarah, but don’t fuck up. Do me proud.”

She couldn’t believe what she was hearing. Harry trusted her risky strategy — trusted her. “I promise you, Harry. I won’t screw this up.”

* * *

Within the hour Sarah was handing out copies of her report to Julie Bonner and John Mess. They sat riveted as she described the confluence of factors that had led to the baby’s overdose. In terms of the BCMA, she was emphatic that there had been insufficient training and buy-in of the staff, from lowly pharmacy technicians to physicians. The failure to offer onsite tech support from the developer during the critical first weeks of implementation had also contributed to the dosing error. Taken together, those factors had greatly diminished the BCMA’s power to prevent medication errors. Sarah minced no words on the role played by staffing shortages. With fatigue being a well-documented cause of performance failures, having tired nurses doing back-to-back shifts was nothing short of playing with fire.

Mess and Bonner took it all in, but said nothing in response. Finally, Sarah came to her recommendations. She took a deep breath and laid them out: Admit fault to the parents; tell them everything that went wrong and why. Offer a sincere apology. Then stipulate in detail what measures the hospital would immediately take to make certain this type of error would not happen again. Finally, make a fair offer of payment for pain and suffering, and a promise to pay for any therapies or remediation the child might need as a result of the medical trauma. Sarah knew that giving these parents money was like giving oil to Saudi Arabia. But it was a necessary gesture of contrition and a required part of the mea culpa approach she was recommending.

Mess could hardly contain himself. “You’re kidding, right? Harry, you don’t buy into this suicidal advice, do you?”

“Actually, John, I think Sarah’s pegged it just about right. Mark Arkin can sully the good name of this hospital in every media outlet from coast to coast and let loose his vengeance via a jury trial. Hell, he can make it his business to bankrupt the hospital. We’ve certainly given him cause to want to see it brought to its knees. I’ve seen him when he’s out for revenge and it’s not something I’d recommend the hospital tangle with — not if there’s any way to avoid it. With Sarah’s approach, we come clean about the weaknesses in the system, promise reform — we’ll have to demonstrate its implementation, of course — and then make a monetary settlement offer. I think it might work.”