Fertility: A Novel (8 page)

“And if it doesn’t?” Bonner asked with more than a hint of incredulity in her voice. “If Arkin doesn’t accept our ‘apology’ he can take what we’ve given him and blow us away in the press and in court — and we will have handed him the ammunition with which to do it.”

Harry stood firm. “What I’m saying is, he can blow us away, regardless. A two-week-old infant nearly bled to death because of a chain of errors made by hospital staff. Sure, we can pin some of the blame on the pharmaceutical company for labeling two doses of heparin nearly identically. But the lion’s share of fault lies with the hospital.”

Sarah was emboldened by Harry’s support. “Look, everyone I met with yesterday was a good person — well meaning, competent and heartsick about what happened. The baby apparently is making a good recovery, due to the efforts of the medical staff. We need to emphasize that very point. We have a staff that is capable of doing world-class work. But we put them at a disadvantage because of the conditions I outlined in the report. When those conditions are corrected, this type of error — everyone’s worst nightmare — will not happen to another infant.”

Mess turned to Bonner. “You know as well as I do that most people who sue say they’re trying to prevent another person from suffering the loss or injury they did. They say that the money is just a way of teaching the doctors and the hospital a lesson so they won’t make the same mistake again. If we can show Arkin and his wife that they needn’t sue us to get that outcome, that we get what went wrong and are committed to correcting the weak links in our quality control system, they might just buy it.”

Bonner didn’t respond right away. Finally, she said, “I’m not saying it couldn’t work. The fact that the baby continues to do well, remarkably well, really — I checked with the attending this morning — is a definite plus. And I guess we could document how much this plan for remediation would cost. It’ll be a bundle; you and I both know that, John. Each new nurse runs a minimum of seventy-five thousand with benefits. And getting onsite tech support from the BCMA manufacturer is extremely expensive. That’s why the hospital passed on it to begin with. We’ve got to take this to Phil before we can agree to anything.”

Sarah guessed Phil to be Philip Kerrey, hospital CEO. Of course, he would have to be consulted before they went into negotiations with the likes of Mark Arkin. But she felt she had to add a final recommendation before they wrapped things up. “It’s my feeling that the sooner the hospital stands up and takes responsibility for what happened, the more likely it is that the parents will be receptive to the hospital’s offer — particularly if the baby continues to improve. I think timing will be everything in this case.”

“Well, Phil is out of the building this morning. I’ll get back to you this afternoon,” Mess said.

“Good, John,” Harry said. “I’d like to reiterate that I think Sarah has shown us the right path out of this mess.” Realizing instantly that he’d stepped on the risk manager’s surname, he quickly apologized. “Sorry, John. I don’t know what I was thinking.”

“Oh, forget it. I get it all the time. Half the time I think my name is what got me into the business of risk management: John Mess — manager of all manner of messes. Maybe they’ll put that on my tombstone when I’m gone.”

CHAPTER TWELVE

Mark Arkin would have given half his fortune to have been spared the events of the prior forty-eight hours. He hadn’t been so powerless since he had been a child in Brooklyn, living under the reign of his mother. Trapped in passive misery, he’d had to watch the staff try to undo the unspeakable harm their co-workers had caused his baby. Most wrenching was listening to Catherine berate herself for infecting Ariel with MRSA. He remembered watching a news story about observant Muslim men who flogged themselves until the blood streamed down their backs in rivulets. He had thought them mad at the time, but what Catherine had done to herself since finding out she was a MRSA carrier was worse than self-flagellation. If Ariel didn’t make it, he worried she might lose her mind. There was only one way the endless loop of self-recrimination would stop, and that was for Ariel to get well.

The truth was, Mark wasn’t beyond blaming himself, either, compliments of his newfound conscience. Though part of him thought it nuts, a little voice kept telling him this was what he got for walking away from Linda and their kids. But if a stiff-necked god was exacting a steep price, it was Catherine and Ariel who were bearing the cost. His special form of anguish was watching them endure agonies his imagination could never have conjured up.

If there was anything that gave him reason to hope, it was that Dr. Smith. He had seemed like a son of a bitch at first, but it had soon become clear that he knew what the hell he was doing. Catherine had it right when she said he was their only hope. Dr. Smith had worked on Ariel that whole first night, making sure to give them continual updates on her condition. He had gotten the bleeding stopped. He had gotten her vitals stabilized. And before he had dragged himself home yesterday morning, he told them he was “guardedly optimistic” that she would make it. Although Mark’s first reaction had been to transfer Ariel out of the hospital that nearly killed her, it was Dr. Smith’s single-minded efforts that had made him change his mind.

Dr. Smith was back on Ariel’s case today and his presence gave Mark some sense of security. That Dr. Cho was good, too, and Ariel had remained stable yesterday when she was in charge. But there was something about Dr. Richard Smith that Mark could lock onto. Dr. Smith might very well be a son of a bitch, but he worked like a dog to win — even when the odds were against him. That was something Mark understood. He was surprised that someone with that kind of drive had become a goddamned pediatrician, of all things. No doubt about it, they’d caught a lucky break with Dr. Smith.

Of course, Catherine had been treated as well. He had to admit that the staff had done a good job getting her MRSA under control. They had gotten her on meds right away and the infection seemed to back off within hours. And they had been gentle with her, too. Catherine had gotten the idea in her head that her milk would dry up once the baby stopped nursing, and became even more distraught. The lactation specialist had gotten her hooked up to a pump to keep her milk supply going. The image of that contraption attached to his wife’s beautiful breasts gave him the creeps. But it did the job. Catherine could see she was still making plenty of milk and that reassured her. They had brought in a counselor of some kind, maybe a shrink, to talk with her. That person had ordered an Ambien so Catherine could get some sleep. Sleeping was what she was finally doing now, on the cot next to Ariel’s crib. In fact, she and Ariel were both sleeping, a first since their odyssey began. He could hear their rhythmic breathing and it sounded so normal. What a relief it was to hear that steady in and out, in and out.

He dozed off in the chair himself, for how long he didn’t know. He was awakened by movement in the room followed by a gurgle coming from the crib. Opening his eyes, he saw Dr. Smith hovering over Ariel. He panicked until he saw that the intern and nurse with him were smiling.

Dr. Smith turned when he heard the baby’s father stir. “Oh, good afternoon, Mr. Arkin. Glad you got a chance to catch some shuteye,” he said in a low voice, so as not to awaken the baby’s mother. Mark was taken with the change in the doctor’s body language and attitude, not only from their first meeting but from earlier in the day. Was it possible that he was cheerful? The doctor turned back to the baby and gave an order for something Mark didn’t catch. Then the intern and the nurse turned and left the room.

“So how’s she doing now, Dr. Smith?” Mark asked.

“Well, I’m actually quite pleased with what I see. You have a little fighter here. She’s responding well to her treatment. Her white count is way down, which means the infection is coming under control. Her red blood count is good. Come and take a look. Your little girl is feeling a whole lot better.”

Mark could hardly believe the effect those words had on him. His eyes started to burn as he got up from the chair. When he looked in the crib, he saw Ariel tracking the doctor’s finger with her eyes, alert and — well, for lack of a better word — happy. She looked at him and held his stare for several seconds. Then she looked at the doctor, kicking her legs and moving her arms. Mark pulled out his handkerchief and wiped his face.

As Ariel grabbed the doctor’s index finger, he shared more good news with Mark. “I don’t want to wake your wife — believe me, I know how much she needs this rest — but I think that perhaps in a day or two she’ll be able to start nursing Ariel again. Let her know when she wakes up. I think she and Ariel will be much happier when they can get back to doing what comes naturally.”

Mark could have given him a bear hug. Instead, he grabbed the doctor’s hand and gave it a vigorous shake. He dared to wonder if it was possible that the whole nightmare was drawing down. Of all the great wins in his life, nothing could match a good end to this ordeal. He couldn’t wait until Catherine woke up so he could tell her the news. He gave a silent thank you to the god he had only recently dismissed as stiff-necked and vengeful. Guilt, helplessness and anguish were joined by yet another new feeling rising up within him: gratitude.

CHAPTER THIRTEEN

Over a lunch of kosher deli, Sarah and Harry hashed out how the apology would be orchestrated if the hospital CEO gave the go-ahead. Sarah argued for having the baby’s doctors — and perhaps one of her nurses — apologize to the parents for the hospital’s error. The mea culpa would have far more credibility coming from them than from hospital administrators or lawyers. She had a twinge of conscience about roping the heroes in the gruesome tale into admitting so egregious an error, but she knew they were the hospital’s best hope.

By mid-afternoon, John Mess called with the okay to proceed. While they were on the phone, Harry strongly recommended that action be taken quickly — before the end of the day, or the following morning at the latest. He also advised that the admission of error come from the medical staff treating the baby. Mess agreed to both. Though he would attend the meeting with the parents, he knew they’d see him as nothing more than a hospital suit. It wouldn’t be the first time, nor the last.

Harry and Sarah were back at the hospital half an hour before charge nurse Jeannie Lopez and Drs. Smith and Cho were scheduled to show up for a meeting in Mess’s office. As they arrived, Sarah exchanged pleasantries with them until Mess called the meeting to order. After introducing Harry, he emphasized the requirement of confidentiality regarding what was to follow. Then he turned the meeting over to Sarah.

Sarah did a reprise of the report she had made to Mess and Bonner earlier that morning. The doctors and nurse cringed when they heard the string of errors that had led to the baby’s overdose, but their responses to Sarah’s conclusions and recommendations differed. Lopez became defensive when back-to-back nursing shifts were listed as a factor contributing to the medication error. Dr. Cho was annoyed that she had been taken away from her work to listen to a litany of errors and their aftermath. And Dr. Smith scratched his head in disbelief.

“You’re really going to admit fault?” he asked Mess.

“Yes, we feel it’s the right thing to do.”

“Well, I have to say that I find that refreshing,” the doctor said, making no effort to mask his sarcasm. “I applaud your decision to do the right thing.”

Mess ignored the pediatric fellow’s tone and continued with his mission. “Thank you for your support. But here’s the thing, Dr. Smith. We want the three of you to meet with the parents and deliver the following message: first, the admission of our errors. Second, that the hospital takes full responsibility for those errors. Finally, that we propose a rigorous plan of reform to make certain this type of error never again happens to any child in our care.”

Lopez looked as though someone had just ordered her to walk the plank. But before she had a chance to protest, the attending doctor got to her feet.

“Oh, no. No, no, no, no, no. You’re not going to dump this on us,” Dr. Cho railed, her face contorting in indignation. “How did
we
get selected to do the hospital’s dirty work?”

Sarah was taken aback by the defiant attitude the doctors had toward Mess. She knew administrators were not doctors’ favorite people, but she had underestimated the antipathy with which they viewed the risk manager. Mess was right about being seen as a hospital suit — and apparently not just by the baby’s parents. It was obvious that neither doctor viewed Mess as playing for their team.

“Please sit down, Dr. Cho,” Mess said.

“I’d rather stand, thank you,” she snapped.

“Suit yourself. I don’t characterize what we’re asking you to do as ‘dirty work.’ It’s certainly most regrettable that the error happened. However, that error has uncovered critical weaknesses in our quality control system. We aim to develop a plan that will address those weaknesses and improve the hospital’s functioning. The three of you are indispensable to making that happen. Since you’ve been working with the baby and the parents for the last two days — and doing exemplary work, I might add — the parents will be most receptive to a hospital apology coming from you.”

“Look,” Dr. Smith interrupted, “you don’t have to butter me up with how exemplary my work is, John. It’s all right to call you John, isn’t it?

“Of course,” Mess replied, annoyed by the unwelcome familiarity.

Dr. Smith continued, “I’ll do it. I’ll make the apology for the hospital even if Jeannie and Esther would rather not.” Then, turning to his colleagues, he said, “Look, I don’t blame you for not wanting to participate. But for me, personally, I like when the administration of the hospital steps up to the plate. After all, it’s a rare occurrence that should be encouraged. The hospital screwed up big time and now it’s ’fessing up. For once, the powers that be are taking the high road. Me, I’m all for it.”