Fertility: A Novel (9 page)

Addressing Mess and the attorneys now, he reiterated, “I’m serious. I’ll tell the parents myself if Esther and Jeannie would rather beg off.”

Mess smiled and nodded. “That’s very kind of you, Dr. Smith, but I think that the presence of the attending and the charge nurse that have been caring for the baby will increase the credibility of the apology and the promise for improvement. I, of course, will be there as well, but I’m certain the parents are far more interested in hearing from you.” There was more than a hint of impatience in his voice.

“So in other words, you aren’t asking us if we’ll do it. You’re telling us we have to,” Dr. Cho concluded as she bit the inside of her cheek.

“Well, that’s true, Dr. Cho. However, the hospital administration greatly appreciates your part in remediating this very troubling situation. I promise you, your efforts on behalf of the hospital will not go unnoticed.”

Sarah felt as though she was watching her strategy unravel. If Dr. Cho made the apology to the parents while gnashing her teeth, she’d likely torpedo the plan, even if Dr. Smith played his role to perfection. She had to intervene. “May I, John?”

“Why yes, Sarah, feel free.”

“Dr. Cho, a ghastly error occurred that nearly took the life of a tiny infant. Now there are two possible outcomes for the hospital. Both involve money — lots and lots of money. Given the fact that the baby’s father is extremely powerful and influential, here’s one outcome: The parents go to the media and ruin the hospital’s good name and reputation from coast to coast. They institute a suit that will likely take many years to resolve, using the best lawyers money can buy. The hospital will defend itself, both in the media and in the courts, spending millions. Some will go to enriching my firm, some to filling the coffers of the hospital’s PR firm. In the years leading up to the trial, you and everyone involved in the case will be called to law offices to give sworn depositions, perhaps numerous times. Then you’ll be called to testify at trial. It will be highly unlikely that we will win a case such as this. Our best hope will be to minimize the damages for pain and suffering. These damages — probably in the many millions of dollars — will go to the child of one of the wealthiest men in New York.

“Here’s the other outcome — also extremely expensive. The hospital acknowledges its error, using the only people the Arkins trust to make its heartfelt apology — that would be you. The parents agree to entertain a proposal for remediation in lieu of filing suit against the hospital. Within the week, the heads of nursing and pharmacy, the designer of the BCMA system, Mr. Mess, Mr. Meinig and I present the parents with a detailed plan for improving the staffing of nurses and the implementation of the computerized medication administration system. We include contingencies for staff illness, such as when the recent flu decimated the nursing ranks. We offer a reasonable amount to the child for her ordeal and for any therapies that she may need in the event that she has suffered permanent damage. We include guarantees that the improvement plan will be implemented, with oversight by a neutral third party mutually acceptable to the parents and the hospital.

“Both outcomes are costly, but I think you would have to agree, Dr. Cho, that the second one will actually do the hospital, its staff and its patients some good. I wish the error had never occurred. I wish we could avoid a legal and PR disaster without your help. Believe me, I would rather all of you were on the floor now working with your patients. But the facts are what they are. You three alone have the credibility needed to persuade the parents of our earnest desire to make things right.”

When Sarah finished laying out her argument, no one spoke. She hoped her two scenarios had persuaded Lopez, who had said nothing so far. But Dr. Cho was the nut she had to crack. Even if Cho wasn’t won over by the argument, Sarah hoped the idea of depositions and testimony at trial had made an impression on the doctor who had neither the time nor the patience for meeting with lawyers.

It was Lopez who broke the silence. “Point taken, Ms. Abadhi. I’ll do it. If the hospital has to fork over millions to defend itself, that’s millions the hospital won’t have to actually improve staffing, training and patient care. We certainly could use that money. And I have to say that giving this family millions of dollars bothers me, even though the baby did suffer a terrible trauma.”

Now all eyes turned to Dr. Cho. She had stood with her arms crossed throughout Sarah’s monologue but something seemed to soften in her body language. “The second alternative is clearly preferable,” she said. “I think I’m beginning to appreciate the role I can play in making that happen.”

* * *

After everyone else left, Dr. Smith stayed behind. Having volunteered to take the lead in the meeting with the Arkins — referring to his role as “apologizer-in-chief” — he needed to study Sarah’s conclusions and recommendations. As he read over the report, his appreciation of the attorney’s way of thinking grew. He would have no problem delivering her report to the parents the following morning.

* * *

Catherine Malloy-Arkin was overjoyed to be given the go-ahead to start nursing her daughter again. When Jeannie Lopez entered the baby’s room the morning after her meeting with the hospital attorneys, she saw the father sitting on the armrest of the recliner, gazing lovingly at his wife and baby. Ariel was suckling heartily at her mother’s breast, as though making up for lost time. The parents seemed transfixed by their infant. It was a tableau Lopez hated to disturb.

Though her heart was pounding in her chest, the charge nurse did her best to appear calm as she told the Arkins that the doctors wanted to speak with them in a nearby consultation room. Both mother and father leapt to the same conclusion: They had discovered something else wrong with their child. Jeannie took pains to reassure them that the baby — who at that very moment had fallen asleep after taking her fill of her mother’s milk — continued to do well. When questioned by the father about the reason for the meeting, she demurred, saying the doctors would meet them in just a few minutes.

The consultation room was a small, windowless affair outfitted with soft lighting, a round table and chairs, a box of tissues and a telephone. All the participants arrived within moments of one another. As soon as they sat down at the table, Mark Arkin cut to the chase. “What’s this all about?”

Dr. Smith was ready.

“Mr. and Mrs. Arkin. You know Dr. Cho and Ms. Lopez. This is John Mess, who also works for the hospital. We’ve asked you to meet with us for two reasons. The primary one is to offer you the hospital’s heartfelt apology for your family’s ordeal. This has been a terrible time for you. Every person who’s worked on this case is remorseful about the mistakes made by our staff that led to Ariel’s overdose. We all chose medicine because we want to help, not harm, our patients. So, speaking for myself and my colleagues, we are so very sorry this ever happened.”

Mark sat stone-faced at the table. But Catherine’s reaction was as swift as it was furious. “The monsters who nearly killed my daughter are sorry, are they? Sorry doesn’t cut it, Dr. Smith. You saw her. You saw what happened to my child because of their mistakes,” she said, pounding her fist on the table. “Damn them. They can burn in hell as far as I’m concerned.”

Mark put his arm around Catherine, but said nothing in response to the doctor’s apology. He wondered why the hospital would have him admit to so serious a mistake. He kept his face expressionless and his thoughts to himself.

“If it’s any consolation, Mrs. Arkin, I share your rage,” Dr. Smith said. “The mistake should never have happened, and yet it did. I believe you both have the right to know how. That’s the second reason for this meeting. I’d like to tell you what happened and what the hospital is proposing to do to prevent the error from happening again. May I?”

Catherine looked at her husband and nodded her agreement. Thus began Dr. Smith’s full exposé of the staffing shortages and errors that had led to the overdose of their baby. Though it was excruciating to hear how small errors — so avoidable and unintentional — had led to their calamity, both Catherine and Mark sat in awe as Dr. Smith laid it all bare: the days-old implementation of the BCMA system, the novice pharmacy tech’s error, the failure of the veteran pharmacist and the crackerjack nurse to catch his mistake.

When Dr. Smith was done, Lopez made her apology for the over-scheduling of the baby’s nurse, saying she was hopeful the plan for remediation would address the hospital’s nursing shortage. Finally, Dr. Cho weighed in, saying that she had every reason to hope that Ariel’s ordeal would not be in vain — that the hospital was committed to learning from the terrible mistake and to correcting problems the investigation had uncovered.

When Dr. Smith, Lopez and Dr. Cho were finished, Mess, who until that point had said nothing, entered the conversation. “I’m here representing the hospital to let you know that it is our intention to do everything in our power to make certain that what happened to Ariel never happens to another patient in our care.”

“You’re here to head off a lawsuit,” Mark shot back.

Mess continued, unfazed. “Of course you’re free to pursue whatever course of action you choose in response to our error. I ask only that you give us the opportunity — perhaps next week — to detail our proposal for addressing the weaknesses exposed by this terrible event.”

Dr. Smith could tell Mark was ready to blow Mess off as a hospital lackey. He came to his aid. “Look, I’ve read the outline of a plan for fixing what went wrong here. And I wouldn’t be here now unless I was convinced the hospital means business about making sure no other baby goes through what Ariel went through — that some well-meaning novice doesn’t make a simple error with such awful consequences. What the hospital proposes is creating a system that will catch a novice’s error before any patient is harmed.”

Dr. Cho stepped in to bring the point home. “The hospital’s proposal will be very costly: more nurses, better training on the new computer medication system and contingencies for staff shortages due to illness. The hospital has promised us that they intend to do whatever it takes to minimize the risk of medication errors. I’m not easily persuaded; I think my colleagues here would tell you as much. But I am persuaded that the hospital has every intention of making something good come out of Ariel’s ordeal.”

Catherine looked at Mark, trying to get a sense of his take on what was happening in that small room. Unable to get a read on him, she took the lead. “Mr. Mess, you mentioned that you would like an opportunity to detail your plan for improvement. I don’t think we would be averse to such a meeting,” she said, looking to Mark for approval. He raised one eyebrow as she added, “Of course we will be inviting our legal counsel to be in attendance.”

“Naturally. Both you and the hospital ought to have legal counsel at the meeting,” Mess responded matter-of-factly. “However, I want to stress that the purpose of the meeting is to share with you our explicit plan to redress our errors.”

Mark had heard enough. “Sure. We’ll meet with you — but after Ariel is well enough to go home. We’ve already spent more time away from her than I’m good with. This meeting is adjourned.” He nodded to his wife, took her hand and proceeded toward the door. Then he turned back and said, “Oh, and I expect Dr. Smith here to be at that meeting. Consider it a requirement.” Then he and Catherine headed back to their baby girl, who was sleeping soundly in her crib.

* * *

Ariel Arkin made the kind of speedy recovery for which the very young are famous. On Friday, when all indicators pointed to the trouncing of the staph infection, Drs. Cho and Smith sent her home with instructions to her parents to have a CBC — complete blood count — done daily for the next five days. As a courtesy, they arranged for the physician’s assistant who had worked with Ariel to do the blood draws at the Arkin home. The discharge orders also indicated that the parents should not hesitate to call either doctor should any questions arise. To drive home the point, the doctors’ work and home numbers were provided. An office visit with them both was arranged for the following Monday.

The moment Sarah got word that the meeting with the parents had gone as she’d hoped, she asked John Mess to assemble an ad hoc committee to hammer out the improvement plan. The directors of nursing and pharmacy were appointed, as was Albert Cappelli. His long experience as a working pharmacist and his jaundiced view of the new computer system provided a perspective Sarah felt was needed. The head designer of the BCMA system, Rob DiPerna, flew in from his Kansas City corporate headquarters. The hospital’s vice president for finance and budget, Ted Ainslie, was added to provide fiscal parameters to the group. Mess was nominal leader of the committee.

Their working sessions were long and sometimes contentious. The head of nursing, Aimee Sackoff, though happy about the prospect of hiring more nurses, rankled at the idea of prohibiting mandatory overtime. She argued that even with new hires, unforeseen things were bound to happen, and her charge nurses needed the authority to assign back-to-back shifts. But Sarah had done her homework. The state legislature was poised to outlaw required overtime. She pointed out the benefit of getting in front of the law’s passage, making the hospital look proactive — rather than recalcitrant — in dealing with the problem of fatigue in the nursing ranks. Given that, Sackoff got on board.

To her credit, Joanne Marsh threw herself into making the BCMA system live up to her claim of it being “nearly foolproof.” Albert Cappelli’s sense of having seen it all, as well as his part in the overdosing error, gave him a unique role and a stake in the whole project. When Rob DiPerna espoused the elegance of the program’s design, Cappelli was there to remind him of how things really worked in a busy urban hospital pharmacy. And, as Cappelli readily admitted, elegant design meant nothing when hospital staff put more faith in their own judgment than the judgment of software designers in Kansas City.