Hospital Ship (The Rim Confederacy #5) (14 page)

At 1600 hours, in the large conference room on Deck Twenty-four, the Mortality and Morbidity monthly meeting was filling up with doctors and staff, and as each came in, they found their place cards and sat, files put in front of them, ready for reference. Each of them usually then looked at the thick Agenda document that lay in front of them. As usual, each turned to their own section and read, and there were some real shocked looks and some audible sighs.

Maddie noted the doctor in charge of the Radiological Services area looked especially upset as she should be and that the ER doc was all smiles.

More than once, she remembered, the faces had changed during the meeting, and that was still a possibility today too.

She busied herself at her side table, nodded to a steward who held up a carafe, and said, "Black," when asked what she wanted in her coffee.

Moments later, in walked the chief of medicine for the Barony Hospital Ship, Dr. Zacrom Mendoza, an average-sized man of no real distinguishable features. He was seventy-two years old, with graying, thinning hair, and as a cardiac surgeon, he had made the best of his time and his career. He had risen through the ranks from the College of Physicians & Surgeons more than fifty years ago to now being in charge of the complete medical administration here on the ship. He wore, as they all did, scrubs, but he always had a half lab coat on too, pure white with only his name on the left breast pocket.

He smiled at the group of more than fifty doctors in front of him in the room from his place at the head of the table and said simply, "Let's get started, shall we, Doctors?"

He looked down at his Agenda and said as he always did, "For the record, this is the monthly meeting of the Mortality and Morbidity group here on the Barony Hospital Ship. As usual, this is our peer review of mistakes occurring during the care of patients. The objectives of a well-run M&M conference are to learn from complications and errors, to modify behavior and judgment based on previous experiences, and to prevent repetition of errors leading to complications. And as always with the Hospital Ship, our conferences are non-punitive and focus on the goal of improved patient care. The proceedings are generally kept confidential by law," he said.

Nods happened all around the table, and he turned to Maddie.

"Please note, Maddie, that we have ...ah, full attendance, I believe, correct?" he said.

She nodded and said, "Yes, Doctor, all are here."

He nodded back and looked to his far right at the ER section chief and said "ER, please present your monthlies," and he then sat back to listen.

The doctor who ran the ER on the Hospital Ship nodded and then referred to his own files and gave the breakdown of the full medical care the ER had provided over the past month.

Number of patients broken down by triage as to their ailments and injuries; numbers of simple ins and outs, and the percentage was as usual a good ratio; numbers of more detailed maladies then took him almost a full half hour to present and discuss. He said as a simple matter of fact they had issues trying to get other sections to respond STAT at the needs that their patients had presented. This was a standard issue from ER—never fast enough response times from Radiology or Surgery or Psych. But that would never change, yet the head of ER pushed for better response times from all.

Maddie made the notes for the minutes, and on her sheet, she just put SERC, which stood for "standard ER criticism" and later when she'd make the full minutes out, she'd put in the standard four or five paragraphs like she always did. As she wrote, Dr. Mendoza called the next section.

The Research section, headed up by Principal Research Scientist Alex Toombs, always had a spot on the Agenda, but as usual, he didn't have much to report. As they were not involved with patients—human or alien patients not the Garnuthian mice that they imported by the hundreds of dozens—they had little to report. As usual, Toombs was short and curt and didn't bring any files or notes, nor for that matter had he even looked at the Agenda. He had to be here, yet he looked down on medicine from his purely research-only pedestal. The fact that he had an MD after his name mattered not a whit to him; he lived and died for research. This meeting was a waste of his time, and his whole demeanor and attitude was that of someone who was not here by choice.

Dr. Mendoza thanked Toombs as usual with a slight hint of sarcasm in his voice and then called the next section.

Surgery was a difficult section; there was no doubt about that. By the time a patient got to Surgery, they were sorely in need of help by the most talented of doctors, surgeons. Cardiac surgery, neurosurgery, orthopedics, plastic surgery—all areas that were here to establish and review deaths as part of professional learning and have the potential to provide hospital boards with the assurance that patients were not dying as a consequence of unsafe clinical practices.

Section after section went by, and the numbers presented were all, Maddie noted, within some kind of normality when it came to deaths. Not one single case of poor doctoring appeared at all.
So far, so good
, she thought.
And now to the big one ...

"Fine, ICU, well presented," Doctor Mendoza said and then said, "Radiology is next," and he once again sat back to listen.

"I must say, right up front, that this is wrong. The numbers shown stand for themselves and I will not—Radiology will not—accept this kind of karma. We are the best in the RIM for what it is we do," Doctor Maria Cotton said loudly. She flipped the Agenda away from her, and it sailed halfway across the table.

Doctor Mendoza let that sit for a moment.

"From my understanding, Doctor, nuclear medicine imaging involves the administration into the patient of radiopharmaceuticals consisting of substances with affinity for certain body tissues labeled with radioactive tracers. The most commonly used tracers are technetium-99m, iodine-123, iodine-131, gallium-67, indium-111, thallium-201, and fludeoxyglucose. The heart, lungs, thyroid, liver, gallbladder, and bones are commonly evaluated for particular conditions using these techniques, and you and your department have messed up, Doctor. Again. Once more. As usual," he said and held her gaze.

She squirmed. She shook her head negatively and then choked back an answer. And then another. Finally, she looked up at him from her spot halfway down the long table.

"Doctor Mendoza, it was not our fault. Yes, we did lose more patients, and yes, it was again larger numbers than we would ever want. But simply, our radiologists had their hands tied in the specific area of the liver disease, Doctor. As you know, our PET scanning, also a nuclear medicine procedure, deals with positrons. The positrons annihilate to produce two opposite traveling gamma rays to be detected coincidentally, thus improving resolution. In our PET scanning protocols in the past month, a radioactive, biologically active substance went undetected within the media. It made the fusion with our anatomic CT scans to be inaccurate, and we missed our PET findings and hence our diagnostic accuracy was compromised."

She shrugged.

"And we lost five patients with liver disease—hepatitis all of them—and yes, we are aware, and we are in the process of identifying that substance and finding out where it came from, Doctor. Until then, we are at a standstill as we await new tracers."

She had a look on her face that if she said it, she'd lose her job, Maddie thought. She was upset, and if she had a reason to want to say more, she swallowed it.

Doctor Mendoza glared at her and then finally nodded in the silent room.

"First I've heard about any contamination, but fine. Maddie, I want the Purchasing Department head in my office soon as this meeting is over. I want the whole Radiology records for hep on my console at the same time. And lastly, I want those numbers to disappear, Doctor," he said and then nodded once more.

"Next section—Endoscopy, please" and the meeting went on.

####

"Captain, I knew I'd find you here," Lieutenant Irving said with a grin on her pretty face.

Today she was wearing the simple work blues of a navy lieutenant and had an extra button undone on her uniform top.

Tanner stared at her cleavage for a moment and then grinned at her.

"Lieutenant, yes, I suspect that after being here for a month and a bit, that one can always find me pretty easily. But why is it that you're looking for me?" he said.

He took another big slurp from his smoothie as he sat in the huge lobby rotunda of the Hospital Ship. He'd sit here for at least a couple of hours every day, watching the parade of patients and visitors and healthcare workers as they glided by on the walkway. Some, of course, walked while others were in wheelchairs and were propelled by family or friends. Busy, busy, busy, he always said, and he looked up at his lieutenant.

"Captain, if it's okay, could I take you for lunch, and could we catch up? So much is new—and I feel like I want you to know, too," she said and her voice was almost plaintive, he noted.

"Absolutely but only on the condition that I get the bill—agreed? Let's call it a captain's prerogative," he said as he smiled back at her.

She cocked her head to one side and then nodded. "Okay, then about noon up at the CPR Cafe—will that be okay?"

"Agreed. See you then."

As she walked away, Tanner had the distinct impression that she had lots of news. An hour and a half later, he was proved correct.

They'd started with appetizers, and he smiled and shook his head no when asked if he'd like a cocktail. Instead, he had a Virgin Caesar and smiled as he asked for it extra spicy. Most folks thought this would mean more Tabasco, but he knew—as he hoped the bartender knew—that what he really wanted was extra Worcestershire sauce. The lieutenant had a nice glass of the house Pinot Grigio, and his Caesar was dark brown instead of the red that most Caesars were, and he knew he liked this bartender.
Too bad, I'm no longer trying to be a drinker
, he thought and smiled as the spiciness of the drink settled in.

"Now, Lieutenant Irving—Nancy if I may, what is so new that you came to find me? New and important—not your ears, right?" he asked suddenly aware she may be having some health issues.

She leaned forward and patted the back of his hand. "Oh gosh, no, Captain. Not my ears at all—it's that I'm in love!" she said and those green eyes of hers flashed as she broke into a long story.

She'd met a nice young man right here at the Hospital Ship named Nathan Ward, and he was a Barony scientist who worked here in the "secret lab" that no one knew about. She had no idea as to what it was he worked on, other than he appeared to be in charge of the Animal Testing lab—whatever that was, she claimed. They now virtually lived together after being a couple for almost six weeks, and she was head-over-heels in love she said. He was tall and fair and yet still had all his hair. Tanner wondered at that comment, but then he thought that yes, most scientists pulled it out as they were unsuccessful in their work. They were already planning their future and yes, they intended to marry one day soon too.

That made him think for a minute about his own lack of a life partner, and he realized that down the road he'd be feeling sorry for himself. In less than another minute, he twisted out of that trap, and only then, he noticed a hand had crept down his leg to sit above his knee and his fingers were doing the one-two-one tapping.
Works
, he thought and then noticed the lieutenant was looking at him as if she had asked a question. And he missed it.

"Sorry, Lieutenant—I ..." He shook his head.

She nodded and her smile was still there too. "What I said, Captain, was enough about me—what about you?"

Before he could answer, a couple of servers arrived with their lunches, and it took a moment to arrange the fajitas, tacos, and burritos.
A big lunch indeed ...

Gathering some guacamole into one of his tacos, he nodded at her and then smiled.

"It appears that we're both getting by nicely," he said, "and that is really a good thing. I have been told that I'm doing fine in therapy; that my group is nicely progressing; and that in the grand scheme of things, I think I'm going to be okay. That, and yes, I want the captaincy of the
Atlas
back for sure. That I know for sure!"

He gulped the last piece of the taco and washed it all down with a big slug of his Caesar.

He changed the subject as something jutted into his consciousness.

"Lieutenant, your scientist fellow—did you say he's in the Animal Testing lab?" he asked.

She nodded. "As far as I know, he says he starts a new batch of some kind of vaccine test weekly, then has to kill all the Garnuthian mice at the end of the week, rack by rack, he says. I know that scientists don't much care about their test animals, but I think that's plain stupid. But that's the only thing about my Nathan that is a bit of an issue. But that's science I guess ..." she said and Tanner nodded in agreement.

After the Mexican lunch feast, they shared a crème brûlée served with two spoons, and they nodded to each other over story after story about
Atlas
crew. They finished off laughing about some of the marines and how they all snapped to attention all the time.

Guess we're bonding is what this is,
Tanner thought and smiled often that day.

CHAPTER FIVE

As he sat in the psychiatrist's office, this homage to bland, he really had nothing on his mind.

Except,
he thought as he made a list,
the thing about me and a sidearm, me and my love of Black Scotch, me and how I feel about killing those hundreds of Navy crewman years back in the Earldom of Kinross, me and what I did on Halberd and killing a woman that I had feelings for, and then there was the whole OneTon bar-room brawl. Or what someone told him about that night.
He shook his head.

Nothing to worry about at all,
he thought and he watched as Dr. Etter continued to read from his tablet and made some notes.