Public Anatomy (9 page)

President Daffner put his fingers to his lips in the shape of a triangle. The lawyer, pen poised to paper, stared at Liza, eagerly awaiting her reaction.

Largo continued. “The complication, at least the initial chaos, was broadcast on the Internet.”

The chief of staff shook his head in obvious regret of the decision to contract with SurgCast. “We are receiving numerous calls from patients.”

“Calls?” Liza asked.

“Yes, calls, Dr. French. Patients are canceling their appointments and their operations. And it goes beyond just the OB/GYN department.”

Downing removed a newspaper from his briefcase, slid it across the table. It came to a stop in front of Liza. On the front page, in bold letters:

Second Operating Room Death at Gates Memorial Hospital

The subheading was even more damning:

Botched Procedure Broadcast Live on the Internet

Liza blew out a pent-up breath.

She knew this would be the end of her robotic surgery program. She couldn’t yet fathom what this meant for her career, much less the reputation of the hospital.

Largo reached across the table for the paper. He handed it back to Downing and said, “We want to hear from you what happened in the operating room.”

They waited for her answer.

It was hard for her to even think about the operation without seeing flashback images of uncontrolled hemorrhage, the ensuing chaos, her looking at the clock to pronounce the time of death. She knew these men represented the interests of the hospital and the university, but Liza did not feel as though she was among allies.

“The case was proceeding very well,” she began. “A routine hysterectomy, really.”

Downing cleared his throat, the first of many interruptions. “How many of these,” he stopped and made double quotations with claw-like fingers, cases have you performed, Dr. French?”

She knew where he was going with this. He obviously wanted to invoke the incident from six months ago.

“Mr. Downing, I have completed over two hundred hysterectomies, if you must know.”

French and Downing locked in a stare down.

“And how many with the robot?”

After a brief hesitation, “Twenty.”

A grin appeared on the attorney’s face as though entertained by his next question.

“Does that number include only the patients that lived?”

Largo put both hands firmly on the table. “That’s enough. We’re all aware of the death that occurred a few months ago. Fortunately, we moved past that without a scratch. Let’s focus on this case, shall we?” He glanced at Downing. Then he said, “Please, Dr. French, continue.”

“I had removed the uterus and was about to start closing. My assistants began removing the instruments from the patient’s abdomen.”

Liza stopped.

They waited.

“All of a sudden, there was blood everywhere.”

“Blood, everywhere?” Downing repeated. “Can you be a bit more specific, Dr. French?”

“We had not yet removed the camera from the patient’s abdomen. I saw a flash of blood. Then, the entire screen was red.”

“Where were you at that moment?”

“I was in the OR, of course.”

“What I meant was,” Downing clarified, “where in the operating room?”

“I was at the robotic console, monitoring the procedure. What are you getting at?”

“Is monitoring the same thing as supervising?”

Irritated with his questions,” Liza asked, “What?”

“Were you in control of the operation, Dr. French?”

“Yes, I was.”

Downing hesitated a moment. “What else was going on in the room?”

“The nurses had begun to count the instruments, usual proceedings for the close of an operation.”

Until now, the president of the University of the Mid-South had not spoken a word. “Were personnel from SurgCast still present?”

Liza immediately knew the focus of his concern. A hospital-related death was one thing. A worldwide Internet preview of the death, boasting the university’s seal, was leagues above the concern of one individual or one family.

“Yes, sir,” Liza answered, “they were filming the procedure.”

President Daffner closed his eyes, pressed his fingers together so tightly beneath his chin that the skin turned white.

Downing struck again. “Why did you not supervise removing the trocars?”

“That is a routine part of the procedure. I allow the surgical resident to remove the instruments.”

“Doesn’t sound routine to me, Dr. French. Isn’t this when the patient died?”

Liza had already answered this question before. Or thought she had.

“Describe to us how this could happen, please.”

“I don’t really know.”

“You don’t know? You’re the attending surgeon. Your patient dies on the table, and you don’t know what happened?”

Liza was hesitant to speculate. After the death, she had drilled Thomas Greenway, her chief resident, with these same questions. Cate, the medical student, was still too traumatized to give any detail.

“The autopsy should define the injury,” Liza added.

Largo leaned forward. “Humor us, Liza. What do you
think
happened?”

“One of the trocars must have injured an artery. It hardly seems possible because the trocars were being withdrawn, not plunged deeper into the abdomen.”

“What were you doing at the exact time the instruments were removed?” Largo asked.

Since Downing had already posed that same question, he gave Largo a what-the-hell kind of look.

But Liza gave a very different answer to Largo.

“I was answering an e-mail question from a prospective patient.”

Largo leaned forward, looked as though he might throw up. “An e-mail?”

“Yes.” By the looks on their faces, the men did not know that e-mailed questions were allowed during operations webcast by SurgCast. “We had time for one more question. I was answering it when the problem occurred.”

Downing dropped his pen on the legal pad. “We might as well write the check. Pay them whatever they ask for.”

They wanted him to explain.

He did.

“We can’t defend this. Our surgeon is playing talk-show host while a trainee finishes the operation? And I mean finishes it.”

He glanced at Largo, then the president. “Hope you have millions in malpractice reserve. That’s what it’s going to take.”

Liza wasn’t ready to concede. “I believe the surgical instrument contributed to the death.”

“Excuse me?”

“This had to be a malfunction of the robotic equipment.”

“Dr. French, I reviewed your statements after the first death, six months ago,” Downing said. “You claimed device failure in that case as well.”

“That’s right and—”

Downing cut her off. “I have researched the company’s records. They have had no other such claims. Their quality control is excellent. Spotless, actually.”

This squeaky-clean talk made Liza nauseous. “I’d like to switch to different equipment for future robotic operations.”

“Future operations? You don’t get it, do you, Dr. French?”

Liza sensed they weren’t telling her something. Something big. She had expected her robotic program to be in jeopardy. And suggesting an alternative plan was her only hope for saving it.

Largo delivered the news. “We’re forced to withdraw support from your program, Liza. There’s no way to continue the program given the negative press. Besides, we have larger issues to face.”

Largo hesitated briefly, but just long enough for Downing to take over.

“We received a call yesterday. Criminal charges have been pressed against you and the hospital.” Downing allowed a slight grin to cross his face. “Your little incident has attracted the attention of the FBI.”

Fourth-year medical student Cate Canavan unlocked the deadbolt and entered the Poplar Avenue Free Clinic. Behind her, a line of patients ten deep waited to enter the same concrete structure that, for years, had supplied the same clientele with discount beer and tobacco. Some of those now gathered had slept there through the night, at the edge of the parking lot, asphalt still baking from the previous scorcher.

She saw a couple of familiar faces. Foster, the kind man who came to the clinic more out of habit than medical necessity. He’d never embraced the reality that the beer and tobacco store was no more. Beside Foster stood The Meatman, four of his left fingers chopped off at a slant from an improperly wielded meat cleaver. Most people called him Meat. Cate thought The Meatman sounded more proper.

It was twenty minutes after six o’clock in the morning. The clinic usually opened at eight. By then, the temperature would be soaring to near ninety degrees, and Cate’s homeless patients were already hurting. She turned to face the line and saw others crossing the four-lane avenue toward the clinic. Cate watched Mary Macklin pushing her shopping cart across the pavement, mumbling to herself as usual. In her path stood Joey the Flicker, named for the cigarette lighter in his left hand that he nervously flick, flick, flicked. The tip of his left thumb was a seared leather rind. Mary banged the cart into his leg and Joey stepped aside.

To no one in particular, Cate called out, “Just give me a few minutes.” Then she closed the door behind her. She felt the immediate rush of cool air. Even though the city had mandated that lights and air conditioners be turned off in unused buildings, she was glad she had left one of the
window units on overnight. She knew the clinic would soon be full of bodies trying to escape the heat. She turned the unit on high.

A young man, mid-thirties, his hair long and dirty, stood at the window with vacant eyes fixated on her. She gave him an unconvincing smile and turned away.

Since the clinic had opened six months before, this morning marked the first time Cate was there alone. The free clinic was a project she and a handful of students had imagined their first year of medical school. It was their way of righting the injustices of health-care disparity among the uninsured poor. Now, three years later, after raising money to buy the building, gaining the support of a few medical school faculty members, and fighting a court-ordered injunction citing the building code, the Poplar Avenue Free Clinic opened. Finally, it was gaining a reputation as a compassionate emergency room alternative for care of the city’s most indigent.

Through those three years, however, only a handful of other medical students had stayed the fight. Faculty attendance and supervision at the clinic were scarce and infrequent. Most of the burden fell to the few dedicated students and Cate took on more than her share. While her classmates were kicking ass on specialty rotations so they could get the best residency spots, Cate signed on for two months of indigent clinic rotation, time she feared would be highly suspect as “unfocused” to most top-notch residency review committees.

She peered through the dirt-speckled window. As a female, she felt frightened being alone while a mostly male group waited outside. But she knew that these were the people most in need of care and that she was the only one to provide it. She felt strangely comforted by the sight of Mary pushing her cart past the line, mumbling the select words that comprised her favored vocabulary.

Mary Macklin had become an unsolicited assistant in the clinic early on after proclaiming that she had been a “full-blown” nurse in a previous life. Every day, she pushed herself past those waiting, as if she had risen above them, even though she was just as needy as they, if not more so.

The clinic space occupied one large square room that led into a small break room, added on during the renovation, its pantry serving as a
medical supply closet. Curtains hanging from the ceiling on sliding metal tracks provided the only privacy for a patient during an exam. A metal desk at the entrance marked the reception “triage.” Since the heat wave began, all who came—after receiving a number specifying the order in which they would be seen—got to wait in the luxury of air-conditioning.

So far, the Poplar Avenue Free Clinic had been lucky and missed the rolling blackouts initiated across the city. Although the clinic lacked sophisticated equipment, surplus and slightly-out-of-date medical supplies had been donated from hospitals throughout Memphis. This outward act of benevolence definitely furthered the best interest of these hospitals if it succeeded in keeping just one more uninsured patient from adding to their already crowded emergency rooms. Cate’s clinic had IV fluids, antibiotics, and samples of antihypertensive medicines from generous pharmaceutical companies. Even the fire department had pitched in, donating an early model defibrillator. Cate thanked God she had not had to use it—yet.

There were even a few pills of Viagra to hand out. Cate had sequestered this box in the back cabinet, consciously choosing not to take on erectile dysfunction as the clinic’s main medical mission. She shuddered to think of the consequences of resurrected sexual function in this group.

Cate entered the break room to assess the dwindling supply of bottled water. She turned on the light and immediately noticed that a wicker basket had been placed on the table. A large plastic daisy projected over the handle with “Congratulations” stamped in the fluorescent yellow circle.