Fertility: A Novel Read online

  They were interrupted by a knock on the door. A tall, good-looking black man dressed in nursing scrubs popped his head into the conference room.

  “Hello, is Joyce Hilker in there? I’m her union rep, Cletus Jackson. Joyce has the right to representation in this interview.”

  Sarah knew that the union rep was legally correct, that under the Supreme Court’s Weingarten ruling any unionized employee who might face discipline as the result of an interview with her employer had the right to have a union representative present. But Weingarten rights can be waived. The question was, would Hilker do so?

  “I need to speak with Joyce before your interview continues,” Jackson stated firmly. It was clear he knew the nurse’s rights as well as Sarah did.

  Although she was irked, Sarah showed no hint of her annoyance. “Of course.” She turned to the nurse and said, “Ms. Hilker, as Mr. Jackson states, it is your right to have him present at this interview. You can also waive that right. Would you like a moment to think about it?”

  “I’d like to talk with Joyce for a moment so she can make an informed decision — as is her right,” he said to Sarah, emphasizing his last words. Then he turned his attention to the nurse. “Joyce, let’s have a word out in the corridor.” It was more of a command than a suggestion.

  The nurse hesitated for a moment and then said to Sarah, “I’d like to confer with Clete. It’ll only take a few moments.” She left the conference room, closing the door behind her. Sarah turned off the recorder and gave Doris a “Who-needed-this?” look.

  * * *

  When the nurse returned, she had Cletus Jackson at her side. Sarah welcomed him to the table, suggesting that he sit next to Joyce Hilker. He unclipped a pen from his yellow legal pad and got ready to take notes. Sarah turned on the recorder and stated that the nurse’s union representative, Mr. Cletus Jackson, had joined the interview. She hoped the tenor of the interview wouldn’t be critically altered by his presence, all the more so now that they were getting close to the point where the heparin had been introduced to the baby.

  Sarah asked Doris to read back the last paragraph of the interview. Doris read the portion of Hilker’s statement about Dr. Smith’s discussion of the unknown origins of staph infections in newborns. That seemed to reorient both Sarah and the nurse. They were ready to proceed.

  Sarah asked, “What happened after the doctor’s explanation?”

  “He reminded them again that they should feel free to contact him throughout the evening, and then he left to enter the orders for clindamycin and heparin lock flush into the baby’s computerized chart.”

  “And what did you do?”

  “Well, I asked the mother if she wanted to try nursing the baby. I could tell that she was getting quite uncomfortable. A nursing mother has to nurse — or pump — or she risks getting mastitis. I put a new diaper on the baby and swaddled her in a receiving blanket.

  “As the mother opened her blouse and nursing bra, I saw her left breast was quite red — and apparently engorged with milk. I asked her if she had been nursing successfully until the baby became ill. She said she had, but that she usually had more milk than the baby seemed to need. I asked her if I could look at her breast more closely. The father got really jumpy then and asked if there was something wrong. I explained that a nursing mother who couldn’t empty her breasts could run into problems and I asked again if I could take a look. The mother agreed. I asked her to remove her bra, which she did. And that’s when I saw that she, too, had white pustules typical of a staph infection on the inside and underside of her left breast. Her right breast appeared engorged, but was of normal color.”

  The image of the inflamed, infected breast made Sarah squirm. It crossed her mind that she would have made a terrible doctor, given her aversion to suffering. She was only too happy to set aside the image of the diseased breast by asking Hilker what she did at that point.

  “Well, the mother told me she hadn’t noticed any white pustules earlier in the day. She seemed horrified, as did the dad. I knew Dr. Smith would want to see the mother’s breast and would likely want a culture from one of the pustules. I also knew it was unlikely he’d want the mother to nurse the child, given her condition. So I rang the call button and Tracy, the LPN I was teamed with yesterday, came to the door. I told her to get Dr. Smith back ASAP, which she did.”

  Sarah thought to ask for Tracy’s surname, but then she remembered Nancy Howland was already on the case. “And when Dr. Smith saw the mother?” Sarah prompted.

  “He was very concerned, but calm and patient, as he generally is with the patients and their families. He said sometimes newborns get staph from contact with their mothers; some people carry staph on their skin or in their nasal passages. Babies and their mothers can have concurrent infections. Apparently, this was the case here.”

  “Had the baby’s antibiotic — let me see, clindamycin — or the heparin been administered at this point?”

  “No, Dr. Smith had left to order it, but it hadn’t yet arrived on the floor.”

  “So what did Dr. Smith do, if anything, for Mrs. Arkin?”

  “He said that the mother would also have to be put on an antibiotic regimen. He told the parents that he wanted to consult with one of the hospital’s lactation specialists, but he thought it was probably best for her not to nurse the baby at that time. He said they could give the baby formula if need be. Then the mother got upset. Very upset. She said she couldn’t believe this was happening. Her husband tried to comfort her. Then he got kind of pushy and told the doctor to get that lactation specialist in the room right away. Dr. Smith said he’d do what he could and asked me to page the specialist. I took off my gown and gloves, disinfected my hands and left the room to page the consultant.”

  “And where was the infant at this point?”

  “She was in her crib.”

  “And had you or anyone on the floor administered any medications to her?”

  “The ER had started an IV for fluids. But we were still awaiting the clindamycin and heparin.”

  “And what time did you leave the baby’s room to page the lactation specialist?”

  Hilker thought a moment. “I really can’t say exactly. I would guess it was around 4:15 or 4:30.”

  “Were you successful in paging the specialist?”

  “Yes. She answered her page within just a few minutes. She said she would be at the baby’s room in fifteen minutes — which was amazing, considering it was a Sunday. I thought to myself that at least that baby and mother had caught a little break.”

  Cletus Jackson interrupted. “Joyce, remember to just state the facts as you remember them.” Sarah couldn’t tell if the nurse appreciated the union rep’s advice or found it a put-down. She nodded once and then waited for Sarah’s next question.

  “At what point did the heparin and clindamycin arrive on the floor?” Sarah inquired, drawing the circles of her questioning closer to the actual target of the investigation.

  “Well, that was the thing. The pharmacy technician actually brought the two orders right up to the floor. He said the new computer system had a glitch and wasn’t cooperating. The doctor had ordered them ‘stat’ so he ran them up to the floor himself.”

  Sarah couldn’t help but think of Joanne Marsh’s demonstration of the apparently foolproof system. “Is that an unusual thing for the pharmacy to do?”

  “It happens from time to time, but it’s fairly unusual. I thought the pharmacy tech was going the extra mile and I told him so.”

  “At what point were the clindamycin and heparin administered?” Sarah set her sights for the bull’s eye.

  Hilker looked at her union rep. Jackson nodded and the nurse proceeded, looking down at her hands. “I immediately gowned up and brought the meds into the baby’s room. I told the father that Dina Geissinger, the lactation specialist, would be in to see them very shortly. The mother was still sitting in the chair. She had the yellow paper gown covering her breasts and she was weeping. The da
d was pacing around the room and talking to someone on his cell phone very quietly — almost in a whisper.”

  “And where was Dr. Smith at this time?”

  “Dr. Smith was no longer in the room.”

  “And when were the clindamycin and heparin administered?” Sarah asked.

  At this point tears began streaming down Hilker’s face. She got a tissue from her purse and shook her head in resignation. “When I checked on the baby, she woke up with a start and began to cry. Both of the parents came to the crib to try to calm her down, but the truth was, they were so upset I’m not certain they were much help. I checked that both of the meds had the correct patient name. Then I hung the clindamycin from the IV stand and connected it to the catheter. As I was about to flush the IV with heparin, Dina Geissinger came into the room for the consultation.”

  Sarah interrupted her. “I understand the new computer medication system has bar codes that have to be scanned at every point. Did you scan the drugs before administering them?”

  Still looking at her hands, the nurse explained what had happened next. “I attempted to scan the medications. The clindamycin scanned, no problem. But the heparin wouldn’t scan. I remembered that the pharmacy tech said they were having a problem with the new system so I figured it was just a glitch. The system only started last Monday and we’re all learning as we go. As I said, I visually checked the patient’s name and medication name.”

  “And what about the dosage?”

  Hilker looked up from her hands and stared directly into Sarah’s eyes. “The label looked correct — 10 units per milliliter.”

  “So what did you do then?”

  “I flushed the intravenous line with the heparin to keep it patent — open.”

  “Who was in the room at this point?”

  “As I said, the parents and Dina Geissinger. But then the three of them left for an examining room. I checked the IV one more time before I took off my gown and gloves and left the room. The baby had fallen back to sleep by the time I returned to the nurses’ station.”

  “Do you recall the time you left the baby?”

  “Yes, it was five o’clock. I remember because I knew the cafeteria would be open and I could get a takeout dinner to get me through until nine. Of course, with all that happened after I came back from the cafeteria, I never got to eat that dinner.”

  CHAPTER SIX

  Joyce Hilker’s blow-by-blow account of the events that followed her return from the cafeteria stirred both dread and awe in Sarah. The mother’s screams brought Hilker running into the baby’s room, where she found her wailing, “Oh my God, oh my God, help my poor baby.” The nurse was joined by Dr. Smith, who immediately diagnosed the overdose and started treatment to reverse its devastating effects.

  Hilker finished telling her story fifty minutes after she began. If the nurse had looked tired at the start of the interview, she was drained when it was done. Sarah thanked her for her cooperation. She also thanked Cletus Jackson, shaking hands with them both as she saw them out. Then the agnostic Sarah offered up a silent thank you. The union rep had not, in fact, prevented the nurse from giving what appeared to be a thorough account of the events of the previous night.

  As she’d listened to Hilker’s description of the quick response of the medical team, particularly the work of the pediatric fellow, Sarah wondered what it would feel like to have the skills and knowledge to save a person’s life. Since her last boyfriend had taken a walk rather than entertain the thought of marriage, she had made work the center of her universe. Harry handpicked her to be his protégée last year and gave her more responsibilities than most associates — these interviews being a prime example. She knew she had a good shot at continuing to rise through the ranks of her firm. But she had no idea what it would feel like to prevent someone from dying. She had to be satisfied with protecting hospitals and their staffs from frivolous malpractice suits so that they could engage in their life-saving work. But it was clear that if this family decided to file suit, it would be anything but frivolous.

  She had just a couple of minutes before her next interview. How a mistake of such magnitude could occur was still an open question. From the scene described by the nurse — the frantic parents, the concurrent infection in the mother, the extra five hours tacked onto her shift — Sarah could imagine how an error could be made. She had to wonder if the nurse had really seen 10 units on the vial of heparin. Had it been mislabeled? And if so, who was responsible — the hospital pharmacy or pharmaceutical company? If it wasn’t mislabeled, had Hilker checked the dosage as she said she had? Could she have misread it due to fatigue? And why didn’t the computer system work? Were glitches really being experienced? Joanne Marsh led Sarah to believe the system was foolproof. Did the staff agree? She made notes to herself on all of her queries and was finishing the last one just as a pert, slim woman in her early twenties knocked on the open door. She introduced herself as Tracy Petersen, the LPN summoned by Nancy Howland. Sarah welcomed her into the conference room, showed her to a seat and excused herself, telling the young woman and Doris that she’d be back in a minute.

  Sarah wanted to lay eyes on the heparin vial, and the sooner the better. She made a beeline for John Mess, who was in his office adjacent to the conference room.

  “Excuse me, John. Where is the heparin vial that was used for the baby?”

  “Actually, I have it.”

  “May I see it?”

  “Of course, Sarah.”

  He got up from behind his large, cherry desk and walked to a closet next to the built-in bookcases. He opened the door to reveal a waist-high safe. Kneeling down, he entered several digits on the keypad, and the door opened. On the top shelf was a plastic zip-top bag. He handed it to Sarah. In the bag was a vial with a handwritten label showing the Arkin baby’s name and ID number, her doctor’s name and ID number, the date of dispensing and dosage of heparin: 10 units/mL. The label looked clear enough. However, when the vial was turned a bit there was a blue label from the manufacturer that read: Heparin, 10,000 USP units/mL. Clearly, Hilker never noticed the discrepancy. She handed the plastic bag back to Mess.

  “Thanks. There appears to be some inconsistency in the labeling.”

  “Unfortunately for us, there does, indeed.”

  “I hope to get to the bottom of that by the time I finish up this afternoon. Having a picture in my mind of the medication is a big help. Thanks. I’d better get back; I have someone waiting for me now.”

  Sarah found Tracy Petersen and Doris chatting amiably about the weather and how they both hated it turning cold so early in the season. Doris was such a pro. She knew exactly how to put people at ease — not only in interviews such as this one, which were often fraught with tension, but at their frenetic, high-stress office as well. She was one of the few people at the firm who looked up from working to welcome Sarah when she arrived five years earlier. They hit it off from the start and Sarah always enjoyed teaming with her. Doris was the only one at work who could make Sarah’s dimples show, a point Doris was only too happy to tease her about.

  Sarah gave her standard introduction and then asked Petersen some questions to get a sense of her relationship with Joyce Hilker. Apparently, they had worked on the same floor for the last couple of years and were often paired together by the charge nurse, Jeannie Lopez. In Petersen’s estimation, Hilker was a great nurse, maybe the best she’d worked with. She was also a great teacher, a plus for an LPN studying to become a registered nurse.

  Clearly a fan of her partner and mentor, Petersen would likely hesitate to cite any faults or past errors. Sarah knew she would have to tread carefully when she went down that road in her questioning.

  “Yesterday Joyce Hilker was supposed to finish her shift at 4 p.m. What was your schedule?” Sarah inquired.

  “Well, lately I’ve been doing a noon-to-midnight shift. I know some people don’t like getting out of work that late, but it works for my boyfriend and me,” the nurse volunteered. “
He gets off work at 11:30 and picks me up right at the front of the hospital. But this weekend I was just trying to get some overtime, so I took an extra shift yesterday, 7 a.m. to 4 p.m.”

  “Were you asked to extend your shift yesterday?”

  “Oh, yeah. We were really shorthanded. That stomach flu hit a lot of us. I had it two weeks ago and I wouldn’t wish it on my worst enemy. Anyway, yes, Jeannie — the charge nurse — asked if I would do back-to-back shifts. I didn’t really want to because I’m on today at noon. But I could see she was really desperate so I said okay. Plus, the extra money always comes in handy.”

  “What was your interaction with the Arkin baby when she was admitted?”

  “Joyce did the admission by herself because I was busy with another patient.”

  “Is that the usual procedure?” Sarah asked.

  “Well, if we can, we like to introduce ourselves to the patient and the family together, but yesterday we were very busy and, like I said, short staffed,” Petersen explained.

  “So when did you start working with the Arkin infant?”

  “The first time I came to the baby’s room was when I answered a call that came into the nurses’ station. When I got there, Joyce was at the door and she told me to get Dr. Smith right away.”

  “And what did you do?”

  “Well, luckily he was at the nurses’ station entering some orders into the computer. I told him Joyce wanted him in the isolation room — and that sooner rather than later would be better from the look that Joyce had given me. I know that sounds kind of pushy, talking to a doctor that way, but Dr. Smith is a good guy,” Petersen said, smiling and nodding her head for emphasis.

  Another vote for Dr. Smith. “And did you accompany the doctor into the baby’s room?” Sarah asked.

  “No. I had plenty to do and Joyce didn’t ask for my help — just Dr. Smith’s. We hadW a lot of very sick kids on the floor yesterday — I mean really sick — so there was no way I was going where I wasn’t needed. Believe me when I tell you I had plenty else to do.”