Fertility: A Novel Read online

  Just as Sarah was thinking how human — and even predictable — these kinds of mistakes were, the bathroom door opened. Cappelli emerged wearing a look of defeat just as Joanne Marsh approached, seeming to take two steps at a time.

  “Joanne. It was me. I messed up. Look,” he said, pointing to the incorrectly placed box of heparin. “I grabbed the vial from the new box just like this,” he said as he picked out a vial from the 10,000-unit box, “saw the blue label and never double-checked the dose.”

  Marsh’s face and neck turned pink. She shifted her weight from one leg to the other and folded her arms in front of her. “But Albert, the BCMA wouldn’t allow you to fill the order with the wrong dose. You couldn’t have scanned it. It wouldn’t have scanned. That’s the whole point of the system.” She was almost pleading with him to tell her the system had worked.

  “Joanne, you’re right. It wouldn’t scan. I just thought it was a glitch in the system. How long have the 10-unit vials been on the third shelf of unit eighteen? You and I both know that they’ve been in the same place for years. I just grabbed it. When it wouldn’t scan I thought it was some kind of kink in the new system. And the label was blue. They’re both blue, they’re both blue,” he said, raising his hands in the air. “That’s why we always store the two doses on different shelving units.”

  “Who did the stocking of the shelves yesterday?” the head pharmacist asked.

  “The new fella, Alejandro,” Cappelli replied. As soon as Cappelli said the name, he knew Marsh would make quick work of him. “But he’s a good kid, Joanne,” Cappelli quickly added. “He ran the scripts up to the floor because I knew the doc wanted them stat. He did everything I asked of him yesterday — and he was nice about it, too. You know, no attitude like some of the young guys. He volunteered to restock the shelves without even being asked. He’s a hard worker. He’s gonna feel terrible when he finds out. He’s not devil-may-care about things, Joanne. He takes the job seriously.”

  Sarah could see Marsh’s impatience rising. “You’re being far too understanding, Albert. All the techs have had training in using the BCMA. He was instructed to scan every medication before placing it on the shelf. Had he done what he was trained to do, there would have been no way for him to mistake the 10,000-unit vials for the 10-unit vials.”

  “You’re right, but it’s not as though a computer system can’t have glitches. Name one system that doesn’t fail from time to time. We just started it up last week and we’re still working out the kinks. When it wouldn’t scan for me, that’s what I assumed — it was a kink. And maybe Alejandro figured the same as me,” Cappelli responded, defending both himself and the young technician.

  Marsh had reached her limit. “Albert, the point of the system — when used as designed and as the staff was trained to do — is to prevent careless errors. If the tech had used the system — and if you had, for that matter — we wouldn’t have a critically ill baby in the peds wing right now. This was human error — the tech’s error, your error and for that matter, the error of the nurse who administered the heparin. None of you used the system as it was designed. And if you had, the error would have been avoided.”

  Cappelli was in no shape to argue. He accepted his culpability and surrendered. “You’re right, Joanne. We messed up. I messed up. I’m so very sorry.” He turned to leave, shaking his head. Then, as though he’d forgotten something, he turned back and took Sarah’s hand in both of his.

  “Good-bye, Ms. Abadhi,” he said before bowing his head to his supervisor and heading for the exit.

  CHAPTER NINE

  Alejandro Avila was scheduled to work that day from 3:30 to midnight. Sarah knew Joanne Marsh wanted to hit Avila with both barrels as soon as he walked through the door, but Sarah needed to talk to him before he realized he was in trouble. She told Marsh to hold her fire until the pharmacy tech had a chance to tell his side of the story. Marsh agreed, as long as she could be in the room when that story was told. Sarah acceded to her condition, provided that Marsh remain mum during the interview. They arranged for the pharmacy tech to be sent up to risk management when he arrived.

  Sarah answered the knock on the conference room door at 3:35 to find a skinny kid with curly black hair blinking furiously and biting his lip. He reminded her of the high school boy who mowed her parents’ lawn. It was hard to fathom that this young man was the pharmacy tech whose actions had caused so much harm. Sarah showed him in and directed him to a seat at the table. She introduced herself and Doris. In keeping with their negotiated deal, Marsh said nothing. As he sat down, the young technician said, “Hello, Mrs. Marsh,” without making eye contact.

  Before Sarah could give her standard introduction, Alejandro jumped the gun. “Am I in trouble? Did I do something wrong?” he asked anxiously.

  “Alejandro — is it okay if I call you Alejandro?” Sarah asked.

  “Sure, sure.”

  “Alejandro, we’re investigating a medication error. We would very much appreciate it if you could help us out.”

  “Sure, I’ll help any way I can.”

  “Good. Do you remember the scripts for baby Ariel Arkin that were filled yesterday?” Sarah asked.

  “No. I can’t say I do. Sorry.”

  “Maybe I can help jog your memory. You delivered them in person to the pediatric wing late yesterday afternoon.”

  “Oh, yeah. Now I remember. Albert — Mr. Cappelli, I mean — said they needed them in a hurry and to hightail it to the nurses’ station on Four.”

  “Do you remember anything else about those scripts?”

  “Just that Albert — Mr. Cappelli — said there was a glitch in the computer system, so he had to hand label one of them,” the boy explained. At that point Marsh let out an audible sigh, and Sarah gave her a warning look.

  “Yeah, I ran up the stairs two at a time. When I got to peds, I handed the meds off to a blond nurse at the nurses’ station. I told her one was hand labeled because the computer system wasn’t cooperating. She thanked me and I was back in the pharmacy in no time flat.”

  Sarah could see the boy start to relax as he told the story of how he’d followed his orders to the letter. She was reluctant to question the obviously well-intentioned tech about his method of stocking the shelves, but she knew that if she didn’t get to it quickly, Marsh’s fuse would likely blow.

  “Alejandro, did you restock any medications yesterday?” Sarah inquired, with as much nonchalance as she could muster.

  “When I came in at 3:30 yesterday, things were a little slow, so I asked Albert if I could get some of the inventory onto the shelves. He said, ‘Sure,’ so I did some restocking until things started to pick up.”

  “Do you recall putting some heparin on the shelves?”

  “Yeah, I sure do. It was the last thing I restocked.”

  “And can you tell me how you restocked it, that is, what dosage it was and where you put it?”

  “Definitely. It was a box of heparin, 10 units. I knew it was 10 units because that dose has a blue label. I learned that at my first pharmacy job back in my neighborhood.”

  “And do you recall on what unit you shelved the heparin?”

  “I checked the stocking guide. I don’t remember the exact number of the unit but I know it was near the front. Let me see,” he said thinking, “maybe on the third shelf. I’m trying to remember. Yeah, one of the units in the teens, like seventeen, eighteen, something like that.”

  Sarah could see Marsh’s impatience grow. She had better ask the critical question. “When you restocked the heparin, what procedure did you follow?”

  “Procedure? Oh, you mean the BCMA procedure?”

  “Yes, the BCMA procedure.”

  “Well, that’s the thing. For everything that I stocked yesterday, I followed the BCMA procedure just like I was taught and it worked perfectly. I scanned the bar code on the box and then scanned the bar code on the shelf label and everything went great. But when I scanned the bar codes for heparin 10, it wouldn�
��t work. I was trying to figure out why when it got real busy in the pharmacy all of a sudden. It goes like that — quiet, quiet, quiet, then all of a sudden all hell breaks loose.”

  “So when it wouldn’t scan, what did you do?” Sarah asked.

  “Well, I left the box on the shelf and took care of an order for Mrs. Pollack. She was one of the other pharmacists on duty yesterday.”

  “Did you inform anyone of the problem with the scanning of the heparin?”

  “No. I mean, I meant to, but as I said, we got really busy and we stayed busy until my shift ended at midnight. I didn’t even take a dinner break.” Looking at Marsh and then Sarah, he added in an almost plaintive voice, “I guess I forgot all about it. I’m really sorry.”

  At this point Marsh broke in. “Mr. Avila. What did you learn in the training session about meds that wouldn’t scan?”

  “Well, they said that if it wouldn’t scan it was probably because something was wrong.”

  “Did you consider that perhaps you were making a mistake when the scanner wouldn’t accept the box of heparin on the shelf for 10 units?”

  “Well, not really, since the blue label is heparin 10. I’m sure of it. And all week I’ve been hearing other people in the pharmacy say they were having trouble making the BCMA system work for them, so I figured that was the reason it wouldn’t scan,” Alejandro explained. It was evident that the logic of his thinking gave him some hope that he was not in trouble with his new boss.

  Marsh was outraged. “Mr. Avila. Today we discovered the reason that the box of heparin wouldn’t scan.” With contempt dripping from each word she added, “And it had nothing to do with a BCMA system failure. The box you left on the heparin 10 shelf contained vials of 10,000 units of heparin.”

  “It did?” the young man asked incredulously. “No way,” he protested. “Heparin 10 has a blue label. Blue is 10 units. It is.” He was almost pleading with Marsh.

  Sarah jumped in. “Unfortunately, Alejandro, the label of heparin 10,000 is nearly an identical blue. The reason the heparin wouldn’t scan was that you stocked 10,000 rather than 10 units on the shelf.”

  * * *

  A scapegoat had to be found, and at the end of the interview, Alejandro Avila, the eager-to-please young pharmacy technician — a probationary, at-will employee — was told by the head pharmacist to clear out his locker and hand in his security tag. For good measure, she added that if he even thought of using her or the hospital as a reference, she would make sure he was never hired by any pharmacy in the tri-state area. For the final blow, when Avila opened the conference room door to leave, there was a security guard present to escort him out of the hospital. After he left, Joanne Marsh headed straight for John Mess’s office. Sarah guessed she was on a mission to mount an offensive, laying all the blame at the feet of Avila, and absolving the system she touted as foolproof, even in the hands of a wet-behind-the-ears pharmacy technician.

  CHAPTER TEN

  Sarah and Doris needed a break after the Avila interview. The two women were a study in contrasts as they made their way to the “two holer” down the hall. Sarah, tall, tailored and serious, matched her short, matronly and agreeable colleague step for step.

  After coming out of the stalls, they stood side by side washing their hands. It was Doris who brought up Alejandro Avila.

  “I know, Sarah. He made a terrible mistake, but I feel sorry for that young man.”

  Looking at herself and Doris in the mirror, Sarah nodded as she dried her hands and pushed a lock of her dark, curly hair from her face. “He seemed like a well-meaning guy, but he set in motion a terrible chain of events.”

  “True enough, but it was an honest mistake. His only real error was not asking for help when the labels wouldn’t scan. But even then, he explained how they got so busy. He probably figured he was going above and beyond by stocking the shelves when it got slow. He could have just as easily sat there playing with his phone until things picked up. You know, a lot of kids his age would have done just that. Anyway, I feel bad for him…and of course, the poor little baby, too. It’s a very sad story, any way you look at it.”

  “That it is,” Sarah said as she and Doris simultaneously took their lipsticks from their purses and each applied a new coat. “I think that will have to do for our beautification, Doris. We’d better head back just in case that Dr. Smith is on time. I know,” she smiled, making her dimples show, “it’s a long shot, but we can hope, can’t we? The faster he gets in, the faster you can go home.”

  “Frankly, I can’t wait to go home. I’m gonna put my feet up, have a glass of merlot and do my best to put what I’ve heard today behind me.”

  * * *

  The women’s hopes were realized just a few minutes later when a panting man entered the conference room and introduced himself as Rick Smith. He looked like something the cat had dragged in: unshaven, his dark hair tousled, his blue jeans and Columbia sweatshirt having seen better days. If he had the look of someone who had just rolled out of bed, it was because that’s exactly what he had done — just minutes earlier. He’d run all the way to the hospital.

  “Would you like some coffee, Dr. Smith?” Sarah asked.

  “No thanks,” he said, begging off. “I’m hoping to go back to sleep after we’re done here.” Seeing the quizzical look on the lawyer’s face, he added with some impatience, “Look, I was on from noon yesterday until after eight o’clock this morning. I’m behind on my sleep and this interview isn’t helping.”

  “I am very sorry we had to call you in today,” Sarah responded. “I’ll be as quick as I can so you can get your much-deserved rest.” She started the digital recorder and made her standard opening. “The hospital is investigating the medication error that occurred yesterday in the case of the infant Ariel Arkin.”

  “Damn well better investigate it. Someone nearly killed that baby,” the doctor said.

  Sarah was taken aback by his blunt, albeit correct, assessment of the situation. “The hospital is eager to find out how the error occurred, as I’m sure you are, Dr. Smith.”

  “It’s obvious how it occurred. Someone from the pharmacy screwed up. They sent heparin with a thousand times the potency I ordered.”

  “Yes, that seems clear, but I’m investigating the circumstances that allowed that error to be made, particularly given the fact that the BCMA system is in operation.”

  “Yeah, so much for that. We’ve been hearing for months how the BCMA was going to make medication errors a thing of the past. Guess that particular emperor has no clothes.”

  Sarah was eager to hear more. “How so, Dr. Smith?”

  “Isn’t it obvious? Even with all the scanners in place, the infant nearly bled to death from an enormous overdose.”

  “Do you have an idea as to how that could have happened?” Sarah was particularly interested to hear his answer since he had played no role in the overdose and had no reason to try to cover his rear.

  The pediatric fellow sat slumped in the armchair, his head resting on his hand. He was either very relaxed or dead tired. “How did it happen?” he asked incredulously, suddenly coming to life. “Someone wasn’t doing their job, that’s how. The manufacturer clearly labeled the vial “10,000 units.” Hard to miss all those zeroes — even without a scanner,” he said impatiently.

  “Apparently the labels for the 10- and the 10,000-unit vials of heparin are nearly an identical shade of blue. It appears that contributed to the mix-up,” Sarah explained.

  “What, people can’t read now? We go by colors? What is this, preschool?”

  Sarah was impressed by his forceful condemnation of those responsible for the overdose. She was still looking for the part of him that engendered fondness in the people who worked with him. Perhaps his high expectations for patient care were part of his appeal. And, truth be told, he’d likely clean up nicely. Little doubt about that, Sarah thought, before getting back to the business at hand.

  “I can understand your intolerance for this
type of error. But it appears there were circumstances that contributed to people making the mistake. One factor appears to be that the hospital was short staffed because of the flu going around. The newness of the BCMA may also be a factor.”

  “Look, I have some sympathy for the nurses — and all the floor staff, for that matter. People are being asked to work back-to-back shifts and they’re exhausted. And it’s not just because of the flu that’s going around. Understaffing is a constant problem here. As far as bedside care goes, the administrators are trying to run this place on the cheap. As for the computer system, which I’m sure cost the hospital a bundle, trouble-free it’s not. It rejected scripts from me without reason several times this past week. I know a lot of people have found it to be a thorn in their side.

  “That being said,” Dr. Smith continued, “do you have any idea what happened to that little baby yesterday? It was disastrous. There’s no other word for it. I spent an entire night trying to undo the horror caused by simple carelessness. That baby did not have to suffer this trauma. She shouldn’t have suffered this trauma. So if you think I have, what did you call it, an ‘intolerance’ for the error, you’re goddamned straight I do. I am intolerant of an error that could inflict so much harm on a helpless infant.”

  Doris coughed. Maybe she had a tickle in her throat, but Sarah took it as a signal that she was impressed by the rumpled doctor’s passionate advocacy for his patient. Sarah couldn’t take her eyes off him. His unvarnished appraisal was both helpful and refreshing. Maybe that’s what people enjoyed about him. There was no bull from Dr. Smith.