Fertility: A Novel Page 6
“I appreciate your assessment of the conditions that may have contributed to the baby being harmed. I am certain this will be cold comfort, but many of the people with whom I’ve spoken today are stricken with a deep sense of remorse. No one wanted this terrible error to happen.”
“Well, I know Joyce Hilker is a wreck about this. She’s a great nurse; don’t get me wrong. She trusted the pharmacy’s label on the heparin. And she should have been able to trust it. If the pharmacy had done its job correctly, she would never have administered a near-lethal dose of heparin to her patient. But as it stands, she’s got to live with the knowledge that she nearly killed a baby.”
Sarah thought this would be a good time to get Dr. Smith’s take on the rollout of the system lauded by Joanne Marsh. “To what degree, Doctor, would you say the staff believes in the efficacy of the BCMA system?”
“You want the truth?”
“I do.”
“So far, I’d say the BCMA has been more trouble than help. If the company who sold the system had flooded the hospital with their own people to debug it as we rolled it out, maybe we would have had a better first week. But that didn’t happen. I know that I overrode it when it rejected perfectly appropriate scripts. I can’t speak for the others, but I wouldn’t be surprised if they did the same.”
Bingo. The system had problems. Help was scarce. Maybe most importantly, people hadn’t bought into the BCMA. Hence, Alejandro Avila’s reluctance to believe the scanner’s error message and Albert Cappelli’s override of the system with his handwritten label. Joyce Hilker had followed suit, chalking up the failure to scan as a system failure. Sarah would guess Dr. Smith, Avila, Cappelli and Hilker were not alone in responding to the “foolproof” system by blowing it off. In this particular case, however, had everyone involved not overridden the BCMA, Ariel Arkin would likely be healing nicely from the staph infection that brought her to the ER, and the pediatric fellow sitting next to Sarah would be enjoying his day off.
Sarah could see the guy was beat, but there were still some bases to cover. In the event the baby didn’t survive, there would be a further investigation into how the staff had responded to the error. So she asked the pediatric intensivist to describe his efforts to stabilize the baby. She knew she could get much of what he had to say from the baby’s chart, but she figured she couldn’t be too careful. Dr. Smith complied in painstaking detail. When he was done explaining how he had labored through the night to save the child, she shook his hand and thanked him for his help in the investigation.
For Rick Smith’s part, he hightailed it back to his apartment and the lure of at least another couple of hours of shuteye. As he left the interview, he toyed with the idea of checking on Ariel Arkin, but he knew that if he went up on the floor, he’d get sucked in for hours. Instead, he jogged home and thought about that good-looking attorney. She was a little uptight, but a beautiful woman. No doubt about that. Once in his apartment, he quickly pulled off his sweatshirt and jeans and got back into bed. He thought about how he wouldn’t object to spending a little time alone with that lawyer — and then he was out like a light.
* * *
After Doris headed home, Sarah gave John Mess and Julie Bonner a verbal summary of her findings. She emphasized that it was more complicated than just the careless error of a novice pharmacy tech — the story Joanne Marsh had tried to sell earlier to Mess. Sarah told them they would have her written report in the morning. They were both happy — no, ecstatic — to share news on the baby’s condition. Her vitals were strong and her infection retreating. She was responding to stimuli appropriately for her age.
After a day filled with graphic accounts of so ghastly an event, Sarah was relieved to know there was reason to hope that little Ariel Arkin might recover.
CHAPTER ELEVEN
Sarah worked until the wee hours of the morning on her report. It shouldn’t have made any difference that the injured baby had a powerful father, but knowing the big guns Mark Arkin could aim at the hospital did, in fact, make her even more meticulous than usual. She paid particular attention to writing up her highly strategic — some might say daring — recommendations. She planned to share her work with Harry in the morning. If, after hearing her out, he didn’t think she’d lost her mind, they would go to the hospital together to deliver her report to John Mess and Julie Bonner.
She knew she was sticking her neck out on this one. Until now she’d been the ideal protégée on every project, doing what Harry would have done had he had the time or inclination. She read him like a fortune teller reading a palm and often knew his preferences without him offering a hint of direction. That was why he’d plucked her out of the pool of associates and made it his business to groom her for partner.
But this time was different. Her recommendations were based on what she thought was right for all involved, but she knew they might incite an infamous Meinig tantrum. She was willing to chance it, though. If she could persuade Harry to her way of thinking, she had a feeling they could neutralize the “cluster fuck” and actually do some good at the same time.
* * *
Another morning without time for a swim or a run. Sarah was in the office by seven, putting the finishing touches on her report. She handed it over to Harry for his review just before eight. He muttered to himself as he read her findings about how Alejandro Avila’s initial error had not been caught — and why. The report was as much an indictment of the hospital’s staffing policies and half-baked implementation of the BCMA system as it was of Avila, Albert Cappelli and Joyce Hilker, at least one of whom, under different circumstances, might have caught the error. Leaving nothing out, Sarah slammed the pharmaceutical maker for marking such vastly different doses of heparin with a nearly identically colored label.
When Harry turned to the last page of her report — her recommendations — she held her breath. He kept reading, gesticulating with his hands, raising his eyebrows and muttering to himself. She had prepared herself for an explosion, but all Harry said when he was done was, “Are you sure about this, Sarah?”
“Yes, I am. I think this is the best way to go.”
“Well, it’s a risk. But I’ve heard about some other cases that were handled this way with good results. I’ll back you up on this, Sarah, but don’t fuck up. Do me proud.”
She couldn’t believe what she was hearing. Harry trusted her risky strategy — trusted her. “I promise you, Harry. I won’t screw this up.”
* * *
Within the hour Sarah was handing out copies of her report to Julie Bonner and John Mess. They sat riveted as she described the confluence of factors that had led to the baby’s overdose. In terms of the BCMA, she was emphatic that there had been insufficient training and buy-in of the staff, from lowly pharmacy technicians to physicians. The failure to offer onsite tech support from the developer during the critical first weeks of implementation had also contributed to the dosing error. Taken together, those factors had greatly diminished the BCMA’s power to prevent medication errors. Sarah minced no words on the role played by staffing shortages. With fatigue being a well-documented cause of performance failures, having tired nurses doing back-to-back shifts was nothing short of playing with fire.
Mess and Bonner took it all in, but said nothing in response. Finally, Sarah came to her recommendations. She took a deep breath and laid them out: Admit fault to the parents; tell them everything that went wrong and why. Offer a sincere apology. Then stipulate in detail what measures the hospital would immediately take to make certain this type of error would not happen again. Finally, make a fair offer of payment for pain and suffering, and a promise to pay for any therapies or remediation the child might need as a result of the medical trauma. Sarah knew that giving these parents money was like giving oil to Saudi Arabia. But it was a necessary gesture of contrition and a required part of the mea culpa approach she was recommending.
Mess could hardly contain himself. “You’re kidding, right? Harry, you don’t buy into t
his suicidal advice, do you?”
“Actually, John, I think Sarah’s pegged it just about right. Mark Arkin can sully the good name of this hospital in every media outlet from coast to coast and let loose his vengeance via a jury trial. Hell, he can make it his business to bankrupt the hospital. We’ve certainly given him cause to want to see it brought to its knees. I’ve seen him when he’s out for revenge and it’s not something I’d recommend the hospital tangle with — not if there’s any way to avoid it. With Sarah’s approach, we come clean about the weaknesses in the system, promise reform — we’ll have to demonstrate its implementation, of course — and then make a monetary settlement offer. I think it might work.”
“And if it doesn’t?” Bonner asked with more than a hint of incredulity in her voice. “If Arkin doesn’t accept our ‘apology’ he can take what we’ve given him and blow us away in the press and in court — and we will have handed him the ammunition with which to do it.”
Harry stood firm. “What I’m saying is, he can blow us away, regardless. A two-week-old infant nearly bled to death because of a chain of errors made by hospital staff. Sure, we can pin some of the blame on the pharmaceutical company for labeling two doses of heparin nearly identically. But the lion’s share of fault lies with the hospital.”
Sarah was emboldened by Harry’s support. “Look, everyone I met with yesterday was a good person — well meaning, competent and heartsick about what happened. The baby apparently is making a good recovery, due to the efforts of the medical staff. We need to emphasize that very point. We have a staff that is capable of doing world-class work. But we put them at a disadvantage because of the conditions I outlined in the report. When those conditions are corrected, this type of error — everyone’s worst nightmare — will not happen to another infant.”
Mess turned to Bonner. “You know as well as I do that most people who sue say they’re trying to prevent another person from suffering the loss or injury they did. They say that the money is just a way of teaching the doctors and the hospital a lesson so they won’t make the same mistake again. If we can show Arkin and his wife that they needn’t sue us to get that outcome, that we get what went wrong and are committed to correcting the weak links in our quality control system, they might just buy it.”
Bonner didn’t respond right away. Finally, she said, “I’m not saying it couldn’t work. The fact that the baby continues to do well, remarkably well, really — I checked with the attending this morning — is a definite plus. And I guess we could document how much this plan for remediation would cost. It’ll be a bundle; you and I both know that, John. Each new nurse runs a minimum of seventy-five thousand with benefits. And getting onsite tech support from the BCMA manufacturer is extremely expensive. That’s why the hospital passed on it to begin with. We’ve got to take this to Phil before we can agree to anything.”
Sarah guessed Phil to be Philip Kerrey, hospital CEO. Of course, he would have to be consulted before they went into negotiations with the likes of Mark Arkin. But she felt she had to add a final recommendation before they wrapped things up. “It’s my feeling that the sooner the hospital stands up and takes responsibility for what happened, the more likely it is that the parents will be receptive to the hospital’s offer — particularly if the baby continues to improve. I think timing will be everything in this case.”
“Well, Phil is out of the building this morning. I’ll get back to you this afternoon,” Mess said.
“Good, John,” Harry said. “I’d like to reiterate that I think Sarah has shown us the right path out of this mess.” Realizing instantly that he’d stepped on the risk manager’s surname, he quickly apologized. “Sorry, John. I don’t know what I was thinking.”
“Oh, forget it. I get it all the time. Half the time I think my name is what got me into the business of risk management: John Mess — manager of all manner of messes. Maybe they’ll put that on my tombstone when I’m gone.”
CHAPTER TWELVE
Mark Arkin would have given half his fortune to have been spared the events of the prior forty-eight hours. He hadn’t been so powerless since he had been a child in Brooklyn, living under the reign of his mother. Trapped in passive misery, he’d had to watch the staff try to undo the unspeakable harm their co-workers had caused his baby. Most wrenching was listening to Catherine berate herself for infecting Ariel with MRSA. He remembered watching a news story about observant Muslim men who flogged themselves until the blood streamed down their backs in rivulets. He had thought them mad at the time, but what Catherine had done to herself since finding out she was a MRSA carrier was worse than self-flagellation. If Ariel didn’t make it, he worried she might lose her mind. There was only one way the endless loop of self-recrimination would stop, and that was for Ariel to get well.
The truth was, Mark wasn’t beyond blaming himself, either, compliments of his newfound conscience. Though part of him thought it nuts, a little voice kept telling him this was what he got for walking away from Linda and their kids. But if a stiff-necked god was exacting a steep price, it was Catherine and Ariel who were bearing the cost. His special form of anguish was watching them endure agonies his imagination could never have conjured up.
If there was anything that gave him reason to hope, it was that Dr. Smith. He had seemed like a son of a bitch at first, but it had soon become clear that he knew what the hell he was doing. Catherine had it right when she said he was their only hope. Dr. Smith had worked on Ariel that whole first night, making sure to give them continual updates on her condition. He had gotten the bleeding stopped. He had gotten her vitals stabilized. And before he had dragged himself home yesterday morning, he told them he was “guardedly optimistic” that she would make it. Although Mark’s first reaction had been to transfer Ariel out of the hospital that nearly killed her, it was Dr. Smith’s single-minded efforts that had made him change his mind.
Dr. Smith was back on Ariel’s case today and his presence gave Mark some sense of security. That Dr. Cho was good, too, and Ariel had remained stable yesterday when she was in charge. But there was something about Dr. Richard Smith that Mark could lock onto. Dr. Smith might very well be a son of a bitch, but he worked like a dog to win — even when the odds were against him. That was something Mark understood. He was surprised that someone with that kind of drive had become a goddamned pediatrician, of all things. No doubt about it, they’d caught a lucky break with Dr. Smith.
Of course, Catherine had been treated as well. He had to admit that the staff had done a good job getting her MRSA under control. They had gotten her on meds right away and the infection seemed to back off within hours. And they had been gentle with her, too. Catherine had gotten the idea in her head that her milk would dry up once the baby stopped nursing, and became even more distraught. The lactation specialist had gotten her hooked up to a pump to keep her milk supply going. The image of that contraption attached to his wife’s beautiful breasts gave him the creeps. But it did the job. Catherine could see she was still making plenty of milk and that reassured her. They had brought in a counselor of some kind, maybe a shrink, to talk with her. That person had ordered an Ambien so Catherine could get some sleep. Sleeping was what she was finally doing now, on the cot next to Ariel’s crib. In fact, she and Ariel were both sleeping, a first since their odyssey began. He could hear their rhythmic breathing and it sounded so normal. What a relief it was to hear that steady in and out, in and out.
He dozed off in the chair himself, for how long he didn’t know. He was awakened by movement in the room followed by a gurgle coming from the crib. Opening his eyes, he saw Dr. Smith hovering over Ariel. He panicked until he saw that the intern and nurse with him were smiling.
Dr. Smith turned when he heard the baby’s father stir. “Oh, good afternoon, Mr. Arkin. Glad you got a chance to catch some shuteye,” he said in a low voice, so as not to awaken the baby’s mother. Mark was taken with the change in the doctor’s body language and attitude, not only from their first meeting bu
t from earlier in the day. Was it possible that he was cheerful? The doctor turned back to the baby and gave an order for something Mark didn’t catch. Then the intern and the nurse turned and left the room.
“So how’s she doing now, Dr. Smith?” Mark asked.
“Well, I’m actually quite pleased with what I see. You have a little fighter here. She’s responding well to her treatment. Her white count is way down, which means the infection is coming under control. Her red blood count is good. Come and take a look. Your little girl is feeling a whole lot better.”
Mark could hardly believe the effect those words had on him. His eyes started to burn as he got up from the chair. When he looked in the crib, he saw Ariel tracking the doctor’s finger with her eyes, alert and — well, for lack of a better word — happy. She looked at him and held his stare for several seconds. Then she looked at the doctor, kicking her legs and moving her arms. Mark pulled out his handkerchief and wiped his face.
As Ariel grabbed the doctor’s index finger, he shared more good news with Mark. “I don’t want to wake your wife — believe me, I know how much she needs this rest — but I think that perhaps in a day or two she’ll be able to start nursing Ariel again. Let her know when she wakes up. I think she and Ariel will be much happier when they can get back to doing what comes naturally.”
Mark could have given him a bear hug. Instead, he grabbed the doctor’s hand and gave it a vigorous shake. He dared to wonder if it was possible that the whole nightmare was drawing down. Of all the great wins in his life, nothing could match a good end to this ordeal. He couldn’t wait until Catherine woke up so he could tell her the news. He gave a silent thank you to the god he had only recently dismissed as stiff-necked and vengeful. Guilt, helplessness and anguish were joined by yet another new feeling rising up within him: gratitude.