Mabry is a storyteller extraordinaire! This was a “suck you in and hold you to the last page” story. I was holding my breath as I read and couldn’t figure out how Dr. Anna McIntyre was going to prove her innocence. At every turn the complications stacked higher, the evidence against her looked worse and “innocent until proven guilty” sure wasn’t working in her case. On Anna’s side was a pathologist with his eye on romance, and a once crackerjack lawyer fresh out of rehab and dying for a drink.Â They were supposed to be helping Anna, but she was the one counseling them on faith.
I started reading this book in the waiting room at the garage while my car was being serviced. The place was less than optimally clean, and smelled of grease and oil. I opened the book and was instantly in an operating room — pristine — struggling with the doctors to save a man’s life ….
Next thing I knew the mechanic was saying, “Hey lady, your car is done. Lady? Lady? Are you all right?” I looked up from my book at him blankly. I heard his words, but they made no sense. Couldn’t he see I was in the middle of a police interview and they suspected me of writing bonus scripts for narcotics? And then reality intruded. It has been a long, long time since a book has pulled me that far away. I highly recommend Medical Error, by Richard L. Mabry, MD!
It is time for a FIRST Wild Card Tour book review! If you wish to join the FIRST blog alliance, just click the button. We are a group of reviewers who tour Christian books. A Wild Card post includes a brief bio of the author and a full chapter from each book toured. The reason it is called a FIRST Wild Card Tour is that you never know if the book will be fiction, non~fiction, for young, or for old…or for somewhere in between! Enjoy your free peek into the book!
You never know when I might play a wild card on you!
and the book:
Abingdon Press (July 12, 2010)
***Special thanks to Maegan Roper, Marketing/PR Manager, Christian Fiction, Abingdon Press for sending me a review copy.***
Dr. Richard Mabry built a worldwide reputation as a clinician, researcher, author, and teacher before retiring from medicine. He entered the field of non-medical writing after the death of his first wife, with the publication of his book, The Tender Scar: Life After The Death Of A Spouse.
Richard describes his work as “medical suspense with heart.” Medical Error is his second novel. His first novel, Code Blue, was published by Abingdon Press in April of 2010, and will be followed next spring by the third book in the Prescription For Trouble series, Diagnosis Death.
He and his wife, Kay, live in North Texas.
Visit the author’s website.
Visit the author’s blog.
List Price: $13.99
Paperback: 288 pages
Publisher: Abingdon Press (July 12, 2010)
AND NOW…THE FIRST CHAPTER:
Eric Hatleyâ€™s last day alive began routinely enough.
He paused beside his brown delivery truck, shifted the bulky package, and turned in a tight circle to search for the right apartment.
Shouts filled the air. Firecrackers exploded all around him. A dozen red-hot pokers bored holes through his gut.
The package flew from his arms. He crumpled into a privet hedge at the edge of the sidewalk, clutching his midsection and recoiling when his fingers encountered something wet and slimy.
A wave of nausea swept over him. Cold sweat engulfed him.
Eric managed one strangled cry before everything faded to black.
* * *
Dr. Anna McIntyre bumped the swinging door with her hip and backed into Parkland Hospitalâ€™s Operating Room Six, her dripping hands held in front of her, palms inward. â€œLuc, tell me what youâ€™ve got.â€
Chief surgical resident, Dr. Luc Nguyn, didnâ€™t look up from the rectangle of abdomen outlined by green draping sheets and illuminated by strong surgical lights. â€œUPS driver, making a delivery in the Projects. Got caught in the crossfire of a gang rumble. Took four bullets in the belly. Pretty shocky by the time he got here.â€
â€œFind the bleeding source?â€
â€œMost of it was from the gastric artery. Just finished tying it off.â€
Anna took a sterile towel from the scrub nurse and began the ritual of gowning and gloving made automatic by countless repetitions. â€œHow about fluids and blood replacement?â€
Luc held out his hand, and the nurse slapped a clamp into it. â€œLactated Ringerâ€™s, of courseâ€”still running wide open. Weâ€™ve already pushed one unit of unmatched O negative. Heâ€™s finishing his first unit of cross-matched blood. Weâ€™ve got another one ready and four more holding in the blood bank.â€
â€œHowâ€™s he responding?â€
â€œBP is still low but stable, pulse is slower. I think weâ€™re catching up with the blood loss.â€
Anna plunged her hands into thin surgical gloves. â€œLab work?â€
â€œHematocrit was a little over ten on admission, but I donâ€™t think heâ€™d had time to fully hemodilute. My guess is he was nine or less.â€
Anna turned slightly to allow the circulating nurse to tie her surgical gown. â€œBowel perforations?â€
â€œSo far I see four holes in the small intestine, two in the colon.â€
â€œOkay, heâ€™ll need antibiotic coverage. Got that started?â€
Luc shrugged. â€œNot yet. We donâ€™t know about drug allergies. His wallet had ID, but weâ€™re still working on contacting next of kin. Meanwhile, I have Medical Records checking his name in the hospital computer for previous visits.â€
â€œAnd if heâ€™s allergicâ€”â€œ
The nursing supervisor pushed through the swinging doors, already reading from the slip of paper in her hand. â€œThey found one prior visit for an Eric Hatley, same address and date of birth as on this manâ€™s driverâ€™s license. Seen in the ER two weeks ago for a venereal disease. No history of drug allergy. They gave him IM Omnilex. No problems.â€
The medical student whoâ€™d been assisting moved two steps to his left. Anna took his place across the operating table from Luc.
Luc glanced toward the anesthesiologist. â€œTwo grams of Omnilex IV please.â€
Anna followed Lucâ€™s gaze to the head of the operating table. â€œI donâ€™t believe I know you. Iâ€™m Dr. McIntyre.â€
The doctor kept his eyes on the syringe he was filling. â€œYes, maâ€™am. Iâ€™m Jeff Murray, first year anesthesia resident.â€
A first year resident on his own? Where was the staff man? â€œKeep a close eye on the blood and fluids. Let us know if thereâ€™s a problem.â€ Anna picked up a surgical sponge and blotted a bit of blood from the edge of the operative area. â€œOkay, Luc. Letâ€™s see what youâ€™ve got.â€
In the operating room, Anna was in her element. The green tile walls, the bright lights, the soft beep of the monitors and whoosh of the respirator, the squeak of rubber soles as the circulating nurse moved about the roomâ€”all these were as natural to her as water to a fish or air to a bird. Under Annaâ€™s direction, the team worked smoothly together. Conversation was at a minimum, something she appreciated. Do the job in the OR, talk in the surgeonsâ€™ lounge.
â€œI think thatâ€™s got it,â€ Luc said.
â€œLetâ€™s check.â€ Annaâ€™s fingertips explored the depths of the patientâ€™s belly with the delicate touch of a concert violinist. Her eyes roamed the operative field, missing nothing. Luc had done an excellent job. Heâ€™d do well in practice when he finished his training in three months.
Anna stepped away from the table. â€œI think youâ€™re through. Routine closure, leave a couple of drains in. Keep him on antibiotic coverage for the next few days.â€
Luc didnâ€™t need to hear that, but she figured the medical student did. She might as well earn her Assistant Professorâ€™s salary with a little low-key teaching.
She stripped off her gloves and tossed them in the waste bucket at the end of the operating table. â€œIf you need meâ€”â€œ
â€œLuc, weâ€™ve got a problem. Blood pressureâ€™s dropping, pulse is rapid.â€ A hint of panic rose in the anesthesiologistâ€™s voice.
The scrub nurse held out fresh gloves, and Anna plunged her hands into them. â€œHe must be bleeding again. Maybe one of the ligatures slipped off.â€
â€œNo way,â€ Luc said. “Everything was double-tied, with a stick-tie on the major vessels. You saw yourself, the wound was dry when we finished.â€
â€œWell, weâ€™ve got to go back in and look.â€ Anna turned to the anesthesiologist. â€œRun the IV wide open. Hang another unit of blood and send for at least two more. Keep him oxygenated. And get your staff man in here. Now!â€
He snapped out a couple of requests to the circulating nurse before turning back to Anna. â€œHeâ€™s getting hard to ventilate. Do you think we might have overloaded him with fluid and blood? Could he be in pulmonary edema?â€
â€œI want your staff doctor in here now! Let him evaluate all that. Weâ€™ve got our hands full.â€ Anna snatched a scalpel from the instrument tray and sliced through the half-dozen sutures Luc had just placed. â€œDeavor retractor.â€ She shoved the curved arm of the instrument into the edge of the open wound and tapped the medical studentâ€™s hand. â€œHold this.â€
Anna grabbed a handful of gauze sponges, expecting a gusher of blood from the abdomen. There was none. No bleeding at all within the wound. So why was the blood pressure dropping?
â€œPressureâ€™s down to almost nothing.â€ The anesthesia residentâ€™s voice was strained. â€œAnd Iâ€™m really having trouble ventilating him.â€
Dr. Buddy Jenkins, one of the senior anesthesiologists, pushed through the swinging doors. â€œWhatâ€™s going on?â€
Anna gave him the short version. â€œBlood pressureâ€™s dropping, pulse is climbing. Weâ€™ve gone back into the belly, but thereâ€™s no bleeding. And thereâ€™s a problem ventilating him.â€
Jenkins moved his resident aside, then slipped a stethoscope under the drapes and listened for a moment. â€œWheezes. And no wonder. Look at his face.â€
Anna peeked over the screen that separated the patientâ€™s head and upper body from the operative field. Her heart seemed to skip a beat when she saw the swelling of the lips and the red blotches on the manâ€™s face.
â€œItâ€™s not blood loss,â€ Jenkins said. â€œHeâ€™s having an anaphylactic reaction. Most likely the blood. Did you give him an antibiotic? Any other meds?â€
Annaâ€™s mind was already churning, flipping through mental index cards. Anaphylaxisâ€”a massive allergic reaction, when airways closed off and the heart struggled to pump blood. Death could come quickly. Treatment had to be immediate and aggressive.
â€œHe had two grams of Omnilex,â€ Luc said. â€œBut his old chart showedâ€”â€œ
Jenkins was in action before Luc stopped speaking. â€œIâ€™ll give him a cc. of diluted epinephrine by IV push now, then more in a drip.â€ He turned to the anesthesia resident. â€œGet that readyâ€” one milligram of epinephrine in a hundred milliliters of saline.â€
â€œLuc, you two close the abdominal wound,â€ Anna said. â€œIâ€™m going to break scrub and help Dr. Jenkins.â€
Jenkins handed her a syringe. â€œGive him this Decadron, IV push. I need to adjust the ventilator.â€
Anna injected the contents into the patientâ€™s intravenous line. She said a quick prayer that the epinephrine and steroid would turn the tide, that they hadnâ€™t been too late in starting treatment.
The team battled for almost half an hour, at first gaining ground, then losing it steadily. Finally, Jenkins caught Annaâ€™s eye. They exchanged glances. There was no need for words.
She sighed and stepped away from the table. â€œIâ€™m calling it.â€ Her voice cracked. â€œTime of death is eleven oh seven.â€
Luc let the instrument heâ€™d been holding drop back onto the tray. Jenkins picked up the anesthesia record and began to scribble. Murray, the anesthesia resident, turned back to his supply table and started straightening the mess. The medical student looked at Anna. She nodded toward the door, and he slipped out of the room. She didnâ€™t blame him. This was probably the first patient heâ€™d seen die.
Anna tossed her gloves and mask into the waste container. She shrugged, but the tension in her shoulders didnâ€™t go away. â€œAny idea why this happened? The blood was supposed to be compatible. Heâ€™d tolerated Omnilex before. What else could have caused it?â€
No one offered an answer. And she certainly had none. But she intended to find out.
The OR charge nurse directed Anna to the family room, where she found Hatleyâ€™s mother huddled in a corner, twisting a handkerchief and occasionally dabbing at her eyes. The room was small and quiet, the lighting was soft, the chairs as comfortable as possible. A box of tissues sat on the table, along with a Bible and several inspirational magazines. Soft music playing in the background almost covered the hospital sounds drifting in from the nearby surgical suite.
Anna whispered a silent prayer. Sheâ€™d done this dozens of times, but it never got any easier. She knelt in front of the woman. â€œMrs. Hatley, I have bad news for you.â€
Anna stumbled through the next several minutes, trying to explain, doing her best to make sense of a situation that she herself couldnâ€™t fully understand. When it came to the matter of permission for an autopsy, Anna wasnâ€™t sure of the medico-legal situation here. Hatley had died after being shot, but his injuries werenâ€™t the cause of death. Would she have to call the County Medical Examiner and get him to order one? The weeping mother solved the problem by agreeing to allow a post-mortem exam.
There was a light tap at the door, and the chaplain slipped into the room. â€œIâ€™m sorry. I was delayed.â€ He took the chair next to Mrs. Hatley and began speaking to her in a low voice.
Anna was happy to slip out of the room with a last â€œIâ€™m so sorry.â€ Outside, she paused and took several deep breaths.
It took another half-hour for Anna to write a chart note, dictate an operative report and final case summary, and change into clean scrubs. She was leaving the dressing room when her pager sounded. The display showed her office number followed by the suffix â€œ911.â€ A â€œstatâ€ pageâ€”respond immediately.
As she punched in the number, Anna wondered what else could possibly go wrong today. â€œLisa, whatâ€™s up?â€
â€œDr. McIntyre, there are two policemen here. They want to talk with you. And they say itâ€™s urgent.â€
* * *
Nick Valentine looked up from the computer and grimaced when he heard the morgue attendantâ€™s rubber clogs clomping down the hall. The summons he knew was coming wasnâ€™t totally unexpected. After all, he was the pathologist on autopsy call this week, which was why he was sitting in this room adjacent to the morgue of Parkland Hospital instead of in his academic office at the medical school. But heâ€™d hoped for some undisturbed time to get this project done.
The attendant stuck his head through the open door. â€œDr. Valentine, youâ€™ve got an autopsy coming up. Unexpected death in the OR. Dr. McIntyreâ€™s case. She asked if you could do it as soon as possible. And please page her before you start. Sheâ€™d like to come down for the post.â€ The manâ€™s head disappeared like that of a frightened turtle. More clomps down the hall signaled his departure.
There was nothing new about an attending wanting a post-mortem done ASAP. Youâ€™d think theyâ€™d realize there was no hurry any more, but that didnâ€™t seem to stop them from asking. At least she was willing to come down and watch instead of just reading his report. Nick turned to the shelf behind his desk and pulled out a dog-eared list headed â€œFrequently Needed Pager Numbers.â€ He ran his finger down the page. Here it was: Department of General Surgery. Anna E. McIntyre, Assistant Professor. He picked up the phone and punched in her number. After he heard the answering beeps, he entered his extension and hung up.
While he waited, Nick looked first at the pile of papers that covered half his desk, then at the words on his computer screen. Heâ€™d put this off far too long. Now he had to get it done. To his way of thinking, putting together this CV, the curriculum vitae that was so important in academics, was wasted effort. Nick had no interest in a promotion, didnâ€™t think heâ€™d get one even if his chairman requested it from the dean. But his chairman wanted the CV. And what the chairman wanted, the chairman got.
The phone rang. Probably Dr. McIntyre calling back.
â€œNick, this is Dr. Wetherington. Do you have that CV finished yet?â€
â€œIâ€™m working on it.â€
â€œWell, I need it soon. I want you to get that promotion to Associate Professor, and I have to be able to show the committee why Iâ€™ve nominated you. Donâ€™t let me down.â€
Nick hung up and riffled through the pile on his desk. Reprints of papers published, programs showing lectures delivered at medical meetings, textbooks with chapters heâ€™d written, certificates from awards received. His professional rÃ©sumÃ© was pitifully small, but to Nick it represented the least important part of his job. What mattered most to him was what he was about to do: try to find out why the best efforts of a top-notch medical staff failed to save the life of some poor soul. If he did his job well, then maybe those doctors would be able to snatch some other patient from the jaws of the grim reaper.
His phone rang. â€œDr. Valentine, are you about ready?â€ the morgue attendant said.
Nick looked at his watch. Almost half an hour, and Dr. McIntyre hadnâ€™t responded to the page. He hated to start without her, but he might have to. â€œGive me another ten minutes.â€
While he waited, Nick figured he might as well try to make Dr. Wetherington happy. Now when did he deliver that paper before the American Society of Clinical Pathology? And who cared, anyway?
* * *
Her administrative assistant met Anna at the doorway to the outer office. â€œDr. McIntyre, I didnâ€™t know what to do.â€
â€œThatâ€™s all right, Lisa. Iâ€™ll talk with them.â€ Anna straightened her white coat and walked into her private office, where two people stood conversing in low tones. Lisa had said, â€œTwo policemen,â€ but Anna was surprised to see that one of them was a woman.
The man stepped forward to meet Anna. â€œDoctor McIntyre?â€
He pulled a leather folder from his pocket and held it open for her inspection. Anna could see the gold and blue badge pinned to the lower part of the wallet, but couldnâ€™t read the words on it. The card in the top portion told her, though. It carried a picture beside the words, US Drug Enforcement Administration.
Lisa had been wrong. These people were from the DEA, not the police. Still, an unannounced visit from that agency made most doctors sweat. You never knew when some innocent slip might get you into trouble.
The man flipped the credential wallet closed. â€œThis wonâ€™t take long.â€
â€œGood. Iâ€™ve just finished an emergency case, and I still have a lot to do.â€ Anna moved behind her desk and sat.
â€œYour chairman said youâ€™d give us as much time as we need.â€
Anna glanced pointedly at her watch. â€œWell, have a seat and letâ€™s get to it. What do you need from me?â€
The man lowered himself into the chair, his expression slightly disapproving. His partner followed suit. â€œWe have some things we need for you to clear up.â€
â€œCould I see those credentials again?â€ Anna said. â€œBoth of you.â€
They obliged, laying the open wallets on the desk. Anna pulled a slip of notepaper toward her and began copying the information, occasionally glancing up from her writing to match the names and faces on the IDâ€™s with the people sitting across from her. The spokesman was Special Agent John Hale, a chunky, middle-aged man wearing an off-the rack suit that did nothing to disguise his ample middle. Anna thought he looked more like a seedy private eye than an officer of the law.
The woman, the silent half of the pair so far, was Special Agent Carolyn Kramer, a woman who reminded Anna of a California surfer bunny, complete with perfect tan and faultlessly styled short blonde hair. The resemblance stopped there, though. Kramerâ€™s eyes gleamed with a combination of intelligence and determination that told Anna sheâ€™d better not underestimate the woman. Kramer wore a stylish pants suit that had probably cost more than Anna made in a week, How could a DEA agent have money for an outfit like that?
Anna handed the badge wallets back to Hale and Kramer. â€œAll right, how can I help you?â€
Hale pulled a small notebook from his inside coat pocket and flipped through the pages. â€œDoctor, recently youâ€™ve been writing a large number of Vicodin prescriptions, all of them for an excessive amount of the drug. Can you explain that?â€
â€œI donâ€™t know what you mean,â€ Anna said. â€œIâ€™m pretty sure I havenâ€™t written any more Vicodin â€˜scripts than usual, and I certainly havenâ€™t changed my prescribing practices.â€
Hale nodded, stone-faced. â€œWhat are those practices?â€
â€œI prescribe Vicodin for post-operative pain in many of my patients, but always in carefully controlled amounts, usually thirty pills at a time. By the time theyâ€™ve exhausted that first prescription I can generally put them on a non-narcotic pain reliever. Itâ€™s rare that I refill a Vicodin â€˜script.â€
Apparently it was Kramerâ€™s turn in the tag-team match. She picked up a thick leather folder from the floor beside her chair, unzipped it, and extracted a sheaf of papers held together by a wide rubber band. â€œWould you care to comment on these?â€ Her soft alto was a marked contrast to Haleâ€™s gruff baritone,
Annaâ€™s eyes went to the clock on her desk. â€œWill this take much longer? I really have things I need to do.â€
Kramer seemed not to hear. She held out the bundle of papers.
â€œOkay, let me have a look.â€ Anna recognized the top one in the stack as a prescription written on a form from the faculty clinic. She pulled it free and studied it. The patientâ€™s name didnâ€™t stir any memory, but that wasnâ€™t unusual. She might see twenty or thirty people in a day. The prescription read:
Sig: 1 tab q 4 h PRN pain
At the bottom of the page, three refills were authorized. The DEA number had been written into the appropriate blank on the lower right-hand corner.
Anna squinted, closed her eyes, then looked again. There was no doubt about it. The DEA number was hers. And the name scrawled across the bottom read: Anna McIntyre, MD.
â€œCan you explain this?â€ Kramer asked.
A familiar vibration against her hip stopped Anna before she could reply. She pulled her pager free and looked at the display. The call was from the medical center, but she didnâ€™t recognize the number. Not the operating room. Not the clinic. She relaxed a bit when she saw there was no â€œ911â€ entry after the number. If this was about the autopsy, sheâ€™d have to miss it.
Hale picked up the questioning as though there had been no interruption. â€œWhat can you tell us about all these prescriptions for Vicodin?â€
â€œI suppose the most important thing I can tell you is that I didnâ€™t write them.â€ She riffled through the stack, paying attention only to the signature at the bottom of each sheet. â€œNone of these are mine.â€
â€œThatâ€™s your number and name. Right?â€ Kramer said.
â€œRight. But thatâ€™s not my signature. Itâ€™s not even close.â€
â€œCan you explain how someone else could be writing prescriptions on your pads using your DEA number?â€ Hale asked.
â€œI have no idea.â€ Anna made no attempt to keep the bitterness out of her words. â€œSorry, Iâ€™ve just lost a patient, and Iâ€™m not in the best of moods. Canâ€™t we wind this up? I didnâ€™t write those â€˜scripts, and I donâ€™t know who did.â€
Obviously, Hale didnâ€™t want to let the matter go. â€œYouâ€™re sure thereâ€™s nothing you want to tell us?â€
â€œWhat would I have to tell you? I said I donâ€™t know anything about this.â€
Kramer spoke, apparently filling the role of good cop. â€œTake a guess. Help us out here.â€
Anna felt her jaw muscles clench. These people were relentless. She had to give them something, or this would never end. â€œI really donâ€™t know. I mean, weâ€™ve got an established routine, and all the doctors here are pretty careful.â€
Kramer pulled a silver ballpoint from the leather folder and began twirling it between her fingers. â€œWhy donâ€™t you walk us through that routine?â€
Anna wanted to follow up on Hatleyâ€™s autopsy, talk with her department chair about todayâ€™s events, eventually sit down and try to relax. She was drained. The agents, on the other hand, seemed to have unlimited time and energy.
â€œDoctor?â€ Kramerâ€™s voice held no hint of irritation. Patient, understanding, all the time in the world. Just two women chatting.
â€œSorry.â€ Anna tried to organize her thoughts. â€œThe prescription pads in the faculty clinic are kept in a drawer in each treatment room. That way theyâ€™re out of sight, although I guess if someone knew where they were he could latch onto one when no one was in the room.â€ She looked at the agents. Kramer simply nodded. Hale scowled. â€œHey, we know itâ€™s not perfect, but thatâ€™s the way we have to do it. Otherwise, weâ€™d waste all our time hunting for a pad.â€
â€œAnd do you ever forget and leave the pads sitting out when youâ€™ve finished writing a prescription?â€ Kramer asked.
â€œSure. Especially when weâ€™re in a hurry.â€ Annaâ€™s cheeks burned.
Hale turned a page in his notebook and frowned. â€œHow about your DEA number?â€
â€œYouâ€™ll notice those arenâ€™t printed on the forms. Each of us has to fill in our number.â€
â€œMaybe someone else had access to your number. Do nurses ever write the prescriptions for you?â€ This came from Kramer. Anna felt as though she was watching a tennis match, going back and forth between the two agents.
â€œWhen we have a nurse in the room with us, yes, sheâ€™ll write the prescription. I donâ€™t know what the other doctors do, but I sign the prescriptions after she writes them. And I add the DEA number to the narcotic â€˜scripts myself.â€
The questioning went on for another half hour. Annaâ€™s throat was dry, her eyes burned, she felt rivulets of sweat coursing between her shoulder blades. Finally, sheâ€™d had enough. â€œLook, am I being charged with something? Because if I am, Iâ€™m not saying another word without a lawyer.â€
Hale replaced his notebook in his pocket. Kramer picked up her folder and purse. They let the silence hang for a moment more before exchanging glances, then standing.
â€œRight now, weâ€™re simply investigating, Doctor,â€ Hale said. â€œYou may be hearing from the Texas Department of Public Safety and the Dallas Police as well. Also, since your DEA number and identity have been compromised, Iâ€™d advise you not to prescribe any controlled substances for now. Youâ€™ll receive formal notification in writing tomorrow about applying for a new permit.â€
The agents walked out, leaving Anna with her hands pressed to her throbbing temples.
* * *
Nick stepped back from the autopsy table, pressed the pedal under his right foot, and spoke into the microphone hanging near his head. â€œNo other abnormalities noted. The balance of findings will be dictated after review of the histopathology specimens and the results of the toxicology tests. Usual signature. Thanks.â€ He turned away from the body and gestured to the morgue assistant to close the incisions. â€œIâ€™ll be in the office if you need me. Thanks for your help.â€
Nick removed his goggles and stripped off his mask, gown, and gloves. He was standing at the sink outside the autopsy room, drying his hands, when he heard footsteps hurrying down the corridor toward him. He turned to see a woman approaching. The attractive redhead wore surgical scrubs, covered by a white coat. As she neared him, he could make out the embroidered name above the breast pocket: Anna McIntyre, MD. She stopped in front of him, and the set of her jaw and the flash of her green eyes told Nick she was in no mood for light banter.
â€œNick Valentine. I paged you, but when you didnâ€™t answer I had to go ahead and get started. Sorry.â€
She waved away his apology. â€œNo, itâ€™s my fault. I couldnâ€™t break free to answer your page. What can you tell me?â€
â€œWhy donâ€™t I buy you a cup of coffee and Iâ€™ll tell you what Iâ€™ve found so far? If we go to the food court, we can get away from the smell down here. I hardly notice it anymore, but Iâ€™ve learned that my visitors arenâ€™t too fond of the odor of chemicals.â€
She hesitated for a few seconds. â€œOkay. Lead the way.â€
It seemed to Nick there was a Starbucks on every corner of every major city in the US. Most important to him, however, was the one here in the basement of the Clinical Sciences Building at Southwestern Medical Center. As he waited to order, he sniffed the rich aromas that filled the air. The smell of coffee never failed to lift his spirits. Maybe it would do the same for the woman who stood stoop-shouldered beside him. For most doctors, caffeine was the engine that helped propel them through long days and longer nights. Maybe all she needed was a booster shot.
When they were seated at a corner table with their venti lattes Nick filled her in on his findings at the autopsy heâ€™d just completed. â€œThatâ€™s about it,â€ he concluded. â€œIâ€™ll sign the death certificate with the preliminary cause of death as anaphylaxis due to an unknown cause.â€
â€œBut you wonâ€™t have a final diagnosis untilâ€”â€œ
â€œRight. Iâ€™ll review the tissue samples and the results of the toxicology screen, but I doubt that weâ€™ll find anything there. Iâ€™m going to have some tests run on the blood samples I took, and maybe that will help us. Iâ€™ll need to research whether thereâ€™s a good blood test for a drug reaction or latex allergy. The long and short of it is that we may never know the real reason he developed anaphylaxis and died.â€
â€œI hadnâ€™t even thought of latex allergy,â€ she said. â€œBut thatâ€™s pretty rare, isnâ€™t it?â€
â€œLess than one percent of the population. Seen in people chronically exposed to latex: surgeons and nurses, industrial workers, patients with lifelong indwelling catheters.â€ He felt himself slipping into his lecture mode and made an effort to pull back. â€œI mean, we could talk about all these uncommon things, but Iâ€™ll bet you learned the same thing in medical school that I did. When you hear hoof beatsâ€”â€œ
â€œThink horses, not zebras.â€ She managed a tiny smile. â€œYes, I know. So we should concentrate on the blood or the antibiotic. If it was the blood, thereâ€™s a problem in the blood bank because he got one unit of unmatched O negative, which should have been okay, and one unit that was supposedly compatible by cross-match.â€
â€œThe residuals in both bags of blood are being re-typed and cross-matched against your patientâ€™s blood as we speak. Weâ€™ll know the answer by the time we finish our coffee.â€ He drank deeply from his cup. â€œDonâ€™t you think an antibiotic reaction is the most likely cause?â€
She took a sip of coffee. â€œProbably, although I hope not. Choosing an antibiotic wasnâ€™t a routine matter, because we didnâ€™t know if Hatley had any drug allergies. The residentâ€”one of our sharpest ones, by the wayâ€”thought heâ€™d see if we could get the information another way. He had medical records check for a previous visit for the patient. They found a recent emergency room visit by the patient where he tolerated Omnilex. Since that antibioticâ€™s the best choice to cover spillage from a perforated bowel, I agreed with Luc when he ordered it.â€
â€œI know. If you give that drug to a patient whoâ€™s allergic to it or to penicillin, their reaction is likely to be severeâ€”like this one. But I thought, since we had that history of tolerance, it was okay.â€ She blinked hard. â€œI should have known better. Should have made him use a different drug.â€
Nick sensed he was treading on thin ice here. Maybe he should change the subject. Besides, he wanted to know more about this woman. â€œYou know, Iâ€™ve seen you in the halls, but weâ€™ve never actually met. Did you train here?â€
She hesitated before reeling off what had apparently become a stock answer. â€œRaised in Oklahoma. Graduated from med school in North Carolina. Duke, actually. Lucky enough to get a surgery residency here at Parkland, and when I finished I was offered a faculty position in the Surgery Department. Iâ€™ve been here a little less than a year now.â€
Nick held up a hand, palm out. â€œI know better. You donâ€™t get a surgery residency here because youâ€™re â€˜lucky.â€™ You get one because youâ€™re good. Let me guess. AOA at Duke?â€ If Anna was Alpha Omega Alpha, she must have been in the top ten percent of her class.
â€œRight. But I donâ€™t guess itâ€™s enough to be bright if you foul up and cost a patient his life.â€ She drank from her cup, and Nick noticed that she kept swallowing several more times after that.
Nick was barely aware of the activity around him, the ebb and flow of people, the sounds of pagers punctuating dozens of conversations. All he saw was Anna. She was one of the prettiest women heâ€™d encountered in quite a while. But he was certain there was more to this trim, green-eyed redhead than striking good looks. Right now she was focused on medicineâ€”it was obvious she cared a great deal about her patients, and this loss hit her hardâ€”but Nick had a sense that in a different setting sheâ€™d be fun to know. And he intended to see if he couldnâ€™t arrange that. Anna shifted in her chair. He couldnâ€™t let her leave yet.
â€œWait a minute,â€ he said. â€œArenâ€™t you curious about me at all? There may be a prize if you can answer all the questions later.â€
Did he see the ghost of a grin? â€œSure. Why not? Whatâ€™s your storyâ€”the Readerâ€™s Digest version?â€
Nick moved his cup aside and leaned forward with his elbows on the table. He wasnâ€™t sure how much longer he could draw out their time together, but he was determined to give it his best shot. â€œMy roots are Italian. Named for my grandfather. He was Nicolo Valentino when he got off the boat, changed his name when he got his citizenship. Iâ€™m Nicolo the Third.â€ He ticked off the points on his fingers. â€œWorked my way through pre-med at Texas Tech. Got into the med school there by the skin of my teeth. Managed to get a residency in pathology here at Southwestern. When I finished, they had an opening in the department.â€ He held out his hand, palm up, fingers spread, thumb tucked under. â€œSo here I amâ€”four years in the department, still an Assistant Professor. Up for promotion now, and I suspect that if I donâ€™t make it theyâ€™ll cut me like a dead branch from a tree.â€
Nickâ€™s last sentence rang a faint alarm bell in his head. He had to finish that project or the chairman would be royally ticked off, but it only took Nick a second to put that chore out of his mind. He was sitting with the most beautiful woman heâ€™d ever met. He wanted to get to know her better, and he intended to keep her here as long as possible, even if it meant incurring Dr.. Wetheringtonâ€™s wrath.