Trauma

CHAPTER 6

The BCH conference room was nearly full. By quarter to eight in the morning, all but Knox Singer, the gray-haired CEO of Community, had arrived for the meeting. Carrie was sandwiched between Julie Stafford, the head nurse for 4C, the neurosurgical floor where Leon Dixon had stayed before surgery, and Emily Forrester, legal counsel for White Memorial Hospital. As part of her official residency at White Memorial, Carrie rotated through various satellite hospitals, including BCH. Her operating room mistake had dragged the neurosurgical departments of two organizations into this legal morass.

Sitting across from Carrie were Dr. Stanley Metcalf and Brandon Olyfson, the CEO of White Memorial. Olyfson was whippet-thin, with a long and narrow face, and hawkish eyes that made Carrie shrivel inside. There was coffee, of course, but the usual platters of donuts and pastries were absent, probably in deference to the gravity of the situation. No one was chatting; periodic, desultory sips of coffee were all that broke the silence.

Olyfson and Dr. Metcalf exchanged a few quiet words. Carrie was deeply unsettled by the tension on their faces. Her actions had not only injured a patient, but she had damaged the credibility of her hospital and the man whose skill and poise she had worked so tirelessly to emulate. Her failure was egregious. Unconscionable. Soon she’d hear it dissected in all its grotesque detail by the higher-ups at BCH and White Memorial.

Until a few hours ago, Carrie had been in the same scrubs she’d worn to Leon Dixon’s surgery. Now she had on her most professional-looking outfit: a dark suit jacket, slacks, and a blue blouse. Carrie had returned home to her empty Brookline apartment; fed her goldfish, Limbic, named after a primitive memory circuit in the brain; and passed out on the futon, getting a fitful couple hours of sleep. She awoke mired in self-loathing and disbelief, and the pang in her heart confirmed it had really happened.

She did a reasonable job pulling herself together. After studying the spectral being she’d become in the bathroom mirror — her skin was moonlight pale, with dark circles ringing each eye, and her tousled hair stuck out in all directions — she’d swept her hair into a ponytail and figured they’d at least see she was suffering.

At two minutes past eight, the door to the conference room swung open. In strode Knox Singer, accompanied by Carla Mason, head of legal for BCH. Singer was all alpha male, tall and broad-shouldered, with a finely coiffed mane of silver hair and the swarthy good looks of a guy who made his living doing Cialis commercials. Mason was pint-sized by comparison, but her severe bangs, ramrod-straight back, and sharply tailored business suit seemed to add a few inches of height.

Emily Forrester grabbed a chair from against the wall and wheeled it over for Mason, while Singer took a seat at the head of the conference table.

“Sorry I’m late,” Knox said in a rumbling low voice. His tone suggested this was the worst possible way to start his day. “Let me begin by saying this meeting is privileged. No minutes. The reputation of Community has to trump the glaring negligence from any member of its staff. So, tell me, Stan, what happened in there?”

Mason managed to get Knox Singer’s attention, and she gave him a look he understood.

“Wait,” Knox said, preempting Dr. Metcalf’s response. “Do you want counsel, Stan? You can have it. Just say the word.”

Dr. Metcalf sat stone-faced and issued no response. None was necessary. Everyone knew what this meant: There was no defense. As the attending physician, Dr. Metcalf was responsible for everything that happened in the OR, including the negligent actions of his first assistant.

Carrie sat rigid in her chair and felt a tight band pull across her chest. Her throat had gone Sahara dry, but she could not manage even a sip from the glass of ice water in front of her. They might be talking to Dr. Metcalf, but this meeting was about her. She fixed her gaze on her hands, which were clutched together in her lap. She needed to keep it together.

“Got it,” Knox said. “So I’ll ask again, and pardon my language, but what the fuck happened in there?”

Carrie lifted her head and somehow found the courage to look Knox in the eyes.

“It was my mistake,” she said. Her voice came out in a whisper, so she had to repeat herself. Louder. “I’m the one responsible.” Carrie pursed her lips against a sob, a few tears leaking down.

Julie Stafford’s nursing instincts kicked in, and she put a comforting arm around Carrie’s shaking shoulders. Gently, Julie eased the glass of water closer to Carrie and encouraged her to drink. Carrie couldn’t; she was nauseated with grief.

Knox appraised Carrie thoughtfully. He bore a sympathetic expression, as did about half of those seated at the table, with Dr. Metcalf being the most notable exception.

“How did this happen, Dr. Bryant?” Knox asked more mildly.

Carrie shook her head slowly, still in shock. On the occasions when Carrie checked her cell phone while driving, she tried to imagine what it would feel like to cause a traffic fatality, as a way of weaning herself from the habit. But now she knew. She knew exactly what it felt like. It was a sickening, horrible feeling she would not wish on anybody.

“I put the film up backward,” Carrie said, struggling with her voice. “I should have known — I should have — Mr. Dixon was aphasic, his right side was weaker, he had a right Babinski. All the signs were there to remind me that the problem was in the left hemisphere, but somehow I just forgot. I guess I was tired from my last surgery, but I know that’s not an excuse, I know that. I’m so very sorry to everyone involved.”

Carrie braved eye contact with everyone at the table, desperate to convey her sincerity. Dr. Metcalf focused on his notepad as if refusing to look at Carrie somehow separated him from her and her mistake.

“Had you reviewed the film prior?” asked Sam Stern, the sixty-five-year-old chief of neurosurgery at Community. It was obvious he would try to shift the blame to another department, and radiology was as good a target as any.

Carrie swallowed hard. “I reviewed the MRI with Dr. Nugent the day before the surgery,” she said. “I’d seen the films, Sam. I have no excuse.”

The silence that followed lasted several seconds before Knox spoke up and broke the spell.

“Julie, what’s Mr. Dixon’s status?”

Julie Stafford had been head nurse on the neurosurgical floor for fifteen years, and a staff nurse at Community for fifteen years before that. She essentially ran the place. Jokes abounded about her supernatural ability to know everything that happened on her floor, even before it seemed to happen. It was a well-established fact that Nurse Stafford could make or break the career of any resident rotating through 4C with just a few choice words. But she’d always been good to Carrie; they shared the same work ethic and commitment.

“Mr. Dixon is stable,” Julie said. “But he’s mute and won’t follow any commands. Right now his wife and his brother are with him. They know what happened. Dr. Metcalf hasn’t been in to see him, though.” Dr. Metcalf shot Julie a stern look.

Carla Mason had been quietly taking notes and looked up over her glasses. “I’ve told him not to,” Carla said.

“I would like to go on record here and say a few words,” Julie said.

With a nod Knox gave his consent, and Julie spoke.

“I have worked with Carrie Bryant since the start of her residency, when her responsibilities were limited to doing mostly scut work at all hours of the day. Carrie, more than anyone, took the extra time to get to know her patients and families. I understand that she had been up all night operating on a complicated case. I spoke personally with Beth Stillwell’s sister, Amanda, who praised Carrie’s kindness and compassion. I’ve personally seen Dr. Metcalf tear apart residents for any delays that derailed his schedule, so I’m sure that played a role in Carrie rushing to get the OR set up right. Carrie made a terrible mistake. There’s no denying that fact, but she’s not the only culpable party.”

Dr. Metcalf made daggers with his eyes.

“I refuse to be intimidated by any doctor on staff, regardless of their stature here,” Julie continued. “In my opinion, I’m tired of the attending physicians using the hospital like a personal garage whenever a physician friend wanted a favor. Look, I sincerely appreciate our close relationship with White Memorial and the excellent doctors from there who otherwise wouldn’t be in a position to care for our city’s less fortunate. But perhaps if Dr. Metcalf deigned to venture up to 4C to see his patient before operating, or God forbid at least look at the MRI prior, none of this would have happened.”

A heavy silence ensued, and Carrie felt somewhat vindicated. Better procedures for double-checking should have been in place, and Carrie believed protocols would change as a result.

“Look, there’s really no issue here,” Carla Mason interjected.

As chief counsel for Community, Carla was directly responsible for malpractice cases like this one. Unfortunately, they seemed to be happening with greater and greater frequency. The majority of these cases were meritless, but the hospital continued to cough up millions in legal fees defending them, not to mention countless hours of deposition, fact-finding, and copying records. The impact on productivity was now just a cost of doing business. For everyone involved, the expense of a lengthy trial was more than a matter of money; it was years of legal wrangling in terms of time, reputation, and emotional well-being. Carla tried to avoid the courtroom whenever possible, even for the most meritless claims — a strategy Knox Singer fully endorsed.

“The family will sue and the hospital will settle,” Carla said. “And the sooner this is done, the better. The last thing BCH and Chambers University need is something like this getting out to the press and the public.”

“Carla and I are meeting with the Dixons at eleven,” said Emily Forrester, the lawyer for White Memorial. “We will advise them to seek counsel immediately. Knox, I take it you’d agree to our informing the family that the hospital and university will offer a very generous settlement, and will assume responsibility for any upcoming and future medical care that the Dixons might require. I’ve already discussed this with Brandon, who concurs.”

Brandon Olyfson nodded. As CEO of White Memorial Hospital, he wanted out of this meeting, and quick. Olyfson thought of BCH as nothing more than a cesspool. Three-quarters of the patients were drunks or drugged out. No one had insurance. He could give a crap about Leon Dixon, Carrie believed. All that mattered to Olyfson was that Dr. Metcalf, his choice for the next chief of neurosurgery, was now a potential plague on the reputation of White Memorial Hospital.

“So, this Dixon guy. I mean, he was probably going to have problems regardless of any surgery, right?” Olyfson asked.

Dr. Metcalf became indignant. “Brandon, Mr. Dixon has a left temporal lobe tumor, most likely an astrocytoma. But of course, we don’t know that for certain now. His tumor may be aggressive, and if so, his prognosis wouldn’t be very good. Maybe a few years with radiation and chemotherapy. But just maybe, this could have been an abscess and potentially curable. The MRI isn’t definitive. It can’t distinguish between an abscess and a tumor. But we can’t operate on the other side until we know what damage we caused by this error.”

“So was Mr. Dixon going to be compromised regardless?” Olyfson asked.

“The tumor might be less aggressive and potentially more amenable to adjunctive treatments than usual,” Metcalf said. “One never really knows. Mr. Dixon was losing control of his speech. Now we’ve only added to his deficits. He may never speak another word. He may lose all his memory function. His behavior is likely to be very different. Hell, he could lose functional control of his sphincters for all we know. Bottom line is he will now be functionally dependent for the rest of his life, however long that’s going to be. Considerably shorter, I suspect. We can do a simple biopsy of his tumor at some point, but because of the damage we’ve done, aggressive care won’t be of any benefit.”

Carla Mason and Emily Forrester took copious notes, but Carrie looked only at her lap. She was finished. She sat silent, holding herself together by remaining as still as possible. But she couldn’t stop the tears, which cascaded down her cheeks, dripping into her lap. Once again, Julie put an arm around Carrie to comfort her.

“It’s going to be okay, sweetie,” Julie whispered. “We’ll get through this. I promise.”

“Carrie, anything else you want to add?” Knox asked.

“Just that I’m tendering my resignation,” Carrie said. “Effective immediately.”