First Do No Harm (Benjamin Davis Book Series, Book 1) (2 page)

On a raw February night, Dr. Laura Patel paused at the water fountain just outside the entrance to the critical care unit and took a long drink. She rubbed her eyes. It was almost midnight, and she was sixteen hours into a twenty-four-hour shift. Tomorrow was about to begin.

She missed her family and Saint Francis Hospital, where she did her residency in Saint Paul, Minnesota. She regretted moving to Tennessee and hated the administration of her new employer, Plainview Community Hospital.

Although Saint Francis was a Catholic institution, run by Sisters, Laura, who was a Hindu, had not felt alienated by the staff or the clergy. But here at Plainview Community Hospital she was an outcast. Her dark brown skin set her apart from Plainview’s southern white medical staff, and her education and professional training only emphasized her differences.

Her specialty was in osteopathic medicine, while all the other physicians on staff were medical doctors. Her degree lent itself to conflict with medical doctors. Historically, there had always been a divide between DOs and MDs because the MDs felt superior. The American Medical Association for many years ran a
very successful negative ad campaign against DOs targeting both the general public and its MD membership. In the United States the DOs image was tarnished and denigrated.

The ignorance of her colleagues didn’t upset her, though. Laura thought the controversy made her strive to be a more holistic and better physician.

Laura started making her rounds in the critical care unit. No one was at the nurses’ station. It was unheard of for the nurse and two techs to be away from their post at the same time. According to hospital policy, at least one medical professional was supposed to monitor patients at all times, with the only exception being a Code Blue.

She continued down the corridor, wondering where they’d gone. As she walked, she asked herself again why she had ever come to Plainview. She’d first been attracted to Tennessee by the hospital’s generous compensation package. The hospital’s two-year employment contract guaranteed a minimum salary of $5,000 a month and allowed her to generate additional income by developing her own private practice. The hospital also agreed to pay her office rent for the first two years. The medical staff of the hospital, after the bankruptcy, left town in disgrace, and Woody Douglas, the hospital’s administrator, was on a mission to replenish the staff through attractive offers of employment.

Plainview not only offered a slower pace, allowing her to focus on her instantaneous family, but it was also close to Nashville, where Maggie, Laura’s life partner, grew up. Maggie’s family supported their same-sex relationship and loved the little girls. Laura and Maggie recently adopted two Chinese orphans, Kim and Lee.
I’m so glad that Maggie’s parents and sisters embrace our family
, Laura thought.
Our daughters need to be surrounded by loved ones
.

Laura’s immigrant father was less understanding, and her American mother was embarrassed. Neither the Indian nor Hindu cultures tolerated homosexuality. Her father had come to this country during India’s nonviolent, yet bloody, revolution for independence. Laura’s father and his brother worked for their uncle, who managed a hotel in Minneapolis. Eventually, the brothers owned a Howard Johnson’s franchise in West Fargo, North Dakota.

Growing up, Laura had been a source of great pride to her parents. She excelled academically and displayed a strong work ethic. However, her deeply religious family did not understand Laura’s chosen lifestyle. Her parents had met Maggie only once, at Laura’s graduation from A. T. Still University, the oldest DO program in the country. Her parents had not yet met her children, which saddened but didn’t surprise her.
Maybe if I keep sending pictures of the girls, they’ll ask to see them in person
.

A faint cry from down the hall broke into her thoughts: “Help, please help me.”

Again, moments later, she heard moans for help and determined that the sounds were coming from room 303. She grabbed the chart off the desk at the nurses’ station and walked to the ailing patient’s room. The patient, an elderly woman, was obviously in pain.

Laura quickly read the admission notes in the chart:

The next page had the patient’s physician orders. Gentamicin was a pretty powerful antibiotic, and it was being given in large doses. Dr. Herman must have suspected a severe infection. As she continued reading, her suspicions were confirmed. On February 1st at 9:00 a.m., Rosie Malone’s temperature was 102.4. By 2:30 p.m. that day her temp had risen to 103.8.

Mrs. Malone’s last recorded temp, at 9:30 that evening, had been 104.2. Clearly, the gentamicin wasn’t working. During the January 31st procedure, the surgeon, Dr. English, had to have nicked the bowel. A third-year resident would have reached the same conclusion. Within a day after the surgery, Mrs. Malone had developed an infection that was currently traveling through her bloodstream. The patient was slowly but surely dying from septicemia as the infection was shutting down vital organs.

Laura checked the patient’s drips and temperature. Mrs. Malone was getting a high dose of antibiotics and morphine, and the thermometer read 104.8. Sweating profusely, she was literally lying in a puddle of sweat.

“Help me, I’m burning up. I want my doctor. I need Dr. Herman, please,” the patient whispered weakly.

Laura left the room and went directly to the nurses’ station. Carole Black, RN, had returned to her post while Laura was with Mrs. Malone.

Wasting no time with pleasantries, Laura asked, “Where were you?”

Nurse Black looked annoyed. “Ladies’ room. When nature calls, it must be answered.”

Laura accepted the response but pushed forward. “What’s the story on Rosie Malone?”

“Miss Rosie has been a regular around here. She was admitted in February 1990 for a heart attack. We almost lost her then. This is her third hospitalization since that time. Last week Dr. Herman diagnosed her with gallstones after she presented with abdominal pain. This was all confirmed by an ultrasound at Dr. Herman’s office. On the 31st, Dr. English performed a laser procedure removing her gallbladder, but it appears he nicked something. Her white count is off the chart. I was about to retake her temp.”

“Don’t bother. I just took it—104.8. The gentamicin isn’t working. We should try vancomycin or maybe alternate gentamicin and vancomycin. This patient is septic, and without a change in course, she’ll die. You need to call Dr. Herman and get him here immediately. His patient is deteriorating quickly.”

Without another word, Laura returned to room 303. Mrs. Malone had both cardiac and pulmonary history and needed to be referred to a cardiologist and a pulmonologist. She also needed an infectious disease specialist to address her septicemia. However, none of those specialists was on the hospital staff. Rosie Malone needed to be transferred to Nashville where she could get the care from the subspecialists she required.

Without warning, a hand was placed on Laura’s shoulder, and she was spun around. She was face-to-face with Dr. Herman, who did not look at all happy.

“What the hell are you doing to my patient? Everything is under control.”

Herman’s antagonistic demeanor took her by surprise, but Laura immediately explained the situation: “I heard this patient calling for help, and there was no one at the nurses’ station. Her temperature is over 104. It needs to be addressed, and at the very least, she needs her bedding changed. Despite the high dose of morphine, she’s still in pain. It appears she’s septic, and her systems are in distress—”

Herman cut her off. “Look, Doctor, this is
not
your concern. She’s my patient. Thank you for your interest, but this is a complex case, and I don’t need you second-guessing Dr. English and me. Now get out of my way so I can treat my patient.”

She was astonished by Herman’s words and attitude. One of her responsibilities as the physician on call was to check on all patients in the critical care unit and to provide treatment as needed. It was not unusual for the on-call physician to write orders for other doctors’ patients.

“Doctor, I was just trying to care for your patient. She was in obvious distress and needed treatment.”

“Well, I’m here now, so move on. I will not be second-guessed by a DO.”

Laura realized she was getting nowhere with Herman. Whether it was the fact she was a woman or a doctor of osteopathic medicine, she couldn’t be sure. All she knew is that he never liked her, and he certainly didn’t respect her. She wondered if her sexual orientation created resentment as well or just made Herman feel threatened. She left the doctor with his patient and continued her rounds.

An hour later, she returned to the CCU. Nurse Black was seated at her desk, but Dr. Herman was nowhere in
sight. Laura was somewhat concerned that Nurse Black would report patient follow-up to Herman. Nevertheless, she grabbed the Malone chart and walked into an empty room to read it undisturbed.

A more careful review of the surgical report confirmed what she and Nurse Black suspected. Dr. English had nicked the patient’s bowel three days earlier during a laparoscopic gall-bladder surgery. Two days post-op, Mrs. Malone’s fever spiked and continued to rise. Twelve minutes prior to Laura’s return, Dr. Herman had taken the patient’s temperature, and it was up to 105.1. Herman’s physician note and order were illegible, but Laura made an educated guess about his intended course of treatment.

He increased her antibiotic dosage and her morphine
, read Laura.
But this patient is at serious risk of cardiac arrest and is in severe pulmonary distress
. Although the morphine was helping to manage the pain, it was also shutting down the patient’s systems.
To receive the necessary standard of care, Mrs. Malone should be transferred to either Vanderbilt Hospital or Saint Thomas Hospital in Nashville where specialists can treat her. What is Dr. Herman thinking? This patient will die if she remains at Plainview
.

Laura suddenly understood the real reason Mrs. Malone was not going anywhere: those bastards were trying to cover up their mistakes. By keeping Mrs. Malone at Plainview, Drs. Herman and English would be able to control and maintain the medical records, thus concealing their breach of the standard of care.
Those assholes!
She almost yelled out loud.

Laura felt ethically obligated to advocate for the transfer of Mrs. Malone, even though she was not the treating physician. She couldn’t just let a human being
die, nor could she let Herman get away with his deception.

She approached Nurse Black, who was checking the monitor of the patient in room 301. “Carole, I just looked in on Mrs. Malone in room 303. When are you scheduled to take her vitals again?”

“Dr. Herman ordered that they be taken every half hour, and if there is any deterioration of her condition, I’m to call him at his home. He’s very concerned about her.”

Laura decided to continue monitoring the situation. An hour and a half later she returned to the CCU and checked in with Nurse Black. Mrs. Malone’s temp was at a constant 104.8, and her vitals were about the same. At least the temp had gone down slightly.

She went back to the critical care unit at 6:00 a.m. The patient’s temp, taken just minutes before, was still 104.8. Laura decided to report Mrs. Malone’s condition to Woody Douglas, the hospital administrator.

At 7:10, Laura walked into Douglas’s office and asked his secretary if she could see him immediately. Douglas’s secretary knocked and led Laura into his private office.

Woody Douglas was seen as a hero, taking Plainview Community Hospital from red to black under his leadership. This turnaround was quite an achievement. It had been difficult for Douglas to recruit doctors after the bankruptcy four years earlier, so the thirty-seven-year-old had definitely earned the huge golden trophy, prominently displayed on the corner of his desk, from an appreciative board.

“Hello, Dr. Patel. What can I do for you?” Douglas asked.

“Woody, we’ve got a serious situation in critical care. Rosie Malone has a temperature of almost 105, and there’s no indication that it’s going anywhere but up. She’s septic and needs an infectious disease specialist. In addition, she has a cardiac and pulmonary history. She needs to be transferred to Nashville.”

“Since you’re here and reporting these concerns, I assume she’s not your patient.” Sitting back in his chair, he folded his hands on the giant desk. “Whose patient is she?”

“She’s Dr. Herman’s and Dr. English’s patient.”

“Have you discussed your concerns with either of them?”

“I tried to talk to Dr. Herman last night, but he abruptly told me to mind my own business.”

“I suggest you let the treating physician handle the care.”

“Woody, this patient is going to die if she’s not transferred to Nashville. You’ve got to intervene,” Laura insisted.

Douglas quickly responded, “I’m not a physician. I can’t second-guess two members of our medical staff. You did what you could. You expressed your opinion to Herman, but he’s the one who has to make the final medical call. It’s hospital policy.”

“Then I want to make a formal complaint.”

“That’s your prerogative, but it’s against my advice. A formal complaint will go to committee at the next scheduled meeting. What will that accomplish, considering that it’s two weeks from now? If she dies, you can file an incident report with the Morbidity Committee.”

What a cold-hearted jerk!
Laura seethed.

“It will be a little late, Woody. Mrs. Malone will be dead and buried by then. Is Dr. Kelly here? I want to bring this to his attention. Dr. Kelly, as the medical director of the hospital, can call an emergency meeting of the Executive Medical Committee. I have no alternative if you’re going to sit on your hands and let this patient die.”

“Dr. Kelly is on vacation out of town and won’t be back until Thursday. You can take it up with him then.”