{"id":270,"date":"2016-09-05T12:33:14","date_gmt":"2016-09-05T16:33:14","guid":{"rendered":"http:\/\/www.herbheineman.com\/?page_id=270"},"modified":"2024-07-25T17:09:01","modified_gmt":"2024-07-25T21:09:01","slug":"chapter-24","status":"publish","type":"page","link":"https:\/\/herbheineman.com\/Eden\/edensgarden\/chapter-24\/","title":{"rendered":"Chapter 24: The Last Crisis"},"content":{"rendered":"\t\t
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PART II<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Karen looked over Alan\u2019s shoulder. \u201cIt looks awful. Shouldn\u2019t she be on antibiotics?\u201d<\/p>

The object of concern was Eden\u2019s knee. The scrape had seemed innocent enough, but instead of healing it had become infected. With last year\u2019s anaphylactic reaction now in Eden\u2019s record, the nurse had convinced the camp director that it would be best to send her home.<\/p>

\u201cPolysporin is an antibiotic \u2015 three, in fact,\u201d he said, showing her the ointment he planned to apply after each hot compress, \u201cnone of them related to penicillin.\u201d<\/p>

\u201cI meant a shot, or taking something by mouth.\u201d<\/p>

\u201cI\u2019d rather not give her anything internally.\u201d<\/p>

Karen had gone as far as she dared. She asked, \u201cDo you have to take a culture?\u201d<\/p>

\u201cIt\u2019s probably staph, and it\u2019s covered.\u201d<\/p>

Lying around was not how Eden would have chosen to spend the afternoon. Once she was alone she disregarded Alan\u2019s directive to do just that. By evening, though, she could not ignore the throbbing pain. Now she wanted comforting, so she called Josh. That, at least, she could do lying down. \u201cFor God\u2019s sake!\u201d he told her, \u201cDo as your dad says. Do you want to get blood poisoning? We have a lifetime to think about!\u201d It was both more and less than she\u2019d hoped for.<\/p>

Well, I asked for it, she told herself, and next day she did as she was told. All the same, the pain woke her in the night. \u201cWe\u2019ll give it one more day,\u201d Alan said when he saw it in the morning. \u201cAfter that it\u2019s IV antibiotics. Flat on your back now. You promise?\u201d<\/p>

\u201cI promise,\u201d she said, defeated. She had only herself to blame. She cried more out of mortification than pain. Where were her common sense and maturity now? What had she brought on herself?. . . What would Josh think of her?<\/em><\/p>

By afternoon she felt ill, muscles aching and head pounding. Though she had neither eaten nor drunk anything since breakfast, she felt neither hunger nor thirst. She took two pain pills from the bathroom and was about to lie down again when a wave of nausea overcame her. She made it back just in time to vomit and have a loose bowel movement. After this she fell into a fitful sleep, only to awake an hour later to an overriding sensation of weakness and an inexplicable chilliness. This is July, she thought, how can it be so cold? Then the gooseflesh appeared on her upper arms and she began to shiver. Now she was frightened enough to call her mother. The first thing that struck Karen on seeing Eden was her flushed appearance and the warmth of her skin, as if she had fever. Her jaw dropped when she saw how right she was.<\/p>

\u201cA hundred and four,\u201d she barely managed to say the words. \u201cWe\u2019re going straight to the hospital. Enough of compresses and ointment.\u201d<\/p>

\u201cIt\u2019s probably just a bad case of flu. Maybe the knee has nothing to do with it.\u201d<\/p>

\u201cMaybe, and maybe not. We\u2019re not taking any chances.\u201d<\/p>

\u201cOh God, I feel so miserable.\u201d She allowed her mother to help her up. As she stood, she became lightheaded and almost fainted. Karen felt only mildly guilty for her remark about the compresses and ointment. But past and present were merging in her mind, and she was angry.<\/p>

\u201cWho\u2019s her doctor?\u201d the receptionist in the emergency room asked.<\/p>

\u201cHarmon.\u201d Seeing the receptionist\u2019s eyes widen, Karen added, \u201cShe\u2019s not quite seventeen.\u201d<\/p>

\u201cAh, I guess she won\u2019t be a pediatric patient much longer.\u201d Karen was in no mood for small talk. \u201cWould you call him please, or else let me?\u201d<\/p>

\u201cOf course,\u201d the receptionist said, all business now. \u201cHere, I\u2019ll dial for you.\u201d<\/p>

\u201cRick?\u201d Karen related the details of Eden\u2019s illness. \u201cDo you think this could just be flu?\u201d<\/p>

\u201cI don\u2019t know, but you did right to bring her in. Nothing by mouth all day? She needs fluids, especially with that fever. The house staff\u2019ll take care of her. Cathy Cross is very good. I\u2019ll stay out of the way till they\u2019re done.\u201d<\/p>

\u201cWill you get back to me at home? I don\u2019t want to be in their way either.\u201d<\/p>

The time was six-thirty. Karen accompanied Eden\u2019s stretcher to the second floor, where she met the house physician. He was a young man only slightly taller than she, seemingly in his mid-twenties. He turned to Karen with a kind smile. \u201cI\u2019m Calvin McCrae, intern. You\u2019re Mrs. Avery ? Eden\u2019s going to room 226. I\u2019ll see her as soon as they\u2019ve got her in bed.\u201d<\/p>

\u201cIs she going to be OK?\u201d<\/p>

\u201cPeople her age bounce back fast. I\u2019ll do a physical and order some lab tests. We\u2019ll take blood cultures and start her on antibiotics. Most likely Prostaphlin and Garamycin.\u201d<\/p>

\u201cIt\u2019s been such a rush, my husband doesn\u2019t even know. Do you know Doctor Avery ?\u201d<\/p>

\u201cI certainly do. Would you like me to page him for you?\u201d<\/p>

\u201cNo, he\u2019s in the office this afternoon. I\u2019ll take care of it.\u201d<\/p>

\u201cI\u2019m sure he\u2019ll understand, Mrs. Avery . You did exactly what you should have done. Leave your number at the station in case we need to call you. No need for you to stay.\u201d<\/p>

Her mind wandered back to her days of promise at F & D, when she would meet Alan, then a resident himself, at the hospital for dinner. How much had happened since then!\u00a0 She felt comforted by Doctor McCrae. He seemed self-assured and sensitive.<\/p>

~~~~~~~~~~<\/p>

Calvin McCrae was less than two weeks into his internship, still savoring the letters M.D. newly added to his name. He smiled inwardly at his double life. At the hospital, he was the lowest of the low, trying to prove that he was more of a doctor now than he had been as a senior student. Things were different at home. To his parents he was now a doctor<\/em>, transformed on one magic capped-and-gowned day from bleary-eyed student to knowledgeable healer. His new status in the neighborhood also brought challenges, in the form of curbside consultations by people he knew. These he fended off by insisting he was but an intern<\/em>,<\/u> thereby implying he wasn\u2019t a real doctor yet. In time he\u2019d be able to handle them with confidence.<\/p>

Eden\u2019s case was as straightforward as it was serious. He concluded in minutes that she had a life-threatening illness. Adding together chills, high fever, a heart murmur, and a skin lesion through which bacteria could have entered the blood stream, he diagnosed a staphylococcal infection on the aortic valve, which could destroy it in days. Accordingly he ordered two blood specimens drawn immediately for culture. On second thought, he drew them himself to save time. He then ordered intravenous oxacillin specifically for staph, and gentamicin in case other bacteria were involved. Like many doctors exposed to pharmaceutical advertisements and salespeople, he thought in terms of trade names, Prostaphlin and Garamycin, and ordered accordingly. He handed the chart to the nurse. \u201cGet this started right away, Connie. It\u2019s urgent.\u201d He\u2019d write the admission note later.<\/p>

\u201cHow about the resident\u2019s signature?\u201d Connie asked.<\/p>

\u201cAs soon as I find her. I don\u2019t want to hold up treatment. The girl\u2019s shocky.\u201d<\/p>

Connie hesitated briefly and set about her job.\u00a0 \u201cBy the way, Cathy switched with Mort.\u201d<\/p>

\u201cOK,\u201d Calvin answered casually, \u201cI\u2019ll look for him.\u201d<\/p>

Nothing like a solid diagnosis \u2015 acute bacterial endocarditis and septicemia \u2015 and effective treatment to match, he thought. His decisive action made him feel good. By morning he would see grateful smiles on the faces of Eden and Mrs. Avery . Even Doctor Avery would be pleased. He looked forward to the morning.<\/p>

By rights his treatment orders were not valid without a superior\u2019s approval. It took a year of internship to qualify for a medical license, and he was barely two weeks into that year. But rules could get in the way of good medicine. Luckily, tonight\u2019s nurse, whom he\u2019d known since his high school days, was willing to bend the rules too. Mort would countersign later. He was probably at dinner. As soon as the infusion was running, Calvin made his way to the cafeteria.<\/p>

He did not see Mort, but he did see Cathy Cross. Newly arrived in Philadelphia, she was two years ahead of him in training but ten years older, having worked as a nurse before going to medical school. He sat down at her table, noticing that the chair was warm.<\/p>

\u201cFeels like someone just sat here.\u201d<\/p>

\u201cMort. He just left.\u201d<\/p>

\u201cDid he say where he was going? I had an admission. I need him.\u201d<\/p>

\u201cI don\u2019t know where he went,\u201d she replied. \u201cHe was in a hurry \u2015 made some remark about hoping things would stay as quiet as they\u2019ve been all day.\u201d<\/p>

\u201cHe should be satisfied with his quiet day. It\u2019s not quiet now. That girl is pretty sick.\u201d<\/p>

\u201cCan I help?\u201d she asked.<\/p>

\u201cI thought you were off tonight.\u00a0 How come you\u2019re still here?\u00a0 It can\u2019t be the food.\u201d<\/p>

Cathy screwed up her face.\u00a0 \u201cI was supposed to be on, so I didn\u2019t make plans. Mort wants tomorrow off.\u00a0 Mother\u2019s birthday or something. I didn\u2019t want to refuse, though it wouldn\u2019t hurt if he remembered his ma a little sooner.\u00a0 Anyway, here I am.\u00a0 Can I help?\u201d<\/p>

\u201cNot really. I\u2019ve already started antibiotics.\u00a0 Mort just needs to countersign the orders.\u201d<\/p>

~~~~~~~~~~<\/p>

Morton Friedman, M.D., enjoyed eating, and the cafeteria fare was much to his taste. Still, tonight he had eaten more as a matter of necessity than enjoyment. He was preoccupied. Under other circumstances he would have liked to flirt with his junior colleague, but on this occasion he excused himself as soon as he had finished. Expressing the hope that the evening would be as quiet as the day had been, he hurried out. Luckily Cathy asked no questions.<\/p>

As senior resident, he was responsible for all patients on the pediatric service. Supervising two interns meant checking their physical findings on all new patients, approving lab tests and x-rays, and countersigning treatment orders. No drugs could be given without his approval. This early in the year, interns needed close supervision. Mort expected to be paged but hoped he wouldn\u2019t. He had other interests to pursue. He was in his final year as resident. One of the privileges of seniority was time for research. The choice of a topic presented no problem, for he had long been fascinated by sleep, which renders healthy people unconscious for a quarter to a third of their lives. Luckily the chief neurologist was conducting research on this very subject and invited Mort into his laboratory, where he was now learning to analyze fluids from the spinal canal and brain cavities. His goal was to study the chemistry of dreaming, the molecular transformations connecting imagery, eye movements, and brain waves.<\/p>

He had arranged to be on duty.\u00a0 Last night he had needled the brains of his experimental cats. Tonight he would study computer printouts from the fluids he collected, looking for blips and squiggles that might point the way to chemicals not previously identified. He was unwilling to wait till his next on-call \u2015 and even more unwilling to do his research on his own time \u2015 so he had rescheduled his mother\u2019s birthday to make sure Cathy would go along.<\/p>

With a prayer to be left in peace, he hurried to the laboratory.<\/p>

~~~~~~~~~~<\/p>

\u201cI assume they\u2019re holding the antibiotics till Mort signs?\u201d Cathy said.<\/p>

\u201cNo, it\u2019s too urgent,\u201d Calvin answered. \u201cShe has acute endocarditis.\u201d<\/p>

Cathy tilted her head and arched her eyebrows. \u201cYou could have got an OK by phone.\u201d<\/p>

\u201cIt was straightforward textbook stuff.\u00a0 I\u2019m sure he\u2019ll agree.\u201d<\/p>

\u201cWhat did you order?\u201d<\/p>

\u201cProstaphlin and Garamycin.\u201d<\/p>

\u201cDon\u2019t they teach you to use generic names any more?\u201d she asked with feigned disgust.<\/p>

\u201cOK, oxacillin and gentamicin. How\u2019s that?\u201d<\/p>

\u201cBetter. We\u2019re not in the business of promoting brand names. Anyway, it sounds like a reasonable choice. Unless, of course, she\u2019s allergic. I assume you asked about that.\u201d<\/p>

Calvin frowned briefly. \u201cCome to think of it, I didn\u2019t. But most people aren\u2019t.\u201d<\/p>

\u201cTrue. But don\u2019t bet your patient\u2019s life \u2015 or your own hide \u2015 on the odds. Better get up there and make sure. I\u2019ll see to it nobody steals your food.\u201d<\/p>

\u201cCan\u2019t it wait till I\u2019ve eaten?\u201d<\/p>

\u201cNo.\u201d She wagged her finger in the manner of a schoolteacher. \u201cNow do as your resident says \u2015 even if I am off duty.\u201d<\/p>

~~~~~~~~~~<\/p>

After leaving Doctor McCrae to examine Eden, Karen turned to her next task \u2015 notifying Alan. She found a pay phone and rang his office.<\/p>

\u201cGilda, it\u2019s Karen Avery . Is Alan available?\u201d<\/p>

\u201cAfraid not, Mrs. A. I\u2019ve been trying to reach you. You must not be calling from home. Alan\u2019s at the hospital, with one of his patients. Emergency surgery. Alan\u2019s watching.\u201d<\/p>

\u201cThat\u2019s where I am. I just brought Edie in, with a fever of a hundred and four. She suddenly got sick this afternoon. Everything was such a rush I didn\u2019t take time out to call.\u201d<\/p>

\u201cMy goodness! What is it?\u201d<\/p>

\u201cI don\u2019t know. Could be a bad case of flu, that\u2019s what Edie thought. But she also has this infection on her knee. For all I know, it might have spread. I didn\u2019t want to take any chances.\u201d<\/p>

\u201cAnd right you are, too. Is she OK now?\u201d<\/p>

\u201cShe\u2019s got an IV going and the intern sent me home so he could attend to her.\u201d<\/p>

\u201cAlan\u2019s patient ruptured an aneurysm. I bet he\u2019s on the table this minute.\u201d<\/p>

\u201cCan you reach him?\u201d Karen asked.<\/p>

\u201cNo. He told me he\u2019d be scrubbed so he can get close. Gordon\u2019s taking his calls.\u201d<\/p>

\u201cWell, that\u2019s no good to me. How long does this operation take?\u201d<\/p>

\u201cI have no idea. I\u2019m supposed to tell you it could get pretty late.\u201d<\/p>

Karen stamped her foot in frustration. \u201cWhy do these things always have to happen together? The one time you need a person you can\u2019t reach him!\u201d<\/p>

\u201cI\u2019ll page him every half hour \u2015 I can even do it from home \u2015 and I\u2019ll catch him the moment he comes out. That\u2019s the best I can do short of sending someone after him.\u201d<\/p>

\u201cNo, that\u2019d be overdoing it. If it turns out she just has the flu, he\u2019ll be upset about being called out. He doesn\u2019t like to make a production over little things.\u201d<\/p>

Gilda wondered what lay behind the sarcasm. \u201cWill you be home?\u201d<\/p>

\u201cI\u2019m going home now.\u201d<\/p>

Seven o\u2019clock. Karen went into room 226 to bid Eden goodnight, shrugged apologetically to Doctor McCrae, and went home to await Alan\u2019s and Rick\u2019s calls. Wondering which would come first, she made a cup of tea, but she had no appetite for food.<\/p>

At nine o\u2019clock the telephone rang.<\/p>

~~~~~~~~~~<\/p>

The encounter with Cathy had shaken him up. Behind the casual fa\u00e7ade, he was angry at himself. How could he ask about allergy now that the drugs were already infusing?\u00a0 He took the stairs three at a time. As he burst through the stairwell door, opposite the nurses\u2019 station, he saw a woman in the blue uniform of kitchen staff speaking hurriedly to Connie. Connie\u2019s mouth was hanging open and before Calvin could ask any question she had dashed off.<\/p>

\u201cWhat\u2019s going on?\u201d he shouted as he ran after her, but she was too absorbed to hear. They reached room 226 at the same moment, and there was Eden Avery , sitting up, face bloated, lips swollen, fighting a hopeless battle to breathe. As they stood, frozen by terror, the deep red of her face took on a purple tinge, and she slowly slumped over.<\/p>

\u201cCode Blue, quick!\u201d he screamed. As fast as Connie had flown to the room she flew to the phone. Calvin instinctively attempted cardiopulmonary resuscitation, without stopping to feel whether Eden\u2019s heart was beating. As he breathed into her mouth, he felt the tremendous airway resistance. He forced air in, but there was no way to get it out. When the code team arrived, he realized that his efforts had availed her no more than her own.<\/p>

\u201cDid anyone give adrenalin?\u201d asked a small man in a green scrub suit. Guiltily Calvin remembered how he used to joke about that outfit \u2015 referred to variously as monkey suit or pajamas \u2015 which was the working garb of surgeons and anesthesiologists. Now he muttered a prayer of thanks for the life-saving skills of these doctors and vowed to be more respectful. He would have confessed on the spot, had he not been dismissed on answering no. Sensing his panic, the small man added: \u201cToo many people and we get in each other\u2019s way. We\u2019ll be OK.\u201d<\/p>

But they were not. After twenty excruciating minutes, they emerged, grim and silent. Too numb to ask questions, Calvin watched as they made their way to the nurses\u2019 station to record their efforts. He didn\u2019t need to ask the cause of death. If the diagnosis hadn\u2019t been obvious, Cathy\u2019s last words would have made it for him. Don\u2019t bet your patient\u2019s life \u2015 or your hide \u2015 on the odds. He had not bet indifferently or recklessly. His motive, to treat a life-threatening infection with all possible dispatch, would have satisfied a conscience even more demanding than Calvin\u2019s. But motive was not enough. It would have taken less than a minute to ask the life-sparing question, and give vancomycin instead. In his overconfidence he had committed the most egregious error. He was guilty of a young girl\u2019s untimely and unnecessary death.<\/p>

After the code team had gone, he turned to Connie, who met his gaze with solemn eyes.<\/p>

\u201cHas Friedman been told?\u201d<\/p>

\u201cI\u2019ve paged him,\u201d she said. \u201cHe still hasn\u2019t answered.\u201d<\/p>

\u201cKeep trying. I\u2019ve been looking for him too. He doesn\u2019t even know she was admitted.\u201d<\/p>

~~~~~~~~~~<\/p>

Constance Bader had a long association with the pediatric service at Cresheim Valley Hospital. For twelve years she had worked there full time. Now she filled in as needed. Connie knew most of the staff as well as the attending doctors. She also knew Calvin McCrae, the new intern \u2015 had, in fact, known him since at thirteen he had paid daily visits to his injured friend Tim Haig on this very floor. She had met Calvin again some years later when he did volunteer work \u2015 even knew the circumstances that brought him there. As a teenager he\u2019d been bright, impetuous, and warm-hearted. He\u2019d also had a crush on her, even though she was almost twice his age. Maybe, she fancied, she had even had a role in his becoming a doctor.<\/p>

Familiar as she was with the hospital, in one area she was at the same disadvantage as other substitute nurses. Her sporadic calls to duty gave her little time to get to know the patients. As she would reflect later, had Alice Brown, the regular nurse, not been ill, Eden Avery would not have died that night, because Alice would have caught Calvin\u2019s mistake. And Alice would not have let old friendship blind her to proper procedure. She would have insisted on a resident\u2019s OK for the orders.<\/p>

Connie had ample reason to be frustrated.\u00a0 As if the circumstance of Eden\u2019s death wasn\u2019t depressing enough, she had failed repeatedly to reach Doctor Friedman. He\u2019d been unavailable to stop the lethal order; now he was unavailable to deal with the consequence.<\/p>

Neither her supervisor nor Doctor McCrae, nor Doctor Cross, who had come up during the code, had any idea of Friedman\u2019s whereabouts. Finally Connie called Doctor Harmon.<\/p>

\u201cThis is Nurse Connie Bader at Cresheim Valley. Doctor, I don\u2019t know how \u2015 I can\u2019t \u2015 Doctor \u2015 your patient Eden Avery, in room 226, died. Anaphylactic shock. About twenty minutes ago. I\u2019ve been trying to reach Doctor Friedman, and he\u2019s not answering his page.\u201d<\/p>

Doctor Harmon could not believe his ears. \u201cMy God! Did someone give her penicillin?\u201d<\/p>

\u201cOxacillin. But there\u2019s nothing in the chart about allergies.\u201d<\/p>

\u201cWho wrote the orders?\u201d<\/p>

\u201cDoctor McCrae.\u201d<\/p>

\u201cDidn\u2019t he ask her, or her mother?\u201d<\/p>

\u201cI don\u2019t know. Should I read his history to you?\u201d<\/p>

\u201cNo, never mind, I\u2019ll deal with that later. And where in the world is Friedman?\u201d Then he remembered. \u201cWait a minute!\u00a0 I thought Doctor Cross was on tonight.\u201d<\/p>

\u201cShe was scheduled, but they switched.\u201d<\/p>

Rick broke out in a cold sweat.\u00a0 \u201cDid Friedman countersign McCrae\u2019s orders?\u201d<\/p>

\u201cDoctor McCrae was unable to reach him and he thought it was urgent.\u201d<\/p>

\u201cAnd you took orders from the intern without the resident\u2019s signature?\u201d<\/p>

A moment of silence. \u201cDoctor McCrae was sure Doctor Friedman would approve.\u201d<\/p>

\u201cYou should have called me. Where\u2019s McCrae now?\u201d<\/p>

\u201cHe\u2019s pretty crushed. I don\u2019t think he\u2019s up to calling.\u201d<\/p>

\u201cI\u2019ll be right over. Don\u2019t call anybody. Let\u2019s hope her mother doesn\u2019t show up.\u201d<\/p>

Doctor Harmon lived twenty to forty minutes from the hospital, depending on traffic. The distance was short enough for a timely response in off-hour crises, long enough to think about what he would say and do when he reached his destination. He needed this cooling-off period, because he took his patients\u2019 setbacks so personally. Never was this truer than tonight, for the victim had been a favorite of his and her parents were long-standing friends.<\/p>

There was no shortage of scapegoats. The intern had committed a fatal error of omission. The nurse had carried out unauthorized orders. The supervising resident had abandoned his station. Every one of them could justifiably be held responsible.\u00a0 But the real blame lay at his own doorstep. After hearing Karen\u2019s account, he knew that Eden needed antibiotics, at least till the diagnosis was clear. McCrae would have been derelict not<\/em> ordering them. And what choice did McCrae have but to insist they be given without delay? Were it not for the allergy, his decisiveness might have saved his patient\u2019s life.<\/p>

And Rick knew about Eden\u2019s exquisite allergy. He would have ordered vancomycin.<\/p>

Cathy Cross was one of Cora Hamilton\u2019s appointees. Cora knew who was dedicated to the care of children and who was dedicated to his own advancement. Cathy would have been at her post. Of that he was sure. If he had known Friedman was on call, he would have known not to take anything for granted. It was his own fault for not asking.<\/p>

McCrae was a brand-new intern, oscillating between insecurity and overconfidence. As for Connie Bader, her actions were typical for substitute nurses. Whereas the regulars often knew more than the house staff and weren\u2019t afraid to make suggestions, substitutes tended to follow doctors\u2019 orders without question. And the doctors could be intimidating.<\/p>

When the lawyers got hold of this \u2015 Rick could hardly imagine they wouldn\u2019t \u2015 he, as attending physician, would be at the head of the lineup. Deservedly so. But the prospect of a lawsuit was trivial compared with Eden\u2019s death and her parents\u2019 bereavement.<\/p>

~~~~~~~~~~<\/p>

Calvin walked to the end of the hallway. He looked at the street and the homes on the other side. How often he had gazed on this scene as a student. How restful to watch the traffic after a day of examining patients, trying to impress his professors, cramming ever more data into his reluctant brain. How inconsequential the fatigue of those days seemed now.<\/p>

He was no stranger to mistakes, reckless ones even. But with the help of caring friends he had survived the consequences and continued his climb. Now he tasted defeat as he had never known it. He thought of the condescension with which he had dismissed Eden\u2019s mother, his cockiness as he went to dinner, the certainty of tomorrow\u2019s smile. \u201cOh doctor, I feel so<\/em> much better.\u201d\u00a0 He thought of his parents\u2019 pride and his modesty in belittling his stature by insisting on being called intern. Modesty, indeed! He didn\u2019t deserve even that title. What right, for that matter, did he have to his degree, Doctor of Medicine? The patient goes to the doctor for help, and the doctor prescribes death. Yes, that is what he had done, prescribed death<\/em>. For Eden Avery , the antibiotic had been an agent of death as certain as arsenic, only faster.<\/p>

Overcome by despair, Calvin wept: for his patient, who would never again enjoy life, family, and friendship; for those who would miss her; and for himself. How utterly his self-image as healer had been crushed. How would he face his next patient? \u201cHi there, Annie! Hi, Mrs. X. I killed the last girl I admitted. Not deliberately, just careless. But don\u2019t worry. I\u2019m sure it won\u2019t happen to Annie.\u201d And his career? Would he even last out the year? My God, less than two weeks! Next day there\u2019d be morning report, where tonight\u2019s events would be dissected for the instruction of all.\u00a0 Then the monthly mortality conference.\u00a0 How would he survive that? . . . And where, dammit, was Friedman?<\/em><\/p>

He felt an arm on his shoulder. He turned and looked into the face of Cathy Cross.<\/p>

\u201cI began to worry when you didn\u2019t come back. Then I heard the code.\u00a0 I\u2019m so sorry.\u201d<\/p>

\u201cYou told me, but it was too late. It\u2019s so awful.\u201d<\/p>

\u201cI wish I could make you feel better. Who among us hasn\u2019t made mistakes and gotten away with them by sheer luck? Would you feel better if I stayed around the rest of the night? You shouldn\u2019t be on service alone anyway, and I can\u2019t imagine what\u2019s happened to Mort.\u201d<\/p>

\u201cBut you\u2019re off duty.\u201d<\/p>

\u201cRight now there\u2019s nothing I\u2019d rather be doing, and I have other evenings off coming.\u201d He welcomed her embrace and gave himself up to his grief.<\/p>

~~~~~~~~~~<\/p>

By the time Rick reached the hospital, an eerie quiet had descended on the nurses\u2019 station. There sat Connie Bader; Martha Vinton, the nursing supervisor; Calvin McCrae; and Cathy Cross. Except for Cathy, all looked as if they expected a reprimand.<\/p>

\u201cIt\u2019s been a bad evening, hasn\u2019t it?\u201d Rick said.<\/p>

\u201cYes,\u201d they replied as a group, trying not to show their relief. Rick was popular with the nurses and house physicians. He had been associated with Cresheim Valley more than thirty years and knew the stresses facing those on the front lines. This was not the time for criticism. \u201cI thought when Mort was on duty you were off,\u201d he said to Cathy.\u00a0 \u201cIsn\u2019t that what\u2019s meant by switching?\u201d<\/p>

\u201cI heard the code in the cafeteria, so I stopped by.\u201d<\/p>

\u201cIt was good of you. Can you fill me in?\u201d<\/p>

~~~~~~~~~~<\/p>

The call was from the hospital. \u201cMrs. Avery ? This is Flo Decimo, circulating nurse in the OR. Your husband asked me to call. This aneurysm is taking longer than they thought, and he wanted me to tell you he could be very late, and not to wait up or worry.\u201d<\/p>

Karen thanked Nurse Decimo, poured herself more tea, and sat down to wait. An hour later her patience gave out. The telephone rang again just as she got up to call Doctor McCrae.<\/p>

\u201cKaren?\u201d The voice sounded like Rick\u2019s, but why did it have such a strange intonation?<\/p>

\u201cYes? Who\u2019s calling?\u201d A cold fear gripped her. She cursed the silence of the house and her solitude in it. Why couldn\u2019t Alan be here tonight of all nights?<\/p>

\u201cIt\u2019s Rick. I went to see Edie. All hell had broken loose. The code team was there in her room, with their emergency equipment, the drugs, the crash cart.\u201d<\/p>

Karen screamed: \u201cNo! Oh God, no! Please don\u2019t let it be . . . !\u201d<\/p>

Rick knew it was futile to beat about the bush. \u201cShe had a reaction to oxacillin and they couldn\u2019t bring her out.\u201d<\/p>

\u201cWhat is oxacillin?\u201d she cried hysterically. \u201cDoctor McCrae never mentioned that.\u201d<\/p>

\u201cMaybe he used the trade name, Prostaphlin. It\u2019s a kind of penicillin for staph.\u201d<\/p>

\u201cBut McCrae should have known. Everybody knows she\u2019s allergic to penicillin. . . . And Alan isn\u2019t home.\u201d She was crying uncontrollably. \u201cHe\u2019s been watching some stupid operation all night. He doesn\u2019t even know she\u2019s in there. I\u2019m all alone. What shall I do?\u201d<\/em><\/p>

\u201cYou\u2019d better come to the hospital. I\u2019ll get Alan out of the OR.\u201d<\/p>

Rick took a deep breath and steeled himself. The power of denial! First, he himself. It hadn\u2019t happened the way he told her. Went to see Edie,<\/em> indeed! He was home, reading the newspaper while his patient lay dying. They\u2019d called him. Now Karen. A mother who has this minute been told she has lost her only child, and she takes time out to quibble about the name of the antibiotic. As if the enormous truth could be diminished by this delaying tactic.<\/p>

~~~~~~~~~~<\/p>

One of the endearing institutions at Cresheim Valley Hospital, in Mort Friedman\u2019s eyes, was midnight supper. Actually it was served at ten-thirty, but by that time those on duty could readily believe it was midnight. Mort, not one to miss a meal, stowed his printouts and helped himself to a trayful of food more suitable for an athlete than a student of sleep, and sat down to work it over. His appetite was fired up; he\u2019d had a rewarding evening in the sleep lab. Basking in visions of glory, he almost failed to notice Cathy Cross sitting down opposite him. \u201cWhat\u2019s a nice \u2015 uh \u2015 person like you doing in a place like this on her night off?\u201d<\/p>

\u201cI\u2019m hungry and the food\u2019s free.\u201d<\/p>

\u201cTouch\u00e9. Well, I only hope your next night on is as satisfying as mine. Would you believe it, not a single call. Not even an admission. That\u2019s the way I like them. Gives me a chance to study sleep. And please note, I said \u2018study.\u2019 \u201d<\/p>

When his wit failed to elicit even a weary ha-ha, he looked at Cathy, ready to ask if she was feeling all right. He stopped cold, mouth open, fork poised in midair. She was looking at him with an expression he had never seen before, a mixture of accusation, disgust, and hate.<\/p>

\u201cWhat\u2019s the matter? Am I talking with my mouth full? Sorry, I\u2019ll watch my manners.\u201d<\/p>

\u201cYou were in the lab all evening?\u201d<\/p>

\u201cYes. Why? For God\u2019s sake, what\u2019s going on?\u201d<\/p>

\u201cYou didn\u2019t answer your page.\u201d<\/p>

\u201cPage? There was no page. Who paged me?\u201d<\/p>

\u201cJust about everybody. In your absence a patient was admitted, worked up, treated, and pronounced dead.\u201d<\/p>

Mort slowly rose and deliberately placed his fork on his plate next to the remaining food.<\/p>

\u201cEither you\u2019re a fantastic actress or you\u2019re telling me something I don\u2019t want to hear.\u201d<\/p>

\u201cIt\u2019s true, every word. This girl came in febrile and shocky. Heart murmur. Possible acute endocarditis. Cal took blood cultures and ordered oxacillin and gentamicin. He was looking for you to countersign, but he didn\u2019t think the girl could wait. I thought he\u2019d done the right thing, except he\u2019d forgotten to ask about allergies. I sent him back up, but by then she was in anaphylactic shock, and the code team couldn\u2019t bring her round. Harmon\u2019s here.\u201d<\/p>

Mort\u2019s legs turned to rubber. \u201cHarmon\u2019s patient? Endocarditis? Penicillin allergy? Was this a readmission?\u201d<\/p>

\u201cYes. The old chart\u2019s flagged all over the place. \u2018Allergic to penicillin.\u2019 Her last admission was for anaphylaxis. Bicillin. She had rheumatic heart disease.\u201d<\/p>

\u201cOh God, I know that girl. They had a big conference about her. Eden Avery ?\u201d<\/p>

\u201cThat\u2019s her. You would have stopped that order. I\u2019m sorry to be so blunt.\u201d<\/p>

\u201cYou\u2019re being remarkably tactful,\u201d he said bitterly. \u201cWhat you\u2019re saying is the patient died because I wasn\u2019t there to supervise an incompetent intern. Right?\u201d<\/p>

\u201cHe\u2019s not incompetent. He responded to an urgent situation and overlooked a caution. We\u2019ve all made mistakes. He\u2019s new. Things you and I do without thinking take a conscious effort on his part. Please try not to be too hard on him. He\u2019s suffered a great deal tonight.\u201d<\/p>

\u201cI\u2019m sorry. I shouldn\u2019t be passing the buck to him. But I still don\u2019t understand why I didn\u2019t hear the page.\u201d<\/p>

\u201cChecked your beeper lately?\u201d<\/p>

\u201cI put in a new battery just last week.\u201d<\/p>

\u201cLook at it now to be sure.\u201d<\/p>

The display panel was blank. He jiggled the switch but it made no difference.<\/p>

\u201cShit,\u201d he muttered and ran from the cafeteria. The remainder of his precious food grew cold on the tray.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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Chapter 25 >><\/a><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

PART II Karen looked over Alan\u2019s shoulder. \u201cIt looks awful. Shouldn\u2019t she be on antibiotics?\u201d The object of concern was Eden\u2019s knee. The scrape had seemed innocent enough, but instead of healing it had become infected. With last year\u2019s anaphylactic reaction now in Eden\u2019s record, the nurse had convinced the camp director that it would […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":21,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-270","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/pages\/270","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/comments?post=270"}],"version-history":[{"count":5,"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/pages\/270\/revisions"}],"predecessor-version":[{"id":819,"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/pages\/270\/revisions\/819"}],"up":[{"embeddable":true,"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/pages\/21"}],"wp:attachment":[{"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/media?parent=270"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}