{"id":313,"date":"2016-09-10T13:36:29","date_gmt":"2016-09-10T17:36:29","guid":{"rendered":"http:\/\/www.herbheineman.com\/?page_id=313"},"modified":"2024-07-26T09:25:43","modified_gmt":"2024-07-26T13:25:43","slug":"chapter-26","status":"publish","type":"page","link":"https:\/\/herbheineman.com\/Eden\/edensgarden\/chapter-26\/","title":{"rendered":"Chapter 26: A Conference"},"content":{"rendered":"\t\t
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PART III<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Cora Hamilton, chair of the Department of Pediatrics for the past three years, was a tall, thin, stoop-shouldered woman with graying black hair pulled back in a tight bun. Labeled by her detractors \u2015 peers for the most part \u2015 as severe, gaunt, or American Gothic, she regarded charm as a useless frill. Conventional ideas that didn\u2019t match her own were ignored.\u00a0 In appointing house staff to her service, she paid more attention to the applicants\u2019 character than their grades or research interest. Knowledge could be acquired, she reasoned; humanity either was or was not there. She also took issue with the prevalent attitude that valued publications over clinical practice. The credo \u201cPublish or perish\u201d made for bad research, bad literature, and bad doctors. If she had had her way, publishing an article in a medical journal would have ranked equal with restoring productive life to a disabled patient, no higher.<\/p>

On the subject of medical malpractice she was even more unyielding, if that was possible. If doctors practiced with competence and caring, there would be no lawsuits. It followed that the burden of proof lay with the doctor. In the case of Eden Avery, she saw not only the potential for a lawsuit, but inevitable \u2015 and totally justified \u2015 victory for the plaintiff.<\/p>

Cathy Cross and Calvin McCrae had been her choices; Mort Friedman\u2019s appointment preceded her elevation to the chair.<\/p>

She called the mortality conference to order.<\/p>

\u201cWe had only one fatality in the past two weeks, but that one\u2019ll give us more than enough to think about. Doctor McCrae, please present the case.\u201d<\/p>

Calvin made the best of a bad situation. In a subdued but clear voice, he told of his diagnosis and the urgency of treatment, of persuading Nurse Bader to fill orders without review by the resident on call, of his abbreviated visit to the cafeteria, and the disaster in progress on his return. He gave credit to Cathy Cross for cautioning him about drug allergy and then coming to his aid later. He made no reference to Mort Friedman.<\/p>

The audience, already in possession of the facts through the all-reaching grapevine, had anticipated a confrontation between intern and resident; so far it had not happened.<\/p>

\u201cSo much for the facts,\u201d Cora said. \u201cDo you wish to add anything?\u201d<\/p>

\u201cYes, I do, Doctor,\u201d Calvin replied. \u201cIt\u2019s my fault that Eden Avery died.\u201d<\/p>

Cora studied Calvin\u2019s face. \u201cYou did commit an error, and a costly one it was. Learn from it. And everyone else learn from it. That\u2019s why we have these conferences.<\/p>

\u201cNow, we also have fail-safe mechanisms to protect our patients from errors like this. An intern\u2019s orders have to be countersigned by the resident on call and the nurse is not supposed to carry them out unless they have been. Isn\u2019t that your understanding, Ms. Brown?\u201d<\/p>

\u201cYes.\u201d Alice Brown, the nurse for whom Connie Bader had substituted, was back.<\/p>

\u201cOf course, you weren\u2019t here when this happened.\u201d Alice was relieved not to be put in the uncomfortable spot of criticizing her colleague.<\/p>

\u201cSo, Doctor McCrae, how did it happen?\u201d<\/p>

\u201cI persuaded Nurse Bader to start the antibiotics right away. I thought I could get the order countersigned later. I had no right to do that.\u201d<\/p>

Cora did not drive home the point. She turned her focus to the resident.<\/p>

\u201cDoctor Friedman,\u201d she said, her expression blank.<\/p>

\u201cI didn\u2019t get a page. My beeper had a dead battery, for the second time this month.\u201d<\/p>

\u201cDid you stop by any time during the evening, just by way of checking up on things?\u201d<\/p>

Mort was beginning to squirm. \u201cNo, I did not.\u201d<\/p>

\u201cDid the name Eden Avery mean anything to you prior to this admission?\u201d<\/p>

\u201cYes.\u201d<\/p>

\u201cHow did you learn about her?\u201d<\/p>

\u201cShe had a previous admission.\u201d<\/p>

\u201cMany of the people here may not know about that. Tell them about it.\u201d<\/p>

\u201cAnaphylactic reaction to Bicillin.\u201d<\/p>

Half the audience sat with eyes downcast; the other half gasped.<\/p>

\u201cMay I ask where you were during the time Eden Avery was dying?\u201d<\/p>

\u201cIn the sleep laboratory.\u201d<\/p>

\u201cYou\u2019re doing research there?\u201d<\/p>

\u201cYes.\u201d<\/p>

\u201cAnd are your results encouraging?\u201d Cora\u2019s tone was totally dispassionate. Mort had no choice but to answer likewise, knowing he was digging his own grave.<\/p>

\u201cYes, quite.\u201d<\/p>

\u201cTell us about them.\u201d Cora wrote the words \u201cdrug allergy\u201d on the blackboard.<\/p>

Mort gritted his teeth. He had envisioned presenting his research at a different kind of conference, to the kudos of other researchers. He knew there were major discoveries in his future; publications that would be cited by others; invitations to speak at national, even international, meetings. And, of course, top-notch academic faculty appointments. Now this!<\/p>

\u201cMost interesting,\u201d said Cora when he had finished. \u201cYes, we do need good research, and good research does take dedication. And time too. We may all be thankful one day that you gave both to your project. Sleep is such an important part of all our lives.\u201d<\/p>

As she was speaking, still with her back to him, Mort heard her matter-of-fact tone but could not see her face. He could not tell what she was accusing him of \u2015 if anything. Against such an elusive attack he could not defend himself. She slowly turned round to face him.<\/p>

\u201cYou must have been glad the evening was so quiet,\u201d she continued in the same tone.<\/p>

Mort blushed deeply. He had indeed been glad \u2015 had, in fact, openly expressed his hope for just such an evening. Cathy would remember. How could he own it without seeming not to care about his patients? How could he deny it without being caught lying?<\/p>

\u201cMy beeper didn\u2019t go off,\u201d he said.<\/p>

\u201cDid you check the battery before going where you couldn\u2019t hear the public address?\u201d<\/p>

\u201cIt was less than two weeks old.\u201d<\/p>

\u201cDo you check the warning lights on your dashboard before driving your car?\u201d<\/p>

Mort stood mute. \u201cThat is not a rhetorical question,\u201d Cora said.<\/p>

\u201cYes, I do.\u201d<\/p>

\u201cEvery single time?\u201d<\/p>

\u201cYes.\u201d<\/p>

\u201cAnd do you check your equipment in the laboratory before making a measurement?\u201d<\/p>

Silence.<\/p>

\u201cDoctor Friedman?\u201d<\/p>

\u201cYes.\u201d<\/p>

\u201cEvery single time?\u201d<\/p>

\u201cYes, Doctor Hamilton.\u201d<\/p>

\u201cYou may sit down.\u201d<\/p>

He sat down. Cora had dangled before him the option to hate her instead of himself, but he was in no state to choose.<\/p>

\u201cThe lesson is obvious,\u201d she said to the audience at large. \u201cBeing on call means just that.\u201d As a calculated afterthought she added, \u201cA patient\u2019s life may depend on it.\u201d<\/p>

In the silence that followed, breathing risked drawing unwanted attention.<\/p>

\u201cDoctor Cross, you were off duty but you stepped in. Is there anything you wish to add?\u201d<\/p>

\u201cNot really, Doctor Hamilton. I\u2019m afraid I was no help to the patient.\u201d<\/p>

\u201cBut you were to Doctor McCrae. I\u2019m sure he\u2019s very grateful for your help\u2014\u201d<\/p>

\u201cI am,\u201d Calvin said, \u201cI cannot thank her enough and I\u2019ve told her so.\u201d<\/p>

\u201cI thank you, too,\u201d Cora said to Cathy. To the others, she added, \u201cThat\u2019s <\/em>the kind of example I want you to take from here. . . . Alice, I don\u2019t want to put you on the spot, but do you have any comment?\u201d<\/p>

\u201cThis does show how a nurse can make a real difference. I knew Eden, and I\u2019d have been able to remind Doctor McCrae that she was allergic. Connie didn\u2019t know her and had no basis for questioning the orders. But I\u2019d like to ask you a question, Doctor Hamilton, if I may.\u201d<\/p>

\u201cGo ahead, and you\u2019re right in what you said. We never appreciate nurses enough.\u201d<\/p>

\u201cIf I\u2019d been on duty and had carried out the order, would I be held liable?\u201d<\/p>

\u201cMorally and ethically, without a doubt. Legally, I don\u2019t know, since you were carrying out orders. Perhaps you could take refuge in there being nothing about allergies in the new chart, and the old one wasn\u2019t up yet. Does anyone want to speculate?\u201d<\/p>

\u201cIt\u2019s clear she\u2019d be held liable.\u201d It was the voice of Homer Radcliffe, a pathologist. \u201cIf she were put under oath, she\u2019d have to admit that she knew of the allergy \u2015 or she\u2019d be committing perjury. So she couldn\u2019t take shelter in the chart not being up.\u201d<\/p>

\u201cI\u2019ve heard you can\u2019t be forced to remember. If it\u2019s not in writing, it doesn\u2019t count.\u201d<\/p>

\u201cLying is lying.\u201d<\/p>

\u201cThanks, Homer. Nowadays physicians have to know something about law too. That makes us smarter than our forebears; we know the rules of liability. So what do we do in our wisdom? Gamble that nothing will go wrong when we violate those rules. Well, we\u2019d better add another rule: You don\u2019t stake a patient\u2019s life on the odds, no matter how long the odds.\u201d<\/p>

Calvin\u2019s and Cathy\u2019s eyes met in a moment of private understanding.<\/p>

\u201cThe other point,\u201d Cora continued, \u201cis that this case has all the makings of a malpractice suit. Our lawyers will caution us not to discuss it with anyone. Not even among ourselves where others might hear us. I\u2019d much rather encourage open discourse, but we have to make concessions to reality. And as long as we\u2019re all here, let me give you a piece of my own mind. Whether we get sued or not, we deserve to. And we deserve to lose.\u00a0 And losing should be a lesson to us, not to vilify the lawyers who sue us, but to remind ourselves how much power we hold in our hands. I\u2019m talking about our patients\u2019 trust, not the latest technology. Every negligent act is a betrayal of that trust. You think malpractice awards are too high? You think malpractice premiums are too high? How would you like to lose your child because the doctor forgot to ask a question \u2015 or was busy elsewhere with a dead beeper?\u201d She paused before delivering the coda. \u201cI have no desire to repeat this lecture. Don\u2019t give me reason to.\u201d<\/p>

With that, the conference ended. As the assemblage left the room, a voice was heard. \u201cQuite a sermon! I wonder whether she preaches on the side.\u201d<\/p>

\u201cShut up, Friedman!\u201d Doctor Hamilton was out of earshot.<\/p>

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

Before returning to her office, Cora went to the administration suite. \u201cIs Mr. Small in?\u201d<\/p>

\u201cYes, Doctor, let me see if anyone is with him.\u201d<\/p>

A moment later she motioned Cora into an office bearing the name \u201cPatrick Small, Esq.\u201d<\/p>

\u201cGood afternoon, Cora. Going to keep me from my wife and kids again?\u201d Pat Small rarely passed up an opportunity to tease the doctors about the hours they spent in the hospital. His work as legal counsel involved fairly mundane matters such as contracts, regulations, and the necessary dealings with labor unions. Malpractice litigation was outside his expertise.\u00a0 For this ever more important area, the hospital\u2019s insurer had engaged the firm of Burns, MacAdoo & Ferguson. Still, Pat knew enough about liability to offer informal comments. He and Cora enjoyed each other\u2019s respect and friendship. In his presence she sometimes laughed.<\/p>

She closed the door behind her and said, \u201cThere\u2019s no reason for your family to be so privileged. I don\u2019t see myself getting out of here any time soon, so you can suffer with me.\u201d<\/p>

\u201cWhy not make that \u2018supper\u2019? I\u2019ll call my wife and say I\u2019ve had a late admission.\u201d<\/p>

Cora laughed \u201cYou could probably make her believe it \u2015 unless she\u2019s a better lawyer than you. But I don\u2019t want you to get in trouble with her. I\u2019m sure you know why I dropped in.\u201d<\/p>

\u201cIt\u2019s all over the hospital. Too bad the bottle couldn\u2019t have been corked right away. I don\u2019t lack in sympathy for the family, but that loose talk could come back to haunt you.\u201d<\/p>

\u201cI know. I just told them that at the mortality conference, but it\u2019s a little late, obviously.\u201d<\/p>

\u201cIf my information is correct, you don\u2019t have a leg to stand on. But I know those boys at Burns and company. They don\u2019t give up without a fight. McCrae, Friedman, and Bader are hospital employees, but they\u2019ll try to dump it all on Rick Harmon. The more Harmon pays, the less the hospital\u2019s share of the damages. I\u2019ll bet you three to one they put Bruce MacAdoo on the case. He\u2019s their toughest.\u201d<\/p>

\u201cWell, I hope Rick\u2019s carrier has a lawyer even tougher than MacAdoo and dumps it right back where it belongs. To use your words, I\u2019m not lacking in sympathy for my own house staff, far from it, but that\u2019s where the liability is. And I\u2019m no less to blame than Rick. . . . And will you kindly stop taking notes. This is supposed to be off the record.\u201d<\/p>

Pat had made a pretense of taking notes as Cora implicated herself. \u201cListen, Cora. What\u2019s between you and me stays between you and me. But I get an occasional urge to do something to shock you. I just don\u2019t trust you not to say things like that to the wrong people. For God\u2019s sake, don\u2019t even hint at such a possibility, or you\u2019ll get your nose rubbed in it under oath.\u201d<\/p>

\u201cHow do you think it\u2019ll come out?\u201d<\/p>

\u201cMy best guess? MacAdoo will try bluffing first \u2015 emergency, too sick to give history, records not up yet. In other words, terrible tragedy but can you blame the hospital? Now that\u2019s where the plaintiffs\u2019 lawyer comes in. I\u2019ve learned that the girl\u2019s mother is, guess what? a lawyer \u2015 a goddam medical malpractice plaintiff\u2019s lawyer! Can you beat that?\u201d<\/p>

\u201cYou move fast,\u201d Cora said admiringly. \u201cAll I knew was that her father\u2019s on staff here.\u201d<\/p>

\u201cIt\u2019s my job to be informed. Anyway, they\u2019re not going to buy those excuses. There\u2019ll be a settlement. MacAdoo won\u2019t let it go to a jury. Their best hope is to get the damages downgraded because of the girl\u2019s limited life expectancy. She had heart disease, you know.\u201d<\/p>

\u201cBut with modern surgery, who knows? In any case, there\u2019s the stigma of culpability.\u201d<\/p>

\u201cThe question is culpability, not the stigma thereof.\u201d<\/p>

\u201cI guess I\u2019ll be making the acquaintance of Bruce MacAdoo all too soon,\u201d she sighed.<\/p>

\u201cDon\u2019t sound so depressed about it. He\u2019s on your \u2015 our \u2015 side.\u201d<\/p>

Cora Hamilton smiled as she got up. \u201cGive my apologies to your wife for keeping you.\u201d<\/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><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Chapter 27 >><\/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 III Cora Hamilton, chair of the Department of Pediatrics for the past three years, was a tall, thin, stoop-shouldered woman with graying black hair pulled back in a tight bun. Labeled by her detractors \u2015 peers for the most part \u2015 as severe, gaunt, or American Gothic, she regarded charm as a useless frill. […]<\/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-313","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/pages\/313","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=313"}],"version-history":[{"count":5,"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/pages\/313\/revisions"}],"predecessor-version":[{"id":829,"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/pages\/313\/revisions\/829"}],"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=313"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}