No Such Thing
as Bad Publicity
I sit at the most sheltered table in the Smoker's Showcase, wrap my leather Eddie Bauer coat around me, pucker my blue lips around my Virginia Slim, and wonder once again why this habit has such a hold on me. Why am I not only willing but eager to walk half a mile?okay, I'm exaggerating a bit?and freeze to death for a hit of nicotine? It's not like I don't have other things to do. I am already ignoring messages from various people, most of whom are on my list.
You know what list.
On my bulletin board in the form of a fax someone sent me is a pirated reproduction of Calvin, from the Calvin & Hobbes comic strip, with one of his famous scowls. The copy says, "You don't know just how happy I am to add your name to the list of people who piss me off!!!!" There are about four lines under the heading permanent list and a few more lines under list for today.
All the lines are blank. Anyone who actually writes down the names of people on her list is some kind of idiot.
On my permanent list, which is not written down anywhere and doesn't need to be, are quite a few names.
The most important person is Ben Langstrom, the CEO of the hospital where I am the risk manager. He insists on being known as Dr. Langstrom even though his degree is Ph.D. (in health administration), not M.D. or D.O. Okay, he's earned the right, but in a hospital this does not strike me as especially brilliant. He was brought in by the board last fall to replace a guy everyone liked, and immediately won many soduk (a local expression, the opposite of kudos) for his rigid, military management style. His assistant left me a message that it was most urgent he meet with me today, at either one, five-thirty, or six. On a Friday. Give me a break. And she didn't say why.
I'm avoiding my boss, Jette Wakefield, also on the permanent list. Like me, she is a nurse with a law degree. Actually, I envy her; I'd like her job?vice president of legal affairs?and I could do it. In fact, I do. Her message said that she wanted a report of all pending claims on her desk by noon Monday (on a disk, so she can present it as work she did) and my budget for the next year as soon as possible. Grrr.
I look through bare branches toward the open sky at a flock of birds doing their laps. I see them every morning, soaring together in apparently random circles, swooping in one direction and then in another, as if guided by radar. Except one: it always lags behind the flock, just hanging on, just keeping up, not anticipating the swoops and turns of the others. That's how I feel, like I'm just keeping up, and completely at a loss about what's guiding the motions of everyone else.
My pager beeps, interrupting my reverie. The people who really need to reach me know how to do it. I'm not sure Nolan Horowitz, our PR director, really needs to reach me, but if he just wanted to chat he'd leave a message on my voice mail. I pull out my flip phone and, as I listen to his line ring, I watch the birds do another group figure eight and wonder who might be watching me.
The Smoker's Showcase is a deck between two buildings of the hospital. It looks out onto the glassed-in walkway that leads from the parking garage to Admissions and is situated so that it always gets wind and rarely gets sun. Tilt your head back and you can also see, four stories up, the windows of Administration, where many of the people on my list have offices. Nolan could be there now, looking down at me. At any rate he's there.
"Nole here, what's up?" Nolan always sounds cheerful on the phone but looks so mournful in person that I have secretly dubbed him "Eeyore."
"You paged me." I don't need to tell Nolan who I am. He remembers voices like I remember phone numbers.
"Jan Terwilliger at the Denver Post just called me asking about an incident where a patient got the wrong blood. You know, I really need to be in the loop on these things...."
"You mean that thing we had back before Thanksgiving? The patient checked into the hospital again, but not because he got the wrong blood. I mean, something else is wrong with him this time. Has nothing to do with the blood."
"Sounded like a new incident," Nolan says. "Maybe the Post needs to sell a few newspapers so they're just going to dredge it up again. I didn't know what to tell Jan."
"It better not be a new incident." I wonder why the press would resurrect this.
"Ah, well. Speaking of new incidents, Wayne Monroe filed suit. He had a press conference."
"Finally," I say with a certain relief.
I can explain. No, normally I do not do a victory dance when I find out we have been sued. However, Monroe's case was different: a sad case, but Not Our Fault. His press conference might explain why Jan Terwilliger wants to dig up last year's bad blood incident.
Wayne Monroe and his wife, Merrily (as in "Row, Row, Row Your Boat," was how they explained it), attended their second Lamaze class at our birth center, then went home. Later that night, Merrily had difficulty breathing and Wayne called 911. The paramedics rushed the young mother-to-be to our emergency room. Their efforts to resuscitate her failed, and she was pronounced dead shortly after arriving at the hospital. The baby, delivered at twenty-six weeks gestation, hung on for four days in the NICU before he, too, succumbed. Tragic, yes, but Not Our Fault?her postmortem indicated she died of an embolism.
The doctors who reviewed the file found no indication of medical malpractice. Even if they had, hospitals don't practice medicine; doctors practice medicine. And doctors are not (usually) employees of the hospital. So. We were not negligent, therefore we are not liable.
Wayne Monroe didn't see it that way, of course. He threatened to sue everybody?the hospital, the birth center, me, the obstetrician, the Lamaze instructor, and the couple who brought the refreshments for that night's class (they took turns). We logged forty or so increasingly vitriolic phone calls a day from him. Offices all over the hospital have a little card from our lawyer with the exact wording of what to say to him when he calls: "We cannot discuss this with you. Please call our attorney, Ken Sharpe, at 555-1234. Good-bye."
Now that he's filed, maybe the calls will stop?and if not, Ken can take the matter up with the judge.
I suppose I sound cold and heartless. After all, who am I to measure a man's grief over such a tragedy? I am not stone, and I had tears in my eyes when I talked to him the night of the tragedy. I misted up at the funeral. But in the medical profession you learn to get over these things quickly, even when you don't get hundreds of irate phone calls demanding forty million dollars in damages.
"So how'd the press conference go?" I ask.
"Could have been worse," Nolan says. "He could have held it at the Medallion."
The Medallion is a large, expensive, rather poorly done brass sculpture in front of our new, highly touted Women's Wing. In bas-relief it depicts a tranquil older woman, a pigtailed preteen, and a young mother nursing a smiling infant.
"So is it going to hit the front page?" I ask, glad Nolan, who thinks of these things, is our PR person and not Monroe's.
"Maybe page seven. If that. You know, it's kind of an old story."
I groan. "Old or not, it's bad publicity."
"Vicky," Nolan says. "There's no such thing as bad publicity."
Maybe from Nolan's perspective it's job security. But it seems like I always catch heat. For instance, in this case, Jette could ask me where I'd failed, so that Wayne Monroe went ahead and sued the hospital. Isn't it my job to talk people out of suing and into a quiet settlement whose terms are never disclosed?
Jette's boss, Harley Sloane, the head of operations, can ask me what kind of impact it will have on this year's legal budget for outside counsel. He will then mutter that he has two attorneys on staff and what good are we, anyway? Why is our outside-counsel bill always so high? Isn't it my job to keep things like this from happening?
Well, gee, I can't be everywhere at once.
I have no idea what Langstrom will say about it.
"Rojan didn't say a word," Nolan adds. "Just looked somber and dignified in his black suit."
I have a small choking fit. Thomas Rojan, Monroe's lawyer, always wears black, probably because it doesn't show stains.
"Rojan dignified?" Rojan is one of the sleaziest personal-injury lawyers in Colorado, possibly in the West. Since I don't watch late-night TV, I missed his ads, so the first time I saw him in court, I thought he was maybe a pedophile or a pornographer or a lower-echelon drug dealer. Imagine my surprise when I learned he was the plaintiff's counsel.
"He's got hair. A rug," Nolan says. "Black, with touches of steel gray. Looks like he got it slightly used from Burt Reynolds. Distinguished."
I try to picture Rojan as distinguished. It gives me a headache.
"I haven't seen the complaint," I say. "Did they pass out a copy?" That would be Rojan's style.
"Nope, just a press release, which is on the fax to you now."
Besides, I'm freezing. I stub out my cigarette with chilled fingers and head back to my office to thaw out.
My office does not overlook the Smoker's Showcase, but I've seen some spectacular sunsets through the girders of the parking garage. At my desk, I spend a few seconds admiring distant snowcapped peaks and pulling on my hair, a technique rumored to release tension in the scalp and prevent headaches. Then I clear a space on my desk, plop all my recent faxes on it, open my notebook, and go through the fax pile while listening to my messages.
Most people here in the hospital know I just hate it when they leave long, rambling messages defining the entire problem. Here's what I want: name, extension, and how urgent the problem is.
Here's what I get: "Hi, Vicky, uh, well, it's about a quarter to ten on, uh, Friday, the tenth of January, and, uh, well, we may have a problem here, that's on Four North, um, oh, that's the Internal Medicine Unit, we have this patient who might be filing a complaint, that is, maybe his wife will. He was in for a heart workup and somebody came into his room and said he was a member of the pastoral staff and then proceeded to interview him about his sex life. Anyway, he's mad and he wants that person fired, although I really don't think that the person was actually on the pastoral staff, and I'm not sure if I should write this up as an incident report or what. Well, that's all. Oh, call me back and let me know. Thanks, bye. Oh, wait, did I say who this is? This is Patty over on Four North.... Um, extension 4711. Thanks!"
The really awful thing is, when I call Patty back, she will go through the whole sordid thing again. When I interrupt to remind her that she told me this already, she will think I am rude. She won't tell me that, though. She'll spread it among the staff, where I already have a reputation as a harpy.
My inclination is to hit the Next button, but sometimes valuable information as to urgency and importance is buried in these messages, so I listen to the bitter end. As I listen, I scan the Monroe press release for obvious inaccuracies and put a sticky note that says file on it. I add it to my secretary's to-do pile, which is nearly as tall as I am. Not all that tall in my case, but impressive for a to-do pile.
Most of my messages are nonurgent or merely annoying. Claudia, at the blood bank, is a different story. She's not an alarmist, so when I get her message, that a transplant patient got mismatched blood, I pay attention. Damn, damn, damn, it sounds like the Post knows something I don't.
I call Claudia immediately. Her line is busy.
I speed through the rest of the messages to see if any of them pertain to this new incident. None do. I try Claudia again and catch her, apparently between calls.
"Oh, Vicky," she says, sounding relieved. "Remember that problem we had with the blood last fall? We've got another one. Another patient got the wrong blood. This time it's bad, one of Dr. Hrdlcka's transplant patients, and he got almost a whole unit before anybody realized it was mismatched."
I groan. Even if there aren't serious consequences to the patient, it's a serious lapse. It's a rare occurrence, or at least it should be. We could lose our license, and the blood bank could lose its certificate of operation. That probably won't happen, but each incident does generate a lot of paper.
"The patient died, right?"
Claudia is silent for a moment. "I hadn't heard that."
"What tipped them off that it was the wrong blood?" I ask.
"I don't know," Claudia admits. "The patient's reaction, I assume."
"So what are we doing? I'll need to talk to the clinical people who were involved, start an incident file, talk to the survivors. I'd better come down."
"Yes," she says. "I'm calling an emergency meeting, as soon as I get hold of the pertinent people. Actually, right now."
Dr. Langstrom will not be one of the pertinent people, but I wonder if this is what he wants to meet about. I call his assistant quickly, before the desirable times (not 5:30) are filled. Lucky me, I get to see him right after lunch.
As I replace the phone, it rings.
"This is Vicky." I realize it would be more professional to use my last name, which is Lucci. I don't know how the esteemed Susan Lucci, the one who got nineteen Emmy nominations before she won one, pronounces her name?my guess would be "Lootchy," to rhyme with Gucci or Pucci?but our family has chosen to pronounce it as "Lucky." Imagine what a thrill it was to go through junior high with the moniker Vicky Lucky. Enough to make you contemplate early marriage. The thrill has not entirely worn off, either. So I just say Vicky. Anyway, it sounds friendlier.
"Hi, Vic." It's Nolan again. "Seems we do have another blood incident and this time the patient's dead. The newspaper thinks he's dead, anyway. I hate getting information about my job from the newspaper."
"Hmmm. How did Jan hear so fast?" I demand.
"So we do have one." I can almost see Nolan smiling in satisfaction: Good, a challenge. "How come you didn't let me know? I'm on the front line here. ..."
"I just heard about it. I don't suppose Jan told you who tipped her off."
"Come on, Vic."
"I didn't think so. Don't tell her anything yet. I'll call you as soon as I find out more."
I make one more call, to our outside counsel, to alert him about the blood and tell him about the press conference, so he can think up some good ways to defend against Wayne Monroe's crazy suit. Dirty lawyer tricks, we call them. I inform his voice mail of the situation. Then off I go, taking the stairs instead of the elevator because I want to get to the unit where the incident occurred fast, before the nursing staff makes any mistakes with the evidence.
The special Intensive Care Unit for posttransplant patients seems pretty quiet. I stop at the door to the nurses' station, where two nurses sit before an array of monitors.
Before I have a chance to speak with the charge nurse, I am met by the patient's doctor. Met, actually, is the wrong term. He seizes my lapels and slams me against the wall, banging my head.
"What is going on here? Someone is out to get me! I can't leave the side of my patients for a minute!" he yells.
Dr. Harvey Hrdlcka has a very good reputation in his field; he has good outcomes. Always. In the past few weeks, some of them haven't been so good, and hospital personnel?employees, that is, not doctors?have been at fault. The wrong drug. The right drug in the wrong dose. A respiratory arrest during surgery due to a fault in the device that breathes and pumps blood for the patient during open-heart surgery. And now a transfusion of the wrong blood.
I can't blame him for being upset. But I wish he'd put me down. This is assault. I feel like my feet are dangling off the floor, but they can't be, my toes are touching.
"Harvey, get a grip," I say. Interesting wording. He has a grip. On my lapels. "Look, you're ripping my jacket. Calm down. Let's talk about this."
He releases me. His jaw is tight and very square. He looks like he's been clenching his teeth and acting stubborn all his life, which he probably has. His red hair stands up in clumps, as if he's been pulling it. While I'm not saying all us redheads have flashes of temper, some of us do. We tend to get over them quickly, however. At least I do.
"I'm here to investigate," I say. "What happened?"
Hrdlcka seems calmer, but his syntax gives him away. "Drinkwine, that schmuck, is trying to out me get from my contract. She's setting these things up."
Our physician recruiter is by no means a schmuck. She recruited Hrdlcka for our transplant center, and his contract, though secret, was the talk of the hospital for a year. Rumors say he has a guarantee of $800,000 a year, which means if he collects anything less than that from his patients, we, the hospital, make up the difference.
I don't know how these rumors get started. I have seen his contract, and the guarantee is comparable to what most of our doctors get. What sets his contract apart is the termination clause.
Most such clauses are simple: Thirty days' notice from either party to terminate without cause. Hrdlcka, however, can leave whenever he wants with thirty days' notice, but if we want to get rid of him, without cause, we pay his full guarantee for one year, no matter how much he makes anywhere else, and he gets the guarantee less his collections the next year. That's why he thinks his recent bad outcomes were set up?to get him out of his contract, with cause. But he's wrong; it's just bad luck.
"Harvey. Just tell me what happened."
"Hell if I know," he says. "Somebody paged me. Said patient's in respiratory failure and the Cor Zero team is on the way. I came on the run, but when I got here they'd lost him." He runs his stubby fingers through his hair. "How it happened? Jesus God in heaven, how these things happen? And why? That's a real fucking good question. Why don't you get your ass in there and answer it?"
That's what I'm here for. He was the one who sidetracked me.
"Harvey," I say gently. "Where is the patient now?"
He starts sputtering again. "In the cooler, where you fuck the think?" Harvey came from some eastern European country as a teenager. When he's calm, you'd never guess it; his diction is flawless and his accent a mere hint.
"Can we calm down and talk about this? What makes everybody think he got the wrong blood? I'm trying to investigate this. Can we start at the beginning?"
He calms down, a bit. "In the beginning, this man comes from Texas to be treated by us, because we are the best. He has dialysis three times a week, he gets near death, and finally a match is found. Has one failure and then this, a really good match, is found. And then some bozo comes in and him the wrong blood gives."
Warned by Harvey's diction, I proceed carefully. "And what type of blood did he get?"
"B negative," Hrdlcka says. "The worst."
"And you checked this."
"Oh, yes. B negative on the bag. B negative in the sample from the bag, I myself typed. He is lying there after surgery, recovering, his body healing. And then bam! He's dead. All the way from Texas he came, to die. And why? Because some incompetent clod cannot be bothered to make a check of all the factors."
It can't be as simple as that, but I don't say this to Harvey. You don't have to be a brain surgeon to match up blood. The blood type is everywhere: on the patient's chart, on the patient's wrist tag, in the doctor's orders.
I'm talking to the wrong person. It's the nursing staff I need to speak to.
"Harvey," I say, trying not to agitate him. "When the autopsy is done, will there be conclusive evidence that this patient died because he got the wrong blood?"
As I feared, he begins to get angry again. "You are saying there's something wrong with my transplant?"
"No, I mean ... well, okay, obviously he's on immunosuppressants, for the transplant. He's had surgery. It was his second surgery, is that right? He's diabetic?"
My attempt at soothing him fails miserably. "You are not trying to find answer," he says. "You are trying to find out can his survivors sue us. I say yes, they should sue this hospital for shit, and the fool who hangs the wrong blood and the schmuck who put that person up to it, and everybody. And that is what I will tell the family."
"Oh, no," I say. "No, I have to find out where we went wrong."
"Oh, no," he echoes, "you have to find out how to save the hospital a buck here and a buck there, when you kill the innocent ones. You will say, well, he was a diabetic. And he was an alcoholic. And he was old. And he would have died anyway. It's true, he would have died anyway. Many years of life later." Hrdlcka reaches for me again, but I back away.
"No, Harvey, I have to find out what's going wrong, so nobody else gets hurt. So whoever made this mistake is punished."
"Oh, so we are going to find the guilty person and tie her down and pump into her some kind of blood that will quickly kill her?"
"Punish that schmuck Belinda Drinkwine," he says. "Whoever did this, she behind it is."From the Paperback edition.
Excerpted from Bad Blood by Suzanne Proulx. Copyright © 1999 by Suzanne Proulx. Excerpted by permission of Ballantine Books, a division of Random House LLC. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.