Table of Contents
FATHER OF THE DEAD
Morgan tried to calm the man. I understand how upset you must be, but I promise you, your sons received expert medical care.
My sons are dead, Dr. Connolly. Kaines stony glare never shifted from Morgans eyes. She didnt feel physically threatened, but his intimidating demeanor made her uneasy. It was obvious her words were falling on deaf ears.
Kaine dropped his hands to his sides. His voice never became louder but its added intensity left no possibility of misinterpretation. I dont believe you did everything possible. Absent your excuses, the obvious conclusion is that you failed to save the lives of two healthy boys.
Without waiting for a response, Kaine walked past Morgan. When he got to the doorway he stopped. If you think this is over, youre sadly mistaken. You have no idea who youre dealing with, and if I have anything to say about things, you and this hospital are going down.
PRAISE FOR
Gary Birken, M.D., and Plague
Fans of Robin Cook, Patricia Cornwell, and Kathy Reichs are going to want to put Plague on his or her must-read list. The heroine is spunky, intelligent, and intuitive, a combination that makes her an excellent medical detective.
Midwest Book Review
Titles by Gary Birken, M.D.
ERROR IN JUDGEMENT
FINAL DIAGNOSIS
PLAGUE
EMBOLUS
CODE 15
To my parents
To err is human, to cover up is unforgivable, and to fail to learn is inexcusable.
SIR LIAM DONALDSON,
SPEAKING AT THE LAUNCH OF THE
WORLD ALLIANCE FOR PATIENT SAFETY IN
WASHINGTON, DC,
ON OCTOBER 27, 2004
DADE PRESBYTERIAN HOSPITAL
TO: All Officers, Department Chiefs, Chief Nursing Officer.
FROM: Robert Allenby, C.E.O.
SUBJECT: CODE 15s
Listed below is a partial list of the types of medical errors and adverse patient outcomes, termed CODE 15s, which must be reported to the state of Floridas Agency for Health Care Administration (AHCA) within fifteen days of their occurrence. Please be advised that all medical mistakes that result in patient injury must be reported to this office.
Death
Wrong surgical procedure
Spinal damage
Brain damage
Surgery performed on the wrong patient
Surgery performed on the wrong site/side
Procedures to remove foreign objects remaining from surgical procedures
Surgical repair of injuries or damage from a planned procedure
Significant medication errors
Failure to diagnose a life-threatening illness/ injury
PART ONE
CHAPTER
DADE PRESBYTERIAN HOSPITAL
NORTH MIAMI, FLORIDA
MARCH 3, 2007
The port wine-colored rash that shrouded Andy Kaines body was an undeniable omen of his impending death. Clad in a sterile green gown and wearing a protective plastic face mask, Dr. Morgan Connolly, chief of Emergency Medicine, moved to the head of the stretcher. She motioned to the paramedic who had just transported the critically ill young man to the hospital.
Whats the story on this kid? she asked above the cacophony of numerous high-pitched alarms.
Hes a freshman at Florida International University. His girlfriend found him in his dorm room about forty-five minutes ago. He was completely unresponsive.
What were his vital signs coming in? Morgan asked.
We had a lot of trouble getting a blood pressure. Maybe it was forty.
What about a pulse?
He shook his head. We never felt one.
When did you start CPR?
In his room. We also intubated him, he said, pointing to the plastic tube that they had placed through Andys mouth and down into his windpipe.
Taking particular note of his ashen color and vaporous eyes, Morgan turned to Pam Devlin, the charge nurse. His blood pressures not registering on the monitor. See if you can get one manually.
I just did, Pam answered. Its thirty over zero.
From her new vantage point, Morgan studied the amorphous, punched-out lesions on Andys torso. They each wept a blood-tinged straw-colored fluid and, as a group, seemed to be multiplying in front of her eyes. Morgan was quite familiar with the highly contagious strain of meningitis. It was one of the few diseases that instantly filled her with an all-encompassing feeling of doom and helplessness. Morgan took a step back.
Even though she knew a full-blown code blue was almost certainly an exercise in futility, she felt she had no choice.
Were going to give this a shot. Continue the chest compressions. She then pointed to a plastic IV bag suspended from a metal pole. Open up that saline all the way. Somebody get me a full loading dose of penicillin.
Hes crashing, Pam said, pointing at the flashing red display on the blood oxygen monitor that was in a freefall. I cant get a blood pressure.
The respiratory therapist, who was standing next to Morgan, continued to squeeze the breathing bag. Im not getting much air in. His lungs must be filled with fluid.
Morgan eyes bolted to the cardiac monitor. It showed flatline. Keep up the chest compressions and give him an amp of epinephrine.
Giving it now, one of the other nurses answered as she injected the medication into Andys IV.
Hes not responding, Morgan yelled. Give him another amp.
Going in now, the same nurse answered.
For the next half hour Morgan and the code blue team did everything possible to bring Andy back to life. But his face remained the color of chalk, and his eyes fell deeper into his skull, leaving his pupils widely dilated and hollow.
Finally, Morgan stepped back from the stretcher. The words of her mentor and professor of emergency medicine echoed in her mind with the same sobering effect as they had fourteen years ago when she was an intern: Any physician worth their salt will learn to recognize the difference between a resuscitation and a resurrection.
Morgan pulled off her gloves and noted the time.
Were done here, she announced in a monotone. Make the time of death ten past nine.
Morgan stepped away from the bedside and pulled off her sterile gown and mask. She tried, but she couldnt shift her eyes from Andys lifeless face. Over the past ten years she had seen death come in many forms. But the loss of Andy Kaine and what was soon to follow would remain rooted in her memory for many years to come.
CHAPTER
In a hush that inevitably follows the unexpected death of a young, healthy person, the nurses and other health-care providers steadily made their way out of the room.
Morgan stayed for a time, eventually finding a seat on a scuffed-up plastic chair. The fact that Andys fate was almost surely sealed before the ambulance ever arrived was of little consolation.
Pam pulled up another chair and sat down beside her. His girlfriend told the paramedics he was fine this morning. She saw him in the library studying for a marine biology exam.
Dr. Connolly, came a hesitant voice from the doorway. I know this is a lousy time but North Miami Rescues on the phone. Theyre on scene of a bad car accident and want to speak with you stat about two injured kids.
