Memorial Hospital, Chicago Lakefront

Saturday Morning

It’s quiet on the orthopedic floor at Memorial Hospital on the Chicago lakefront this morning.  Twenty-six year old first-year orthopedic resident, Dr. Julie Brendan tosses her files onto the desk and sits stretching her back from a long night on-call.  Her wrinkled coffee stained green scrubs and light blue lab coat appeared rumpled and unflattering.  Her eyes seemed hollow in the harsh glow of fluorescent lights humming overhead.  She said “I am so glad that overflow gyne patient Sheila Flynn had a simple laparoscopic procedure.” 

Jennifer McMaster, RN the young day shift charge nurse just finished taking report from the night shift. She stood at the printer filling out paperwork and she looked fresh and sharp since she had just arrived to start her day shift.  Julie looked tired and irritated and constantly yawned.  The whole nursing station looks like a yawn and a stretch crying for the touch of a caring cleaning crew. 

Julie, “Too bad that Dr. Cohen won’t be coming by today.  He’s at his temple this morning.  One of his junior partners, Dr. Fishman, is on call for the group.” 

McMaster tossed her paperwork into Julie’s pile and asked, “When will he be up to discharge Ms. Flynn?”  Without looking up, Nurse McMaster shakes her head and said,  “All of this damn paperwork to fill out and file.  Wouldn’t it be great to have an electronic health record installed in this paper warehouse?  And just think of the trees we will be saving.” 

Henrietta Johnson, the ward secretary, tried her hand at tackling the disorderly mess adding,  “I just heard from Dr. Fishman.  He told me to proceed with discharging Sheila.  He has been discharging healthy mothers and babies over in OB.  I told Dr. Fishman that I called Sheila’s husband James Moretti and told him to come to the hospital to pick her up.  He knows our rule that all post-op discharges are required to ride to the lobby in a wheelchair.  And about your electronic health record, be careful about new fangled things that you wish for.” 

Julie rubbed her heavy eyes.  McMaster grabbed her clip board and started to walk off.  Dr. Brendan blurted out, “Oh, I forgot to tell you, I spoke with Dr. Fishman at around 2:00 am.  I told him I was concerned about Sheila’s restlessness and anxiety.  She had no complaints of any abdominal pain, but she said that she was sweating a lot.  She seemed a bit confused and thought that she had been discharged already.

McMaster inquired, “What about her vitals?” 

Dr. Brendan replied, “There was just a slight decrease in her blood pressure to 90/60 and a tachycardia of 110, but she was making urine and in fact was incontinent times 1.” 

McMaster, “Incontinent? Why was she incontinent?” 

Julie, “I do not know why she was incontinent.  She was breathing a bit fast, but her chest was clear and her breath sounds were good.  Her abdomen was mildly distended, but not tender to touch.  She had no rebound abdominal tenderness and had a few bowel sounds. Her urine output was 50 ml per hour before midnight, so I did not think that she was hypovolemic.  To me she looked like she was having a really bad panic attack, so I decided to give her one milligram of Valium IV and 0.5 milligrams of Xanax PO over night to calm her down. She was a bit sweaty and disoriented, but she fell asleep.” 

McMaster replied, “None of this makes sense. How does all of that add up to a panic attack?  Did she have a history of panic attacks or have meds for panic attacks listed in her meds pre-op?  Why should she be having a panic attack in her hospital bed?  Can’t say that I have ever heard of such a thing.” 

Dr. Brendan added, “Dr. Fishman gave me permission to request a consult from the internal medicine resident on call.  I spoke with the resident but he has not yet had a chance to come to see her.  He told me to examine her again and consider getting an arterial blood gas (ABG) and a chest x-ray. He was thinking about ruling out a pulmonary embolus (PE).  I told him that she did not have any shortness of breath so I decided to wait for him to see her before sending off the ABG.” 

“I have to grab a cup of coffee.  I’ll be back in a couple of minutes.”

The Home of James Moretti

Saturday 8:00 AM

Meanwhile, Sheila Flynn’s husband James Moretti helped their six year old daughter Heather get ready to leave the house.  Heather spoke up. “Daddy, look at the drawing that I made for mommy.  Do you think that she will like it?  I’ll show it to her at the hospital.” 

The cool day, one of the first crisp autumn mornings, marked the end of Indian summer.  James and Heather arrived at the front entrance of the hospital.  A pleasant, uniformed security guard greeted James and handed him two visitor badges as a parking attendant valeted the car.

The security guard pointed to the elevator doors and said, “Take that elevator to the 9^th floor.”  They are interrupted by the overhead audible paging system: “Code blue, room 1930.”  Doctors and nurses responding to the call rushed past.  James held Heather’s hand while she clutched her favorite stuffed animal.

As they entered the elevator James asked, “Heather, would you please push the 9 for daddy?”

Heather smiled and pushed the right button.  James and Heather exited the elevator and sat in the chairs in the 9th floor elevator lobby.  James let Heather put her visitor’s pass on her stuffed animal while they waited for Sheila to arrive by wheelchair.  Ten minutes passed.  James picked up the house telephone and asked the operator to connect him to the nurses’ station. No answer. Another ten minutes passed and still no call back was made.   He waited another twenty minutes and again received no communication from anyone.  The house phone rang.  The hospital operator called James back, “Mr. Moretti?”  “Yes, this is Mr. Moretti.”  The operator apologetically announced, “I cannot find anyone on the ninth floor to speak with you.” 

James paced anxiously about the elevator lobby and then decided to make his way to the nurses’ station.  He kept Heather close and held her hand firmly.  As they cautiously approached the Nurses Station James had an eery feeling about how quiet and deserted it was.  No one was in sight.

James heard distant sounds that caused his attention to shift to their source at the end of another corridor.  The level of commotion made him apprehensive.  He felt the hair on the back of his neck standing up.  He did not know why he felt frightened.  He clutched Heather’s hand and walked down the hallway towards the excitement.

CODE BLUE In Progress Room 1930

Earlier at 8:50 am Saturday Morning

* * *
 Over a year later at the trial, the family’s legal champion, Peter Richmond, stood at the podium to examine Dr. Fishman.
The jury leaned forward as Richmond began, his voice steady but sharp.
Q: Doctor Fishman, how many glasses of wine did you drink the night of Ms. Flynn’s operation while covering for Dr. Cohen?
Dr. Fishman shifted uneasily in his chair.
A: Yes.
Each question cut deeper, exposing not only Dr. Fishman’s poor judgment but also his indifference that had cost Sheila her life. For the jury — and for Sheila’s family — Richmond was more than an advocate. He was their scalpel, carving away excuses until only the truth remained.
Q: Of course not. And at 2 a.m., when Dr. Brendan called you about Sheila Flynn’s worsening condition, you chose not to see her, isn’t that right?
A: That’s correct.
Q: And then when you finally arrived at the hospital at 7 a.m., you spent your morning discharging healthy mothers and newborns — instead of attending to Ms. Flynn.
Q: So the first time you saw Ms. Flynn that morning was when she was about to be pronounced dead?
A: Yes.
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