Huttner’s mounting concern was mirrored each day in an increasing number of orders for laboratory tests and diagnostic procedures, all unrevealing. Efforts intensified to keep pace with Merchado’s deteriorating condition, but there could be no doubt that the man was on a downhill slide.
As David read, the germ of an idea took root. He scanned page after page of laboratory reports, looking for the results of the stool cultures that had been ordered on several successive days.
“Well, what do you think?” Huttner said, turning to David. “David? …”
“Oh, sorry.” David looked up. “I noticed the manwas still on tetracycline and was just looking to see if he might have somehow developed staph colitis secondary to the treatment. It doesn’t happen often, but …”
“Tetracycline?” Huttner interrupted. “I called in a stop on that order days ago. They’re still giving it to him?”
Behind Huttner, in David’s line of vision, the charge nurse nodded her head in vigorous confirmation.
“Well, no matter,” Huttner said, hesitating slightly. David could almost hear him asking himself whether he had actually called in the stop order or had just meant to. “The culture reports have all been negative. Why don’t you write an order to take him off tetra. Go ahead and get another culture if you want to.”
David was about to comply when he noticed a culture report at the bottom of the lengthy computer printout that listed all results obtained on the patient to date. It read
“9/24, STOOL SPEC:
MODERATE GROWTH, S. AUREUS,
SENSITIVITIES TO FOLLOW.”
Staph aureus
, the most virulent form of the bacteria. David closed his eyes for a moment, hoping that when he looked at the sheet again the words would be gone. He took several seconds in making the decision to say nothing about his discovery and to correct the problem later. The hesitation was too long.
“What is it, David?” Huttner asked. “Have you found something?”
“Dammit,” David cursed to himself. A dozen possible responses poured through his mind, were evaluated and rejected. There was going to be no comfortable way around it. No place to hide. Out of the corner of one eye he saw the two nurses standing motionless at the end of the bed. Did they know that in the next fewmoments the success of the evening and possibly of David’s career might vanish?
The whole scene became strangely dreamlike for him. The hand slowly passing Merchado’s chart to Huttner, the finger pointing at the offensively impersonal line of type—they were someone else’s, not his.
The look David had last seen directed at the O.R. scrub nurse sparked in Huttner’s eyes. They locked with his for a fraction of a second, then turned on the nurses. He thrust the chart at the charge nurse.
“Mrs. Baird,” he growled, “I want you to find out who is responsible for failing to call my attention to this report. Whoever it is, nurse or secretary, I want to see her in my office first thing Monday morning. Is that clear?”
The nurse, a stout veteran who had engaged in her share of hospital wars, looked at the page, then shrugged and nodded her head. David wondered if Huttner would actually follow through with what seemed so obvious an attempt to produce a scapegoat.
“Come along, Dr. Shelton,” Huttner said curtly. “It’s getting late and we still have several more patients to see.”
It was nearly ten o’clock when they arrived on Four South to see the last of Huttner’s patients, Charlotte Thomas. For the first time all evening Huttner deviated from the routine he had established. Taking the chart from the charge nurse, he said, “Come and sit down in the nurses’ lounge for a bit, David. This next patient is by far my most complicated. I want to take a few minutes to go over her with you in some detail before we see her. Perhaps someone could bring us each a cup of coffee.” The last remark was transparently addressed to the nurse, who managed a faint
As David read, the germ of an idea took root. He scanned page after page of laboratory reports, looking for the results of the stool cultures that had been ordered on several successive days.
“Well, what do you think?” Huttner said, turning to David. “David? …”
“Oh, sorry.” David looked up. “I noticed the manwas still on tetracycline and was just looking to see if he might have somehow developed staph colitis secondary to the treatment. It doesn’t happen often, but …”
“Tetracycline?” Huttner interrupted. “I called in a stop on that order days ago. They’re still giving it to him?”
Behind Huttner, in David’s line of vision, the charge nurse nodded her head in vigorous confirmation.
“Well, no matter,” Huttner said, hesitating slightly. David could almost hear him asking himself whether he had actually called in the stop order or had just meant to. “The culture reports have all been negative. Why don’t you write an order to take him off tetra. Go ahead and get another culture if you want to.”
David was about to comply when he noticed a culture report at the bottom of the lengthy computer printout that listed all results obtained on the patient to date. It read
“9/24, STOOL SPEC:
MODERATE GROWTH, S. AUREUS,
SENSITIVITIES TO FOLLOW.”
Staph aureus
, the most virulent form of the bacteria. David closed his eyes for a moment, hoping that when he looked at the sheet again the words would be gone. He took several seconds in making the decision to say nothing about his discovery and to correct the problem later. The hesitation was too long.
“What is it, David?” Huttner asked. “Have you found something?”
“Dammit,” David cursed to himself. A dozen possible responses poured through his mind, were evaluated and rejected. There was going to be no comfortable way around it. No place to hide. Out of the corner of one eye he saw the two nurses standing motionless at the end of the bed. Did they know that in the next fewmoments the success of the evening and possibly of David’s career might vanish?
The whole scene became strangely dreamlike for him. The hand slowly passing Merchado’s chart to Huttner, the finger pointing at the offensively impersonal line of type—they were someone else’s, not his.
The look David had last seen directed at the O.R. scrub nurse sparked in Huttner’s eyes. They locked with his for a fraction of a second, then turned on the nurses. He thrust the chart at the charge nurse.
“Mrs. Baird,” he growled, “I want you to find out who is responsible for failing to call my attention to this report. Whoever it is, nurse or secretary, I want to see her in my office first thing Monday morning. Is that clear?”
The nurse, a stout veteran who had engaged in her share of hospital wars, looked at the page, then shrugged and nodded her head. David wondered if Huttner would actually follow through with what seemed so obvious an attempt to produce a scapegoat.
“Come along, Dr. Shelton,” Huttner said curtly. “It’s getting late and we still have several more patients to see.”
It was nearly ten o’clock when they arrived on Four South to see the last of Huttner’s patients, Charlotte Thomas. For the first time all evening Huttner deviated from the routine he had established. Taking the chart from the charge nurse, he said, “Come and sit down in the nurses’ lounge for a bit, David. This next patient is by far my most complicated. I want to take a few minutes to go over her with you in some detail before we see her. Perhaps someone could bring us each a cup of coffee.” The last remark was transparently addressed to the nurse, who managed a faint
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