An emergency physician never wants to hear those words. The next line won’t be, “He stopped by the ER today to say he’s doing well.” Instead, the inevitable bad news will ignite emotions somewhere between regret and outright terror. Sometimes the bearer of bad news won’t make the slightest effort to spare your feelings. As an ER doc, you take the lumps, figure out what went wrong, whether or not preventable, and prepare for consequences. You also do intense soul-searching to improve your clinical knowledge and judgment.
Talented voice actor, Daniel Thomas May, narrated the audio book of my medical thriller, DEAD ALREADY, released this month. He did a virtuoso job with the following scene, which occurs just after Dr. Zack Winston has failed to save the life of one Carl Barnett, whom he saw and released from the ER the previous day. Carl’s wife is ICU head nurse, Janice Barnett. Carl has just died from unsurvivable cardiac arrest. Zack has resumed seeing other patients in the ER, when . . .
“God save us from emergency physicians!”
The epithet greeted Zack when he returned to the main treatment area. He recognized the bombastic voice of Dr. Jeremiah Hartman, medical director of the ICU and chief of the medical staff. Hirsute, stout, and loud, he could verbally eviscerate the most confident of colleagues; and he didn’t care about witnesses. Oblivious to the patients in the curtained cubicles lining his path, Hartman bore down on Zack like an eagle on a wounded gerbil.
“Did you not realize Carl Barnett was my patient?”
Concerned about confidentiality and his pending humiliation in earshot of patients and staff, Zack gestured toward the ER lounge. “Let’s talk in private.” He led his accuser into the room, shut the door, and turned to face him. “I did treat Carl. I noted you are his physician.”
“Why the hell didn’t you call me?” He barked as if Zack had stolen a favorite bone. No doubt his baritone voice projected to the treatment area. Zack retreated a step. “No time. He was full code.”
Hartman sneered. “You should have had someone contact me. I was in the ICU. Jan just called to tell me her husband is dead, and she doesn’t understand why.”
“He arrived in non-survivable cardiac arrest.”
“You should have summoned me.”
Jerry and Janice were tight professional colleagues based on their complementary ICU roles. The hospital grapevine buzzed about a secret personal relationship. Zack didn’t care. Until now.
“He was dead when he hit the door. No one could have saved him.” Zack moved to leave the lounge. Patients needed him, and he had another hour to go before he could retreat to solitude and a bottle of Tuscan red at home.
Zack stopped. “What?”
“You saw Carl yesterday. Sent him out with acute coronary syndrome.”
Zack folded his arms, squared his stance. “Not true. I did evaluate him yesterday. He came in with atypical chest pain and I ruled out cardiac etiology. HEART score was zero, including two negative troponins four hours apart. He was pain-free when I discharged him.”
Hartman’s voice dripped with contempt. “You had him in the ER four hours and didn’t think to inform me?” The man could blow like an IED if not contained. Jerry Hartman had the political clout and authority to hurt Zack Winston.
Zack struggled to maintain a reasonable tone. “We don’t contact the private physician in all cases. We exercise clinical judgment. Most attendings appreciate not getting called every time one of their patients comes to the ER. I repeat, he was pain-free, without treatment, at discharge. I referred him to you for follow-up.”
Jerry moved closer, snorted into Zack’s face. “Yet he suffers a fatal cardiac arrest the next day? You missed something, Doctor.”
“No. I did not.” Zack reached for the doorknob.
Jerry stopped him. “This death was preventable. I will review the record. If I find a single discrepancy, you will answer for it.”
Zack scoffed. “Do what you wish. Now get out of my face.” He pushed past Jerry and returned to the main treatment area, ignoring the curious eyes looking for a cloud of smoke billowing from his rear.
I had the great fortune of doing a Facebook live chat with the voice actor, Daniel Thomas May, last week. It was an enlightening conversation, and I learned a lot about his profession (and his favorite role in “The Walking Dead.”) Here’s a link to that video.
In DEAD ALREADY, this inciting event starts Zack Winston and his dynamic legal advocate, Bridget Larsen, down a spiraling path of intrigue and betrayal that threatens both their lives. A strong bond ignites between them. I hope you enjoy it.