JULIE TRIAGED the patient in room six for the better part of an hour. The end of the busy workday came, and not much had changed except for Julie’s lunch plans. Jordan was still an ex-employee of White, Shirley Mitchell was still dead, Lucy still MIA, and Julie still baffled by the test results. Julie was in her office, doing paperwork, preparing for the next round of battles with the insurance companies, when her desk phone rang.
“Dr. Devereux here,” Julie said.
“Dr. Devereux, this is Marilyn Bates, Mr. Janowski’s personal assistant. I’ve been asked to see if you could please come up to Mr. Janowski’s office right away. The matter is urgent.”
A pit opened in Julie’s stomach. “What is this about?”
“I’m afraid I don’t know. I only know that it’s extremely important.”
JULIE HAD never been to Roman Janowski’s office before, but eventually she found it on the fifth floor of the Wilcox Building. A dour woman with curled gray hair sat at a desk near a set of shuttered double doors made of burnished wood. The nameplate on the woman’s desk read MARILYN BATES. She managed a look Julie felt was one part contempt, one part glee, and one part empathy.
“Roman is waiting for you inside.”
Perhaps Ms. Bates’s monotone was meant to be intimidating. Julie’s heart thundered as her stomach went through a series of somersaults. She had no clue what this meeting was about, but gut instinct told her it was not going to be anything good. The feeling was confirmed when Julie opened the door and saw Roman Janowski, Lucy Abruzzo, and Amber, the nurse who had cared for Shirley Mitchell, all seated at the large conference table in his spacious office, with grave looks on their faces. Three people dressed in business attire like Roman, two men and a woman, were also present.
“Please take a seat, Julie,” Roman said in a joyless voice.
Roman sat at the head of the table and pointed to an empty chair directly across from him. There was no handshake hello, no trace of the warmth he had shown at Sherri’s funeral. The CEO’s dead-eye stare chilled Julie’s blood.
“This meeting is being recorded,” Roman said. “I should advise you that you have the right to refuse to be on record, but just know we will consider your lack of cooperation justification to have you escorted from these premises and your employment suspended as a result.”
“Roman, what on earth is this about?”
There was a tremor in Julie’s voice, unusual given how many orders she had uttered in life-and-death situations that day.
“It’s about what happened to Shirley Mitchell,” Roman replied.
Julie’s eyes went wide and she directed her gaze toward Lucy, who was seated closest to her on the left side of the table. “Lucy, what is happening here?”
“Because you may not know everyone, I’m going to repeat introductions for the record,” Roman said. “Seated at the table are Dr. Lucy Abruzzo, White’s chief of pathological services; Amber Ellis, ICU nurse; Dr. Julie Devereux, pulmonary and critical care physician; Max Gilbride, director of patient safety; Val Mesnik, from human resources; and Bob Anderson, legal counsel for White.”
“Roman, please, I demand an explanation,” Julie said.
“I would like to lead this discussion, if you don’t mind, Dr. Devereux,” Janowski replied, his eyes boring into her. “Amber, would you please repeat what you told us right before Dr. Devereux arrived.”
Amber, who sat next to Lucy, shifted uncomfortably in her chair and refused to make eye contact with Julie.
“After Shirley came back from radiology, I heard her say ‘I want to die.’”
Bob Anderson said, “And at the time did you think Dr. Devereux heard these comments?”
Julie’s face flushed with anger. “I demand to know what this is all about,” she repeated.
Lucy shot Julie a stern look that said keep calm, stay quiet, and be controlled, all with a glance. Lucy had never admonished Julie before, and the experience was as unpleasant as it was unfamiliar.
“Yes, I’m sure Dr. Devereux heard those comments,” Amber said. “We looked at each other like, okay, that just happened. Let’s move on.”
“Move on, all right,” Roman grumbled as he slid a manila folder down the table. The folder scraped across the smooth surface and needed a push from Val to reach Julie, the intended target.
“What’s this?” Julie asked as she picked up the folder.
“Please have a look,” Roman said. “I would like you to confirm the contents. It’s articles, op-ed pieces and such, written by you that espouse your stance on death with dignity-patient self-determination, as you call it. Your views on mercy killing.”
“We’ve had these on file for some time.” Bob Anderson felt this was legally relevant to share, for reasons Julie could not fathom.
She glanced through the folder and claimed authorship for every document within.
“Okay, so I wrote these,” Julie said, waving the folder in front of her face like a fan. “But I wrote these before my fiancé’s accident, and to be honest, my views on the subject have changed since then. In fact, I believe my views are still evolving. I’m sorting it out. But what does this have to do with anything? These are policy opinions about medicine, not related to any of my patients or patient care. Certainly not related to Shirley Mitchell.”
Julie set her gaze on Max Gilbride, the beady-eyed director of patient safety, who sported jowls like an orangutan’s.
Lucy cleared her throat. Her expression was deeply pained. “I was very concerned with Shirley Mitchell’s labs,” she said. “In a typical DIC, the platelets would be low, the PT and PTT high, and the fibrinogen would be low. The labs on Shirley came back showing the opposite.”
A knot formed in Julie’s stomach. She understood now what was happening here.
“Those levels made me look beyond DIC as a cause of the bleed, which is why I asked Dr. Stinson, one of our residents in pathology, to look for heparin levels. For the benefit of those who do not practice medicine, the heparin xa level should be less than point one in anyone not on heparin. Shirley Mitchell was three-point-zero. The only possible way she could have a level that high is if someone injected her with heparin.”
The hairs on the back of Julie’s neck began to rise as she fixed Lucy with a wide-eyed stare.
“What are you saying, Lucy?” Julie’s mind was reeling.
“And why was Dr. Devereux in the patient’s room?” The question from Gilbride was directed at Amber.
“Someone pulled out the patient’s central line and it needed to be reconnected.”
“Wait, wait, wait,” Julie said, glaring now at Amber. “Someone pulled out the line? That someone was Shirley Mitchell.”
Gilbride cleared his throat. “She was on what dose of propofol?” he asked. Max Gilbride, an internist turned bureaucrat, was the internal affairs equivalent for doctors and put the A in a-hole.
“Thirty mic per kig,” Amber said.
Julie translated the dose in her head. Propofol is a weight-based drug and thirty was a high dose per minute.
“In other words, Shirley was pretty out of it,” Gilbride said.
“Yes,” Amber answered in a quiet voice.
“What are we thinking here?” Julie asked the question and sent nervous glances around the table.
“I’ll tell you what we’re thinking, Julie,” Roman answered. “I’m not here to waste your time, or ours. Shirley’s bleeding began minutes after you flushed the central line.”
“Yes, with saline I got from Amber.”
“That couldn’t have been just saline,” Roman said. “Somehow Shirley was given heparin, a blood thinner, and that caused her to bleed out.”