Code 15 Read online

  Table of Contents

  Title Page

  Copyright Page

  Dedication

  Epigraph

  PART ONE

  CHAPTER 1

  CHAPTER 2

  CHAPTER 3

  CHAPTER 4

  CHAPTER 5

  CHAPTER 6

  CHAPTER 7

  CHAPTER 8

  CHAPTER 9

  PART TWO

  CHAPTER 10

  CHAPTER 11

  CHAPTER 12

  CHAPTER 13

  CHAPTER 14

  CHAPTER 15

  CHAPTER 16

  CHAPTER 17

  CHAPTER 18

  CHAPTER 19

  CHAPTER 20

  CHAPTER 21

  CHAPTER 22

  CHAPTER 23

  CHAPTER 24

  CHAPTER 25

  CHAPTER 26

  CHAPTER 27

  CHAPTER 28

  CHAPTER 29

  CHAPTER 30

  CHAPTER 31

  CHAPTER 32

  CHAPTER 33

  CHAPTER 34

  CHAPTER 35

  CHAPTER 36

  CHAPTER 37

  CHAPTER 38

  CHAPTER 39

  CHAPTER 40

  CHAPTER 41

  CHAPTER 42

  CHAPTER 43

  CHAPTER 44

  CHAPTER 45

  CHAPTER 46

  CHAPTER 47

  CHAPTER 48

  CHAPTER 49

  CHAPTER 50

  CHAPTER 51

  CHAPTER 52

  CHAPTER 53

  CHAPTER 54

  CHAPTER 55

  CHAPTER 56

  CHAPTER 57

  PART THREE

  CHAPTER 58

  CHAPTER 59

  CHAPTER 60

  CHAPTER 61

  CHAPTER 62

  CHAPTER 63

  CHAPTER 64

  CHAPTER 65

  CHAPTER 66

  CHAPTER 67

  CHAPTER 68

  CHAPTER 69

  CHAPTER 70

  CHAPTER 71

  CHAPTER 72

  CHAPTER 73

  CHAPTER 74

  CHAPTER 75

  CHAPTER 76

  CHAPTER 77

  CHAPTER 78

  CHAPTER 79

  CHAPTER 80

  CHAPTER 81

  CHAPTER 82

  CHAPTER 83

  CHAPTER 84

  CHAPTER 85

  CHAPTER 86

  CHAPTER 87

  CHAPTER 88

  CHAPTER 89

  CHAPTER 90

  CHAPTER 91

  EPILOGUE

  ABOUT THE AUTHOR

  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.” Kaine’s stony glare never shifted from Morgan’s eyes. She didn’t 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 don’t 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, you’re sadly mistaken. You have no idea who you’re 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

  THE BERKLEY PUBLISHING GROUP

  Published by the Penguin Group

  Penguin Group (USA) Inc.

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  South Africa

  Penguin Books Ltd., Registered Offices: 80 Strand, London WC2R 0RL, England

  This is a work of fiction. Names, characters, places, and incidents either are the product of the author’s imagination or are used fictitiously, and any resemblance to actual persons, living or dead, business establishments, events, or locales is entirely coincidental. The publisher does not have any control over and does not assume any responsibility for author or third-party websites or their content.

  CODE 15

  A Jove Book / published by arrangement with the author

  PRINTING HISTORY

  Jove mass-market edition / December 2009

  Copyright © 2009 by Gary Birken, M.D.

  All rights reserved.

  No part of this book may be reproduced, scanned, or distributed in any printed or electronic form without permission. Please do not participate in or encourage piracy of copyrighted materials in violation of the author’s rights. Purchase only authorized editions.

  For information, address: The Berkley Publishing Group,

  a division of Penguin Group (USA) Inc.,

  375 Hudson Street, New York, New York 10014.

  eISBN : 978-1-101-15156-3

  JOVE®

  Jove Books are published by The Berkley Publishing Group,

  a division of Penguin Group (USA) Inc.,

  375 Hudson Street, New York, New York 10014.

  JOVE® is a registered trademark of Penguin Group (USA) Inc.

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  http://us.penguingroup.com

  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 Florida’s 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 1

  DADE PRESBYTERIAN HOSPITAL

  NORTH MIAMI, FLORIDA

  MARCH 3, 2007

  The port wine-colored rash that shrouded Andy Kaine’s 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.

  “What’s the story on this kid?” she asked above the cacophony of numerous high-pitched alarms.

  “He’s 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 Andy’s 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 pressure’s not registering on the monitor. See if you can get one manually.”

  “I just did,” Pam answered. “It’s thirty over zero.”

  From her new vantage point, Morgan studied the amorphous, punched-out lesions on Andy’s 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.

  “We’re 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.”

  “He’s crashing,” Pam said, pointing at the flashing red display on the blood oxygen monitor that was in a freefall. “I can’t get a blood pressure.”

  The respiratory therapist, who was standing next to Morgan, continued to squeeze the breathing bag. “I’m 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 Andy’s IV.

  “He’s 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.

  “We’re 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 couldn’t shift her eyes from Andy’s 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 2

  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 Andy’s 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 Rescue’s on the phone. They’re on scene of a bad car accident and want to speak with you stat about two injured kids.”

  Morgan filled her lungs and then let the breath slowly escape.

  “What now?” she muttered before turning around and heading out of the room. When she reached the nursing station, the unit secretary handed her the red phone, which was used exclusively to communicate with the paramedics in the field.

  “This is Dr. Connolly.”

  “This is North Miami Rescue, Doctor. We’re on scene of a motor vehicle accident. We have two pediatric patients who were unrestrained backseat passengers. Their vehicle was broadsided on the driver’s side. It took us twenty minutes to extricate them. We have them on backboards and would like to transport them to your facility.”

  “What are their vital signs?”

  “Pulse and blood pressure both within normal limits.”

  “What’s their neurological status?”

  “The younger one’s a little groggy. The older one seems okay. They’re both able to respond to my questions.”

  “What are their ages?”

  “Nine and seven.”

  “Are they having any trouble breathing?” she asked.

  “Negative, but the nine-year-old is complaining of some chest pain.”

  “Anything else?”

  “The seven-year-old is a little pale.”

  “Can you identify any major injuries?” she asked.

  “Not at this time.”

  Knowing that paramedics tend to overreact when assessing injured children, Morgan said, “Both victims have normal vital signs and are breathing without difficulty. Is that correct?”

  “That’s affirmative.”

  “And both are alert and responding to your questions?” she asked.

  “Yes, but we’d like to save some time by transporting them to Dade Presbyterian. We’re less than ten minutes from your facility.”

  “Negative. We are not a state-designated pediatric trauma center. Both of your patients are stable. Transport them directly to Ryder Trauma Center per Dade County protocol.”

  “Will do. Thank you, Dr. Connolly.”

  Morgan replaced the phone and pushed back in her chair. She was just about to dictate a note documenting the events of Andy Kaine’s death when Pam approached.

  “You’re not going to believe this,” she said in a hurried voice. “The paramedics are bringing in Andy Kaine’s roommate. He’s already got the rash.”

  “How bad is he?”

  “They said he’s still breathing on his own but his vital signs were borderline.”

  “What’s their ETA?”

  “About five minutes.”

  “Are the parents here yet?”

  “Patient Relations said that the mother is in the Far East on business. I’ll check with them to see if the father got here yet.”

  “Let’s use the trauma room,” Morgan suggested.

  “It’s already set up.” Pam turned and started to walk away. After a few steps, she stopped and turned around. “There’s someth
ing else you should know. This kid’s not just Andy Kaine’s roommate. He’s his brother.”

  Well aware of what she would soon be faced with, Morgan came to her feet. Fearing the worst, but seeking no explanations for the injustice or making any pleas for divine intervention, she simply walked toward the trauma room, ready to do her job.

  CHAPTER 3

  Waiting for any news regarding the condition of his sons, Mason Kaine, a muscular man with a jutting forehead that overhung narrowly spaced eyes, paced in front of the registration desk.

  His apprehension mounting, he finally decided to find a seat among the countless others waiting restlessly for either medical attention or some news of their loved ones. Loosening his tie, he wondered why the hospital felt compelled to keep the emergency room’s waiting room so oppressively hot. Normally he wasn’t particularly sensitive to temperature, but the heat mingling with the foul scent of illness left his stomach in turmoil.

  Ten minutes passed. His patience exhausted, he stood up and walked over to the same desk that he had already visited twice. He waited for the triage nurse, a frazzled-looking woman with washed-out and thinning silvery hair, to look up and acknowledge his presence.

  “Excuse me,” he began in a measured voice, trying to put aside the irritation on her face, “I’m still waiting for information regarding my sons.”

  “As I told you before, Dr. Connolly is very busy. She’ll be out to speak to you as soon as she can. Now, if you’ll just have a seat.” Without waiting for a response, the nurse looked back down at the chart that she had been working on.

  Kaine looked down at his watch. “But you told me that the doctor would be out to see me at least—”

  She raised her eyes slowly. Stopping after every word, she said, “It’s been a very busy night. We’re asking all family members to bear with us and be as patient as possible.” He watched as she craned her neck to see past him. He didn’t have to turn around to know there was somebody behind him. The nurse, now wearing a scripted smile, said, “Dr. Connolly will be out as soon as she gets a free minute.”