was said.
After the first presentation, Fowler swept his eyes around the room, focusing one by one on the faculty members, inviting comments. A couple of the more senior faculty had a few words about the management of the case. Each agreed that the morbidity—in this case, a severe postoperative infection that kept the patient in the hospital an extra week—might have been avoided had certain things been done differently. Fowler closed the discussion by mentioning a specific antibiotic that would likely have been more effective. "Moving on. Tim?"
Anna was still processing the chairman's remarks, adding the knowledge to the mental card file she maintained on management of complications, when it hit her. Fowler hadn't looked directly at her since she'd taken her seat. Not at any time during lunch. When he polled the faculty for comments on the previous case, he'd passed over her. It was as though she weren't there. Was this the way it was going to be until she could clear herself of the suspicion that hung over her like a cloud?
Her initial hurt gave way to grim determination. She wasn't about to be kept in limbo until those guys at the DEA found out who was using her information. And as for the Dallas Police, if Green and Dowling were typical examples, she wasn't sure she'd trust them to find a lost dog. They'd probably fine the owner for failing to keep it on a leash. No, she was going to become more actively involved in the process. And she planned to start right after M&M.
Anna's reverie was interrupted when she heard Fowler say, "Luc, how about Mr. Hatley?"
Anna pulled a blank three-by-five card from the bunch she kept in the pocket of her white coat. As Luc related the events of Hatley's case—his emergency admission, the surgery, the measures taken to replace blood loss and combat the infection that was sure to follow the colon injury—she jotted notes, all the while wishing that she could be the one making the presentation. But it was protocol that the resident on the case detail what happened and what went wrong. After that, the attending was free to speak up, defending where necessary and accepting any criticism alongside the resident.
As Luc wound down the presentation, Anna found her toes tapping in a nervous dance under the table. She picked up her soft drink can, found it empty, and longed for something to counteract the sandpaper-like feeling in her throat.
Anna was trying to organize her thoughts when the door at the back of the room opened, and the anesthesiologist Buddy Jenkins slipped in. He eased into one of the empty chairs along the far side of the room. His eyes met Anna's. Although his expression was carefully neutral, Anna knew what was behind it. Don't try to hang any of this on my resident . . . or on me. Well, she couldn't blame him. She'd probably do the same thing if she were in Jenkins's place. Besides, Nick had pretty well convinced her that the young anesthesia resident's only error had been failing to make the diagnosis early on. But then, neither she nor Luc had picked up on it either. They'd depended too much on that incorrect history, had been too complacent.
"Okay. Dr. McIntyre, your comments?" Fowler's tone conveyed neither approval nor censure.
Anna cleared her throat. "Luc's summarized things pretty well. He put first things first, treated the shock and stopped the bleeding. His repair of the perforated bowel was perfect. Since there was considerable fecal spillage into the abdominal cavity, antibiotic coverage was important." She lifted her eyes from her notes and looked directly at Fowler. "We've already been reminded today how it's possible to have a good surgical result compromised by an infection, and in this case the risk of fatal sepsis was significant. It's unfortunate that, even though we had good information that Mr. Hatley should tolerate the Omnilex, he suffered a severe anaphylactic reaction."
"Who decided on Omnilex? You or Luc?" The speaker was Linda Farley,
After the first presentation, Fowler swept his eyes around the room, focusing one by one on the faculty members, inviting comments. A couple of the more senior faculty had a few words about the management of the case. Each agreed that the morbidity—in this case, a severe postoperative infection that kept the patient in the hospital an extra week—might have been avoided had certain things been done differently. Fowler closed the discussion by mentioning a specific antibiotic that would likely have been more effective. "Moving on. Tim?"
Anna was still processing the chairman's remarks, adding the knowledge to the mental card file she maintained on management of complications, when it hit her. Fowler hadn't looked directly at her since she'd taken her seat. Not at any time during lunch. When he polled the faculty for comments on the previous case, he'd passed over her. It was as though she weren't there. Was this the way it was going to be until she could clear herself of the suspicion that hung over her like a cloud?
Her initial hurt gave way to grim determination. She wasn't about to be kept in limbo until those guys at the DEA found out who was using her information. And as for the Dallas Police, if Green and Dowling were typical examples, she wasn't sure she'd trust them to find a lost dog. They'd probably fine the owner for failing to keep it on a leash. No, she was going to become more actively involved in the process. And she planned to start right after M&M.
Anna's reverie was interrupted when she heard Fowler say, "Luc, how about Mr. Hatley?"
Anna pulled a blank three-by-five card from the bunch she kept in the pocket of her white coat. As Luc related the events of Hatley's case—his emergency admission, the surgery, the measures taken to replace blood loss and combat the infection that was sure to follow the colon injury—she jotted notes, all the while wishing that she could be the one making the presentation. But it was protocol that the resident on the case detail what happened and what went wrong. After that, the attending was free to speak up, defending where necessary and accepting any criticism alongside the resident.
As Luc wound down the presentation, Anna found her toes tapping in a nervous dance under the table. She picked up her soft drink can, found it empty, and longed for something to counteract the sandpaper-like feeling in her throat.
Anna was trying to organize her thoughts when the door at the back of the room opened, and the anesthesiologist Buddy Jenkins slipped in. He eased into one of the empty chairs along the far side of the room. His eyes met Anna's. Although his expression was carefully neutral, Anna knew what was behind it. Don't try to hang any of this on my resident . . . or on me. Well, she couldn't blame him. She'd probably do the same thing if she were in Jenkins's place. Besides, Nick had pretty well convinced her that the young anesthesia resident's only error had been failing to make the diagnosis early on. But then, neither she nor Luc had picked up on it either. They'd depended too much on that incorrect history, had been too complacent.
"Okay. Dr. McIntyre, your comments?" Fowler's tone conveyed neither approval nor censure.
Anna cleared her throat. "Luc's summarized things pretty well. He put first things first, treated the shock and stopped the bleeding. His repair of the perforated bowel was perfect. Since there was considerable fecal spillage into the abdominal cavity, antibiotic coverage was important." She lifted her eyes from her notes and looked directly at Fowler. "We've already been reminded today how it's possible to have a good surgical result compromised by an infection, and in this case the risk of fatal sepsis was significant. It's unfortunate that, even though we had good information that Mr. Hatley should tolerate the Omnilex, he suffered a severe anaphylactic reaction."
"Who decided on Omnilex? You or Luc?" The speaker was Linda Farley,
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