Dead Right

By Bert Wagner

The heart monitor alarm suddenly screamed as the patient's EKG pattern abruptly changed to ventricular fibrillation.

"Code Blue!" Dr. Singh screamed, "Get the crash cart in here, now!"

THUMP! The convulsive thrash of his patient after each defibrillation attempt was beginning to be too much for Dr. Brady. THUMP! He didn't know if he could stand the helpless feeling any longer. Attempt after attempt failed to resuscitate Mrs. Winter. He wanted to scream or run away, but continued in his efforts to save his patient. He prayed he was just going to wake up from this nightmare, hug his wife, and be thankful that this surrealistic scene didn't exist.

But that simply wasn't going to happen. What began as sixty seconds of shock and terror, soon became forty minutes of futility. After trying everything they could think of to restore a normal heart rhythm to the patient's lifeless body, Dr. Singh called off the code.

Jessie Winter was dead!

This action-packed mystery will take you from the operating room to the courtroom as Dr. Brady searches for the truth behind his patient's unexpected death, and the resulting malpractice and manslaughter trials.

• Language: English
• Publisher: iUniverse
• Release date: May 31, 2005
• ISBN: 9780595796434

Bert Wagner

Philip ?Bert? Wagner was raised in Wyoming and worked as an engineer before earning his medical degree. His work has been published in medical journals, but this is his first novel. He is currently in private practice in Wyoming where he lives with his wife, Lisa, and their four children.

Book preview

PROLOGUE  

She paid little attention to the traffic on I-635 as she continued along the wide thoroughfare to the northwest. She also failed to notice the sky as it gradually began to blacken, the swelling thunderheads looking more ominous by the minute. If she had noticed, she would have considered the darkening clouds the perfect compliment to the worst day of her life.

She made her way into the right lane and exited the interstate so she could continue south on the Central Expressway. She had been driving more or less aimlessly for almost two hours. Her husband was probably frantic, wondering where she was and trying desperately to find her. He probably had been trying her pager and calling her cell phone, but she had turned them both off. She needed to be alone.

After the verdict.

As she pulled off the Expressway, her thoughts returned once more to the catastrophic events of this afternoon. She simply could not believe that after thirty years of the nearly flawless practice of medicine, she would be ruined by one unjustified grand jury indictment. An indictment made possible by the relentless pursuit of lies and the constant references to her lack of documentation.

If only she had dictated a few more notes for Mr. Weintraub’s office chart detailing the phone conversations she had had with her patient! Then, the grand jury would have seen that she had tried her best to see Mr. Weintraub in a timely manner. They would have realized it was the patient’s noncompliance that hastened his death, not her failure to recognize the symptoms of worsening disease. Hell, she wasn’t guilty of manslaughter; she was only guilty of poor record keeping!

But that’s not how the District Attorney saw it. There would be no medical malpractice case filed in civil court. She was going to be tried in criminal court. They were going to use her as a test case. Every doctor and lawyer in the country would watch this case closely.

She was amazed that something like this could happen. She was one of the most well respected physicians in the Dallas area! Last year she had been at the top of her profession, and now she was going to trial for a crime. And she hadn’t done anything wrong! But it didn’t matter anymore, and soon her anger gave way again to her anguish.

Tears welling in her eyes, she sighed deeply as she pulled into the lot of the motor hotel on the east side of the Expressway. Distant thunder was approaching and the first drops of cool rain began spattering the windshield as she turned off the ignition and trudged into the office. After paying in cash and receiving the key, she found her unit and parked her car in front of the door. She opened her handbag and checked its contents before climbing out of the driver’s side door and letting herself into the rented room.

She sat on the edge of the bed for almost twenty minutes, listening to the steady drum of rain against the window. It’s time, she whispered out loud, as she picked up the phone and dialed her home number. Her husband answered almost immediately.

Roberta! My God, where have you been? I’ve been worried sick!

Jim…I don’t know what to say. She took a deep breath and felt the words catch in her throat. I love you.

What are you talking about? And where the hell are you?

She fumbled in her handbag again. And I love Sandy and the grandkids, too. Her voice broke with a sob.

You’re scaring me! Please come home.

It’s so unfair. I didn’t do anything wrong, she said, weakly, as she hung up the phone. She was amazed that she lived in a world where she could do everything right and still be punished. And she was amazed at the desperate acts she had considered because she was accused of causing a man’s death by her negligence. She felt that the depths of her despondency were leading her on a crash course of irrational behavior from which she would never regain her sanity.

Had other physicians felt this way? Had a situation like this ever happened before? Were there others out there whose lives had been changed forever by an unjustified accusation? Or was she all alone?

Her hands shook nervously as she found the .357 Magnum and checked the cylinder. It was full. She closed her eyes and pulled back the hammer. The click was louder than she remembered, and it caused her to wince. She clenched her teeth around the cold steel of the barrel, and said to herself again, God, help me, I didn’t do anything wrong!

That was the last thought she ever had.

CHAPTER 1  

Dr. Randall Brady refolded the morning newspaper and tossed it onto the counter at the nurse’s station in Labor and Delivery. He almost missed the small article on the last page of the front section, but the headline caught his eye at the last minute. Doctor Indicted for Manslaughter—Takes Own Life it had said.

Randy read with astonishment the account of a physician in Dallas who, after losing a patient is indicted for manslaughter. Before she went to trial, however, she checked into a motor hotel and committed suicide. His heart went out to the woman he had never met and to the family she left behind. How could she have been so despondent? So desperate? How could…

We’re getting closer Dr. Brady, informed the nurse as she poked her head briefly from Birthing Suite #6. When Randy waved acknowledgment, she quickly disappeared back into the room to attend her patient. He pulled up his waterproof shoe covers and followed the nurse into the birthing suite, closing the door behind him.

Take a deep breath in and hold it! Now, PUSH, Joni, PUSH! Hold it as long as you can! That’s it, Joni, you’re doing a great job! I can see some of the baby’s head now. She’s got lots of hair, just like her mom. O.K., Joni if this contraction’s over, go ahead and rest up for the next one. You’re doing a super job!

Joni Bushwell collapsed back into the pillows on her delivery bed for a well-deserved two-minute rest. The uterine contractions were more frequent and extremely painful in the second stage of labor, and she needed to conserve her energy to effectively deliver her first baby. Randy also used this brief interlude between contractions to let his mind wander. He slowly moved his gaze towards the large picture windows that lined the entire west wall of the plush birthing suite. From this fifth floor vantage point, the skies over Denver looked unusually clear on this crisp autumn day. The recent breezes had swept the brown smog out of the valley leaving behind only the fresh, crystal clear, Rocky Mountain air. It was somehow like a new beginning. A rebirth…

Here comes another contraction. Take another deep breath and PUSH, Joni! encouraged Randy and the labor room nurse. That was a good one, Joni. I don’t think it will be too much longer!

* * * *

Randy loved his job. He knew he wanted to be an obstetrician-gynecologist as soon as he delivered his first baby while still a third year medical student. It had been one of the most awesome and rewarding experiences of his life, and he was so moved he could think of nothing else for days after. He knew from that moment on, he would devote his career to the health care of women.

While most of the other 175 third year medical students were complaining about the lousy hours of the OB rotation, Randy jumped into the experience with both feet. He never stopped reading about pregnancies and their unique sets of problems. Not only did he read the basic texts on obstetrics, Randy continued his self-motivated learning with related subspecialty texts on perinatology, endocrinology, gynecologic surgery, and oncology. But his extensive reading was no substitute for the hands-on learning he also obtained on the rotation.

He particularly liked to scrub on as many of the surgeries as he could. And it was Randy’s good fortune that many of the OB/Gyn physicians he encountered were excellent teachers, as well as surgeons. It was these physicians that he would emulate when he began his own career.

* * * *

I don’t know if I can do this much longer! gasped Joni in desperation. She was becoming exhausted. Can’t you just use forceps or something Dr. Brady, PLEASE!

You’re almost there, Joni, and you’re doing just fine, reassured Dr. Brady in a soothing voice. Primigravidas, or first-time moms, often had longer labors and could easily get discouraged without emotional support from their husband, nurse, and physician. Let’s give it just a few more good pushes and I’ll bet you can do it!

Although Randy had witnessed the birth of hundreds of babies, each one was a special moment. Each new life brought with it a hope for the future and a remembrance of things past…

* * * *

As a fourth year medical student, Randy found he enjoyed the excitement of the operating room over that of the delivery room, but one patient in particular made delivering babies a special thrill.

On the high-risk obstetric rotation, Randy encountered pregnant patients with complex medical problems. When one such patient requested that he, a simple medical student, be the doctor in the delivery room for the birth of her twins, Randy found excitement he had never experienced before. Her faith in him as a doctor gave Randy the confidence he needed that his career choice was right. One month after graduating from medical school, he began his four-year residency in Obstetrics and Gynecology at Northwestern University in Evanston near Chicago.

* * * *

As Joni continued to push, Randy stopped his daydreams long enough to once again ponder the article he read about the doctor in Dallas. Randy found he could not even imagine what it would be like for him to be sued for malpractice. He cared deeply for his patients and made every effort to reduce his chances of a bad outcome related to his medical care. He continued to attend postgraduate training courses and he read many of the professional journals related to his specialty. His career was his life, and he spent every moment trying to improve his skills as a physician. If he were to be sued, it would be a blow of such unimaginable grief for him, he was unsure if he would be able to survive it.

It seemed ironic that the high-risk pregnancies that, in part, had attracted him to his specialty, were now making him wary. High-risk patients had much more potential for bad things to happen to them and therefore more potential for a malpractice lawsuit. But to be charged with a crime when a patient died had a more sobering effect. Although he hadn’t thought much about it before now, the article in the paper this morning had definitely caused him some anxiety…

Isn’t that baby ever going to come? asked Joni as she collapsed, sweaty and exhausted back into her pillows. The exasperation in her voice was obvious, and the frustration on her husband’s face was beginning to show, as well.

I think only one or two more contractions will do it, Joni. Hang in there! You can do it, I know you can! encouraged Randy. He knew there were a few physicians whose impatience would result in an unnecessary cesarean section or forceps delivery, but he never felt that his time was wasted. In fact, Randy felt he was more patient than ever, now that he was in private practice. Why, compared to his residency training…

* * * *

During those four years of residency, Randy practically lived in the hospital. The residency program that Randy chose to further his education in Obstetrics and Gynecology was known for being extremely busy. While some of the residents learned to hate the long hours and the sheer numbers of patients they were required to care for, Randy saw each patient as a new opportunity to learn. He felt that the more situations he encountered as a resident, the more situations he would be comfortable in as a private practice physician.

And the stress of the work only added to the excitement. Randy had so much fun working that he never had a chance to worry about medical malpractice. He felt if he worked hard and learned to practice good medicine, things would turn out right for everyone. Fortunately, it was rare that he was proven wrong.

Occasionally, however, a bad outcome occurred even when appropriate medical care was rendered. A patient died or a baby had a birth defect—these things were unpreventable in most cases. Sometimes bad things just happened.

And it wasn’t until his last year, as Chief Resident, that he even heard of the University being sued for malpractice. Even then, it didn’t involve Randy so he didn’t hear much about it as he began looking for places to begin his own private practice. To Randy, medical malpractice was just something that only bad doctors were involved in, and he knew he wasn’t one of those.

* * * *

You were so close that time, Joni! encouraged Randy. He knew his words were probably falling on deaf ears, as his patient’s concentration was intense. Nevertheless, he continued to support her and knew she would deliver her new baby soon. The next uterine contraction began after only one short minute and Randy could see the pain reflected in Joni’s expression. Here we go again…

* * * *

As he was finishing his four-year residency, Randy heard of an opportunity to practice in the Denver area. He immediately booked a flight to look over the facilities, since Randy’s wife, Laura, grew up in Denver, and her parents still lived there. Although she never pressured Randy when it came to joining a practice, she was secretly overjoyed at the prospect of moving back to be near her folks.

Randy was welcomed at Denver International Airport by three physicians, two women and one man, wanting to expand to a group of four. He seemed to fit in well with their style of patient care and he liked them right away. They must have felt the same way about Randy, as they offered him a generous salary, great benefits, and the opportunity to become a partner in the practice after one year. He discussed the offer with his wife, but had already decided this was the practice for him. That was seven years ago.

He truly seemed to flourish in private practice and soon developed quite a following by word of mouth. His patients loved his mellow bedside manner and appreciated his extraordinary skills as an obstetrician and a gynecologic surgeon. They continually recommended Dr. Brady to their friends and soon his waiting room was full.

Laura, however, paid a price for Randy’s popularity. His patient load meant he had less time to spend with his family. She had even encouraged Randy to give up delivering babies in favor of limiting his practice to gynecologic surgery. She cited better hours as the main reason, but also warned him again of the malpractice liability of practicing obstetrics.

But giving up the obstetrics portion of his specialty wasn’t an option for Randy. Although he loved surgery, he couldn’t imagine his life without the excitement of being in the delivery room. No matter how many times he helped with the delivery of a new baby, he often became quite choked up. How marvelous it was to see parents behold their brand-new baby for the first time! A new person that is, at the same time, your legacy and a totally new creation unlike any other. Someone who will love you unconditionally, and who will need you and depend on you absolutely.

* * * *

This is the one, Joni. Take another deep breath, instructed Randy. Hold it in and push with all your might! Boy, this baby has lots of hair. That’s it, another quick breath and then right back at it! Great! Here she comes, Dad, get the camera ready! One more push, that’s it. Now, O.K. Stop pushing! Let me suck out the babies mouth and nose here. O.K. now push gently. Good job, Joni! Here comes her shoulders, and it’s a GIRL! I was right! Joni, she’s beautiful! She’s just gorgeous!

What a great job I have, Dr. Randall Brady thought to himself as he placed the precious bundle of squalling heaven on her mother’s abdomen. He turned and pretended to be busy with the instruments on his delivery table so the others in the birthing room wouldn’t see the tears welling up in his eyes.

CHAPTER 2  

Jessie was the only one awake in the Winter household. She didn’t think she could stand the pain another minute. The cramping in her lower abdomen was so bad she could hardly stand up straight, let alone sleep the whole night through. Her bleeding and pain had progressively become worse to the point where she was incapacitated by it every month. She was also becoming more anemic and despite being on large amounts of iron supplements, just didn’t seem to have the energy to keep up with her daily activities any more.

Even worse, although her husband had been increasingly distant over the last year or so, he was especially less interested in her sexually. Jessie felt responsible for his lack of interest in the bedroom. She had been having so much pain over the last several months that she began to make excuses to avoid being intimate. And although she dreaded the few times she had acquiesced, she longed for the closeness she had shared with her husband in years past.

She looked at herself in the unflattering fluorescent-lighted mirror over the bathroom sink and saw herself as plain and unattractive. She had had difficulty losing the extra thirty pounds from her unsuccessful infertility treatments and her mousy blond hair hung limply to her shoulders. But her husband seemed not to age at all, becoming more handsome every day. And now those natural good looks and athletic body that had originally attracted Jessie to her husband were like a curse to her. And she was sure that his appearance was not lost on other women.

Maybe she was just insecure, but he did spend a lot of free time at the tennis club doing God knows what. When she questioned him on his activities, he became defensive and even more withdrawn. Somehow, she needed to rekindle their romance before it died out.

And she felt if she could have just one day without the pain or bleeding, things would be a lot better with the only man she had ever loved. It was a good thing she had an appointment with Dr. Brady today. He was going to talk about fixing her pain and her abnormal bleeding once and for all.

* * * *

The air was crisp and clean at this time of morning. The sun was still struggling to clear the horizon, and most of Denver’s commuters were sitting at the breakfast table trying to shake the sandman from their eyes. Randy was grateful that he was a morning person and wondered how he would make early rounds in the hospital if he were not.

Randy turned off Warren Avenue into the large physician’s parking structure at the hospital in which he had most of his practice. He inserted his magnetic key card into the slot and the electronic gate slowly rose. He put his Tahoe into gear and continued up the ramp and into the structure itself.

He liked the design of this particular parking garage. Instead of competing for the parking slots on the first floor, he could park near a pedestrian walkway on the third or the fifth floors of the garage, which led directly onto the corresponding floors of the general hospital. Randy proceeded straight up to the fifth floor and found a spot close to the walkway. Another advantage to being a morning person, he thought to himself. He always went to the fifth, since Labor and Delivery was on 5-West and he didn’t have to climb any stairs.

He turned off the motor, and slipped from behind the wheel. He strolled towards the pedestrian walkway and was startled by Janie Lungren who honked as she drove by. She was one of the Labor and Delivery nurses, but parked in the physician’s lot since her husband was a cardiologist on staff. He quickly gathered his composure and waved back as he turned into the walkway which opened directly onto 5-Main. After crossing the walkway bridge, he turned left and headed towardsL&Dand the other obstetric and gynecologic units. He preferred making morning rounds on all of his hospitalized patients before seeing patients in his office.

Although he had no patients in labor this particular morning, he always walked through Labor and Delivery to greet the nurses who worked there. L & D nurses worked very hard and Randy liked to show his appreciation for their effort by spending some of his own time visiting with them.

Looks like you guys might have a good day today, he said as he referred to The Board. This large white board could be written on with non-permanent marking pens, and listed the occupant of each of the thirteen birthing rooms. With the number of each room listed down the left column, each line on the board was filled with information about the patient and her progress in labor. At a glance, one could also tell the name of the patient’s physician and nurse, the number of weeks she had carried her pregnancy, and how many pregnancies she had delivered in the past. Today, there were only three women in labor, and none of them were patients of Dr. Brady.

I hope you didn’t jinx us, smiled Anne Carroll, the Head Nurse on Labor and Delivery.

Randy just smiled. I know you can handle it if it gets busy. You guys are the best. He walked off the unit towards the adjacent postpartum ward to see the patients that had delivered over the last few days.

Good morning, Dr. Brady, greeted the ward clerk on the postpartum ward. She had already begun to gather the hospital charts for his patients when she saw him approaching the desk.

G’morning, Nancy, replied Brady. How’s your daughter doing in medical school? Has she decided on a specialty, yet?

She’s thinking about Dermatology, I think. She liked her OB/Gyn rotation, but was scared away by the stories of all the lawsuits against OB doctors, she said, suddenly embarrassed by her candor. Actually, Nancy was right. Obstetricians were sued more than any other doctors. Although being sued for malpractice might be very complicated, being charged with criminal negligence would probably be unbearable. But until he read that article in the paper yesterday about the suicide in Dallas, Randy hadn’t spent much time thinking about the risk involved in the practice of his specialty.

I hate to say it, but she’s probably making a wise choice, replied Brady. They both laughed politely and he thanked the clerk for gathering his charts before he made his way down the hall. The first patient was Joni Bushwell, who delivered the baby girl yesterday.

Randy knocked softly and pushed open her door. Good morning, Joni. How did you sleep last night?

Not that great, I was too excited to sleep. I kept waking up just to look at her and watch her sleep. I just can’t believe she’s here! Ron and I can’t thank you enough for every thing you did.

You guys did most of the hard work. I was just there for moral support. Randy smiled and began asking her questions about her condition and did a brief exam. Everything looks fine, Joni. Is there anything I can get for you or any questions I can answer?

She said that she couldn’t think of any, and again thanked Randy for helping bring her new baby into the world. See you tomorrow, Joni, said Brady. We’ll probably let you go home in the morning.

He then continued to round on all of his postpartum patients, reviewing their vital signs and morning labs. Before he left each patient’s room, he made sure that all of their questions were answered and that they were comfortable with caring for their new baby.

As he finished with his charting, Randy noticed Joni approaching with her baby. Can I take your picture holding the baby, Dr. Brady? You know first time moms—we can’t take enough pictures of our baby!

My pleasure, he replied. He didn’t mind this part of his job at all.

Randy’s last stop on rounds was the gynecologic ward where he had two postoperative patients. Randy examined both of his patients and pronounced them fit for discharge. He discussed post-op instructions with them and made arrangements for their follow-up care in his clinic. After their questions were answered, he went to the nurse’s station and wrote discharge orders on the two charts. He then used the dictation system to narrate summaries of their care and progress for the hospital record. Finally, he was ready to tackle his office full of patients. It was

8:05 A.M.

He darted down the stairs to the third floor where he could cross the pedestrian bridge connecting the hospital with the modern office building in which his offices were located. He would begin his day with a new patient scheduled at

8:15. He hated being late and hurried along the corridor past the offices of the largest orthopedics group in this part of Denver. He turned left at an intersection in the hallway and proceeded to the back door of his office suite. He unlocked the dead bolt and let himself in. Randy quickly donned his long white lab coat, and pushed his intercom button. Good morning, Cathy. I’m here, he informed his receptionist.

Good morning, Dr. Brady. Your first patient is here. She’ll be in room #1, replied Cathy. She had been with Randy since he began his practice seven years ago. She served not only as his receptionist, but scheduled patients for his office as well as scheduling his surgery. Without her, Brady thought his office would barely function at all.

Randy glanced at his phone messages while his nurse, Sheila McDermott, weighed the new patient, took her blood pressure and showed her to exam room #1. Randy preferred to conduct a new patient interview himself and Sheila asked only a few basic questions. She jotted down the information obtained from her brief encounter, and informed the patient that the doctor would be right in. She then left the room and placed the chart in the rack outside of the exam room. As Randy quickly reviewed the chart, Sheila went to the waiting room to get the next patient.

Randy knocked on the exam room door and walked in. Good morning, Mrs. Petroni. I’m Dr. Brady, he began as he crossed the room and extended his hand to the new patient. He had a small table and three chairs on one end of each of his three exam rooms. On the other side of each room was a curtain, where the patient could change into the exam gowns. Next to the curtain were an exam table and a sink. There were plenty of storage cabinets in each room as well. Since all three rooms were identical in their layout, he knew where everything was. This saved time when he needed instruments, information pamphlets, or other supplies.

Randy began his interview while sitting opposite the patient at the small table. He asked her questions about why she had come to the office and about her past medical history. When he felt he had the necessary information and history, he left the room so the patient could disrobe in private. Sheila always accompanied him when he returned to examine the patient. He knew that some patients were uncomfortable with male physicians and Sheila helped them feel more secure. When he was done with his exam, he again left the room so the patient could get dressed. When he returned, Randy spent time informing the patient of his findings and recommendations. He also answered any questions the patient might have regarding his treatment plan.

With Mrs. Petroni taken care of, Randy moved on to the next patient and the next. Before he knew it, his morning schedule was down to his last patient. Jessie Winter was here to discuss the possibility of having surgery.

Randy picked up Mrs. Winter’s chart from the rack outside of exam room #3 and quickly scanned the contents. Mrs. Winter had been a patient of his for the last several years, but recently called complaining of increasing pain and was now interested in definitive treatment.

Randy knocked and entered her room. Mrs. Winter sat with her husband at the small table, and Randy took the remaining chair opposite them. Good morning, Jessie, he greeted. Then he nodded to her husband, Mr. Winter.

Morning, Dr. Brady, replied the patient. Her husband sat quietly and let his wife do the talking. He didn’t even attempt to make eye contact with the doctor. Mrs. Winter continued, I can’t go on like this, Doctor Brady. I’m bleeding so much each month that I’m always tired. I also have so much pain that I can’t even get out of bed sometimes. We have given up on the idea of having kids of our own, and we might even try to adopt a baby. Anyway, I was thinking maybe, just a minute… She fumbled in her purse and withdrew a folded piece of paper, which she opened.

My friend told me about this surgery that her sister had called a myomectomy. Wouldn’t that solve all of my problems?

It might, Jessie, agreed Randy. "Remember we had discussed this particular surgery a couple of years ago during your fertility treatments. We elected not do undergo the risk of the surgery then since it wouldn’t have helped your particular fertility problem. I think your fibroids are much bigger now and I think we should do something different.

In the myomectomy procedure you asked about, we remove as many of those tumors from your uterus as we can, while trying to preserve your uterus. Unfortunately, you have so many of them, that it would be very difficult to perform the procedure without significant blood loss and with a higher risk of other complications.

Jessie Winter looked dejected. What else can you do?

"I think you would benefit from a hysterectomy, or just removing the uterus and all of its fibroid tumors. This particular surgery doesn’t take as long, and is associated with less blood loss, and fewer complications than a myomectomy. Hysterectomies might be performed more