CHAPTER THIRTY-ONE
LOOKING AROUND, I SAW THAT EVERYONE WAS THERE—THE BOY, tall and slim and ill; the boy’s shaken parents, pale mom, dad unsmiling; an intern; and a nurse. The nurse had a run in her stocking; I know because I was checking out her legs. Thick ankles, Jesus, ankles like a cart horse, as Pop would say, whatever the hell a cart horse is. Something you don’t want to rub up against in the night, Collie, I was thinking.
The boy’s name was Gary. He was seventeen years old. His leukemia had reappeared after a long remission. I was treating him for the first time. His regular doctor was sick at home. I was annoyed because we weren’t on the oncology ward. There weren’t any available beds. Instead we were on a surgical ward, and it was seven o’clock in the morning.
The official inquiry would eventually refer to the cumulative effect of small factors.
Geography was small factor number one.
I was new to St. Agnes-Marie Hospital and still learning their protocols.
Small factor number two.
Gary was prepped to receive the first round in a chemotherapy regimen of spinal canal injections of methotrexate, cytarabine, and hydrocortisone. I gave my head a shake and focused. Later in the day he was scheduled to receive an intravenous treatment with a drug called vincristine.
I was accustomed to protocols on the oncology ward at my previous hospital, where intravenous medications were stored separately for safety reasons. In oncology, they weren’t allowed in the same room together. And they were packaged differently. Drugs such as vincristine were double-bagged and wrapped in a towel. On other wards, on this ward, they weren’t so meticulous. Hospital rules didn’t oblige them to be—small factor number three. I wasn’t thinking about that, of course. Somewhere in my unconscious, I was making the assumption that standards of risk management with regard to drug handling were the same on all wards.
But even on oncology I always double-checked the medications—that’s how thorough I was; that’s how seriously I took my responsibilities. I always checked the labeling first. I was strangling, all that virtue a lump in my throat. I could hardly breathe for my determination to do it right, follow through, be better than I was, elusive maturity choking the life out of me.
So when a nurse brought a bag containing what I thought were the three syringes into the room, I checked just to make sure. But I didn’t remove the syringes from the bag. I never touched the bag—small factor number four.
The nurse was unfamiliar with chemotherapy procedures. She didn’t know anything about the drugs and how they should be administered. That would never have happened at my old hospital.
Small factor number five.
Viewing the syringes through the transparent plastic, I visually confirmed the contents and the labeling. But there was a fourth syringe. I didn’t see it. It was concealed by the other three.
Small factor number six.
I was chatting with Gary about football. He was a bright, likable kid, cheerful as an accordion. He was making fun of me for not looking like a doctor, and he was right. You look like a skater, he said, and I was shrugging because I knew it was true.
“How’d you get that limp?” he asked me.
“Heliskiing in Nepal,” I told him. I’d told the story so many times, I’d come to believe it myself.
We were laughing and talking. It felt like fun, what was going on between us. I liked the way we were ignoring the crisis, our levity a nice counterpoint to the gravity of the situation.
Ever since medical school I couldn’t help myself: If it looked like fun—and joking with this kid was fun—I was running it down, dog after cat, just for the hell of it, for the sheer pleasure of chasing and catching.
Why didn’t I pull the syringes from the bag and check? Was it because I was having too much fun?
The intern automatically withdrew the syringes from the bag and put all four syringes onto the tray. Small factor number seven. And why wouldn’t he? He had watched me approve the contents. He knew my reputation for thoroughness. I was so confident in my abilities and judgments, I instilled the same assurance in others. Everyone knew I was a star. Unlike Collie the boyish f*ck-up, I didn’t make mistakes. That was behind me.
I sat down and began the procedure. The tray stand was at shoulder level when I was in a seated position. Because I was looking across, rather than looking down, I still didn’t see that there were four rather than three syringes. Now there were eight small factors at play.
At that moment, a fire alarm sounded out in the hallway. The boy’s mother looked anxiously over at the door, as did Gary. I was mildly distracted by the noise and was focused on trying to ensure that Gary remained perfectly still. Small factors nine and ten.
The nurse handed me the syringes one by one, and one by one I injected the methotrexate, the cytarabine, and the hydrocortisone, and then I injected the fourth syringe.
That’s when I killed him.
The second I withdrew the syringe I knew. A fourth syringe. Why did I know the second after and not the second before? I looked down at the syringe. The label was clear: vincristine, written in black letters.
I made immediate efforts to flush out his central nervous system, but vincristine injected into the spinal canal is fatal. It was certainly fatal for Gary.
It took him three agonizing days to die. I have no memory of those three days.
An inquiry exonerated me. There was persuasive testimony as to my competence, my academic standing, my impeccable training and credentials, my reputation for caring and conscientiousness, the conspiracy of circumstance. The hospital decided the matter should end there.
Gary’s parents heroically supported their decision. I found out later both the hospital and the parents accepted large sums of money from the Falcon.