On the drive to the medical school, her little Toyota seemed a bit balky, but Anna put it down to an extension of the bad luck she was having. Maybe she'd gotten some bad gasoline. Maybe it was time to change the spark plugs. She could never recall how often that was supposed to happen. She'd ask around. One more thing to add to the list. She was about a mile from home when the engine coughed three times like a two-packa-day smoker, then quit.
She was sitting behind the wheel, trying to restart the car, when there was a tap on the driver's side window. The middleaged Hispanic man standing there looked pleasant enough. The name over the pocket of his blue work shirt was Ramon. Anna looked beyond him and saw a faded blue pickup parked across the street, a woman in the passenger seat.
"Can I help?" the man said in a voice with only a hint of accent.
Anna measured her options and decided that Ramon was her best one. "Yes, please. It just quit."
After about ten minutes, Ramon peered at Anna from beneath the open hood of her car and said, "I believe it is probably the fuel pump." His brown eyes mirrored the sorrow that was in his voice.
"Can you fix it?"
Ramon shook his head. "No, I am sorry. My wife and I can give you a ride somewhere if that would help."
Anna recalled the Toyota dealership she passed every day on her way to the medical center. She'd never paid any attention to it until now. "Thanks, but I have a cell phone. I can call for a tow."
Forty minutes later, Anna sat in the waiting room of the dealership, turning the pages of a year-old copy of a magazine without any recognition of the words and pictures. The car had served her faithfully through medical school and residency, as well as two owners before her, owners who had probably not been particularly kind to the vehicle. If this episode wasn't the final chapter for the car, that couldn't be far away. Should she look at another car while she was here?
"May I help you while you're waiting?" It was as though the salesman had read her thoughts.
"I'm waiting for my car to be repaired."
"Why don't I show you some of the bargains we have? You might decide to trade up."
"No, thank you."
"If you change your mind, let me know."
The salesman had no sooner left than Anna heard, "Dr. McIntyre?"
She turned in her chair to find the service advisor standing behind her. "Your car needs a new fuel pump. And we've found a couple of other things." He held out a clipboard. "Here's what it will take to repair it. If you want us to do it, we can get right on it and have you out of here in two or three hours."
Anna looked at the figures. She could afford the repairs— just barely. But maybe she'd be better offputting the money into a new car.
"Let me think about it." She looked around for the salesman, and found him at the coffee machine.
The salesman led Anna on a whirlwind tour of the lot, and after half an hour she sat in his office while his fingers flew over the keys of his computer. "Well, Doctor, I believe we can put you in that car at a price you can afford. Let me get a little information, and I'll run a credit report."
Ten minutes later, the salesman swiveled away from the computer screen, and the look in his eyes told Anna everything she needed to know. "I've done a credit check. I think we might have some trouble financing that car. We can probably do it, but I can't get the interest rate I wanted. And that would make the payments—."
"No, I understand." Anna wanted to argue, but realized how futile it would be. The red flags were already up. Her credit had become suspect. And even though the credit reporting companies had promised to put things right, it wasn't going to happen today.
She found the service advisor and said, "Okay, just do the repair. I'll wait."
"Thanks anyway." Nick Valentine hung up the phone and rummaged through the books and journals scattered in front of him. The desk of his academic office, never the most organized eighteen square feet in the Pathology Department, looked like a war zone. He was computer-literate and often did online searches for information, but at times it was comforting to feel the heft of a textbook in your hands, to mark an important passage with a yellow highlighter. For this problem, he'd pulled out all the stops: a computer search, back issues of journals from the department library, textbooks—old and new— taken from his shelves. And now he'd just hung up from a short, albeit rather unsatisfactory, conversation with the head of the Allergy Division. His head swam with information overload. He let his gaze rest on Eric Hatley's chart and the notes he'd made when he reviewed it again. Nothing he'd found changed his mind about the cause of Hatley's death. However, there was one bit of information that puzzled him. Maybe he'd go downstairs and get some coffee to help him think.
"Got a minute?"
The voice brought him instantly alert. Anna McIntyre stood in the doorway. Her shoulders sagged just a bit, even though she had a faint smile plastered on her face. Nick wondered if something more had gone wrong. Then he noticed the two paper cups in Anna's hands.
"I come bearing gifts from Starbucks," she said, advancing and placing one of the containers on his desk like a priest laying a sacrifice on the altar. "I wanted to thank you for the dinner last evening, and for the work you're putting in on the Hatley case."
Nick flipped the lid offthe cup and tossed it into his wastebasket, barely hitting his target. He nodded his appreciation and took a deep sip. "No thanks necessary, but you don't know how much I needed this pick-me-up. I've been working all afternoon trying to find a blood test for allergy to Omnilex. Unfortunately, there isn't one, at least not one that's reliable. Mainly because the drug's too new."
Anna eased into the chair across the desk from Nick and took a taste of her coffee. "So there's no way to know for sure whether Eric Hatley had his anaphylactic reaction because of the antibiotic we gave him." Nick recognized this as a statement, not a question. "His tryptase level came back this morning—sky-high. Hatley defi- nitely had a severe anaphylactic reaction. I just finished the microscopic exam on the tissue samples from the autopsy. Nothing else showed up. Bottom line, there's no question that a massive allergic reaction was the final event. But we can't prove the cause."
"Could this be due to the anesthesiologist giving him a wrong medication of some kind?"
"What makes you ask?"
"The staffman was out of the room. JeffMurray is a first- year resident, not experienced, not necessarily good under stress. At the time I didn't make too much of it, but as I thought about it later, I wondered if maybe he didn't give Hatley something other than the antibiotic Luc ordered."
Nick shook his head. "No way. I went so far as to go up to surgery this morning and look through one of the anesthesia carts. Other than various antibiotics, I couldn't find anything there that could have done this."
"So I can't blame anesthesia for this."
"Afraid not. But this should interest you." Nick reached past the pile of articles and books on his desk, moved aside Hatley's hospital chart, and picked up a thin file held together by a metal fastener strip threaded through two holes punched at the top.
"I had them pull the emergency room record for Eric Hatley, the visit that was the basis for your choice of antibiotics. Have a look." He held out the folder and watched Anna thumb through it the way physicians learn to do, scanning the pages and picking out the important nuggets of information. He could tell when she got to the part that had stopped him cold.
"What do you think?" he asked.
"I think this patient signed in with the same name, address, and date of birth as the man who died on the operating table."
"Our Eric Hatley was a middle-aged Caucasian male."Anna looked down at the page where her finger marked the line that Nick knew would get her attention, as it had his. "It says, 'The patient is a young, African-American male who complains of—' "
"Right. Same identifying data. Different people." Nick drained his coffee cup. "Looks like you're not the only person who's had their identity stolen. But in this case, Eric Hatley lost more than his credit cards. He lost his life." ANNA STOOD QUIETLY BY AS THE EMERGENCY ROOM CLERK EXPLAINED TO A young Latino boy that his father would be seen as soon as possible. The boy nodded gravely and rattled offthe translation so rapidly that Anna, who prided herself on being able to communicate in that language, couldn't follow the Spanish. The father grimaced, clutched his stomach for a moment, then shrugged in resignation and edged back toward a seat in the crowded waiting room.
When the clerk was free, Anna stepped up to the desk."Shirley, what doctor's running the ER today?"
The woman turned with a start. "Oh, Dr. McIntyre. I didn't see you standing there. I thought you were on vacation."
Anna leaned over and dropped her voice. "News travels fast around here. Yes, I'm on a leave of sorts, but there's something I need to . . . I have to get some information from one of the doctors for the project I'm working on. Who's the Pit Boss today?"
Shirley ran her hand through blonde hair that Anna was willing to bet didn't start out that color. "That would be Dr. Fell."
"Do you know if he's tied up right now?"
"I think he just slipped back for a cup of coffee." Shirley pointed the way. Anna nodded her thanks and headed for the break room. Just being in the Emergency Room made her pulse quicken, as she relived memories of her own time as "Pit Boss"—the second-year surgery resident charged with overseeing the ER at Parkland Hospital, arguably one of the busiest in the nation. The pressure was tremendous, but the opportunity to hone one's clinical judgment and skills was almost unlimited.
She recalled the time when one of the senior staffsurgeons had found her sobbing in the ER break room at the end of her shift. He'd put a gentle hand on her shoulder. "What's wrong, Anna?"
She told him about her feverish struggle to save the victims of a horrible crash on North Central Expressway. In the end, the only survivor was a three-year-old child, left orphaned when his mother, father, and older sister died. "I did all I could. And it wasn't enough."
The doctor had eased into the chair beside her. "If you've given it all you had, don't blame yourself when you lose the battle. You can't die with them, you know. If you do, who'd take care of the next one?"
Anna gave a little shudder as she recalled that advice. She'd recently had a patient die—one who should still be alive right now—but for the moment she needed to put any thought of guilt and blame aside. She needed to do something positive. She'd start by questioning the doctor who'd treated the "other" Eric Hatley.
"Dr. McIntyre, what brings you down here? I thought you were on leave." Dr. William Fell was slumped on the couch, sipping from a Styrofoam cup. He started to stand, but Anna waved him back.
"Will, I'm glad you're on duty today. I need to know what you remember about this patient." She held out the emergency room file she'd taken from Nick's office.
He flashed a grin. "Hey, this was two weeks ago. I can't remember the patients from yesterday."
"It's really important. Look at your note. Tell me if it rings a bell."
Will scanned the scrawled note. "Matter of fact, I do recall this guy. In the first place, if you notice the time stamp, he showed up here at two a.m. with a chief complaint of a sexually transmitted disease. I'd just stretched out to take a nap when they woke me. I gave him a pretty good tongue-lashing for picking that time to come in for something like that. Know what he said?"
Anna shook her head.
"Said that he knew we wouldn't be as busy at that time of the morning, and he was up anyway." Will flipped back to the cover sheet. "I remember telling him that, since he had private insurance, he should have gone to his regular doctor during normal hours. He blew me offand asked me if I was going to treat him. I did a quick exam, confirmed my diagnosis with a lab test, and gave him an IM antibiotic. Told him to make a follow-up appointment, but you know they never do. End of story."
"Can you recall what he looked like?"
"Vaguely. Twentyish black male. Taller than me, quite a bit thinner." "Remember anything else about him?"
Will closed his eyes and Anna could almost hear the wheels turning. "Sorry, nothing stands out. Is it important?"
"Not really, I guess."
"What's this about?"
"The man's name came up in connection with another case, and I'm following up on it," Anna said. "We may have gotten a couple of patients with the same name mixed up. But you didn't do anything wrong, so don't worry about it. Thanks."
"I'll walk out with you," Will said. "It's time for me to get back to work."
They stopped in the hall and Anna put her hand on Will's arm. "Hang in there. It's a tough rotation, but it's worth it— sort of like putting iron into a fire to temper it."
As she started down the hall, Anna couldn't help wondering whether the problems that plagued her right now would temper the iron of her resolve or shatter it.