Lynn guessed the dean was somewhere between fifty and sixty. Her complexion was dark. Likewise, her hair was the color of anthracite coal. Through her rimless spectacles, her eyes were like black marbles. If Lynn had been forced to guess, she would have said India was part of the dean’s genealogy.
“I got a major complaint about you,” Dr. English snapped. “You can understand how disappointed I was to learn that two of our best students are causing trouble — students on full scholarship, I might add. And to make matters worse, the trouble was bad enough to involve Dr. Feinberg, the president of the hospital and chairman of Middleton Healthcare. He was upset enough to call me personally to complain.”
There was a pause. Lynn felt an almost overwhelming urge to apologize. She was well aware that the financial support the school had extended to her had been key to her being able to attend medical school. But Michael was as financially dependent as she, and he wasn’t saying anything.
“I was told that you had taken it upon yourselves to question one of our attending anesthesiologists about a recent, very sensitive case. Is this true?”
Both Lynn and Michael started to speak at the same moment, then stopped. Lynn gestured for Michael to talk. She knew he was far better at diplomacy than she, even when she wasn’t as emotionally strung out and sleep deprived as she was now.
“We did talk with Dr. Sandra Wykoff,” Michael said. “But we weren’t, as you say, questioning her. We went to ask her about a case of delayed return of consciousness. As tragic as the case was, we thought that there had to be something for us students to learn.”
“Did you not think of the legal aspects?” Dr. English asked.
Lynn felt herself relax a degree. The dean did not seem to know that Lynn and Carl were romantically involved, which was probably good. Also her voice had moderated. The edge was already gone. It was another reminder for Lynn that Michael was clever at this kind of confrontation. She also noted he was using the King’s English, without the slightest hint of the ’hood.
“As doctors to be, we were thinking more about it from the patient’s perspective,” Michael added.
“I suppose that is commendable from a student’s point of view,” Dr. English said. “But unfortunately there is another aspect. The potential malpractice implications are horrendous when a healthy young man becomes comatose after a simple operation, even when there is no malpractice involved. Such a lawsuit could damage this hospital and affect its ability to take care of thousands of patients. In today’s litigious world, avoiding a lawsuit or controlling it if it does happen in a case like this has to be a prime consideration.”
“We certainly understand that,” Michael said.
“There had been a strict directive from our legal department that no one was to discuss this case.”
“We hadn’t heard that,” Michael said. “But now that we have, we certainly understand and will be cooperative.”
“How exactly had you heard the particulars about this case to begin with?” Dr. English asked.
Michael and Lynn exchanged a quick glance. So far the discussion had been going better than they had anticipated, especially with HIPAA not even being mentioned. But here was the question they feared. Michael nodded to Lynn to take over and try her idea.
“I was talking with the neurology resident on the case,” Lynn began. “He had offered to show me a doll’s eye reflex, which I had never seen before. That was when I had learned the details.”
Dr. English didn’t respond but nodded almost imperceptibly. After a pause she asked, “Did you see the reflex at least? Was it apparent?”
“Yes, I did see it. It was very dramatic.”
“Okay. This is all making more sense to me now. But tell me this: have you two talked about this case with anyone else, like with classmates or anyone besides Dr. Wykoff?”
Lynn and Michael looked at each other and both shook their heads and said no simultaneously.
“Good,” Dr. English said. “As I said, this case is extraordinarily sensitive from a legal perspective. Do not discuss it with anyone!” Dr. English poked a finger at each student in turn to hammer home her point. “If you fail to heed my warning and do discuss it with anyone, anyone at all, I will see to it that you are expelled. Needless to say, being expelled would be a tragedy for both of you, especially this close to graduation. I don’t know how to make it any clearer. I trust you understand the gravity of this?”
“Absolutely,” Lynn and Michael said in unison as if they had practiced the response.
“All right,” Dr. English said. “Let’s move on to another issue.”
Both Lynn and Michael tensed. They thought they were in the clear. Now they weren’t sure. Neither had any idea what was coming.
“When I spoke with the president he said one other thing. As a matter of explanation of your behavior he told me that you two were researching the issue of hospital-acquired morbidity. Is that true, and if it is, why, and why now?”
Lynn and Michael exchanged another glance. A slight nod from Michael encouraged Lynn to answer. “I came across an article recently from Scientific American, which presented some disturbing statistics. It estimated that four hundred forty thousand people die each year in hospitals from mistakes, and that a million leave the hospital with a significant medical problem they didn’t have before they were admitted.
“We were honestly flabbergasted. I mean, we’d heard about the problem during third-year medicine, but we had no idea of the numbers. When we heard about this current case, we thought it was another glaring example and wanted to try to understand how it could have happened.”
Again the dean didn’t respond immediately. She took off her glasses and rubbed her eyes. Then she put her glasses back on and said, “The statistics you quote are sobering. Hospital-acquired infections, or HAI, are the major problem. Did the article point that out?”
“Not specifically,” Lynn said. “It didn’t break the statistics down to specific causes.”
“Well, let me assure you that hospital-acquired infections are the crux of the matter. On a national scale, HAI rates are anywhere from five to ten percent of admissions in the best institutions. In the offending institutions, the rate can go much higher. Do you know what the HAI rate is for Middleton Healthcare hospitals, including this medical center?”
Lynn and Michael shook their heads.
“Let me tell you,” Dr. English said proudly. “Our combined rate is less than two percent.”
“That’s impressive,” Lynn said, and she meant it. Both she and Michael knew that the medical center made a big effort at infection control in many ways, including an active campaign encouraging hand washing and hand sanitizer use in addition to strict control of intravenous lines, respiratory machines, and catheters. Neither was aware of the true extent of the success.
“If you students are interested in hospital morbidity, you should look into nosocomial infection control. That is where you and your classmates could make a difference, not with an isolated case of delayed return to consciousness. Am I making myself clear?”
“Absolutely,” Lynn and Michael again said simultaneously. Their relief was palpable.
“In fact, I will make it easy for you,” Dr. English said. “I will contact IT and arrange for you both to have access to the hospital’s discharge statistics in our medical center system, provided that you adhere to one major condition: If you are going to talk with anyone outside of our community, particularly the media, I want you to run whatever it is by me first. Is that clear?”