If my story were a novel, the audience at this point would be witness to a conversation taking place in the doctor’s office while I, the protagonist, sit in the lobby awaiting my fate. Since I wasn’t privy to the events as they unfolded, I can only use my imagination to guess what happened, but I figure it went something like this:
It’s 11:00 a.m. on a sunny September morning. Holly goes to her office to switch patient charts. She plops the chart of the patient she’s just seen on the short stack on the right corner of her desk and picks up the top chart from the larger pile, those of cancer patients booked for the rest of the day. Before she sits at the desk scattered with files and framed photos of her smiling children she nukes the half cup of coffee she left behind an hour ago. Carrying the steaming mug to her desk, she sits down and looks at the name on the chart, Alice Armstrong. Holly is pleased. She has been seeing Alice for ten years, and she’s an easy patient. There’s never any bad news to deliver to Alice. She responds well to the medication, so the appointments are always perfunctory.
Holly opens the chart and begins her review. First she wrinkles her brow. Something is amiss here. Where are the test results from June’s BCR-abl, she wonders. Slowly, she flips through the pages. Hmm. Not here. I must have forgotten to print them out, she thinks. She logs onto the computer, pulls up Alice’s records, and scrolls down the page. She remembers talking to Alice on the phone in June and telling her the cancer was still undetectable, but now she cannot find those test results. Picking up the phone, she dials the lab. As the conversation with the lab manager progresses, Holly’s eyes open wide and her mouth drops open. “Holy shit!” she says as she drops the phone back in its cradle.
Dr. Cashen is in an exam room with a patient. While Holly waits for her, she looks at the CBC results of the blood test just run on Alice. As her eyes run down the page taking in all of the numbers flagged as abnormal, her complexion grows as white as her anemic patients’ pallors. Alice’s disease has not only returned but progressed, she realizes, and she is to blame. The chart trembles in her hand and tears start to well in her eyes.
Dr. Cashen slips from the exam room looking at the papers she holds in her hand. She senses a presence and looks up to see Holly standing before her clearly distressed. “Holly, what’s wrong?” she asks.
“I screwed up,” Holly blurts. “I screwed up!”
Taking Holly by the arm, Dr. Cashen leads her nurse to her office. They sit. “Tell me what happened,” she says gently.
“I’m not really sure what happened,” Holly begins. “In June, I told Alice her leukemia was still undetectable and gave her another three months of chemo vacation. But she had probably relapsed in June because her CBC numbers are awful.”
“If her disease was undetectable in June, it’s not your fault that it came back and escalated in the last three months,” the Dr. said.
“The problem is we don’t know if she was undetectable in June…because the BCR-abl was never done.”
“What do you mean it wasn’t done?”
“I was reviewing her chart and couldn’t find her June test, so I called the lab and they said the test was never run. Someone cancelled it. So I must have been looking at the results of her March test,” Holly confessed. One tear trickled down her left cheek.
Dr. Cashen logged on her computer and brought up Alice’s records. A heavy silence settled in the room while the Dr. scanned numbers and read notes. After a few minutes, she put her elbows on her desk and rested her forehead in her hands. Suddenly she looked up and pushed her chair back from the desk. “You aren’t the only one who screwed up,” Dr. Cashen said. “I wrote in my notes that I suspected her disease was back in June based on her elevated LDH level. I wrote that I would follow up with her test results. Clearly, I dropped the ball too,” she said looking into Holly’s eyes.
“What are we going to do?”
“Call Risk Management,” Dr. Cashen replied. “They will advise us on how to handle it.”
“I don’t want to see her,” Holly said. “I’m afraid I will cry or something.”
“That’s okay. I’m the one who needs to see her anyway. It’s clear from her CBC that we need to be aggressive in her treatment to get the disease back under control. That is my responsibility. Now, get someone from risk management down here ASAP.” Dr. Cashen looked at her watch. “Her appointment was at 11:15. It’s noon now, and we need to know how to handle the situation before she’s seen.”
Holly headed for her own office while Dr. Cashen picked up her phone and dialed her boss’s number. She got his voice mail. “John, I need to speak with you ASAP,” she said and hung up.
I pulled my cell phone out of my purse and looked at the time. I turned to my husband who was flipping through a Reader’s Digest. “Man, they are really running behind today,” I said. “Someone must be really sick.”
Don’t you love irony?!