Chapter 59: You're Welcome, Mike

November 9, 1990, McKinley, Ohio

On Friday morning, as I drove to the hospital, I had a bad feeling in the pit of my stomach about the outcome of the negotiations. When I walked into the surgical ward and Nurse Amy said Owen Roth wanted to see me, that feeling became worse. When I saw the look on Owen's face, I was certain it had been for good reasons.

"Shut the door, please, and have a seat."

I did as he instructed, then waited, reciting the Jesus prayer over and over to remain calm.

"A final agreement was reached about midnight, and the papers were signed about an hour ago after consultation with the County Board," he said.

"How bad?" I asked.

"$3.5 million, which, in the scheme of things, is good. Josh agreed to write a formal apology, but he won't face a malpractice complaint to the State Medical Board. Ross Burnside agreed to retire with a full pension. Paul Lincoln will be dismissed from the Residency program."

"May I say what I'm thinking? Without it leaving this room?"

"I'd expect no less," Doctor Roth said with a smile. "And I appreciate the qualification."

"Well, I'll discuss it with my «старец» (staretz), but that's under the equivalent of the seal of confession. My opinion is that the settlement is bullshit. Plain and simple." ("Spiritual Director")

"You're actually calmer than I expected you to be."

"You can thank my «старец» (staretz)." ("Spiritual Director")

"With regard to it being BS, it's not that simple. May I explain?"

"Yes," I agreed.

"First, the dollar amount is far less than we had feared, and you know that has to be a consideration because, in the end, it costs money to operate the hospital. Second, Josh volunteered to apologize if it would help, which it did. He also received a written commitment not to bring a malpractice complaint before the State Medical Board.

"Ross was three years from full retirement, and the hospital will simply credit him with enough service to have his full pension, and there are provisions to do so under the State pension plan. He hasn't lost his medical license, and there will be nothing on his record. He, too, agreed to the settlement in exchange for the same commitment regarding malpractice as Josh.

"As for Doctor Lincoln, he was the sacrificial lamb. The Webber family and Mr. Webber's live-in girlfriend wanted blood, and they refused any settlement if they couldn't have it. They wanted someone to blame, and it had to be Paul. There is nobody else they, or we, could point to who made even a small error in judgment. He was, in effect, sunk when Dutch Wernher, correctly in my opinion — and yours — mandated ultrasounds for periumbilical pain.

"Before you respond, and I believe I can read your expression and body language accurately, they could have had you, too, had they named you, because a legitimate case could be made for you ignoring the signs of malignant hyperthermia and failing to administer dantrolene or recommend it be administered.

"Nobody here believes that, but it's not relevant what we as medical professionals believe; it's what the jury would believe. We believe the ice packs under his armpits would have been, in the minds of the jurors, definitive. That is, you knew and failed to proactively administer dantrolene. Again, that's not accurate, but it's what the jury would believe when the attorneys made their closing arguments.

"I'm going to repeat what John Cutter said to me an hour ago when I told him the settlement was BS — we did the best we could in light of the circumstances. He expressly stated that you did everything exactly right, and ALL of us here, from Nels Anderson to Paul McKnight, agree that Mr. Webber did not die from malignant hyperthermia. Period. End of discussion. The jury's potential understanding to the contrary is the real BS, but in cases such as this, that BS carries the day."

"I don't disagree with any of that analysis," I replied. "Based on my conversation with my personal attorney, that is exactly what the jury would have believed. She predicted something similar to this outcome and admonished me to let it be for basically the same reason you just did — they could have come after me, but didn't."

"Do you know why?" Owen asked.

"I have my suspicions."

"It was stated clearly during the negotiations — rather than hang you, they wanted to use your reputation for always telling the truth, always being forthright, and your unwillingness to allow politics to interfere with your answers. They got exactly what they wanted from you, which we all knew was going to be the case.

"In this specific case, nobody was trying to hide anything because there was literally nothing to hide. In most cases, there is something someone wants to hide or keep from coming out, either for their own protection or to protect their friends. In Mr. Webber's case, there couldn't be a cover-up because there was literally nothing to cover up."

"Which is, of course, why the attorneys for the plaintiffs wanted to get all of the salacious material into the record to show the hospital environment was unprofessional, and we engaged in risky practices. I was the perfect vehicle to get those in because I would simply tell the unvarnished truth."

"That's exactly right," Owen said. "Paul is being told now by Dutch Wernher. I know you like him, Mike, but please do not do anything foolish."

"I won't," I agreed. "What is Paul's actual status?"

"Dismissed for making a medical error," Owen replied. "He could, in theory, apply to another program, but we both know that won't happen. My recommendation, if he wants to try to be a practicing physician, is that he try to find a 'Doc in a Box' in a state that only requires a single year of Residency to be a GP and try for a medical license after a year or two of working under an Attending who can vouch for him.

"It'll be tough, but it could work. If not, he could end up being what amounts to a lifetime Resident, something that has been known to happen in such a circumstance. I'm absolutely certain you can predict the problem — insurance. All things being equal, he probably can't get it, which likely precludes my recommendation. But he could try."

"He'd be safer going the research or teaching route," I replied. "Or working for an insurance company. I will give him a call to let him know I believe he got shafted, but I'll do that on my own time and not here at the hospital. Before you respond, I accept your analysis; I just think it sucks that Paul was dropped from the program for following the standard of care."

"Confidentially, so do I," Owen said grimly, "but I think you know why it had to happen."

"Mr. Spock — 'The needs of the many outweigh the needs of the few ... or the one'."

"That does sum it up. Unless you need to vent, I'll let you get to the ED."

"Oh, I need to vent, but I'll do that at a time and place of my own choosing."

Owen laughed, "There are times, Mike, that you make me want to laugh hard."

"I hope that's a good thing."

"It is. I'm sure Dutch will speak with you as well."

"No doubt."

"See you Monday."

I left his office, changed into scrubs in the surgical locker room, then made my way to the ED, where Mary was waiting for me.

"You were with Owen, right?" she inquired.

"Yes."

"He asked me to make sure you had seen him. Quiet night, one left for you — rule-out appy that appears to be gastroenteritis. Repeat ultrasound in an hour, then street him."

"Thanks. Did Owen tell you the outcome?"

"No. Can you share?"

"Ambulance bay, please. Kelly, I'll be right back."

"OK," Kelly said.

Mary and I walked to the ambulance bay, then onto the grass to the left.

"Without comment — $3.5 mil, which is a bargain compared to what we offered; Josh apologizes and avoids a complaint to the State Medical Board; Ross retires with a full pension and avoids a complaint to the State Medical Board; Paul is dismissed from the Residency program."

"WHAT THE FUCK?" she growled, but sotto voce.

"I know," I replied.

"You aren't going to comment?"

"I volunteered to keep my mouth shut. I'll speak to my «старец» (staretz) on Saturday evening. He'll get to hear my unvarnished opinion." ("Spiritual Director")

"Volunteered? Why?"

"Rather than be told," I replied. "Nobody has told me not to express my opinion, so I'm free to do so when I judge it to be the right time. Or, as I said to Owen, I will vent at a time and place of my own choosing."

"On a scale of dropping a penny and having it fall through a sewer grate to Michael's reaction to Sonny at the causeway, how angry are you?"

"She's a Godfather fan! Who knew?"

"Two fantastic movies. So?"

"Sonny, at the Causeway, but like the Don, I'm remaining calm, and I won't take vengeance."

"That'll be up to Rachel, then?" Mary asked with a smirk.

I chuckled, "It was indeed the Don's kid who eventually paid all the debts for the family. And the comparison is apropos because these battles between lawyers and doctors are like the ones between Mafia families."

"I'll let it go, I suppose. I'm going home for a hot bubble bath, then a warm bed."