Sisterhood by Michael Palmer Page B

kind, he acknowledged to himself. A phenomenon.
    Before long, a comfortable pattern had evolved to their rounds. Huttner allowed the charge nurse to lead them to the doorway of a room. Then he took the patient’s chart from her and proceeded to the bedside. David, the charge nurse, and often the staff nurse on the case followed. Next, Huttner handed the unopened chart to David, introduced him to the patient, and gave a capsule history of the initial problem, operative procedure, and subsequent course of treatment, couching details in medical jargon that no one except a physician or nurse could possibly have understood.
    Finally he conducted a brief physical examination while David flipped through the record, using a spiral-bound pad to record pertinent lab data as well as Huttner’s overall approach and plan for the case. For the most part, he tried to remain inconspicuous, speakingwhen addressed, but keeping his questions to what seemed like an intelligent minimum.
    From time to time he glanced at Huttner. As far as he could tell, the man seemed satisfied that his charges were being left in capable hands. Before long, though, David began feeling uneasy. Despite the legends, the backup residents, and the unquestionable—perhaps unparalleled—surgical skills, Wallace Huttner was sloppy: progress notes were brief and often lacking some piece of information; some abnormal laboratory results went undetected for several days before they were noticed and a recheck ordered. Small things. Subtle things. But the pattern was there, unmistakable. It was not the kind of carelessness that would affect every case, but inevitably it would be manifest somewhere—in a prolonged hospital stay, a second operation, even a death.
    He must know, David thought to himself. He knows, but so far he just hasn’t found any way of dealing with the problems. It wasn’t lack of pride or caring or skill—Huttner clearly possessed all three. The man was simply spread too thin, David decided. Too many cases. Too many committees, panels, and teaching obligations. How much could a man do in one day? Sooner or later he must either draw lines or make compromises or … get help. Maybe Lauren was right, he realized excitedly. Maybe Huttner
was
looking for a partner. Or maybe, David laughed to himself, Huttner had chosen him to cover the practice believing that of all the surgeons in the hospital he was the least likely to notice these inadequacies. No matter. The oversights and omissions were small ones. He would go through the charts the next day and fix it all up.
    Just keep your mouth shut, he told himself. Only a few cases to go, then you’re on your own.
    Minutes later, David’s decision to keep silent was challenged. The patient was a man in his late fifties, acommercial fisherman named Anton Merchado. He had been admitted to the hospital several weeks earlier for an abdominal mass. Huttner had drained and excised a cyst on the pancreas and Merchado was recovering nicely when he developed symptoms of an upper respiratory infection. In a telephoned order, Huttner had put the man on tetracycline, a widely used antibiotic.
    The condition must have improved, David thought, because there was no further mention of it in Huttner’s brief notes. However, the tetracycline order had never been rescinded. It had been in effect for nearly two weeks.
    Anxious to speed up rounds, Huttner was giving his capsule review of the man’s history while he examined his heart, lungs, and abdomen. David stood off to one side, his attention focused more on the chart than on what the older surgeon was saying.
    On the day before Merchado was to be discharged from the hospital, he had developed severe diarrhea. Huttner’s initial impression was viral enteritis, but over a few days the condition worsened beyond what a simple viral infection would cause. The early signs of dehydration began to appear.
    David flipped from the progress notes to the laboratory reports and back.