Pennsylvania's Finest, page 19
“He claims it happened to one of his patients,” said the chairman. “Regarding a shift in potassium that couldn’t be explained from a physiologic standpoint. He was blaming the computer system.”
“Did you explain to him the constant calibration of the system?” asked Asher. “I mean it is tested weekly by an independent lab to assure accuracy.”
“Yes I did,” said the chairman. “And I gave him the name of the company that performs the weekly check, just to appease him.”
“We’ve been through this discussion before,” said Asher. “With today’s technology a computer reporting error regarding blood work is next to impossible. I mean there is no human step involved in the process.”
“I know that Jim, but he kept talking about a recent discussion at a department M and M meeting that brought up the possibility of a lab error. The guy had an uneasy look in his eyes when talking to me,” said the chairman.
“Give him my name if he has any other questions regarding the process and overall security,” said Asher. “I’ve met him before but he may not remember me.”
“Sounds good,” said the chairman with relief. “If I had to guess he will be calling back soon. The guy appears to be a bit overbearing.”
“He once asked, or should I say ordered me, to come over his house and hook up his personal computer,” said Asher.
“Did you do it?” asked the director.
“Of course I did,” replied Asher. “That guy is like God around here.” The two men continued down the hall with Asher again saying, “He hates technology with a passion. Nice house though, and I must say his wife was most pleasant and welcoming.”
“It’s his age group, they hate technology,” said the laboratory director immediately realizing his faux pas.
“I believe I’m older than him, young man,” replied Asher as he jokingly grasped the back of the director’s neck.
The two men then turned right towards an elevator. The director spoke again, “He must use the hospital system, at least the EMR? Nobody can function here without using it.”
“Not Dr. Knight,” replied Asher. “He has his nurses and staff use the computer.” Asher then hit the elevator button for his friend. The door opened as he continued to speak, “I would venture to say that he doesn’t even know his password.” The two men then stepped quietly into the elevator car, being confident in the reliability of the system they created.
Asher was right. Dr. Richard Knight had no idea what his password was into the system. He relied on his support staff to access the computer system. This team, which included Jennifer Ranier, performed whatever mandatory EMR tasks the administration mandated. Therefore his computer code and key token were the virtual property of his trusted employees. Knight wasn’t even aware that a token existed for his computer use, and never accessed hospital computer information on his own. So while sitting in front of Chairman Barnes that mid October afternoon, the whereabouts of his token wasn’t even a thought.
“Your surgical case load has risen significantly Richard,” said Dr. Barnes with a smile. “Feeling young again?”
“Don’t be a smart ass Michael,” said Knight with a broad smile. “If this plan succeeds I may someday be Chairman of the Surgical Department.”
“You can have the job if you want it,” said Barnes. “It doesn’t pay well.” Both men smirked at each other realizing that Knight still coveted the position.
“I actually like operating on Friday,” said Knight. “I love to see the misery of the O.R. staff, realizing they won’t be getting home early for the weekend.” Knight paused while looking at a new paperweight on Barnes desk. While picking up the crystal weight he continued saying, “What’s the rush to get home?”
Dr. Barnes appreciated the cruel truth in his colleague’s statement. Surgeons loved being in the hospital, it was their domain. The world made sense within the confines of the surgical theatre. Late weeknights and weekends meant absolutely nothing to a surgeon. Simply put, a surgeon’s life is strung together by an uninterrupted series of interruptions. Peace lived within the walls of the PGH, where the outside world rarely reached in. So while socially sane employees looked forward to Friday night and a weekend, surgeons did not. Spending a weekend in the hospital was a mental vacation for surgeons. If success was measured by how happy a person was on Monday morning, then Barnes and Knight were successful beyond one’s imagination.
Barnes continued, “What did you think of the Brett Charles autopsy report?”
“Not much considering the source,” said Knight looking to the right and shaking his head. “When are they going to weed out that incompetent pathologist?” was his question in reference to Dr. Falcon.
Barnes noted an immediate mood change but continued in the Brett Charles direction. “Legal notified me that a lawsuit is going to be filed within weeks.” He paused, allowing Knight to speak. A long ten seconds passed between the two surgeons. Barnes then continued, “I don’t see a problem, everything was in order. That’s why the surgical consent includes the word “death”.”
“I did everything correctly,” said Knight. “I looked over the chart a hundred times. That verdict is in God’s hands.”
“Remember we can always settle before the press gets a hold of the case,” said Barnes.
“I know,” said Knight, “But that decision is years away. The brutal truth is that when someone dies post op, someone is going to get a cash payout.” Knight then paused only briefly before saying, “Did you think anything was peculiar about that autopsy report?”
“No. Looked over it quite well,” was Barnes response.
“That boob downstairs keeps putting in terminology about cell wall destruction and disorder. I can’t figure that out,” said Knight.
“Didn’t notice that,” replied Barnes.
“Well you should,” said Knight. “If was the same terminology she brought up in M & M rounds.”
“Oh yes, M & M rounds,” said Barnes leaning back in his chair. He smiled and continued, “Our visiting professor, Dr. Riles was well received, don’t you think?”
“Well received by who?” said Knight. “The psychiatry department? That guy is a buffoon. How he got on the Mass General staff is a wonder to me.” Knight paused then spoke after recalling Riles pedigree, “Oh yea, his father was a surgeon there. No wonder. It’s a whole family tree of hackers.”
“Now Richard you are not suggesting that nepotism played a roll in the generational success of the Riles family. Are you?”
“Sure I am,” barked Knight now completely forgetting about the death of Brett Charles and the autopsy report. “I hear his son, who by the way is our problem now, is all thumbs in the O.R.” Knight smirked looking at Barnes then saying, “A real chip off the old block.”
“Give him a chance, give him a chance,” said Barnes realizing that he pushed one of Knight’s emotional buttons. Then trying to change the subject he said, “On the brighter side, I’m glad Mrs. Hine did O.K. with her surgery.”
Knight waited a few seconds to recalibrate. “I’ll give him a chance, just one chance,” was his first response regarding intern Riles. “And yes, I am glad that Mrs. Hine made it through quite well. It would have looked bad for a trustee member to die post op.”
A discussion then occurred regarding the internal politics of the hospital’s Board of Trustees. The name of Howard Rineman surfaced in the conversation. Dr. Barnes voiced his admiration of Rineman in controlling the board, realizing that he treated the medical staff well, with an even hand. By and large he thought Rineman was good for the PGH system in a time of nationwide medical and economic uncertainty. Knight somewhat agreed although still not fully confident of where Rineman’s true allegiance stood.
Barnes again spoke regarding Rineman, “Howard stopped by my office last week, was asking about you.”
“Why me?” asked Knight.
“Wanted to know how our prize surgeon was doing,” quipped Barnes with a smile. He loved Rineman’s description of Knight as a prized surgeon.
“Prize surgeon, what is he talking about?” said Knight.
“Just wanted to see if you were holding up to your self imposed increased case load,” said Barnes.
“Did he happen to mention anything about a certain P.A. that previously worked with me?” asked Knight. Knight was well aware of Rineman’s longstanding infatuation with Jennifer Ranier.
“Yes he did,” said Barnes then following quickly with “And did I hear the phrase previously worked with you?”
Knight shook his head in the affirmative and frowned while looking at his long time colleague. He then said, “That’s right Mike, previously. I let her go earlier today.”
Chairman Barnes nodded quietly wondering about the cause of the dismissal. Certainly from the mouth of CEO Rineman, it appeared that another man was involved. He then asked Knight a simple question, “Why?”
“It was time,” said Knight. “It was just the right time.” He stared down at the floor saying, “Nothing from an employee standpoint, she was a great physician assistant.”
Barnes went to speak but Knight continued, “I’ve contacted the marketing department to post a job position for another P.A.”
“No problem,” said Barnes.
“I’ll need one quickly to keep up the pace,” said Knight.
“No problem, no problem Richard. We can hire one immediately from the P.A. program.”
“She was hired right back by the Plastic Surgery department,” said a dejected Knight referring to Ranier. “Go figure.”
“The Plastics team!” said a surprised Barnes. “She nearly destroyed the chairman’s marriage when she worked there.”
“I know,” said Knight. “But four years have gone by. Surely the chairman’s marriage must be in worse shape by now. It will be a more satisfying experience for him this time around.”
Both men burst into laughter at the humor, realizing the truth of the matter. Yet within the laughter Chairman Barnes sensed a hurt and sorrow in Knight’s feinted bravado. He watched Knight’s eyes drift to the floor in a somber moment of reflection.
“Its definitely over?” asked Barnes leaving the conversation open for more discussion.
“Definitely,” said Knight still staring at the ground. “Definitely. Had to end.”
Knight then rose to leave. “Good conversation as usual Michael. See you in the morning. Thank you.”
“Always a pleasure,” said Barnes as he watched Knight turn towards the door. “My door is always open.”
Knight headed towards the door but before he left Dr. Barnes spoke again, “Oh yes, Richard, I almost forgot.”
Knight pivoted back towards the chairman with a questioning look on his face.
“I see that a Mrs. Katherine McDuff is on the schedule next week,” said Barnes. “Is that the Katherine McDuff of the McDuff Food empire?”
“Yes it is,” said Knight. “The matriarch of the family.” He nodded his head while still staring at Barnes. Both men stared at each other with the same thought running through their minds.
“Keep her healthy Richard,” said Barnes with a smile. “For the sake of us all, please keep her healthy.”
“I plan on it,” said Knight confidently as he sighed and then turned to exit the room. “I do plan on it.”
As Dr. Knight left the room Dr. Barnes leaned back on his chair, slowly rocking back and forth. His mind was digesting the recent information regarding Jennifer Ranier. He wondered if Howard Rineman was aware of her dismissal. The emotional impact on Knight was obvious to him. He then thought of Knight’s plan to increase his surgical volume over the next several months. The McDuff name entered his mind, as did the catchy commercial song for their nationwide food empire. Then, deep within his cranial vault, he heard a pleading voice saying, “Keep her healthy Richard. For the sake of us all - please keep her healthy.”
CHAPTER 18 The McDuff Empire
Katherine McDuff was the 80-year old matriarch of the McDuff Food Corporation. Her great grandfather started a food distribution business in New York City during the late 1800s. Her father took the regional business to national fame during the early 1900s. Katherine and her late husband solidified the corporation as an international player over the past fifty years. McDuff Foods was a conglomerate that owned hundreds of smaller corporations, employing over 30,000 people throughout the world. The McDuff logo was ubiquitous throughout every supermarket in the country.
Katherine McDuff was an articulate, chain smoking, pepper pot that weighed 110 pounds soaking wet. Years of summer vacation and tobacco addiction produced a wrinkled and leathery face. A short grey mop of hair was always held tight together in a characteristic bun. Her clothing was plain, yet from the finest shops of London. She always wore flat brown shoes and walked with a quick pace. Her height was five foot two inches. An entourage of four assistants always trailed a few paces behind Mrs. McDuff. This cadre included two attractive females who cared for her womanly demands. Two thin and balding males managed her daily calendar and logistical needs. Katherine never carried a purse or cell phone. A lit cigarette lived between the second and third finger of her left hand, while her right hand remained in constant motion with her mouth.
Katherine was a philanthropist. No one else in the Philadelphia area gave away money like Katherine McDuff. Her father always told her that a successful corporation had three generational stages of development. The first generation was characterized by hard work, brutality, greed, and at times deceit. The second generation was blessed with success yet carried the burden of constant denial for past crimes of business. The third generation was to be universally adored and hailed as a community treasure and philanthropist. Katherine McDuff was that third generation Good Samaritan. She donated money on a weekly, if not daily basis. A keen marketing department tastefully displayed her generosity, which benefitted all genres of the needy. Beneficiaries included homeless soup kitchens and local foster homes. More cultivated recipients included local high schools and universities. Of course the crème de la crème of Philadelphia could not be denied access to the McDuff purse. This local hierarchy of successors included the Philadelphia Art Museum, Academy of Music and Philadelphia General Hospital. It was within this milieu that the grand world of Katherine McDuff crossed the comparatively pedestrian life of Dr. Richard Knight.
Dr. Knight befriended the McDuff family decades ago while serving on the Philadelphia Fine Arts committee. He graciously accepted their monetary generosity on a seemingly constant basis. The socially striking Dr. and Mrs. Knight were commonplace at the McDuff mansion, rubbing elbows with local and national power brokers. Katherine loved to refer to Dr. Knight as her “young heart doctor” with a grin and puff of cigarette smoke. Unknown to Dr. Knight, she was quite aware of a mutual encounter the young heart doctor had with a cocktail waitress in the McDuff mansion library. Knight considered it one of his greatest scores during a New Year’s Eve party in the late 1990s. During his fit of adultery and passion he was unaware of the family matriarch, who wandered into the library that evening. Katherine was momentarily caught off guard by the spectacle, but ultimately appreciated the young doctor’s verve. The act of fornication reminded her of an illicit encounter she participated in some fifty years earlier, in that very room. From that moment forward, a twisted bond of connection existed between Mrs. McDuff and her young heart doctor.
Of course when Katherine’s cardiologist recently suggested she see a surgeon, her choice was obvious. That October she arrived with much fanfare and a trailing cloud of smoke in Dr. Knight’s office. A one-hour consultation with the esteemed surgeon resulted in a decision to proceed with surgery. Katherine pinched Dr. Knight on the cheek as she left his office with the utmost confidence in him. Her logistical team deemed that early November would be the best time to proceed, based on her calendar of worldwide events. Knight planned on a quadruple bypass surgery to counteract sixty years of smoking and a family history of high cholesterol. Katherine McDuff represented a moderate surgical risk, a risk that Knight gladly accepted in the social eyes of Philadelphia. Knight ultimately left no stone unturned in the preoperative planning of her surgery.
From the moment Katherine McDuff arrived in front of the Philadelphia General Hospital, every step was well orchestrated. Her convoy of stretch Mercedes stopped directly in front of the hospital, ignoring traffic regulations and hustling valet’s. A porter opened the door to her car allowing the spry octogenarian to step out into the crisp, sunlight November morning. Awaiting her arrival was CEO Rineman and a team of hospital dignitaries. The welcoming committee smiled and bowed as they followed the patient into the lobby named after her husband. Smoking was temporarily allowed in the lobby that morning as Katherine stormed through a parting sea of onlookers. She bypassed the admissions office and was led to a private elevator, which took her to the seventh floor. Howard Rineman then escorted her to a reserved suite occupying the corner of the hospital wing. The suite had recently been repainted and decorated in preparation for the hospital’s most gracious donor.
Upon entering the suite her entourage quickly set up a laptop computer and communication center. Female attendants began unpacking several suitcases of clothing and personal items. Mrs. McDuff threw the floral pattern shades open, peering out across the Schuylkill River. The sunlit skyline of Philadelphia looked her directly in the eye and she smiled. Then, over the next six hours, a constant stream of physicians and dignitaries flowed through the room.
Her medical team formed the “McDuff Nucleus”, which was a term coined by Dr. Knight. Each doctor played a specific role in the medical care surrounding the surgery, having been picked personally by Dr. Knight. The Nucleus consisted of a cardiologist, internist, anesthesiologist, and pain management physician. Also included were a pulmonologist, physiatrist and catholic priest. Knight was well aware of the McDuff family’s Irish Catholic roots and their love for religion and a strong Sunday sermon. One by one the dream team of the PGH medical staff entered the McDuff suite. Katherine was repeatedly palpated, probed, pampered and reassured by the medical squad. In between physician visits she answered questions from her business staff over internet connections. She only paused for a short lunch and routine mid afternoon tea. By five o’clock in the afternoon she was seen by every necessary medical provider except her treating surgeon, Dr. Knight.
