Sophie and Adam waited at the nurses’ station for the charge
nurse. She was determined to get an answer to why their son
was lying in the NICU, fighting for his life. She would start by
reviewing her medical records. If anyone wanted to challenge her
request, she was prepared to fight.
When the charge nurse finally arrived, she gave them a pleas
ant hello and asked how she could help.
Sophie said, “I’d like to see my labor and delivery records.”
“Sure, I can help you with that.”
“Oh good,” Sophie answered, relaxing her tensed muscles.
“Thank you so much.”
“You’ll just need to have someone from medical records sit
with you as you go through your record. Hospital policy.” She
picked up the phone and spoke with someone in medical records.
When she hung up, she said, “Now’s a good time to go. Take the
elevator to the ground floor, and you’ll see the signs.”
“Perfect, thanks.” Sophie smiled at the nurse.
They knocked on the locked door of medical records. A woman
let them in and, after hearing what the couple was there for, asked
if they wanted to see Sophie’s records in paper or electronic form.
At the back of the room were shelves that ran the full length of
the wall, stacked with folders. There must have been thousands
of folders holding numbered medical records, organized in a col
or-coded system. There were conference rooms off to the side and
one large conference table in the middle of the main room.
86
“Paper, please.”
JULIE HATCH
The woman walked to a shelf full of files and retrieved a thin
folder with Sophie’s name on it. She led them to an empty table
and handed Sophie the folder. “If you have any questions, don’t
hesitate to ask.” She went back to her desk.
Sophie and Adam sat at the table. Sophie opened the folder and
took a deep breath. Her eyes scanned the pages, looking for clues.
When she got to the end of the chart, she looked at Adam.
“I don’t see it.”
She went back to the beginning of the chart and read more
slowly, her finger going over the pages line by line. She slid the
chart over to Adam. “See if you can find anything.”
Time of admission, time of onset of labor, time of delivery,
vital signs, a list of medications administered—Ativan and pro
gesterone—and the type of IV fluid. The pathology report of her
placenta revealed a completely healthy placenta. Her blood work
was normal. Sophie looked at Adam. They looked through the
chart two more times.
“There’s nothing there. I don’t get it. A normal labor and
delivery according to this. Twenty-six weeks is on the admitting
note, but otherwise, you’d never know anything was wrong.”
Adam closed the chart. “Sophie, go through your delivery again.
Close your eyes and tell me everything that happened in triage.”
Sophie went through the entire afternoon, from her lunch
break to her delivery, to Anna’s death, to the minute Adam
walked into her hospital room.
“Maybe it was the guy you nearly bumped into at the
stoplight?”
“No. Once Carol gave me meds to stop the cramping, I was
fine. I was ready to go back to work.” Sophie held her head in
her hands, eyes closed, concentrating, remembering. “There’s
something about the sound of marbles coming from Dr. Wagner’s
pocket. And his voice.”
87
THE VERY BEST OF CARE
Sophie raised her head and looked at Adam, trying to con
nect the details. “I’ve heard the same clinking in Kim’s pocket
when she gives Danny his medications. She pulls the vials out
of her pocket, draws them up in separate syringes, then puts the
vials back in her pocket while she injects the medications into
his IV. Carol did the same thing with me.”
She was trying to make sense of all the sounds and images
whirling around in her head.
“What are you thinking, Soph?”
“Danny has a little plastic container of supplies at his crib
side. It’s got all his medications, along with the syringes and
needles. Narcotics are locked away and not at the cribside. But
everything else, the medications they commonly use, like the
ones that Danny receives two or three times a day, are there.
I’ve noticed Kim—in fact, every nurse—has a routine. They
pull the vials they need from the container, put them in their
pockets, then do whatever they need to do for the baby—taking
vital signs, checking IVs, doing a quick exam, and last, giving the
medications. Then they either throw the empty vial away in the
red sharps container, or they put the vials back in their pockets.
They finish up by charting everything on the computer.
“These aren’t medications that need to be kept under lock
and key. The nurses probably don’t have time to be running back
and forth every time they need a medication. These babies are on
so many it makes more sense to just carry what they need with
them.” Thinking out loud, she said, “Yeah, I bet that’s right.” She
paused before continuing. “I wonder if that’s what happens in
triage too. Do they keep their meds with them? That place can
get so busy I bet they do.”
They closed Sophie’s chart and handed it back to the records
lady.
“Thanks.”
