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Mia

I wished it was only the Os that had me staying with Nick. I hated how torn up he was about Ms. Mason. I was deeply concerned about how the nightmares were affecting him on and off the job. Staying with him was a risk, but one I took not because I wanted Os, but because I cared for him and wanted to help him.

As I watched him sleep next to me, I knew it wasn’t just my job I was risking. My heart was on the line. We agreed to one night and I knew I’d have to hold steadfast to that agreement. But whether I slept with him again didn’t matter. My heart had already taken him in again. Or maybe he’d never left. Maybe my feelings had just been dormant for the last four years.

The answer for him was to get counseling, but that didn’t stop me from wondering what I could do to help him. One would be to clear up what happened with Ms. Mason, and make sure everyone knew that Nick hadn’t failed her.

If you want to figure out what went wrong, figure out why my tests weren’t done. I ordered them and yet they never happened. Why, Mia? You’re the one that said EMR systems were faillable. Did ours fuck me over?

His words came back to me. I’d checked the EMR system and saw that the tests were ordered, but I didn’t know why they hadn’t been done. I made a mental note to look into it further tomorrow.

Nick rolled over and his arm lay across my middle. I smiled at him, liking the peace I saw in his face. He wasn’t having bad dreams at the moment. I wished I could help him feel like this all the time.

The next morning at work, I pulled the EMR report and read through it with a fine-toothed comb. Nick took detailed notes, and while nothing in them suggested he missed anything, there wasn’t anything exculpatory either.

I saw the order for blood work and a chest x-ray, neither of which had been done. Things moved slow in medical establishments, unless it was life and death. Patients could sit in the ER waiting room for hours. And it could take time for tests to be done.

I worked through the various tabs on the EMR report, trying to track down what happened with the order of the tests. I could see that the lab had received the order for the blood work, but it didn’t appear that the chest x-ray was received. I headed to the lab.

Several specialists in white coats worked with the various equipment testing blood, urine and other bodily specimens not just from the hospital, but from the few private practice physicians as well. The pathologist was head of the lab, so I worked my way to her office.

“Ms. Parker, what can I do for you?” She smiled, but I noted in her tone that she didn’t like the hospital lawyer paying her visit. The truth was, most people in the hospital didn’t like it when I showed up. I supposed I couldn’t blame them as I often had news or instructions they didn’t like.

“I’m following up on Ms. Mason’s lab work. More specifically, why wasn’t it done?”

The pathologist frowned and turned to her computer. “It looks like she died before the phlebotomist was sent.”

“Why? I thought ER tests were always sent to the head of the lin

e? She was there at least another thirty-five to forty minutes after the test was ordered.”

“I’d have to talk to whoever was running the lab that day.” Her jaw was tense, as if she realized what the delay might have cost.

“If you could do that and let me know, I’d appreciate it.” I left the lab and went to radiology, asking about the chest x-ray.

The radiologist available went to the computer and looked up the orders for the day in question. “There is no order for a chest x-ray,” he said.

“What? It’s on her record that it was ordered.”

He turned the screen toward me. “It’s not here.”

I frowned. “Where would it have gone?”

He shrugged. “Computer glitch? Sent to different department? The order button wasn’t pushed? Could be any number of things.” He said it matter of factly, almost dismissively. As if this sort of thing wasn’t uncommon.

“A woman died who could have been saved by this test.”

He jerked his attention to me, as if he’d realized the seriousness of the situation. “We can’t test for what we don’t receive. I’m sorry.”

I inhaled a breath to steady my nerves and my fear that Ms. Mason was the victim of a computer software glitch. I needed an IT person to help me. I went back to my office to find out who was in charge of IT issues. I knew the hospital outsourced that job, but wasn’t sure with whom. After a little research, I learned it was a company in Reno.

I called the tech support line asked for one of the people assigned to us.

“I’d have to come over to examine the system to know for sure what happened,” the woman on the other end of the line said when I explained the issue.

“It is possible the software is at fault?”

“Maybe, but more likely it’s a user error. Someone entered the wrong code or in the wrong place or didn’t push some button. EMR software isn’t the most user friendly. I don’t know that any of these software companies had doctors in mind when it was created.”


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