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Divided We Fall

With Nomura reassigned to ULS to help with the investigation, diagnoses on problematic hospital skin biopsy cases were delayed as residents shuttled between the hospital and ULS to review the cases with Nomura. James developed an efficient routine by meeting with Nomura during lunch. James sacrificed his usual meal and consumed an energy bar during the short commute to the laboratory. If all went smoothly, he could sign out 15-20 cases within an hour. Nomura kept James informed of the progress of the investigation.

"We're still pretty far apart. I thought we would be getting ready to settle. Did they contact you about your deposition time?"

"Next week Thursday, Dr. Nomura. It will be at Memorial."


"A little...a lot."

Nomura smiled. "I've given ten of them, each one is different. You think you can prepare, but you really can't. Just relax and don't volunteer more information than they ask."

"Thanks Dr. Nomura. I wish I could be as controlled as you are."

Nomura glanced at the trays of slides next to his microscope. "I...just have more practice. Thanks for bringing the cases to me. How's Memorial?"

"Same old stuff. I think some of the other departments have heard about this lawsuit."

"Oh? Which ones?"

"Surgery for one. Some of the attendings also operate out of Ladue, so they've been talking about it."

"What are they saying?"

"Most of them are taking your side. Dr. Elliot even shared a similar story where his colleague operated on the wrong kidney. The pathology reports had the wrong site."

Nomura shook his head. "You know, I've heard about things like this happening. Never thought it would happen to me."

"Wilma says hello, " James produced a pink box tied with a red ribbon, "and she made this for you."

Nomura's eyes lit up. "I can smell it from here." Nomura loosened the ribbon and opened the box. "Mmm...pecan pie! How sweet! James, grab some of those paper plates and plastic forks on the shelf there."

The two shared the gift, sitting between stacks of flats, requisitions, and partially dictated reports. Nomura recounted the first time Wilma baked the pecan pie and presented at a laboratory party. "I went back for three helpings. I was pretty careful to make sure no one noticed. But she did. The next day, there was a freshly baked pecan pie waiting for me on my desk." Nomura's eyes twinkled.

"She's a very special woman. Excuse me, Dr. Nomura, I need to return to Memorial. Dr. Haas is presenting at chest conference at 2PM."

"Thanks for bringing the pie. Tell her I loved it! I'll call her later."

James beamed as he left the office and exited the laboratory. His car was parked under an oak tree, just beginning to recover its leaves. The ground was still soft from the melting snow and the streets were a slush of mud and salt. As he opened his car door, a disembodied voice startled him.

"Hello Dr. Deetan."

Audrey Johnson sat in her car, her face buried in a paperback book. A lit cigarette was perched between the fingers of her right hand which rested on the steering wheel. Her scraggly brown hair, streaked with gray, was finished with a peculiar purple tint. Whether it was intentional or an accident, no one ever asked her. James thought it was an interaction between the smoke and hair dye. If she was not at her computer, she was in the parking lot, banished with the other smokers.

"Audrey. I'm sorry I didn't see you."

"Dr. Deetan, do you have a minute?"

James knew this would take at least ten. "Sure Audrey, but I need to be back at Memorial. Dr. Haas is expecting me at our conference."

"Dr. Deetan, I'm very upset."

James forced a concerned look. "What's the problem?"

"Everyone is saying that it's my fault that the reports were screwed up."

"Who is everyone?"

"Everyone. Dr. Nomura, Bryce, Gene...they tell me you're saying it too."

James let out an audible sigh. "Audrey look, a lot of people are upset by what happened. I'm upset. Dr. Nomura. Don't forget that the patient is going through a very tough time as well."

"I know. Everyone hates me."

"No they don't. Everyone is just upset. No one hates you."

Audrey looked up at James, tears welled in her eyes. "Am I a bad person?"

"Audrey, everyone's nerves are on edge and-"

"You think I'm a bad person!" She sobbed. A crowd gathered in front of the entry. Several pointed in James' direction. He quickly turned his back on them.

"Audrey. Please. I never said that. You are not a bad person. Look, I'm late for a conference at Memorial. I'll be here tomorrow, we can talk then."

"Promise?" she dried her eyes with her sleeve.


"Thank you, Dr. Deetan. I'll see you tomorrow." James never heard her last words as his car raced out of the parking stall. He entered the conference room at Memorial as Haas entered, just as the lights dimmed for the presentation.

The next day, James arrived at ULS a half hour early to ensure adequate time to counsel Audrey. After meeting with Nomura, he entered the transcription area, several cubicles stuffed within a hallway niche. Audrey's monitor was dark and her coffee mug upside down. "Where's Audrey?" James queried the entire group.

"She's taken a leave of absence." Two voices simultaneously answered. A conversation with Bryce confirmed this.

"She said she couldn't stand the pressure." Bryce frowned. "She better show up for her depo next week." He threw his arms in the air. "What next?"

A leave of absence was a wonderful idea, if only he could manage the respite. The juggling of schedules between Memorial and ULS devoured the hours and any remaining free time. The work was drowning him but it was the impending deposition that sucked the remaining air from his lungs. He relied upon Nomura's patience. How could he be so calm amidst this turmoil?

It was Wednesday evening and the tightening knot in James' stomach prevented any food from entering. He pushed the plate aside, the solidifying gravy jiggled atop the cold meatloaf.

"You gonna eat that?"

"Be my guest." Carlos lunged his fork and pulled the plate over. "Not hungry, huh?"

"I haven't been eating too well."

"It'll be all over tomorrow. You'll feel much better."

"I hope so. I'm so tired. I get home and I want to sleep but I'm so wound up, my brain won't let me. I'm lucky if I get four hours."

"I'm sorry, man. This whole thing is bogus! It could have happened to anyone. Nomura was just in the wrong place at the wrong time."

"I know. Everyone at ULS is down on us. They think it's our fault."

Carlos slammed his fork on the plate. "Those bastards! They don't even support their own pathologists!"

James nodded. "You know, even Carlisle is acting strangely. He was always so chummy with us. The other day I passed him in the hallway and he looked right through me, didn't even say hello."

"Maybe they want to dump Nomura and trash the Memorial contract?"

"I don't think so." James shook his head. "We're too important for them. They need us."

"They don't need anyone. It's the same everywhere, James. They don't care about us. ULS, Birkman, all these managed care labs only care about their bottom line. They wanted Nomura and now they're pissed because of this lawsuit. Don't you see?"

"I don't."

"Dermatologists won't send their biopsies to these managed care labs unless they have a board certified dermatopathologist on staff. That's why they hired Nomura as medical director and contracted with Memorial. Everything was fine. Everyone's happy. Now this lawsuit happens. They lose some big contracts, other groups are talking about pulling out. They've got a major PR problem." Carlos placed both hands on the table and leaned over to James as he lowered his voice. "I think they might sacrifice Nomura."

"No. No way." It couldn't possibly be true. He wouldn't believe it. Everyone was under scrutiny; the pressure was generating strange realities.

Carlos stood to leave. "Look, I'm sorry. I got carried away. I hate ULS, everything about them. I hope I never have to work for them." He flashed an upright thumb. "Just try to get some sleep, it will be okay tomorrow."

The fatigue overtook James that evening and he was asleep before his head reached his pillow. The next morning, refreshed from his first good rest in weeks, he dressed himself in a gray pinstripe suit and maroon tie. A pressed white shirt with button down collars completed the ensemble. He turned to his reflection and imagined the crowd he would soon face."Good morning, ladies and gentlemen. I am Dr. James Deetan."

The deposition was scheduled for 10AM in the pathology conference room at Memorial. Moynihan was the first to arrive. Irving Goldstein, the attorney for the plaintiff, was close behind. The ULS attorneys were on speaker phone. A stenographer was positioned at the front of the table. The first twenty minutes were routine. James was asked to review photocopies of the surgical pathology reports and identify each one. He loosened his grip on the armchair and sat back. No surprises so far.

"Dr. Deetan. How would you describe the work environment at ULS?" James straightened. The question was from Goldstein, the plaintiff's attorney.

"What do you mean?"

"Do you think ULS provides an environment that is supportive for a pathologist to perform their duties."

James glanced at Moynihan who nodded. "I think the support staff is adequate...things can always be improved."

"Are the transcriptionists supportive?"

"I think they could be more diligent in catching their typos...their typographical errors. They also should follow their written protocols. If they had, this wouldn't have happened."

"Objection-speculative." The ULS attorneys charged.


James wasn't finished. "We've found so many errors in transcription. Once, Dr. Nomura even found a current requisition form in the trash-"


Moynihan intervened. "Dr. Deetan. I'm going to ask you to only answer the question that is put to you. If you don't listen, I'm going to make you sit in the corner."

James' face was scarlet. He wasn't sure if Moynihan was sarcastic or serious but the look on his face convinced him it was the latter. James heart pounded. He couldn't hear the rest of the discussion and simply said yes or no to the remainder of the questions, paying little regard to the content. Within 10 minutes, the deposition was complete and James stood to leave. Moynihan pulled him aside.

"Good job."

James eyes narrowed. "Couldn't you have corrected me in a less humiliating fashion?"

He laughed. "Don't worry about it. Sometimes I've had to stop these depos and put my clients in the corner and gag them! This kind of stuff happens all the time. This was very tame, trust me."

James couldn't share in the levity. As he left the conference room, he overheard the stenographer snickering and whispering to the plaintiff's attorney, "He looks so young!"

He gathered his papers and raced through the hallway that led to the front exit. Two of the transcriptionists and one of the histotechs were in conversation at the end of the hall, about 20 feet from James. As he approached them, the histotech looked directly at him, and in a voice loud enough to provoke hostility, said, "I can't believe these pathologists!" James continued his pace, whipping by the group, almost nudging the histotech.

The door opened to a blast of damp hot air, adding to the heat under his collar. He jumped into his car and started the engine. As he adusted his mirror, he spied Nomura in his office, buried beneath the flats of slides. His fists clenched the steering wheel, shaking, as the blood was squeezed out. He escaped from the parking lot with a frenzied turn.

"Go to hell!" he shouted. The last glimpses of the lab disappeared from his rear view window.

"Go to hell!"

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