Chương 184: CHAPTER ONE HUNDRED AND EIGHTY-FOUR: TWO PRACTITIONERS

Okafor did not summon Calla, which Marcus had known she would not. She wrote her a note. It said: I am running the quarterly mortality review on the fourth day and I would like a legal opinion on a question of documentation liability. It will take an hour. Come at the second hour after noon if you can. The documentation question was real. Okafor did not manufacture pretexts; she selected genuine ones. Calla came at the second hour after noon.

[What follows is from Okafor's own account, written into her personal record the same evening — the only entry in that record that concerns a person who was not her patient.] She answered the documentation question in eleven minutes. She was thorough and precise and gave me three provisions I had not considered. I could see nothing wrong with her at all, which told me that Vance was right, because I have known this young woman for nine years and she used to fidget.

I said: while you are here, I would like your opinion on something else. I put the quarterly mortality summary on the table. Fourteen deaths in the district since the last review. I asked her to read the fourth one. The fourth one was mine. A woman of fifty-one, presenting in the second week of July with abdominal pain. I saw her twice. I diagnosed a stone. It was not a stone.

She died on the nineteenth day of something I did not identify until the autopsy, which I performed myself because Rue offered and I said no. Calla read it. She read it twice — I watched her read it twice. She said: this is your case. I said: yes. She said: you missed it. I said: I missed it. Twice. On the second visit she told me the pain had moved and I did not adjust my thinking because I had already decided what it was. That is the specific error.

It is called anchoring and it is the most common serious error in diagnosis and I have taught it in this clinic for six years and I made it in July. She did not say anything for a while. Then she said: what happens now. I said: it goes in the quarterly. Rue and Kwan review it in front of the full practitioner group next week. They will ask me questions. Some of the questions will be uncomfortable. I will answer them.

It will be entered in the record with my name on it and it will stay there permanently and any practitioner training in this establishment in fifty years will be able to read about the time the senior medical officer killed a woman by deciding too early. She said: killed. This book is hosted on another platform. Read the official version and support the author's work. I said: yes. She said: that's not — you didn't — And I said: Calla. She is dead and I could have prevented it.

I am not going to use a softer word for that because the softer word is for my comfort and she does not get any comfort. She stopped talking. I said: may I tell you the thing I actually want to tell you. She said yes. I said: I have practised for fifteen years in this world and eleven before it. I have lost, by my own count, thirty-one patients I believe I could have saved. Thirty-one. I remember all of them. I can tell you their names and what I got wrong. She said: how do you keep doing it.

And I said: because the alternative is that I stop, and if I stop, the number of people I fail goes from thirty-one to every single person who walks through that door for the next twenty years. She looked at me then in a way I will not forget. She said: that's not the same. If you stop, someone else treats them. And I said: yes. That is exactly right. That is why the question is never whether you can bear to fail. It is whether there is someone else.

If there is someone else who is as good as you, you may stop with a clear conscience and go and do something you can bear. If there is no one else, then your discomfort is not the largest thing in the room and you do not get to weigh it as though it were. She said: and if there's no one else and you fail anyway. I said: then you failed, and someone died, and you write it down with your name on it so the next person does not fail the same way, and you go back to work in the morning. That is the whole of it.

There is no other version. She sat there for a long time. Then she said: Holloway told me he attends the executions. I said: yes. He told me too, four years ago. She said: is that necessary? And I said: for him it is. He decided it was and he has held to it and it is his to decide. It is not a general rule. I do not attend the burials of every patient I lose. Some practitioners do. The decision about what you must witness is yours, and anyone who tells you there is a correct answer is selling you something.

She put her hands flat on the table. She said: I said no to a case in the northeast. A man who will be hanged in spring. I said: I know. Vance told me. She said: I said no because I was frightened. And I said: of course you were. You are twenty years old and six weeks ago you were the only thing standing between a woman and an execution and you found out what that feels like. Anyone who is not frightened by that is not paying attention. She said: that isn't a reason to say no. I said: no, it isn't.

But it is a reason to say not yet, and those are different, and you are allowed to have said the second one even if the words that came out were the first one. She cried then, briefly, and was extremely annoyed about it, which I found genuinely reassuring, because the version of this that worries me is the one where they don't. Before she left she said: does it get easier. I said: no.

You get better at carrying it, and you get better at knowing which parts are yours to carry and which parts you have been picking up because you are young and think everything in the room belongs to you. She said: which part of Vellenmoor was mine? I said: the twenty seconds. That is all. The twenty seconds were yours and they were correct and a woman is alive. Everything else in that room belonged to Kessling, Bertrand, Holloway, the family, the charter, and nine years of a medic in a cottage.

You have been carrying the whole room for six weeks and it was never yours to carry. She said: he said my argument was unnecessary. And I said: he said you had it right and had it in fewer words than he did. Calla. He was not dismissing you. He was a rigid man in a public room saying that a twenty-year-old had reasoned better than he had. In his entire life he has probably said that four times. She went and stood at the window for a bit. Then she said: I want to see the fourteen.

The whole quarterly, not just yours. I said: why. She said: because I have been thinking about failure as a thing that happens to a person and I would like to see what it looks like as a thing that happens to an institution. I gave her the whole quarterly. She was in the clinic until the eleventh hour reading it.