Working Girls

Chaos had never been so organized.

The legacy patient charts were not filed alphabetically, but rather in numerical order. They conflicted with electronic files that had acquired their numerical IDs when the new system had been implemented years ago. Two histories could unintentionally be merged into one patient unless someone double-checked. The long-standing and much-procrastinated task had not yet been resolved.

The legacy files couldn’t yet be deleted, but they did need to be allocated a new home in the Electronic Medical Record. As if death couldn’t be certain enough, it provided a guideline for which files could be destroyed or, at the very least, assigned a new number and inputted into the EMR as a legacy file.

When the director of the Emergency Department lost his grandfather, and his chart was found duplicated and merged with another patient, heads rolled.

“It’s going to take some doing, that’s for sure,” said Emilia, the Medical Coder.

“Well, don’t look at me. I’ve got more to do than I can handle on any given day.” Audrey, the Health Information Technician, was the first to declare that she would not be volunteering her services.

Emma, the Medical Records Clerk, started feeling nervous. She was the lowest on the totem pole, but she had classes in the evenings and worked a night shift job on the weekends. Any added projects could quite possibly run her into the ground, and while she was young, she wasn’t about to risk becoming a lab rat to find out for sure. “Why don’t we just talk to Erica about it?” Nothing ventured, nothing gained.

Erica, the department's director, was already well aware of the situation. The ER director’s dead grandfather had escalated the issue for everyone, but Emma knew that when she suggested “we,” it still meant her. It’s not because she didn’t have her own job to do, but because grunt work tended to fall into her lap. She considered a letter stating the deeper problems in their department. They spanned the spectrum of growing priority made high because of a deceased grandfather right down to the niggling details affecting everyone’s jobs. Sending an email was another option, but it felt a little too casual under the circumstances. Finally, she sat down and spent her lunch hour jotting down everyone’s complaints and felt confident that she’d be able to lay it all out on Erica’s table for her to come up with a plan of action. She picked up the phone, called Erica’s office and requested a meeting with her in person. Erica was energetic, animated and intelligent and could bounce her immediate thoughts off anyone and talk herself happy about the solutions she came up with. Emma could most likely save time by showing up for Erica in person. By the end of the week, Emma had an appointment set up to discuss the problem of the legacy files with their boss.

That’s how they decided on Rosie. It was a collaboration, given Rosie was the young woman who had trained an even younger Emma two years ago. Rosie had taken a calculated risk and applied to fill in for a maternity leave in the Radiology Department. She got the job and kept it.

Rosie was brought up from X-ray to spend as much time as was needed on the files.

“Rosie,” Erica began, “It’s not only your work experience and your knowledge of medical records that we’ve chosen you for this. You have a reputation as one of the most trustworthy workers here, just like all my staff in the department.”

Rosie smiled, blushed and thanked Erica for the praise. Erica went on to assure Rosie that she didn’t need to fear losing her position in Radiology.

“The powers that be want you to know that you have nothing to lose. You’ll be well compensated for your time. We simply need someone who can dedicate all their energies to this until it’s complete. I believe you’re the best person for the job.”

Incidentally, so did everyone else, and Rosie was excited about the project and about working with the ladies in the department once again, if only to get the job done. Audrey was glad to see her. It was proof positive that a long-standing problem was finally going to be addressed.

However, with all the rainbow colours being distributed by Rosie's arrival on the scene and back in the department, Audrey couldn't help but feel a little insecure with Rosie's command. She clearly had favour because of the project, and Audrey was cool towards Rosie.

Audrey had grown used to the change that Rosie's absence had brought to the office. It was a subtle change that benefited Audrey, and she feared losing it, even if this was only temporary.

Just remember that, Audrey. It's only temporary.

There was only one problem. Rosie had an enemy.

Mallory had been the one to take the maternity leave in X-ray when Rosie had been hired to fill her shoes. But no one expected Rosie to learn everything so quickly and surpass Mallory in professionalism and personality. No one expected her to organize Mallory’s position in such a way as to not only make it easier to do the job but also surprise everyone with how badly Mallory was doing hers. No one expected much from Mallory after that.

When she did return, it was in a lesser capacity because Rosie had won with hard work and a cool head when it came to Mallory. To everyone else, she was a breath of fresh air. Mallory still worked in the department, but Rosie’s excellence had awarded her all of Mallory’s duties and then some. As everyone tended now to turn a blind eye to Mallory’s mistakes, Mallory became somewhat invisible, but along with her deep resentments, she was dangerous too:

“I see everything—bone deep,” she would repeat ominously.

Mallory was furious that she hadn’t been picked for the project. In her mind, it was an easy job that didn’t require much effort. In her mind, there wasn’t a job on earth that could challenge that work ethic. One had to wonder if motherhood was fitting into that category, too, but no one asked because the less they knew about her life, the better it was for the department and their work environment.

Mallory was so ostracized that she could almost float around the hospital, finding things out she had no business knowing, but that satisfied her curiosity and added to her arsenal of weapons she could someday use against anyone. When the situation with the director’s grandfather came to light, Mallory wanted to know about the duplicate patient. She wanted to know who it was and what was in the chart. How had the old man bit the dust? Anything she could use that could cause trouble, Mallory was storing it up for future use.

Could she somehow place blame on Rosie for the charts getting mixed up? She would go to any lengths to make Rosie look bad, not only to win her job back but also to get Rosie out of the hospital altogether. Rosie, after all, had worked in medical records before. Surely that could be dredged up and made to work against her, in Mallory’s psychotic mind.

With a little eavesdropping here and some snooping there, some unauthorized scrolling and a few good lies when needed, Mallory learned who the second patient was, and her evil plan seemed to develop right before her eyes. If informing the patient about the mix-up could cause any kind of trouble, Mallory had no time to waste.

“Hello?” The voice on the phone was young and female.

“Yes, good morning. This is Sanctuary Memorial Hospital. Is this Gwen Larkin?” Mallory made the most of what could be called her work experience to sound like a healthcare professional.

“Yes, this is she. What can I do for you?”

Her plan was coming to life, and Mallory concealed the darkness within her by transforming her voice into one of deep concern. She began to tell the young woman that a terrible mistake had been made as a result of hospital negligence, and she wished to apologize on behalf of the hospital because it had resulted in someone’s death.

“Because I’m not at liberty to disclose more information, the hospital feels that you have the right to contact the Medical Records Department yourself and pursue legal action regarding your patient file.”

“Oh...oh my. Ok.”

Gwen didn’t sound angry, as Mallory had hoped. She didn’t even sound scared. This frustrated Mallory, but she worked hard to remain unruffled and get through the call. She could see Rosie in her mind’s eye, and it was enough to bring a strange smile to her lips.

“This is the number to call, and you’ll be speaking with Erica Downing. She’s the Director of Patient Information. She’ll need to know how you would like to proceed. Justice is bone deep, dear. You have to take all that’s yours.” Mallory gave Gwen Erica’s number.

“Um, ok. Thank you. May I ask what your name is?” Gwen asked.

“Thank you for your cooperation. Feel free to call at any time. Goodbye.” Mallory hung up, a little shaken because she didn’t have any legal name to give her, but a lot triumphant because she didn’t have to do anything else but stand back and watch the fallout. She had used a VPN for the VoIP call.

Since Rosie was now on the case in an official capacity, she would have to be implicated as a party to the hospital’s lapse. Or so Mallory thought.

Gwen had different ideas altogether. She was 24 years old and a recent graduate in English Literature. She thought this had all the makings of a great story. She wouldn’t go to the police or the newspaper, even though it might be newsworthy. In her eyes, the hospital would be viewed in a positive light anyway, as coming forward and doing the right thing. At the right time, it would make headlines, but for now, Gwen decided that a fantastic novel about a fictional scandal in the healthcare industry literally had her name written all over it. As far as she was concerned, she had creative license, and she was going to use it very carefully.

At Mallory’s anonymous insistence, Gwen did contact the hospital to make sure she was part of the mix-up. The hospital confirmed that she was, but that precautions were being taken to ensure the problem wouldn't happen again, and that Gwen’s information was indeed secure. Erica was flabbergasted because she knew nothing about the young woman being contacted. There had already been a breach of privacy, and there would be legal considerations, but this hurtful stab in the dark was not warranted or even on record. No crime had been committed, and the legal department was all over it.

Someone was trying to cause mischief; up to no good. The ER director was just as confused, but was also in no mood to deal with a prank call. His grandfather was gone, and he was angry that someone would try to do more harm when the family was grieving. It was a cruel joke, and someday, someone would have to give an account for adding fuel to the hospital’s reputational fire.

Mallory hoped Rosie would be suspected of taking matters into her own hands and creating patient misidentification on purpose, but Rosie’s hands were clean. Mallory had not disclosed her own identity but had created headaches for departments hospital-wide.

Gwen never bothered to tell anyone that she would be using the incident as an idea for a novel, though, and so she began to write.

A year later, she had a Crime Thriller on her hands. An elaborate scam unfolded on the pages. Unnecessary surgeries, procedures and doctors’ appointments were fabricated to make patients believe they had conditions and diseases they did not. Medical and diagnostic tests were ordered, and expensive medications were prescribed at the hands of corrupt doctors who wanted nothing more than to profit from unsuspecting patients. They were padding their bank accounts while paying for their new cars, homes, vacations and drug addictions, and it all came to life in the form of Gwen's book. It was a hospital scandal funded by charts that were duplicated on purpose and merged with other patient charts to make healthy people look sick and sick people sicker.

Gwen decided to self-publish because she was so excited about the finished product that she wanted it out in the world as quickly as possible. It was her first novel, and she was confident. She wanted complete creative control over the book’s subject matter, editing, design, and marketing. She would set her price and not have to take a pay cut. More than anything, she wanted the freedom to be published! She’d been so inspired and spent every spare minute on her baby after working a job all day, and every weekend without fail. She wasn’t doing it maliciously. She only wanted the world to enjoy the fruit of her imagination, fueled by the event that had happened to her. It had felt like she had been handed a gift to unwrap and write about to her heart’s content. It wasn’t hard to have her book publicized. The school’s newspaper hailed her as a breakout author, and everyone wanted to read the first book. She had passed through the Emergency Room for the first time with an ear infection thirteen years ago, and a chart had been created for her that matched the numerical ID of Grandfather Wyatt Dune. His grandson, Henry, read the book when it was released. His grief came back to the surface with a vengeance, but there was no one to sue and no one to blame. He understood that no one had explained to Gwen that it was his grandfather's chart that had been accidentally merged with hers. He just needed to find out who had called her.

Almost everyone who worked in the hospital had read or was reading the book, including patients. Townspeople were spreading the word, but unbeknownst to them, it was a disaster. The hospital morale imploded with an overwhelming blow of embarrassment. Even if there wasn’t anything life-threatening about it or criminally wrong, it was the universal staff secret that carried a weight of pain that had not subsided. Wyatt Dune had died of natural causes. Old age had claimed his long life, and everyone missed him. He just happened to be the grandfather of the director of the Emergency Department. This book should not have been part of the legacy of a man who had loved life and the people in it. It was almost blasphemous, even though no one openly discussed it.

Rosie had done what Rosie does—another outstanding job. It was a high point of the debacle. While she couldn’t do anything about the book itself, she had given new dignity to the legacy charts by giving them all new alphanumeric IDs. She went a step further and preserved all their contents in full in the EMR so that the physical copies could be destroyed. At least something could be deleted and forgotten. Her work shone brightly in the worst of the crisis. She had surpassed what was expected of her and was valued even more for her presence at the hospital. Who else could have exposed Mallory for what she was? More importantly, Rosie had been oblivious to the scandal because she was so involved in the project, and no one was about to disturb her. It wasn’t until she came out of it that she learned of the book. No sooner had questions come out of her mouth than Audrey put a copy of the book in her hands. She looked down at the cover and read the title, then looked up at Audrey. “Bone Deep?”

They were both familiar with Mallory's famous words. When she did use them, they always resonated the wrong way. Gwen, too, had remembered those words about justice but knew nothing about Mallory. Gwen had never felt the need for justice until now, but the words had made an impression on her and Bone Deep was born. Rosie was grieved too and debated whether she was ready to read the book or if she would read it at all. What mattered most to her and everyone else was that Mallory had been arrested.