A Dangerous Diagnosis – Shantanu Rai (1)

“Spare no detail,” he says, and listens with crossed arms. When Sanjay’s finished, he says, “When you made your diagnosis, did you base it on your own read of the CT or the radiologist’s?” “I read it myself. I know how to read a C—” “After Mr. Barnett left, did you call him that day or the next to make sure his symptoms had in fact resolved?”

“I didn’t call him, but I saw him the next day.” Sanjay fills Tom in on the meeting with Barnett and the job offer. He isn’t seriously considering it, but he still wants Tom to know. “So you didn’t proactively follow up with the patient.”

Is Tom on MBH’s side? “Sanjay, I’ve always told you to keep your differential diagnosis as broad as possible for as long as possible. You can never be sure.” Sanjay runs his hands through his hair. “We’re really doing this? You’re really lecturing me on the basics of diagnosis?” Tom uncrosses his arms. “I’m getting you ready for the disciplinary meeting.” Sanjay feels a wave of nausea. “I’m not sure if I can go through with it.”

“What does that even mean?” Tom’s eyes narrow. “Worst case? I get fired and lose my medical license. I won’t be allowed to practice anywhere in Massachusetts. In any state I move to, I’ll have to report that my last license was revoked. I may never get to practice again. Best case? I get my job back, but my reputation’s ruined. Pretty soon everyone will be talking about me getting put on leave. Colleagues won’t send me patients.

Nurses will second-guess my decisions.” “So, that’s it? Towel thrown in?” Tom’s tone is brusque. Sanjay tries to visualize himself standing in front of the disciplinary committee. Ten to twelve of his peers, asking these same questions. Staring at him, judging him. His stomach churns. Tom seems to sense his mounting anxiety.

“In a career where you put patients first, there’ll be thousands of fights like this.” Sanjay’s breath is becoming short. “I just want to do my job. Take care of patients. Not fight the system.” Tom scoffs. “Fighting the system is the job. If you don’t fight, we all lose. Patients lose.” Sanjay can’t speak. “Or maybe you just want to be a doctor to billionaires.

DR. TOM CARPENTER is standing by the window of his clinic, contemplating Occam’s Razor—the centuries-old principle that the simplest explanation is often the right one—when he begins to feel lightheaded. In his medical career, he’s often said that the cardinal sin is diagnosing a patient with multiple conditions when one would suffice. But the sins he’s confronting today are far graver. He looks out over the neighborhood that once housed the working-class community his free clinic was built to serve.

Now his patients are scattered across the city, displaced by the biotech companies and high-end coffee shops that followed the rapid expansion of Mount Beacon Hospital—the institution his clinic is affiliated with. The sun setting behind Boston casts his reflection in the glass. His bald head and oversized white coat make him look more ghost than man.

When did he get so old? When did he get so damn tired? He shakes his head, trying to will the exhaustion away. Around the room are reminders of his younger, more energetic self. A medical diploma from Mount Beacon Medical School. His residency certificate in internal medicine from Mount Beacon Hospital. Photos of himself as a young medic in Vietnam. Of Maria before breast cancer ever entered her mind. And of Emma, his daughter—bright, shining—her arms wrapped around him.

Looking at the image, he has to steady himself. Doc, can you see one more patient? Doc, can you make one more house call? Tom loved being the savior. He knew how to play the role—and he played it well. But being a father? He never had a clue. So he put his patients first, even when he didn’t need to. Even when he shouldn’t have. His gaze drifts a mile away to Mount Beacon Hospital’s newest building: a state-of-the-art ICU.

When it opened six months ago, half the beds were empty. Now they’re full. To the hospital’s board of trustees, it’s a testament to MBH’s value. To Tom Carpenter, it’s a symptom of a broken system—one that measures success by how many sick people it treats, not by how much sickness it prevents. He turns to his whiteboard, where he usually puzzles out complex medical cases. But instead of symptoms and diagnoses, it’s cluttered with names—dozens of patients who’ve been harmed—and a tangled web of clues connecting them.

He’s uncovered so much these past few weeks, but there’s no single culprit or explanation. Occam’s Razor be damned. A knock at the door.

This is a short excerpt from the opening of “” by Unknown, quoted for review and introduction purposes. All rights belong to the copyright holders.

Book Information

• Unique ID: dcb714284514fba8
• File Extension: .pdf
• File Size: 5,239,167 bytes (4.996 MB)
• Title: –
• Author: Unknown
• Pages: 307
• Language: English (en)

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• Estimated Reading Time: 430.44 minutes
• Total Words: 86,087
• Total Characters: 489,616
• Average Words per Page: 280.41
• Average Characters per Page: 1594.84

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