Chapter 4 - The Titan’s Defense
In a sleek, glass-walled office on the top floor of the city’s most exclusive medical research institute, Dr. Malcolm Keene was pouring a cup of single-origin Ethiopian coffee when his private tablet buzzed on the mahogany desk.
He glanced at the screen, expecting the usual praise regarding his upcoming keynote address at the National Association of Wound Care Specialists.
Instead, it was an encrypted email from the risk-management department at City General Hospital.
URGENT: PEER REVIEW NOTICE / MALPRACTICE INCIDENT REPORT. Patient: Brooke Dalton. Admitted via ED 03/14. Emergency radical debridement for necrotizing fasciitis. Attending surgeon: Dr. Thomas Vance. Reporting physician: Dr. Kendra Wells.
Keene’s hand paused, the porcelain coffee pot hovering over the cup a fraction of an inch too long before a single dark drop spilled onto the pristine white saucer.
He set the pot down slowly, his face hardening into an expression of cold, calculated disbelief.
“Incompetent fools,” Keene muttered to an empty room.
He tapped the screen, scrolling through the preliminary surgical report. Extensive fascial necrosis, Clostridium/Streptococcus synergistic gangrene, massive debridement.
His jaw tightened. This wasn't just a complication; it was a direct assault on his professional reputation. If word got out that a patient he had personally evaluated, dismissed, and discharged developed full-blown necrotizing fasciitis within twenty-four hours—after he explicitly documented that her pain was psychosomatic—his entire brand would collapse. The media would have a field day. The academic appointments, the book deals, the consulting fees with pharmaceutical giants—all of it would go up in smoke.
Keene didn't feel a flicker of remorse for Brooke Dalton. He didn't wonder if she was alive or dead on a ventilator three miles away. His mind operated in a singular, ruthless dimension: Damage control.
He picked up his desk phone and punched in a direct extension.
“Get me Arthur Vance on the line,” Keene commanded the moment his administrative assistant answered.
“Mr. Vance is in a board meeting at the law firm, Dr. Keene. Shall I interrupt?”
“Interrupt him immediately. Tell him it’s Malcolm Keene, and it concerns an urgent legal liability involving City General Hospital and my institute.”
Within two minutes, the line clicked.
“Malcolm?” Arthur Vance’s deep, polished voice came through the speaker. He was the senior partner at Vance & Sterling, the firm that represented half the major medical malpractice defense syndicates in the state—and, coincidentally, Thomas Vance’s estranged uncle. “This better be good. I’m in the middle of a merger negotiation.”
“Arthur, we have a situation,” Keene said, his tone dropping into smooth, conspiratorial professionalism. “An unhinged attending physician at City General—a Dr. Kendra Wells—has railroaded an emergency surgical intervention on a former patient of mine, a young woman named Brooke Dalton.”
“Railroaded?” Arthur asked, his tone sharpening. “What do you mean?”
“The patient presented with classic somatic amplification disorder—severe health anxiety, completely disproportionate pain responses, zero objective clinical findings of infection,” Keene lied smoothly, reciting his own fabricated notes as gospel. “I prescribed appropriate conservative management, steroids, and observation. Instead of following protocol, Dr. Wells panicked, ordered an unnecessary invasive surgery, and is now trying to pin the iatrogenic complications of her surgical trauma on my initial diagnosis.”
There was a brief silence on the other end of the line.
“You’re telling me she didn't have necrotizing fasciitis?” Arthur asked, his lawyer’s brain already calculating angles.
“I am telling you that if she did develop an infection, it was most likely introduced during Dr. Wells’s own hurried examination or standard hospital cross-contamination,” Keene said, planting the seed of institutional defense. “More importantly, Arthur, Dr. Wells is circulating an official complaint to the state medical board accusing me of negligence. If that complaint goes public, it opens up a Pandora's box of frivolous litigation against every preventive protocol my institute publishes.”
Arthur let out a low whistle. “Thomas is at City General, isn't he? My nephew.”
“Yes. And he’s performing the surgery alongside Wells. It’s a family vendetta masquerading as medicine.”
“Alright, Malcolm, calm down,” Arthur said smoothly. “Here is what we do. First, we secure all your electronic health records for the Dalton patient before City General alters them to fit their narrative. Second, we file a formal counter-complaint with the hospital’s board of directors, alleging that Dr. Wells violated standard triage protocols and engaged in retaliatory reporting. And third... we make sure Dr. Wells realizes that playing hero in the ER has professional consequences.”
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Keene smiled—a thin, humorless stretching of his lips. “Thank you, Arthur. I knew I could count on you.”
“Don't thank me yet,” Arthur replied dryly. “Just make sure your charts are watertight. Because if my nephew actually pulled six pounds of dead tissue out of that girl’s leg, you’re going to need a lot more than a legal team to save your tenure.”
