An excerpt from The Committee Will Kill You Now.

“You couldn’t get her niece to budge on the hemodialysis decision?” Harper sank into the resident lounge’s threadbare couch and kicked up her feet.

“Nope.” Noah slumped in the chair across from her. It was late afternoon, and he’d almost finished checking off the tasks on his scut list. He’d been in such a hurry to get back to teaching rounds without upsetting Andrews any further, he’d rushed back from the SICU without checking again for the missing chart note on Mr. Gordon.

Harper had sent Colleen home early and then ordered Noah into the lounge to take five minutes to scrounge up some carbs. They were alone, not a surprise. Although they called the room the “Resident Lounge,” they did no lounging here. It was a place to grab some calories when they were too busy to take the time for meals, which was most days. He’d been filling her in on his conversation with Joan Turner’s niece.

“The nurse had a good idea for us all to talk to Mrs. Turner together. But she was still too medicated to have a lucid conversation.”

“The niece has the legal health care Power of Attorney?”

“Yeah.”

“And you couldn’t get her to sign off on it?”

“Again, nope. She said her aunt has always been ironclad in her advanced directive—to never go on hemodialysis.”

“Weird. That’s so specific.”

Now that Noah thought about it, it was weird. He should have asked Rose more about it.

Harper closed her eyes and leaned her head back on the couch cushion. “Maybe it’s some weird superstition, and once she wakes up, you can use your superior intellect to change her mind.”

Noah didn’t laugh.

Harper sat up and looked at Noah. “Hey, it’s not your fault. It could have happened to any of us. We all give verbal orders, and we have to trust the nurses. That morning was so bizarre. The patient got dumped on us, and the nurse called right when we heard about Jasmine ….”

She trailed off. Noah held his breath, waiting for her to say something more. It was the first time she’d even mentioned Jasmine’s name since yesterday morning. But she remained silent. She didn’t have to bring up what happened next—Colleen’s seizure and the two of them being left alone by Andrews to manage all the patients post-call.

But her silence on both matters baffled him and deepened his shame over his mistake with Mrs. Turner. The unwritten code of silence. If his father were still alive, would Noah have sought him out to talk about it? Probably not.

Noah didn’t want to be even more of a burden to Harper, but if he had to pick one person in this place to trust, it would be her. And he needed to tell someone what Andrews had said after he’d asked Harper and Colleen to leave the team room this morning. Silence begets shame begets silence begets shame—

He plowed ahead. “The hospital didn’t disclose to the niece what happened.”

Harper cocked her head. “What?”

Noah fiddled with his pager so he didn’t have to meet her eyes. “Andrews and Rankel told the niece the peritoneal catheter had to be removed because of an infection.” A bitter laugh escaped his lips. “It feels wrong, like a cover-up. I didn’t know what to do, so I said nothing. Even though I wanted to. I mean, Andrews told me I couldn’t—”

“Wait, take me back for a minute. Why were you even up in the SICU? Mrs. Turner is on the surgical service now, right?”

“Yeah, but the nurse paged me. It seemed like the least I could do.”

Harper released a long sigh. “You’re right.”

Noah already blamed himself, but hearing Harper say this made his organs shrivel inside. He’d planned to tell her about Mr. Gordon, too, but now he stopped himself. How would he explain his missing note?

Instead, he shared the idea stewing in his mind all day. “I’m the one responsible for her condition. Do you think if I told the niece the truth, she’d then be willing to allow the hemodialysis? It would only be for the two weeks until the surgeons can safely place a new PD catheter—”

“No,” Harper cut him off. “That’s not what I meant. It wasn’t your fault. I mean, c’mon, a nurse paged you and asked for a nutrition order, telling you the patient had a feeding tube. I guarantee you any physician would have done the same. It’s a bad situation all around—for the nurse and for you. Even if she won’t lose her job over it, she has to live with it. Some things we can’t change no matter how much time we spend rethinking them.”

She paused. “But what I meant was, you’re right. The hospital is covering it up.”

“Why?” It couldn’t be to protect him, a measly intern. He’d incorrectly assumed Andrews or Rankel would have explained the medical error to Joan Turner’s niece, in whatever way they trained the faculty to deal with these situations. But even though Noah was willing to step forward and own the blame, the hospital apparently didn’t want him to.

Harper studied him. “Think about it. If they disclose the error, there’ll be an investigation. For root cause analysis.” Her expression became grim. “And what will that reveal?”

The lightbulb clicked on for Noah. “I was sleep-deprived and distracted, distraught because of Jasmine’s death—”

“Ding ding ding!” Harper slumped back on the sofa and closed her eyes again. When she continued, Noah heard the exhaustion in her voice. “And final answer, for a thousand, Alex?”

“It will bring attention to the hospital.” Noah’s words were slow, a part of him didn’t want to make the connection. “Negative attention. Possibly an extensive investigation into the residency program. Which would lead to questions about Jasmine’s death.”

Jennifer Lycette is a novelist, award-winning essayist, rural hematology-oncology physician, wife, and mom. Mid-career, Dr. Lycette discovered the power of narrative medicine on her path back from physician burnout and has been writing ever since. Her essays can be found in The Intima, NEJM, JAMA, and other journals. She can be reached on Instagram, LinkedIn, Facebook, and Mastodon.

Her books explore the overarching theme of humanism in medicine. Her first novel, The Algorithm Will See You Now (Black Rose Writing Press), a near-future medical thriller, is available now. Her second novel, The Committee Will Kill You Now, a prequel in the form of a near-historical medical suspense, is available in paperback and on Kindle.