SPOILER: MR. D.B. DIES
Originally published Octomber 29,2025, via guest authorship on Caro's Writing Perspectives
Today’s post was available on a different substack, as I was honored to have been a guest author on Caro’s Writing Perspectives on October 29, 2025, as part of her October series.
No one takes me seriously, yet if I come to visit, it is for serious business. I’m in charge of monitoring what’s really going on around here. And then taking names!
Doctors in training. Student doctors. Residents and interns. It doesn’t matter. Lives are in their hands. And likewise, so are deaths. It’s tragic, really. Deaths that don’t need to happen; preventable, unnecessary, even careless.
I am charged with teaching these imbeciles what went wrong.
There is something called “Mortality and Morbidity Conference,” or M&M, where the mistakes—both honest and stupid—that result in complications and deaths are discussed. It is an educational tradition that takes place in an amphitheater called “the Pit” on our hospital’s 12th floor. There, the wizened wise—the professors who can’t do but who, then, teach—are presented sad cases by the wannabe doctors for general discussion.
And indictment.
The salient points are plucked from their nervous, stuttering explanations and used to quiz those in the Pit evading eye contact. The person who has the power to fail them targets the presenter—now the person of interest, the caught, tried, and judged suspect who orchestrated their patient’s demise.
I attend every M&M conference. But I already know who the malpractitioners are. Today is no different—I have my list for the day. It’s not a secret list. When someone here dies, word gets around. The whispers—even the snickers from jealous peers—are circulated like dirty money.
If the Pit weren’t punishment enough, replete with reputation-tarnishing and career-killing theatrics that become lore, next is my duty to visit each of these buffoons personally. It gives them a chance to review, in private, their choices and decisions, without the suffocation of peer pressure; without ridicule; but not without significant laying on of guilt.
For that is my job as a teacher. There is no better teacher than guilt. Or me.
“Keet” Murphy was a resident on the Internal Medicine service. Keet was a nickname, short for “Parakeet,” which made fun of his absurd nose. There are some nose jobs that are obviously just that, but plastic surgery isn’t supposed to be obvious. Someone who did Keet’s nose probably had presented his case in the Pit.
Maybe not.
A lot of mistakes and botched therapy escapes the ravaging in the Pit. Some things aren’t reported or noticed; then, sometimes there is so much traffic of malpractice that one Pit just can’t get to them all.
If Keet’s nose escaped the Pit before, the rest of Keet was not so lucky.
There he stood, at the bottom of the architectural concavity. The killing fields. He held a patient’s chart. The amphitheater was packed. The professor walked in, stood next to Keet, and pointed at him. Keet began:
“Mr. D.B. was a 48-year-old man with diarrhea who was admitted with lethargy and weakness. His admission was at 6:30 AM on July 31. He was a frail man with a slightly discolored hue—yellowish.”
Professor Isador raised his finger. Keet stopped. The teacher looked around the pit, raising his eyes, which darted back and forth until making eye contact with one poor soul.
“You! What say you?”
“I think,” the student said—
“You think?”
“I know that this patient is probably suffering from liver disease, which would explain his jaundice.”
“From?” Isador demanded, pointing at another victim. “You!”
“Could be liver cancer,” suggested the newly fingered student.
“Really?” Isador barked. “Hmm…yes, I suppose it could be that. Do the rest of you suppose that? Do the rest of you think his ridiculous answer is the most likely etiology of his ‘icterus,’ his ‘morbus regius,’ or ‘king’s disease’?
None of the rest of them professed to think that. Nor did they know those other names for jaundice. All heads were down; all eyes were in their laps.
“What happened to Mr. D.B., Mr. Murphy?” Isador asked much too politely.
“He was found unresponsive on morning rounds.”
“Oh?”
“Yes, Dr. Isador. A bedside electrocardiogram documented re-entrant arrhythmia.”
“Your patient died, Mr. Murphy!”
There was a hush from the spectators, as typically happened when the “D” word was invoked.
“Yes.”
Professor Isador frowned. “How did his admit labs come back, Mr. Murphy?”
“Well, sir, I was off duty at 7 AM.”
“Oh,” Isador said, “then it wasn’t your responsibility to follow up?”
This was a trick question.
“Read to us, if you would be so kind, your off-service summary, which is supposed to be written so the oncoming service could be apprised of Mr. D.B.’s situation—so as to maintain his continuity of care.”
“Um, uh…” Keet shuffled through his papers. “I don’t seem to—”
“Because you didn’t write one, Mr. Murphy.”
“I’m sure I did.”
“I’m sure you didn’t. As sure as I am that your patient died, Mr. Murphy. Let’s all take a moment of silence for Mr. D.B., who died of diarrhea.”
“No, cardiac arrest.”
“Diarrhea!” Isador screamed. The audience cowered in terror. Keet retook his seat; Isador called his next victim.
That evening, in his on-call room, Keet encounters…me. He had Mr. D.B.’s chart disheveled on the thin bed mattress.
“What was his potassium level, Keet?” I ask.
Keet wondered that, too. Now he found the admit lab values. Mr. D.B.’s potassium level was 2.2 millimoles per liter, a lethal level at which the heart falters. Cardiac arrest, yes, but from low potassium—itself from severe diarrhea.
And his alcoholism didn’t help.
Had someone only checked the electrolyte levels on his admit labs, but the on-coming service didn’t even know the results were ready. If they had, they would have called for them.
“Some potassium via IV, Mr. Murphy,” Keet heard. From me. “Even a banana would have helped, Mr. Murphy!” I screamed in a haunting shriek.
Do any of them ever hear me? I wonder.
It’s my job to make sure they do. It’s my job to haunt them with their stupid mistakes the rest of their lives.
No place has more ghosts than a hospital. And no one alive has more dead ghouls following them than a doctor. Even a good doctor—even a great doctor—has more ghosts than a drunk driver. And this ghost—me—isn’t about to give anyone a pass.
“Isn’t that right, Mr. D.B.?”
“Damn right!” Mr. D.B. answers me.
“Wanna come with me, Mr. D.B.?”
”Where to?”
“I’m on my way to Dr. Isador’s home, to his bedside, where I do all my best work, and where I go every night, because one night I will have finally succeeded in haunting that bastard to death. Unlike him, those who can, haunt!”
BONUS POEM: PO-I-TRY
Since reposting something already posted is cheating (in my quest to offer something new every day), consider the following…
Sick Ghosts: Underinsured
A SONNET FROM THE ACTUARY TABLES
Where do the ghosts stay at the hospital
The sick who died without an even chance
The patients who left without remittal
Of diseased parts that pushed them the distance
***
Of all the ghouls who come to those who fear
There aren’t those more fright’ning—to the staff
Who made the mistakes that haunt each career
And leave the trail of death on their behalf
***
Arithmetic mistakes preclude recount
As when concocting potions meant to heal
These are the blunders making death tolls mount
And guilt that does not pay for lives they steal
***
The horror tales that spin of wraiths and ghosts
Ignore the places where they’re brewed the most
“Throw me somethin’, mistah” is a way to make a one-way tip. Or not.
Glad I take really good mineral salt these days. Great writing and energetic dialog appreciated this early in my morning!