At 6:45 that evening, according to hospital records, a nurse checkedLamar's IV and wrote that she found that the heparin pump was running at 110cubic centimeters an hour, or 11 times the prescribed dose.
When Deborah Kuhls, a medical resident, learned of the nurse's finding, sheordered the IV turned off for two hours. In an interview, Kuhls described theincident as one of the "more memorable and disturbing" crises of her firstyear as a doctor.
Blood test results showed that Lamar's partial thromboplastin time - ameasure of clotting time - from blood drawn at 9:23 p.m. had risen to 195seconds, a potentially dangerous level. It was far higher than the 27 secondsmeasured when he was admitted to the hospital. The heparin IV was turned offand on several times throughout the night.
Kuhls said that overnight she kept a watchful eye on Lamar, checking him 15to 20 times for any sign of bleeding, and consulting with senior residents,none of whom felt that the attending doctor should be called at home."Probably in hindsight it would have been better to call the attending, but Idon't know if it would have made a difference," she said.
At 5:40 a.m., Lamar vomited a "thick mucus with brown digested material,"according to his medical record. After Kuhls left the hospital at 8 a.m.,Lamar's course was short and stormy.
His medical record shows that the hospital did no more lab work until hebegan mumbling and a surgical resident was called to his bedside at 11:45 a.m.Forty-five minutes later, he was found sitting on the side of his bed,incoherent, and was transferred to the intensive-care unit. A little more thanan hour after that, he went into cardiac arrest. Resuscitation efforts failed.
