During those frightening first days in the hospital, Sorrel King came to trust the doctors and nurses looking after her 18-month- old daughter. Hooked up to tubes and machines, sterile dressings covering her burns, Josie looked nothing like the little girl who danced through life wearing ladybug shoes and a gap-toothed grin.
The medical team at the Johns Hopkins Children's Center constantly monitored Josie's mixture of drugs, watched for signs of infection, performed skin grafts to repair the damage from her bathtub accident. If she fussed, someone would immediately check whether she was in pain. After she struggled to fill her lungs with air, a ventilator regulated her every breath. Sorrel, keeping vigil in the intensive-care unit, allowed herself to feel relief at seeing her daughter slowly heal.
As the long days settled into a routine, Sorrel began to view the doctors and nurses not just as caregivers in white coats and scrubs but as people like her, with vibrant lives waiting outside the hospital. The attending physician was Greek and loved to cook. The critical-care doctor was a new father. The pretty pediatric surgeon, a prodigy who had graduated from medical school at age 19, had a long-distance romance. Sorrel thanked them with brownies and fruit baskets and her admiration.
"They were the best," she said. "I loved that place."
Then, after doctors said Josie would soon return to the brother and sisters coloring "Welcome Home" cards, the little girl died. It was the most awful of deaths - one that could have been prevented.
She had become severely dehydrated, causing her heart to stop. Because of what Hopkins acknowledges was a series of errors, the staff had missed the warning signs.
When she died nearly three years ago, Josephine Abby King became a victim of an epidemic her parents never imagined when she was admitted to Hopkins. A model in medicine, it was the hospital of last resort for some of the world's sickest patients, an institution whose doctors weren't only the very best but who trained the next generation of the very best.
"It never would have occurred to me that they would make a mistake," said Sorrel, 38. "I never knew that a hospital could be a dangerous place."
Between 44,000 and 98,000 patients die - and countless others are harmed - from medical errors in U.S. hospitals every year, according to a landmark report by the Institute of Medicine, a government advisory panel. Even the lower estimate, the 1999 report noted, is more than the number of annual deaths in the United States from motor vehicle accidents, breast cancer or AIDS.
The errors range from medication overdoses to surgeries performed on the wrong body part to X-rays read backward. In most cases, patients aren't injured as a result of a single mistake by a doctor or nurse but from a cascade of failures in a system without enough safeguards.
The results can be tragic. A man scheduled for a spinal scan at a Maine medical center died in October after the wrong dye was injected. A woman who underwent a double mastectomy in St. Paul, Minn., later learned that she never had cancer; biopsy results had gotten mixed up.
Even the most elite hospitals are not immune. A 17-year-old girl died in February at Duke University Hospital in North Carolina after receiving a heart and lungs from a donor with an incompatible blood type. At Children's Hospital in Boston, a 5-year-old boy recovering from surgery died last spring after his doctors failed to treat him for a seizure because each thought someone else was in charge.
In Josie's case, Hopkins had failed Sorrel and her family in the most fundamental way. They had trusted the institution, and that trust had been betrayed.
"Josie died of a Third World disease - dehydration - in the best hospital in the world," said Dr. Peter J. Pronovost, a Hopkins anesthesiologist who is heading that institution's effort to reduce errors. "How could that possibly happen? The answer is, we've created a system that's allowed it to happen."
A magic adventure
An annual Christmas card photograph shows the sunny life Sorrel (pronounced Suh-RELL) and her husband, Tony, had built: Their children are perched on a ladder propped against a lifeguard chair on Martha's Vineyard, in Massachusetts. Jack, the eldest, is on top, with his light-red hair and earnest 6-year-old smile. Next are round-faced Eva, then 3, and her blond sister Relly, 5. Josie, then 1, sits on the bottom rung, her head tilted, wearing a green and purple gingham dress over her diaper.