Deadly Diversion: A Medical Thriller (2 page)

Mr. Guardino had not had any hopes of recovery; that much was clear. Undoubtedly we had just been keeping him alive until his heart stopped and he couldn’t be revived, or until the family agreed to let him die. His death had been imminent, regardless of what code was assigned to him; Bart was right about that.

I’d have to report Bart to my boss, chief nurse Judyth Lancelot, and see what she wanted to do. Although I only saw him briefly in the morning at change of shift, Bart hadn’t seemed to have any problems adjusting to our unit. With the hospital’s accreditation on warning, I doubted Judyth would want to fire him over this incident. We had received strong recommendations to improve in several areas, but our top mandate was to increase the number of nursing staff. We were dangerously understaffed, and with the current shortage of nurses in the St. Louis area and our less-than-competitive salaries, we were struggling to find new hires.

“Safety is the issue here,” one surveyor had said during her accreditation visit. I had to agree. And the team was due back any day, a surprise visit intended to catch us doing the right thing. On top of that, a small group of nurses was threatening to unionize if staffing didn’t improve.

A new nurses’ aide, who had just started on Monday, came out of a patient’s room. “Where are the blankets?” she asked me, popping gum.

“There should be some in the room. If not, there’s more in the storage closet out in the hall.”

“He’s already got three but he wants another one,” she said, turning toward the door.

“Wait. Who needs a blanket?” I asked.

“He does.” She waved toward the room she’d just left. “Says he’s, like, cold.”

Jessie came out of the med room. “Who’s cold?” she asked, setting her tray of syringes and medicine cups on the counter. A small frown creased her forehead and her good eye looked at me, the other into the distance.

“Kleinfeldt.”

“Oh, my God, he’s got blood hanging.” She hurried toward the room. “Call the blood bank,” she yelled over her shoulder.

Serena, currently a student at a local nursing school, came up to the desk. “What’s happening?” she asked me with alarm in her voice. Serena had worked as a student assistant in ICU part-time during the school year and now was working full-time for us through the summer.

Waiting on the phone for the blood bank to answer, I quizzed her. “Tell me, what’s his complaining of being cold mean?”

Serena ran her fingers through her spiked hair, a brilliant red this week. “Uh...reaction! He’s having a reaction to the blood.”

Jessie came out of the patient’s room carrying a nearly full bag of blood and holding the tubing up so it wouldn’t drip. “Yet another mistake,” she said, keeping her voice low. The blood bank was short-staffed, too.

“What happens now?” Serena asked me.

“It depends on the mistake. They might have made an error in typing or cross-matching his blood, or maybe they issued the wrong product.”

“You mean packed red blood cells instead of whole blood?” Serena asked.

“Exactly. They’ll send someone up to draw another blood to type and cross-match again and recheck the order. I hope they get it right this time.”

Jessie came back and I asked her to do the code-cart check.

“Didn’t you and Bart do it?”

“He got away before we did,” I replied.

“Oh?”

I shook my head and she went to do it. Jessie was one of several experienced nurses in the intensive care unit I could count on to do a good job no matter how busy we were.

Part of the change-of-shift routine required that the charge nurse going off and the one coming on check that the code cart was stocked with supplies, that the defibrillator was charging and delivering a charge, and report to pharmacy if the medication drawer needed restocking. Bart and I had also neglected to sign off on the narcotics, which were supposed to be counted and recorded at the change of each shift. These were serious infractions of the rules, but I had too much to do now to think about it.

I had just finished checking the day’s roster of staff against patients’ conditions to see how much care they required when the doors swung open, crashing against a linen cart that had been left there.

“Who killed my pop?” screamed Mr. Guardino’s son.

TWO

Wednesday, 08 August, 0750 Hours

JOE RUSHED TOWARD his father’s room and grabbed the curtain screening the bed, jerking it loose from the rod. “Where is he?” Joe screamed, flinging the tom curtain aside. “What have you done with Pop?”

Guardino’s older son, Charlie, tried to put an arm around his brother’s shoulders, but Joe shook him off. “He was real sick, Joe. We all knew it.”

“He moved his finger yesterday. I saw it, he did!” Joe said, choking on a sob. A hefty young man about thirty, Joe had been in nearly constant attendance at his father’s bedside the past week. “He was getting better until they… he waved his arm toward us … didn’t take care of him. He was just an old man to them. But he was my pop,” he wailed. “And they’re gonna pay.”

Joe lunged toward Serena, who stumbled trying to get out of his way, and he swung around, hitting his brother in the face. Blood spurted from Charlie’s nose as he reached for Joe’s arm, but Joe shook him off.

Charlie held his hand to his nose as I motioned for Jessie to help Charlie, waved Serena behind the desk out of the way, and nodded to a lab tech, who was already calling security. I hurried around the desk toward Joe.

He whirled around at my approach. “You! You killed him!” he screamed, lunging for me.

I backed up quickly. “Joe! Get a hold of yourself! You’re in a hospital!” I yelled, keeping my eye on him as he jerked his head back and forth, looking for another target.

“Joe,” Charlie said, his voice muffled by the blood-soaked towel someone had tossed him. “Stop it.” He pulled the towel away. “Calm down,” Charlie sputtered, coughing on the blood that splashed down his chin. Jessie reached out to help him but Charlie waved her off, flinging the bloody towel at his brother.

The towel hit Joe’s face and a streak of red splashed across his cheek. Jaws clamped and arms held away from his sides in a body-builder pose, Joe balanced on his feet, clenching and unclenching his fists. Then he threw back his head and began to roar from someplace deep in his chest.

Two security guards banged through the doors behind me. One grabbed Charlie, pinning his arms behind him. Blood spurted from Charlie’s nose again, and the other guard jumped back from it. He yelled into his radio that they needed backup.

Tim, coming in the door from the stat lab, dropped his tray of specimens on the counter and joined the second guard and me just as Joe advanced toward us. Joe’s right arm shot out, hitting Tim in the face. Tim doubled over as Joe’s other arm swung wildly. The guard and I both ducked but I raised my head a moment too soon. Joe swung back around and connected solidly with the side of my head. I staggered back and slammed up against a door frame.

Suddenly there were more guards behind us and out of the corner of my eye I caught the blue uniform of a city police officer. Joe raised his arms and emitted one last animal-sounding bellow as guards and police surrounded him. His head hit the floor with a crack, and handcuffs clicked shut on his wrists. He was jerked to a standing position.

His eyes unfocused, he stumbled toward the doors, held upright between the guards. His brother was telling him to keep quiet as they were led out. Joe didn’t seem in any shape to talk anyway.

My knees felt rubbery but I turned to check on Tim as he leaned against the linen cart. Sweat stood out on his forehead, and the color had drained from his face, leaving a saucer-size red blotch on his cheek ending just above his eyebrow.

“You’re going to E.R. and get that X-rayed,” I told him.

He mumbled something about patients.

“Now.”

I told Serena to go with him.

I ran my hand through my hair and yelped as I touched a knot on my scalp.

“You better get an X-ray, too,” Jessie said, tucking a strand of gray hair back into her bun.

“Nah. It’s nothing,” I assured her. She shrugged and passed me the bottle of ibuprophren we kept on the desk for the not- infrequent headaches, backaches and other assorted aches that plague overworked and overstressed nurses.

I shook my head, intending to tell her I didn’t need it, but pain shot through my skull, convincing me otherwise. I dumped out a couple of tablets and went out to the drinking fountain in the hall.

Jake Lord stepped off the elevator as I rose up. Jake was our staff physician, intensivists they’re called now, doctors who specialize in intensive care. One of the first African-American physicians on our staff, Jake sometimes suffered from patients’ and staff’s distrust but overcame their prejudices with competent, compassionate care.

I told him about what had happened with the Guardino sons and then, my voice lowered, I explained about Bart doing a limited resuscitation on the man.

He shook his head. “No matter how bad it is, some family member always thinks the patient’s going to recover, and then they blame us when he doesn’t.”

“Maybe we ought to do a post,” I suggested. “To make sure the cause of death really was a stroke.”

“Probably a good idea,” Lord agreed.

“Will you talk to the family? I will if you don’t want to.”

“I’ll call them. They can’t attack me over the phone,” he added, holding the door for me. “What are you going to do about Bart?” he asked.

“Report him to Judyth. Then, I don’t know. We sure can’t afford to lose any more nurses right now.”

EVERYONE WAS CALMER than I expected. Ruby, back from the morgue, was complaining about how unsafe it was to work here and telling everyone we should get hazard-duty pay. Her son had recently joined the army and she had started using military expressions. She’d have a soon-to-be-exaggerated story to tell her cronies throughout the hospital, the subculture of people who support the work of any large institution and who know more about what is happening than those who are supposedly in charge.

I needed to report Bart’s behavior to my boss, but first I needed to see to our patients, see if any had been upset by the disturbance. Most of them were either comatose or so sick that they were unaware of what had happened. I reassured the few who were conscious that everything was all right now. Fortunately it had been too early for visitors.

“Good, you’re here,” Huey Castle said, taking a breath through the cannula that pumped oxygen to his scarred lungs. Huey had just returned from X-ray and had missed the fight. He gave me his winning smile—yellow, jagged teeth staining his grin. He took another shallow breath and slid his face into a frown. “It hurts, Monika. Bad.” He scrunched up his face. “It’s a ten.”

Pain had become the fifth vital sign—along with blood pressure, temperature, pulse and respiration—we were now required to check routinely. Patients are asked to rate their pain on a scale from one to ten with ten being the worst they could imagine and one, the least. Huey’s pain was always a ten.

“Yeah, yeah.” I checked his IV and 02. Both running fine. “You’re full of it, you know, Huey. You’ve been conning people for so long you wouldn’t know the truth if it hit you.”

Huey was a fifty-six-year-old Vietnam veteran whose stomach cancer had spread. A victim of emphysema as well, he had been hospitalized for more than two weeks following an episode when he’d complained of not being able to breathe. The ambulance brought him to us—we were the closest—and then he’d been too sick to move to the VA hospital. This wasn’t his first time with us, but it would be his last.

“I’ve gone straight,” he said, waving the curved hook he used in place of an arm in my direction.

“Why don’t you put that thing on?” I asked him. “Instead of just playing with it.”

He smiled again, pain apparently forgotten. “They like it,” he said, nodding toward the door. “I like to scare ’em with it. Pull it out like this.”

I stepped back as he stuck the pincers in my face.

“That thing’s dangerous, Huey. Put it on or put it away.”

“Okay, okay. You don’t have to get sore.” He put the prosthesis on his bedside table. He waved his left hand in the air; rings flashing on every finger. “Now I’m the one-arm bandit,” he said, repeating the same joke he’d been telling everyone since he arrived. Huey loved the casinos, he’d told us, especially the slot machines.

I pulled the blood pressure cuff out of its holder on the wall and slipped it around his arm.

“Hey,” he said, watching my face. “I hear Guardino’s dead.”

I pumped up the pressure and slowly let it out, watching the numbers slide by. “You did, eh?” Huey’s pressure was 160 over 90. High but not too high. His complaint of severe pain was probably exaggerated.

“You can tell me, Monika, I knowed him from the old days.”

“You knew him?”

“Just from the neighborhood. St. Ambrose parish.”

The Italian neighborhood in South St. Louis.

“How about some more drugs?” he asked.

“I want to talk to you about something.”

“Then I get some drugs?”

“I need to ask you about what you want us to do if you aren’t able to decide,” I said, ignoring his question.

“What’d ya mean, ‘aren’t able to decide’? Why couldn’t I decide? And what kind of things?” His eyes narrowed. “What’d ya want to do to me anyway? Use my body for research?” He laughed. “It’s some body, ain’t it?”

Huey’s body was shriveled, the skin hung in uneven bunches on his upper torso, a tattoo of a naked woman rippled his upper arm when he moved, and he had the deathly pallor of a patient whose cancer had metastasized.

I pulled up a chair and sat down next to him. People needed to be led into this gently, but I had hurried, thinking about all I had to do. I took a breath and started again. “If you’re unconscious, we need to know how much effort you want us to make to bring you back to consciousness.”

He frowned. “I want everything. What’d ya think? You should let me die?”

“Huey, your prognosis is pretty bleak. Most people in your situation just don’t want to be kept alive if they’re unconscious, hooked up to machines...” I motioned toward the equipment surrounding the head of his bed.