Deadly Diversion: A Medical Thriller (3 page)

He didn’t say anything so I went on. “There are several choices. You can tell me exactly what you want us to do. You can decide if you want to be resuscitated even if there’s little hope of getting better. You can decide if you want to be fed through a tube. Or fluids in the IV. It’s your choice, Huey, but you need to make it now while you can think rationally about it.”

I released the advance directive form from the clipboard I had placed on his bedside table and handed it to him. “Just read it over and let me know if you have any questions. Take your time and think about it. We don’t want to rush you. I just want you to think clearly about it.”

He shoved the paper back to me. “They asked me about this when I got here. I told them I don’t need to think about anything.” He shifted on the bed, one knee bobbed up and down under the sheet. “You just keep me alive. You make sure that if I stop breathing,” he said, wiping his hand across his forehead, “that you revive me. I’m not ready to die!”

“Okay, okay. I understand. You’ll be resuscitated, don’t worry.” I clamped the form back on my board.

“I told Mavis.. .if you don’t...” He struggled for a breath.

“We will, Huey, I promise we will.” I gave his nearly full IV bag a last glance and tucked his sheet around him.

“Or she should sue you,” he said.

I waved off his threat and was nearly out the door when he added, “Not like Guardino.”

I turned back. “What do you mean?”

“Let’s put it this way.” He took another breath. “That family ain’t the kind to sue.”

THREE

Wednesday, 08 August, 0920 Hours

BACK FROM X-RAY, TIM stood at the counter reading a chart. The side of his face puffed out over the cheekbone, and a bruise was just beginning to darken under his eye. A cowlick at his hairline had pushed up a tuft of damp brown hair. Tim held himself steady, using slow, careful movements as if he were afraid he might jar something loose.

“No fractures?” I asked him.

“Just sore.” He reached up and touched his face gingerly. “Nothing broken.”

“Are you sure you’re okay? Maybe you should take a sick day.”

“And leave you here as short as we are? How’s he doing?” he asked, glancing toward Huey’s room.

“I don’t get it, Tim. Jessie gave him twenty-five milligrams of morphine IV push and he says it didn’t help. We should be worrying about being able to arouse him with that much in him. No matter how much we give him, he still complains. And with the accreditation folks coming back soon, we can’t have a patient saying his pain is as bad as it can get.”

“Why?” Serena asked, joining us at the counter. Her flame- colored hair stood up, giving her a permanently surprised expression in spite of her earnestness.

“Because our goal is to have everyone at level four or below,” I told her. “They look to see if we’re making our goal and mark us off anytime we’re not close to it.”

“And Huey’d be quick to tell them, too,” Tim added.

I turned to Serena. “The more he gets, the more trouble he’ll have breathing.” I flipped through his chart. “I see his liver enzymes are up.”

“His liver’s shot,” Tim said. “You notice his skin?” he asked Serena. ‘That his eyeballs are yellow?”

Serena had pulled a small pad out of the pocket of her scrub top and, pen clicked into place, she asked, “Jaundice?”

Tim nodded. “He’s probably been a drinker, then with all the drugs he’s had.. .he wanted to know if he could smoke pot.”

Serena giggled. “He wants to get high?”

“I’m sure he does,” Tim answered. “But he said he’d heard about people getting it for cancer.”

“Why not? It can’t hurt now, can it?” Serena asked.

“Besides the fact that it’s against the law?” I asked her.

“I thought that changed for medical reasons.” Serena twirled a ruby stud in her ear.

“That’s in California. Marijuana is still illegal—for any use, including medical—in Missouri,” I said as Ruby joined us. “And how would he get it? He can’t go anywhere.”

“Someone could bring it to him,” Serena suggested.

“But he still couldn’t smoke it,” I told her.

“Why?” Serena asked. “Because of his lungs?”

“That, too, but it’s the lighting up of the joint with all the oxygen in here—” Tim began.

“Kaboom,” Ruby said, chuckling. “He wouldn’t have to worry about pain no more.”

“Neither would any of the rest of us,” Tim added.

Jake came out of Mr. Kleinfeldt’s room, and I caught him up on my conversation with Huey.

“What’s his C02?” Jake asked, grabbing a chair and scooting up to the desk.

“It’s not that high.” I pulled Huey’s chart out of the rack and flipped through to the lab printout to find out how much carbon dioxide they’d found in Huey’s latest blood test. “Forty-five,” I read.

“02?” Jake asked.

“Seventy-five.” I shut the chart, confirming that Huey’s oxygenation was compromised, as expected. When carbon dioxide in the blood goes up, oxygen levels go down. “But I still don’t think you should intubate. You do and that’ll be the end of talking to him.”

“Okay. I’ll hold off for now, but keep an eye on those labs.” He swung around to face me. “Maybe I haven’t been clear enough about his prognosis. Do you think he knows he’s terminal? Really knows it?” he said.

I knew what Jake meant. Many times patients or their family members seemed to understand when we told them that their condition was terminal, but then went right ahead and made plans for months ahead, as if they expected to be here then.

“I don’t know,” I told him. “I’m pretty sure he’s still in denial.” I chewed my lip. “He keeps insisting that we do everything for him no matter how bad he is. I’ll talk to Huey’s wife if I get a chance,” I offered. “How long does he have, do you think?”

Jake shook his head. “You never know. Sometimes these things go on for a while, especially with a guy who really wants to live, and it sounds like he does. Other times, they go like that.” He snapped his fingers. “You know how it is.”

Indeed I did.

Death kept its own timetable.

“YOU WANTED TO SEE ME?” Judyth asked, her fingers tapping impatiently on the files in front of her. Judyth Lancelot was St. Teresa’s chief nurse, my boss. She wore a business suit in red, her signature color, with fingernails to match.

“Guardino died this morning.”

“I saw the report. Terminal, wasn’t he?” Her voice was clipped, businesslike.

“Did you hear about his sons?”

“Security called me. They want to know if we’re pressing charges.”

“Are we?”

She shrugged slightly. “The man’s father had just died.”

“That doesn’t give him a reason to attack the staff!”

“Aren’t you exaggerating a bit, Monika? As I understand it, he was distraught and just lashed out at everyone. He didn’t really assault anyone, at least not intentionally, and nobody got hurt, did they?”

“Tim did.”

“Oh?”

“He got punched in the face.”

She sighed. “It wasn’t anything serious, though.”

“Judyth, a nurse gets hit and you just blow it off?”

“Of course not, Monika. We don’t want anyone getting hurt, but I have to worry about the legal aspects. Tim’s going to be all right, isn’t he?”

“His face is swollen. Probably a black eye is all,” I admitted reluctantly.

“Is that it, then?”

“No. I need to tell you about Bart Mickelson. He works nights and he should have called a full code on Guardino but he didn’t. He only did a partial, a B code.”

I handed her the incident report.

“Wasn’t the patient terminal?” She scanned the report and looked up.

“Per the family’s wishes we issued an A code. Full resuscitation,” I said.

“Shouldn’t he have been a C? Didn’t Lord arrange that?” Her mouth twisted with distaste. “I told him to get all the terminals down to C.”

“That’s not the point. The man was a full code and Bart didn’t implement it.”

“We’re thinking about going back to the old system,” she said. “These A, B, C codes are too confusing. It was better when they’re either a full code or no code. That way no one gets mixed up.” She gave me a small smile. “Like you said, he was terminal. Even if they could have resuscitated him—which I doubt—the man didn’t have long to live.”

“Judyth, it’s against the law. Bart could lose his nursing license. And you and I, our licenses are on the line, too. We’ve got to report him.”

She shook her head slowly. “Not now, Monika. We’ve got to get through this next accreditation visit and get the union off our backs.”

“Judyth, it’s murder.”

“No, Monika, it’s not. An error in judgment, maybe, but not murder. I think you’re overreacting a bit, aren’t you? It’s not like he didn’t try to resuscitate him at all.”

“No, but—”

“Sure you didn’t get hit instead of Tim?”

“As a matter of fact, I did get hurt.” I touched the lump on the back of my head where I’d hit the wall. “What do you think the family’s going to do if they hear about this?”

She leaned forward, squinting through smoke-tinted lenses. “You just keep quiet. The man was nearly dead anyway.”

“So you don’t want to do anything? No discipline, no consequences?”

“That would be the worst thing to do. It would make us sound like we knew he did something wrong.”

“He did! And he threatened me, too.”

“Who?” She frowned. “The man’s son?”

“No. Bart.”

“What’d he do?”

“He just acted threatening,” I admitted.

“Sounds like you’re overreacting again. Maybe he was just rude. He was upset over what happened and let his anger spill out on you.”

“He was more than rude. For godsakes, Judyth, aren’t you going to do anything? What is it? The nursing shortage? Or our accreditation? You think you can’t get rid of any more nurses till after the accreditors come back? Or are you afraid of the Guardinos, afraid they’ll sue?”

“We’re handling the shortage,” she replied. She glanced at her watch.

“What about the state board?”

“What about them?” Judyth frowned.

“This is a reportable incident, a license violation.”

She pressed her hands down on the desk and levered herself up to her full six feet. “You don’t call anyone,” she said with emphasis. “You don’t talk to anyone about this.” She handed the incident report back to me. “You just get up there...” she nodded toward the ceiling “...and take care of the people you’ve got.”

I was dismissed.

“JESSIE’S IN WITH Huey right now,” I told Father Rudolf, who had come in right after lunch. “She should be out in a minute.” Rudolf glanced at his watch. “I just need to tell him I’ve set up the meeting he wanted.”

“Meeting?”

“Uh, just someone he needs to talk to.”

“A lawyer?”

“I can’t talk about this, Monika.”

“I just need to know if it’s going to compromise his condition.”

Father Rudolf smiled. “If anything it’s going to help. He’s going to feel a lot better afterward.”

“THAT MAN WHO JUST LEFT,” I asked Ruby later, coming onto the unit from my office. “What was he doing up here?”

Ruby had the phone cradled on her shoulder and she didn’t look up. “A visitor, that’s all.”

“Who was he visiting?” I said, my voice rising.

“What you getting so bothered about, girl? He just in talking to Huey.”

“Is he a relative?”

“I ain’t got time to shoo people out. They want in, they in.”

Although hospital policy restricted visitors to ICU to immediate family only, we’d been bending the rules lately, trying to keep patients and visitors alike happy. We needed the business.

“Who?” Serena asked, walking up.

“That guy in with Huey,” Ruby told her. “Probably one of his army buddies. Miss Nosy here wants a report on everyone coming and going. I ain’t got time fer all your questions.” She dropped the phone in its cradle with a thump.

“You know him?” Serena asked me.

“Is Huey okay?” I asked her, without answering.

“He kinda gives me the creeps. With that arm and all.”

“Just check on him.”

She gave me a puzzled look as she turned toward his room.

Dog, that was what he was called when I’d known him. I never knew his real name. His droopy jowls and sad eyes made him look as if his face had been made out of rubber that had been released from its mold too soon, causing his face to sag. No telling his age. He had the same rolling walk I remembered, too. He was a runner for the some of the bookies in town. I felt my face getting warm as I remembered the times when he’d picked up my money wrapped inside a slip of paper shielding my choice of numbers for that week. Since the lottery had become legal, though, the numbers’ business had dropped off. I thought they had gone out of business. Maybe Dog was the person Father Rudolf said Huey wanted to see.

But it hadn’t made him feel better. When Serena came out of his room she said Huey was upset and in more pain. Serena checked his chart and told Jessie that Huey could have another shot.

“That should help,” Serena said.

“WE LOST ONE TODAY,” I told BJ when she joined me at Dolph’s Restaurant later.

BJ had been my best friend since childhood. We had grown up together in the Dutchtown neighborhood of South St. Louis, long home to the city’s German immigrants. Both our families descended from those earlier settlers, and the Southside remained a close-knit community. Most people, though, had moved farther south and west as inner city decay had encroached into the area. Dolph’s bordered Dutchtown where it met up with the Holly Hills neighborhood, where I had moved.

Tall, blonde and blue eyed, BJ looked typically German, and although I had fair skin and blue eyes, my short stature and the coal-black mass of unruly curls that I kept cut close to my head hid my ancestry.

Now BJ was a St. Louis city cop.

She laid her cap on the seat beside her and rubbed the crinkled red line on her forehead that the cap had left. Sweat stained the armholes of her blue uniform. She bloused out her shirt and fanned herself with it.

“Sick?”

“’A course they’re sick. Why else would they be in ICU?”