Deadly Diversion: A Medical Thriller (4 page)

“Just making a joke.” She held up her hand before I could open my mouth. “A sick one,” she added with a grin. She smoothed strands of damp blond hair, tucking them expertly into the French braid on the back of her head.

A waitress plopped glasses of water in front of us, saying she’d be right back.

“The man’s son got in a rage and just went crazy, swinging his arms and screaming at everyone. Tim got a punch in the eye, he slammed me against the door. It took four security guards and a St. Louis police officer to get him down.”

“Who was it?”

“I can’t tell you, BJ. Patient names are confidential. You know that.”

“I mean who was the cop?”

“I don’t know. And my boss said we’re not pressing charges.”

She fanned herself with the menu and looked around.

Dolph’s was filling up fast with the older crowd here for the early-bird dinner special.

BJ nodded to two cops seated in the smoking section separated from us by a half wall. “Nothing funny about the death, was there?” she asked, turning back to me.

“Maybe.”

“What do you mean, maybe?”

“One of the nurses...”

“She did something wrong?”

“He. No, but he might as well have. He didn’t do a full code.”

The waitress returned and asked if we needed more time. We didn’t. BJ ordered her usual—the Favorite Grilled Cheese—and I decided on the breakfast Grand Slam for my dinner.

“What do you mean ‘he didn’t do a full code’ ?” BJ asked when the waitress had gone.

I explained about the three levels of resuscitation.

“Why didn’t he do it all?”

“Mistake, he said. The guy was terminal,” I admitted, “but his family wanted us to do anything and everything we could to keep him alive.”

“Wasn’t there anyone else there? Didn’t the other nurses step in and do something?”

I sighed. “Unfortunately, I didn’t have anyone else on staff who wasn’t already working this morning, so my boss had called the agency for two temps. They don’t know the patients and would just do whatever Bart told them to do.”

“Wasn’t there a doctor around?”

“Only a brand-new resident who’d started last month. Bart probably told him what to do.”

“What’ll happen? Will somebody investigate? Will he be fired?”

I snorted. “My boss is worried about our accreditation. We don’t have enough nurses as it is, and firing one more would make it worse. And Joint Commission is due back any day.”

“What’s that? Some kind of medical group that specializes in bones?”

I laughed. “No, the Joint Commission on Accreditation of Healthcare Organizations. JCAHO, or Joint Commission, Jayco for short.”

“I guess that’s bad,” she offered.

“If we lose our accreditation, we’re out of business. No more government funding, no more Medicare, no more St. Teresa’s.”

“What about the family? You think they might cause trouble?”

“Not if they don’t know. And I’ve been ordered not to tell them.”

“So, it’s probably going to be okay.”

“There’s still the state board.”

“What about them?”

“It’s a practice violation. Bart could lose his license if it came to that. And I’ve been ordered not to say anything.”

“Sounds like it’s his problem, not yours. And the hospital’s.”

“BJ, I could be in trouble for not reporting this. The law says that any nurse who knows about a violation is required to report it. My license is on the line, too.”

“You saw it?”

“Of course not, I would’ve coded the guy. Bart told me about it when I came in this morning.”

“Then you’re off the hook, aren’t you? With your license, that is.”

“The letter of the law, maybe, but not the intent. It for sure violates nursing’s code of ethics.”

“How often does a nurse get in trouble for not reporting something someone else didn’t do?”

“Not much,” I admitted. “I’ve never heard of it. Probably never,” I said finally.

“You reported it up the line. You followed orders. Sounds like if anyone’s in trouble with the board it would be your superior.” BJ knew about following orders and chain of command. “Make sure you document what you’ve done.”

“Good point. My boss gave me back the incident report. I’ll file it along with a note about my meeting with her. Just in case something happens in the future.”

The waitress returned with our food, and we busied ourselves with preparations. I smeared my pancakes with butter and drizzled syrup over them and added salt and pepper to my eggs, sunny-side up. I stabbed the yolks, twisting my fork around in the gooey centers before popping a dripping bite into my mouth.

BJ wrapped her hands around the grilled sandwich stuffed with tomato, bacon and cheese. “The family must have been expecting it even if they didn’t admit it.” She bit into the crunchy wheat toast and cheese oozed out over the side and onto her hand. She put her sandwich on the plate and licked her fingers. “They’ll bury him, and that’ll be the end of it,” she said, wiping her hands on a napkin. “Come on, eat those pancakes before they get cold. You can save the world on a full stomach.”

FOUR

Thursday, 09 August, 0640 Hours

COMING INTO THE HOSPITAL the next morning, I saw Tim hand a flyer to a nurse as she passed him. He turned toward me, his lopsided smile sliding into a neutral expression, his swollen black eye and bruised cheek distorting his face.

“I know you don’t believe in this,” he began, “but we’ve got to do something to get administration to listen to us.” He smiled crookedly at a passing nurse. She took a flyer and moved on.

At this early hour the lobby was nearly deserted. Even the volunteers who staff the information desk hadn’t arrived yet. One elderly man dozed in a chair opposite the wall of portraits of past hospital administrators, their cheery faces smiling at who knew what.

“You see the paper this morning?” He turned to me.

“CEO salaries?”

“Can you believe that? They’re making hundreds of thousands,” he said, loud enough to be heard across the lobby. “On the backs of nurses,” he added, watching an administrator walk by without looking at us. “That’s why we’ve got to get some leverage.”

“Tim, I do believe in unions,” I said after a few more nurses had taken flyers and the lobby was momentarily empty. “My dad was a union member all his life. And my grandfather.”

His lip curled, twisting his face into a grimace. “But not for nurses, is that it?”

“Tim, I can’t vote for a union. I’m part of administration. I’m not eligible.”

“So would you if you could?”

Two nurses came up and took flyers. They stood there reading.

Tim was waiting for my answer.

“I’ll see you upstairs,” I said.

Tim nodded, his expression grim.

Bart was standing in the hall in front of ICU when I got off the elevator. His blond curly hair stood up as if he’d been running his hands through it, and his scrubs were stained with splatters of blood and fluids. “Can I see you?” he asked. A smile crinkled around his clear-blue eyes.

I nodded and opened the door to my office. I motioned to the small chair beside my desk, but he kept standing, bouncing up and down on the balls of his feet.

“I’m sorry about yesterday,” he said, glancing around. His eyes flicked back to me. “I didn’t mean to talk to you that way. It’s just that—” He ran his hand through his hair and shook his head. His words spilled out in a rush. “It’s getting to me, working all night, school all day, I just lost it yesterday. We are just so damn busy.” He stopped and flashed me another quick smile. “Sorry, darn busy. Too many patients, too sick, not enough help...” His voice trailed off.

“Still—”

“It will never happen again, Monika, I promise.”

I didn’t know how to respond so I sat down.

“Please, don’t report me. It would ruin everything I’ve worked for, and you know yourself he was about to die. We all did. Bringing him back—or trying to—I doubt we could have—”

“That wasn’t for you to decide, Bart,” I said before he could justify his actions any more. “It’s the ethical thing to do and, more than that, it’s the law. You know that.” When he hesitated, I asked, “Don’t you?”

“Yes, yes, yes, but—”

“There are no buts!”

He backed up, palms raised in surrender. “You’re right, you’re right. And it won’t happen again, I promise you.”

“I can understand what you mean,” I said with a sigh. “We bring them back to nothing and the family’s kept in limbo and then they die anyway. It goes on way too long for so many.”

“We’re so busy, I know I miss some things.”

“We all do these days. By the way, did you do the counts this morning?”

“Yes,” he said with a quick smile. “Jessie and I checked all the narcotics and everything’s okay. None are missing.”

“Good.”

“Please, Monika, don’t report me. I’ve learned my lesson. I’ll code them all, immediately, no matter what code’s been ordered. I promise.” Another smile.

“Okay, but—”

“Thank you, thank you, thank you,” he said, folding his hands prayerlike in front of his chest. “You don’t know what this means to me,” he added, bowing as he backed up.

“But if I’m asked, I have to tell the truth.”

“You won’t be sorry,” he added, turning quickly. “I promise, I promise.”

“I hope not,” I said to his retreating back.

I WAS CHARTING AT the nurses’ station when I heard Ruby’s chair squeaking. Her back was to me, and at first I thought she was crying.

Just then Huey’s girlfriend, Noni, passed the desk, heading toward Huey’s room.

“Stop!” I ordered.

She turned around, surprise on her face. “Me?”

“Yes.”

She stood at the counter with a small frown on her face. “Anything wrong? Not Huey?” She fingered the top of a small, brown, paper lunch bag.

“He’s fine,” I reassured her. “We’re.. .that is, the nurse is in there now. You’ll have to wait.” Thank goodness the curtain was drawn across his cubicle.

Noni was a small, contained young woman with straight black hair that swung loosely around her face. Her brown eyes had just a hint of a slant that gave her an exotic look, reflecting a mix of Far Eastern and, I suspected, Spanish heritage.

“Uh, it’s going to be a while. Why don’t you go get a cup of coffee and come back a little later?”

“Can’t I just interrupt a minute?” She turned toward his room.

“No, no.” My words stopped her. “They’re in the middle of a, uh, procedure. They can’t stop now. Just give us fifteen minutes. Can you do that?” I hoped I looked earnest.

She checked her watch. “I’d better go on to work.” Huey had told us she worked at the Ambassador, the gambling boat on the Mississippi.

Before the doors had swung shut behind her, Ruby was bent over the desk laughing. “My God, girl, you conned her right outta here.”

“Whew. That was close.”

“She was barreling right on in there.” Ruby pointed to Huey’s room. “I gotta hand it to you, you’re good!”

We both laughed, picturing Huey’s wife and girlfriend meeting over his bed.

Serena came out of another patient’s room. Ruby told her what was so funny. “I can’t see anyone wanting him,” Serena said, with the characteristic bias of a twenty-year-old. “It’s not like he’s good-looking or anything.”

“You wrong there, girl,” Ruby said as Jessie joined us. “That guy’s a lover.”

“Uh-huh,” Jessie added with skepticism in her voice.

“He the king,” Ruby said, giggling. “King. Get it? His name—Castle.”

Jessie waved a dismissal.

Ruby’s dark skin flushed. “Some folks can’t take a joke,” she said, flouncing off.

I sent Serena in to ask Huey’s wife to come see me in my office and moved away to see what another visitor wanted.

“I NEED TO TALK with you about what we should do about Huey,” I said as Huey’s wife, Mavis, settled herself on the chair in my office. Mavis was a lanky, almost skinny woman dressed in jeans, T-shirt and scuffed tennis shoes. Her dirty-blond hair, streaked with gray, hung below her shoulders, and her uneven bangs looked as if they’d been chopped off in a hurry.

“What about him?” she asked in a smoke-roughened voice. She played with the smooth, gold wedding band, her nicotine- stained fingers turning it round and round.

“What has Dr. Lord told you?”

“About what?” She fumbled in her purse and pulled out a package of Marlboro Lights.

“No smoking in here.” 1 smiled to take the edge off my managerial tone. “Too much oxygen.”

She fingered the cigarette, stroking it absently.

“Has Dr. Lord talked to you?”

She frowned. “About what?”

“About his prognosis.”

“What’s that?”

“It’s serious.”

“What’s a prognosis? That what’s wrong with him?”

“Sorry. I should have explained. I’m talking about what you can expect to happen.”

“He’s dying. I know that.” Her voice was matter-of-fact. “He’s had a good run of it.” She smiled, revealing a missing molar. “Made the most of it, I’d say.”

“In these cases, it’s a good idea to think about what all you want done.”

“You mean about a funeral or something?”

“Oh, no. Although that’s not a bad idea. I’m talking about what steps you’d like us to take if he gets worse.”

“Did you talk to Huey about this?”

I hesitated. “I don’t think he’s faced it yet.”

“Probably not. He does love life.” She smiled faintly.

“If he can’t tell us, we’ll need you to.”

“What do I have to decide?”

“Just how much you want done to keep him going.”

“I don’t want him to have pain. I want him to go out smiling.”

“Here are some things to think about.” I handed her the list of possible treatments.

“Feeding tube?” she asked.

“That’s a tube we put down into the stomach when someone :an’t eat for themselves.”

“That’d be good, wouldn’t it?”

“It would if he were going to get better. But if he were already unconscious and not going to come out of it, it would just prolongs the process.”

“You’re saying he’d just go on living, but not really be alive.”

“That’s right. And it’s true for IV fluids as well.”