Deadly Diversion: A Medical Thriller (5 page)

She frowned. “So you’re saying without these things he’d starve to death.”

“Theoretically.”

“I don’t care about theoretically, whatever that is. I don’t want my Huey starvin’ to death.” She stood and the paper slid to the floor. She stomped out, leaving a footprint on it.

“That went well,” I said out loud.

FIVE

Thursday, 09 August, 0955 Hours

THE MEETING WAS HELD in the classroom used for orientation of new staff and in-service education for the rest of us, chairs arranged classroom style with a table facing the audience. We were a few minutes away from a mandatory meeting for administrators.

Judyth stood in front of the table flipping through some notes. She wore a double-breasted pants suit in black, white silk blouse underneath, and a ceramic red rose on her lapel.

Behind Judyth hung a poster stuck up on the wall with thumbtacks. “BE A NURSE,” it proclaimed, showing a diverse group of smiling people dressed in clean scrubs, the obligatory male and woman of color included. A strip along the bottom had been torn off. Presumably it contained a phone number or Web site for more information.

Wanda, a fellow head nurse, joined me at the back of the room, scooting in the door just as Judyth looked up. “You want to make a quick getaway, too, I see.” Wanda nodded toward the door on our left.

“These are about as much fun as a trip to the dentist.”

“And twice as long.”

Judyth tapped her pen on the table in front of her. “Two things on today’s agenda,” she began. “First, accreditation.”

A hand shot up in front, but the speaker didn’t wait to be acknowledged. “What about staff? When are we going to get some more nurses?”

A few others murmured their agreement.

“I’ll get to that. Now to our accreditation.” She cleared her throat. “We’ve had six months to correct the weaknesses the surveyors found on their last visit, the most serious being to adhere to our staffing plan, a Type I recommendation. As you know. The six months are up as of yesterday, so we can expect another visit by surveyors any time.”

A hand went up in front. “How are we doing on staffing? Don’t we have to have a certain number to pass accreditation?”

“Joint Commission doesn’t tell us how many staff to have,” she explained. “Just to have a plan and to adhere to that plan.” A few murmurs.

Judyth raised her hand for quiet. “Of course the plan needs to be realistic for safe practice.” She ignored several hands that shot up. “And we’re not up to full staffing yet. But we’re making progress, and that’s what they want to see when they get here.”

“When?” asked a nurse in the front row.

“We don’t know,” Judyth answered. “It will be an unannounced visit. They’ll just show up one day. So be prepared. Someone will probably just walk up to a nurses’ station and identify themselves. If we’re lucky, they’ll come first to the administrative suite, and we can take them around like we did for the initial visit. This time, though, they’ll be here to see if we fixed the problems.

“We were also cited for our failure to fully implement a sentinel-event policy. I’m sure you remember that.” She looked around at the few nods, and went on to remind us. “That’s when something goes wrong and a patient is hurt. We have to have policies in place to make sure it doesn’t happen again.”

“As long as you use incident reports to discipline nurses for this, you’re not going to get people reporting,” said someone in the middle of the room.

“We’re working on that,” Judyth said quickly. “You just make sure—” she stopped momentarily “—that every event gets reported. In addition, I’ve been making rounds.” She motioned to her secretary, who was sitting in the front row, to hand her a file. She opened the folder and checked the sheet on top. “Here are some of the things I’ve observed. On one unit I found dirty instruments piled on a laundry cart. On another, several staff were showing each other baby clothes they had made while several call lights were lit up.” She looked out over the audience, quiet now, to a spot high up on the back wall. “Finally, loud conversations, shouting back and forth with no regard, in fact, little notice that patients or visitors were around.”

Someone coughed.

I asked, “Are these nurses you’re talking about or some of the...uh, support staff?”

“You can’t tell who’s a nurse and who’s not since you made us quit wearing RN on our name tags,” came a voice from across the room.

“That’s ’cause we’re interchangeable,” added someone else, eliciting snickers from the audience.

Judyth shrugged. “It doesn’t matter. You’re responsible for their performance. And their behavior, whether they’re RNs or nurses’ aides.”

Wanda asked, “Will you back us up if they come crying to you? Saying we’re picking on them?”

“This is your job. If you can’t handle management, let me know.” She leaned back against the table. “Now, about hiring more nurses,” she said. “I’m pleased to tell you administration has approved a bonus program for you. If you recruit someone who comes to work here, you get a bonus of five hundred dollars.”

Murmured approval.

“How do we get them to come here,” Lucille, the head nurse in orthopedics, asked, looked at her friend next to her and then back at Judyth, “with our salaries?”

Judyth smiled slowly. “We’ve raised the starting pay.”

“To what?” Lucille asked.

“To 19.50 an hour.”

“Hey, that’s more than I make now,” someone said.

Judyth crossed her arms and frowned. “We can talk about that. Individual cases can be, uh, considered.”

“What kind of double talk is that?” Wanda said in a stage whisper.

The time allotted for the meeting was up. People started gathering themselves to leave.

“One more thing.” Judyth waited until the room quieted back down. “I want to talk to you about the people trying to get the nurses to organize. Not our nurses. They’re outsiders.”

More murmuring.

“Now there are strict rules about where they can hand out literature, where they can talk to the nurses. They cannot do any lobbying on the units or while the nurses are working. Is that clear? Good. Now be sure all of your staff know about this. If you see any violations, call me right away. And you all understand, don’t you, that you are not eligible to vote for or against a union?”

A few heads nodded.

“That’s all,” she added.

“CAN YOU PICTURE HER as a nurse?” Wanda asked while we were filling our plates at the salad bar.

We were early enough to beat the lunchtime crowd to the cafeteria. Only a few of the surgery staff, whose hours began and ended before the rest of us had trickled in, were sitting at scattered tables.

“Judyth in scrubs? They’d probably be designer ones!” I said, topping my lettuce and spinach leaves with broccoli flowerets, shredded carrots and sliced cucumbers.

“Judyth messy? No way,” Wanda said, adding chopped eggs, a heaping of grated cheese and a handful of Chinese noodles to her salad.

“You know where she used to work, don’t you?” I shook vinegar and oil on my veggies.

Wanda nodded. “Isolation. Gowned, gloved and masked. No contact with patients. She never touched them.”

“It fits.”

“With all these salads I’m eating I don’t know why I don’t lose weight,” Wanda said, ladling a second helping of ranch dressing onto her salad.

We were settling ourselves at a table by the window when Wanda said, “Judyth sure knows how to get everyone on her side, doesn’t she?”

A man outside was picking weeds out of a bed riotous with red geraniums, yellow marigolds and purple petunias. It was a luxuriant display of blooms, unlike my garden at home.

“How do you mean?” I asked.

“Right at the time the union tries to organize us, she comes up with this hare-brained scheme to raise starting salaries and make nurses who already work here mad. They’ll either vote for the union or leave,” Wanda said, slathering a roll with butter. “There’re plenty of jobs in nursing now. Nurses can call the shots.”

I giggled.

“What’s so funny? Oh, I get it. Nurses call the shots. Ha. Ha.”

“I know, nothing’s funny right now.”

“But we need a bit of comic relief, don’t we?” Wanda asked, spearing a tomato wedge and swirling it in dressing. “And that crap about ‘sentinel events.’ If we reported every mistake, we’d all be fired. By the way, you hear the rumor about her? She’s been telling all the staff nurses that they’ll have to join the union if we get one. Whether they want to or not.”

“I think she’s right. They have to pay dues for it anyway.” I stirred sugar into my iced tea and took a sip. “She is trying to fix our accreditation problems. If we don’t have a better nurse- to-patient ratio when the evaluators come back...”

“You hear we had to divert another ambulance last night? That’s the third night in a row we’ve been on diversion.”

When an ambulance picks up a patient, they call the nearest hospital and if that hospital doesn’t have the staff to care for any more patients, the patient is diverted to another hospital and so on. Some patients had been driven miles away from home before an available hospital could be found.

“Anyone hurt by the delay?” I asked her.

“Not that I heard. No wonder we don’t have enough business, no open beds.”

When there were not enough nurses to take care of any more patients than we already had, any available beds were not considered “open,” and the hospital was, in effect, closed to new patients.

“I’m moving on,” Wanda said, popping the last bit of roll in her mouth.

“You’re leaving St. T’s?”

She swallowed. “I’ve started grad school at Milburn, in anesthesia,” she said, wiping her hands and tossing the napkin on top of her plate. “I’ll be here for a couple more years, at least till I finish. I’m taking evening classes.”

I frowned.

“What’s wrong? You don’t think I should go?”

“That’s not it. You just reminded me of one of my nurses who just started there, too. Bart Mickelson.”

“Someone told me another nurse from here was going there. He’s in the day program, isn’t he? That’s why I haven’t met him yet. What’s the matter, you don’t like him?”

“Just something he did.”

“What?”

I looked around to the cafeteria filling slowly, but no one was within earshot. “More what he didn’t do.”

“Screw up?”

“You might say that.”

“Does he know what he’s doing? You have to really have your skills down pat to do anesthesia. Fine motor skills, especially. He any good?”

“His skills are fine. It was just one case that we didn’t agree on. That’s all,” I added.

“What’d he do?”

“I can’t really talk about it, Wanda.”

“I wouldn’t report any of my staff unless they killed someone. We need every nurse we can get even if they’re slow or need watching.” She laughed. “Warm bodies with a license, that’s all it takes.”

“Don’t you think that could be dangerous?”

“What would you want, Monika, a licensed nurse who knows something—there are always other qualified nurses and doctors around in E.R.—or no nurse at all? I try to assign the easy cases to the less-experienced staff.”

“Are there any easy ones in E.R.?”

“Not many. And I don’t always have a choice. We never know what’s coming through the door.”

“Like 1CU. We just do the best we can with the nurses we have,” I said with a sigh. “Maybe, with what Judyth said today, we’ll have more soon.”

“And we’re going recruiting on Saturday.”

“Oh, that’s right, the bazaar,” I said, referring to the career fair for student nurses that some of us had been ordered to attend.

“That’s a hoot, isn’t it? Throw them some bait and reel them in.” She pretended to cast a fishing line and roll it up. “And then wave signing bonuses around and, who knows, maybe a free trip to Bermuda thrown in to seal the deal.”

“Signing bonuses?”

“You don’t know about that? Yes, Miss Administration neglected to announce that, didn’t she?” Wanda snorted. “Okay, here’s the deal.” Wanda leaned across the table and tapped her finger on my tray. “Every new hire gets two thousand dollars.”

“Two thousand dollars! Just for signing on?”

“Not all at once. That’s the catch. They get five hundred after three months, another five hundred after six months, and a thousand after one year. Add it up. Two thousand bucks.”

“And the people who’ve been here the longest get nothing unless they recruit someone.”

“Students have the upper hand right now. No doubt about

it.”

“They’ve had hospitals after them the minute they started school.” I gathered my trash on the tray.

“They can’t graduate soon enough for me,” Wanda said as we made our way out of the cafeteria.

“SHE BACK,” RUBY SAID as I walked up to the nurses’ station. “Huh? Who?”

“His wife.” She pointed toward Huey’s room. “While you was at lunch.”

“What’d she want?”

“She went with Jessie and Lord down to the waiting room.”

“And?”

“She say it’s okay to let him die.”

“What?”

“Ruby,” Jessie said, joining us. “We just explained what her options are if he’s unconscious.”

“What code?” I asked.

Jessie answered. “We agreed on B. CPR, drugs, no intubation. Fluids, yes. Feeding tube, no.” Jessie closed the chart she’d been carrying and shoved it into the rack.

It wasn’t much, but at least she’d accepted there might be a point at which we should stop trying to keep him going.

Ruby leaned closer to me and whispered, “You gonna tell him there?” she asked, nodding toward Huey’s room. “That his wife’s giving him up to die?”

“Ruby, I’m sure she realized the situation, and this is only used if he can’t speak for himself. And two doctors have to agree he won’t regain consciousness.”

“Maybe, Missy, maybe.”

JUDYTH WAS MAKING ICU rounds with a visiting physician when I caught up with her later. Once she had sent her visitor on her way, we went into my office, a tiny, cramped space located in the hallway immediately outside of intensive care. I suspected it had been a closet in earlier days. I cleared off the chair beside my desk and piled the papers, journals and files on top of the unopened mail that spilled across the desktop.