Deadly Diversion: A Medical Thriller (6 page)

Judyth arranged herself in the chair and pulled her skirt together over her knees. Her expression was noncommittal.

“I’ve got a problem,” I began, “with the salaries for new hires. I’ve got one nurse—Jessie—who’s been here her whole career, twenty-five or thirty years,” I went on, ignoring her frown. “With the new salaries you’re proposing, a brand-new grad will make more than she does.”

“We’ve got to get more nurses, Monika,” she said, waving away my concerns. “The only way to do that is to try to top the competition and, believe me, that’s not easy. They’re upping the ante all the time.”

I hesitated, then said, “You know she’s black, don’t you?”

  “What does that have to do with it?” Her tone was sharp. “I hope you’re not implying we’d treat her any differently. And, just for your information, no, I didn’t know she was black.”

“So what should she do, quit and reapply? At least then she’d get the signing bonus.”

She chewed on her lower lip, biting off a corner of lipstick. “If she’s been here her whole career, sounds like she’s committed to us.”

“And you’re counting on that. Once again, nurses are supposed to sacrifice for the good of the institution.” I slapped my hand down on my desk, sending a stack of mail sliding to the floor. I left it there.

“And their patients. Don’t forget their patients,” she said, a note of sarcasm tinged her words. “That’s the business we’re in, isn’t it?”

“Is it? I thought the business we’re in is business!”

“Okay, okay. Listen, Monika, we’re in this together. I’m just trying to do the best I can with what I've got. That’s what you’re doing, too, isn’t it?”

I kept my face neutral.

“So let’s just keep trying.” She smiled as if we were colleagues. “You’re a top-notch manager, Monika. If I haven’t told you that lately, I’m sorry. I think you know that, don’t you?”

I waited.

“As long as we can keep the union out, you can keep on doing your job.”

“We can’t keep working people like we are and keep the union out. These people are working overtime—mandatory, I might add—split shifts, doubling back after only eight hours, and floating to units where they don’t know how to care for patients—again, no choice—and now this, you hire a fresh grad and give her more money.” A whine had crept into my voice. “Where’s the sense in that?” I asked, lowering my tone.

“Let me tell you about my experience with the union. Then maybe you’ll understand how bad it can be.” She leaned back in the chair and stretched her long legs in front of her.

I gathered up the dropped mail as Judyth began. “I had a nurse once with good clinical skills. She worked herself up to head nurse in peds, the kids loved her, she was well-liked by everyone who worked with her—nurses, ward clerks, orderlies, even the docs loved her. She was especially good during the difficult times, you know, when you lose several in a row? She seemed to know just the right thing to say. Some of those kids were in and out a lot and the nurses got really attached to them, but this nurse kept everyone’s spirits up. She was like the frosting between cake layers—you could eat the cake without the filling but it was so much better with it.

“Then her mother got sick and needed care, so the nurse needed more money to pay for that care during the day while she worked. Her salary was lower than the other head nurses because she had been there so long. Just before this happened the nurses had lobbied for a union and got it. I wanted to raise her salary to more than the other managers—she deserved it and she’d leave if she didn’t get it. I put in the request, thinking everyone knew how good she was and how important she was to the hospital. All salary changes for nurses—even those in management—had to be approved by the union. They said no. Wasn’t fair, they said, meaning equal. The only criteria for salary increases were seniority or advanced education or certification. Nothing extra for the nurse’s special expertise or value to the institution, according to the hospital’s contract with the union.” Judyth’s beeper sounded. She looked down at the message and stood up. “You know, Monika,” she said, “fair and equal aren’t always the same thing.”

I sat there thinking about what she had said until Ruby called me out to the desk.

“Him there’s been calling for you,” Ruby said. She jerked her thumb toward Huey’s room.

“Where’s Jessie? She’s his nurse.”

“She says she’s done all she can. He just wants more drugs, she says.”

“When’d he last have something?”

“Don’t ask me nursin’ stuff. I got enough to do with all this paperwork.” She knew what time Huey had his medication, I was certain. She kept strict boundaries, though, on what each person’s work was, especially where her responsibilities began and ended. Since she had been at the hospital so long we acquiesced to her rules. She kept ICU running much better than other units, especially now that we had too few staff.

Sighing, I pulled his chart off the rack. Jessie had given him twenty-five milligrams of morphine IV push twenty minutes earlier.

“THERE YOU ARE, sweetheart,” Huey said, straining to talk.

“Oh, so I’m another of your sweethearts, eh?”

He smiled weakly.

“Noni was in to see you while your wife was here.”

“Uh-oh.”

“Uh-oh is right. You better talk to your girlfriend. We don’t want to have to separate those two fighting over you. God knows why.”

“I’m still a stud, ain’t I?” He jerked his sheet up, revealing his naked body.

“Cover yourself, Huey,” I said, and flipped the sheet back over him.

This wasn’t the first time he’d done this; he tried it out on every new nurse, especially the young students, sending one screaming out of the room.

“You’ve been giving everyone trouble, I hear,” I said, checking his IV. Huey had a central venous device, so-called because a triple-lumen catheter was inserted into a central vein—in his case, the jugular vein. The bag attached delivered total parental nutrition, known as TPN, and contained dextrose with vitamin B added that turned the solution a distinctive bright yellow. If any of the solution spilled, it left a sticky residue. We called it a banana bag because of its color and sweetness.

“I need that PGA. One that works this time.”

“You mean PCA. The pump.” Patient-controlled analgesia allowed patients to administer doses of pain medication intermittently.

“I’m really hurtin’, Monika.”

“Where?”

“Everywhere.” He waved his stub of an arm across his trunk, wincing as he did. “It’s a ten.”

I didn’t doubt he was in pain. What I doubted was if it was as bad as he was saying.

‘The PCA didn’t work for you, Huey.”

“It wouldn’t work. It were broke.”

“You kept pushing it all the time. It’s set to allow only a safe amount. You wanted more.”

“I need it!”

“Listen, if we give you too much now, then if it gets worse we won’t be able to give you enough to control your pain.”

He moved restlessly in the bed. “I don’t care about that. I need it now!”

“I’ll send Serena in when she gets a chance. She can give you a back rub.”

“That won’t do no good. Talk to that doctor. The black guy. Tell him I’m hurtin’. Bad.”

“I’ll tell him,” I said, straightening his sheets.

“How ’bout that thing they put in my back? That made it numb.” He jabbed his thumb toward his abdomen. “He said that wouldn’t stop me breathing.”

“The epidural. They put that catheter in during surgery so you could cough and do breathing exercises afterward, that’s so you don’t get pneumonia. And it only works on the nerves going to your abdomen. Your pain is everywhere.”

“Maybe, but I still think it would help.”

“Even if it would, Dr. Lord wouldn’t do any more surgery on you. Not in your condition.” Huey had slid down in the bed so I positioned myself over him, grabbed him under the arms and pulled him up. He seemed lighter than he’d been the day before. “Now,” I said, resting back on my heels, “have you thought any more about what you want us to do—what we talked about yesterday?”

“You better do everything to keep me alive. Everything! If I stop breathing...” He looked around, his head jerking back and forth as if he was expecting someone. “You better bring me back. You don’t let nothing happen to me, you hear?” He looked at me, his eyes clear and focused. “I told lots of people to make sure you don’t let me die.”

“Huey,” I started, trying to think how to say this. “You’ve got too much life in you to be willing to just exist, hooked up to machines, not knowing anything. That’s not you.”

“Don’t talk like that. And don’t go asking Mavis what to do, neither. I don’t want her deciding anything,” he said with more emphasis than I expected. He grinned and his pointed, yellow teeth gave him a feral look. “She’s gonna get a big surprise.”

“Your girlfriend?”

“They’re both gonna be surprised.” He rubbed his thumb and first finger together on the only hand he had. “Money,” he added, lying back on the pillow, a smile on his face.

I started for the door.

“Hey,” he said.

I turned back.

“Father Rudolf been up here? He’s bringing some cops into see me.”

“The police are coming to see you? Why?”

“Don’t you worry about it. Just don’t give them no trouble about getting in to see me.”

“We haven’t been keeping people who aren’t family members out, as you know,” I said, my reference to Huey’s girlfriend apparent.

I came out of Huey’s room and Ruby jerked her head toward a man with his back to me standing at the counter. He was searching through the files in his briefcase open on the ledge.

“Can I help you?”

The man turned around. He was about my age or a little older, dressed in a finely tailored navy suit, white on white shirt and light blue tie with a subtle sheen on it. His dark hair, a sprinkle of gray along the temples, had been professionally styled. And not at a clip joint either. He’d been brushed and buffed to perfection.

“You’re...” he ran a manicured finger down the file in front of him “.. .Monika Everhardt?”

I nodded. “What can I do for you?”

“Phil Silverman,” he said, handing me a card. Phillip B. Silverman, Attorney at Law. His initials were embroidered on his shirt cuffs.

“Is there somewhere we can talk?” he asked, looking around.

“What’s this about? We’re busy here.”

Ruby was staring, and Serena lingered at the counter pretending to read a chart.

He leaned toward me and lowered his voice. “Just a few questions about a patient. It will only take a moment.” His soft gray eyes crinkled into a disarming smile. One front tooth, slightly crooked, marred its perfection. “I know you’ve got a lot more important things to do.”

I led him into the conference room where I knew a meeting was scheduled to begin shortly. An empty cup and a wadded paper napkin sat among crumbs littering the table. I motioned Mr. Silverman into a chair as I scooped up the trash and grabbed a paper towel to wipe the table.

“What do you want to know?” I asked, joining him at the table.

“I’m here on behalf of the family of Antonio Guardino,” he said.

I groaned inwardly. “What’s the problem?”

“There isn’t a problem. They know he was dying. It’s just that Joe—that’s the younger son—he’s so upset that they asked me to check into it.”

“Even so, I can’t say anything, especially now with the HIPPA regs.”

The Health Insurance Portability and Accountability Act was the federal privacy act that restricted access to patient information far more stringently than earlier regulations.

“You’ll have to talk to administration,” I said.

“I have power of attorney. I’m executor of his estate,” he said, placing his briefcase on the table and fishing out a document apparently signed by Mr. Guardino.

I handed it back. “I still can’t talk to you.”

“I’m not here officially,” he added, his smile revealing a dimple on one cheek. He closed the briefcase. “You know how upset his sons were.”

I nodded, absently rubbing my head.

“I just need to be able to tell them that I followed up and that everything possible was done for their father. Can’t you tell me that? Just to reassure them.” His eyes lingered on mine, and I felt a warm flush spread up my neck.

Serena popped her head in the door. “Mr. Swenson’s pulled his catheter out again,” she said.

“You’d better get Tim to put it back in, and also call Dr. Lord. See if he wants to order some kind of restraint for him.”

“And Ruby says,” she went on, “that Mrs. B’s chart’s missing.”

“Check her room. I saw it on the bedside table.” I turned back to Mr. Silverman, trying to remember what it was he’d asked me.

“I just want to reassure the family that everything was done for Mr. Guardino. And I’m sure it was.”

I studied his hands resting on the table, square-trimmed nails, lightly buffed, cuticles trimmed. “Everything’s down in records now,” I said at last. “We don’t have anything up here.”

“I’ll get the official records—” he began as the door opened again.

“I need a cup of coffee,” Ruby said pointedly.

I scooted my chair back. “You need to see administration and our legal counsel even if you’re here unofficially.”

Ruby had her back to us as she dumped sugar into her coffee.

“I don’t know anything,” I told Mr. Silverman. “I wasn’t here.”

“Thank you for your time, Ms. Everhardt,” he said, standing. We shook hands and he held mine a fraction too long.

I pulled away.

He walked out, leaving a trail of expensive cologne in his wake.

Stirring her coffee, Ruby said, “Uh-huh.”

“What?” I picked up his card and shoved it in my lab coat pocket.

“Why you so flustered, him looking at you like that? You know, you’re a good-looking woman.” She looked me up and down. “For a skinny, white girl.”

SIX

Thursday, 09 August, 1435 Hours

I WALKED IN ON AN ARGUMENT.

“He’s got a wife. She’s the one who should be able to see him,” Jessie said firmly. “Not some girlfriend. It’s not right.”

“He’s dying,” Serena offered. “I think we should let him see anybody he wants. Don’t you, Monika?” she asked as I settled in a chair at the head of the table.