Deadly Diversion: A Medical Thriller (7 page)

We were meeting in our conference room, also called the break room, located behind the nurses’ station. The room held a small refrigerator, microwave, employee lockers and the ever- warm coffeepot.

All my regular day-shift staff were there while agency nurses—at least this shift we had some experienced ones—were watching our patients. A student nurse joined Tim, Jessie, Serena and Laura, who had been off the day before. Bart and my two evening nurses were missing but Jessie would take responsibility for catching them up on our meeting when she saw them at change of shift.

A nurse for only a year, Laura was on probation with the licensing board. She’d abandoned a patient who had died, but she hadn’t caused the woman’s death. Nonetheless she had to report to the board every three months and I had to submit regular reports on her as well. Her clinical skills weren’t up to speed yet either, and I was beginning to feel frustrated, wondering if she’d ever be the nurse I needed for the fast-paced work in intensive care.

“We can’t keep anyone out if he wants to see them,” I said, arranging my notes in front of me.

“We could if we wanted to,” Jessie said, in a rare display of pique. “Family members only, that’s the rule.”

“You’re right, Jessie, but that’s not the policy anymore,” I told her. “With our census down, we’re supposed to let anyone in the patient wants to see. Just not for long. That’s still true.”

“Any more talk about intubating him?” Tim asked.

“Not at the moment. I convinced Jake to wait until we can let him talk about what he wants done. If he gets a tube down his throat, it’ll just be that much harder for him to communicate. And he’s having such a difficult time accepting his prognosis, I just don’t want anything to interfere.”

“Yeah, but if he can’t breathe, he won’t live to tell us,” Tim said.

“What about his pain control?” Jessie asked, her smooth brown forehead creased in a frown.

“We’re going back to the pump,” I told them. “Judyth got onto Jake after she was up here and Huey told her his pain was a ten. She said we can’t have Huey telling Joint Commission that. So Lord agreed to put it back on and he’s also getting a fentanyl patch.”

“What’s a patch?” a student nurse asked. She had been assigned to Huey that day.

“Fentanyl is a different narcotic, and it’s on a patch that the patient absorbs through the skin,” Jessie explained. “It gives those with intractable pain more consistent relief. It’s noninvasive and better tolerated as well.”

“A pump and a patch?” the student asked.

“Sometimes it takes several different medications to control pain in severe cases like Huey’s,” Jessie said.

“How do you know he’s in that much pain?” she asked, chewing on the end of her ballpoint pen. “He was laughing and joking around when I went in there this morning.”

“That’s the problem,” Tim said. “He’s an alcoholic and it takes more analgesic to relieve his pain, but then again he might just want to get high.”

“Or he might really be in that much pain,” Jessie added.

“Aren’t you worried about him getting addicted?” the student asked.

“It doesn’t matter now,” Tim told her.

“He doesn’t have long,” Jessie explained to her.

“But he seems so alive I just thought...” Her voice trailed off and she lowered her head, scribbling in her notebook.

Jessie patted her shoulder. “Some of them are like that right up to the end. Others are never conscious. It just depends on the person, what’s wrong with them, and on their pain tolerance.”

The student smiled a thank-you to Jessie, and I shifted the conversation to the agenda. I told them to expect the Joint Commission surveyors soon and to just go about their business as usual.

“Now about the union,” I began, glancing at the copies of the union flyer strewn on the table.

“Union supporters can lobby you in any public areas, including the cafeteria, the gift shop, the lobby or outside. Or send something to your home, for that matter. What they cannot do,” I said, ignoring Tim’s angry scowl, “is talk about it on the floor or during working hours. If you’re clocked in, you have to avoid discussions about the union until you clock out. Everyone understand?”

“Where do you stand, Monika?” asked Tim. He tipped back in his chair, hooking his feet on the rungs and lacing his fingers behind his head. Brown hair flopped over his forehead. “You for or against?”

“Tim, you know I can’t take a stand on this.”

He looked around for support. The swelling on his face had gone down but the skin beneath his eye was streaked with black and purple, giving him an obvious shiner and belying the seriousness of his manner.

Jessie kept her eyes on the file in front of her. Serena looked toward the door.

Laura, who had been off the day before, piped up. “I’m in favor of it.”

“Really?” I asked.

She swallowed. “I know I’m not as fast as I could be yet, but I know we don’t have enough help. And I can see how administration just blows that off, telling us to do more and more.” She stopped, blush staining her naturally-pale face. She picked at a piece of lint caught on the hem of her scrub top and brushed it away.

Tim dropped his chair to the floor. “That’s right, Laura, and they won’t do anything about it until we can speak with authority. That’s what the union will do for us.”

Jessie spoke up. “Isn’t there any other way? Can’t we convince them we all want the same thing—good, safe patient care?”

Tim snorted. “You know what I heard?” He went on without waiting for a reply. “That I can’t vote because I’m a charge nurse. Management,” he added with a sneer.

“Are you sure?” I asked him. “I thought it was only full-time managers who couldn’t vote, not those who took charge occasionally or frequently, even.”

‘That’s what I heard,” Tim said, sounding not so sure.

“I think you’re wrong,” Jessie told him. “That was just a rumor.”

“Or something they—” he jerked his head toward the door “—tried to pull on us.”

“You’ll each have to decide this for yourselves,” I told them, ending the meeting.

After they left, I picked up one of the flyers. “NURSES CARRY THE PATIENT LOAD” it said over a drawing of a nurse of indeterminate gender bent over double at the waist, a stack of occupied hospital beds piled on her back. “GET BACK YOUR POWER—VOTE UNION” was followed by the union Web site and phone number. I laid the flyer back on the table and went out.

I WAS HEADING BACK to my office to try to get in a few minutes to attack the work multiplying on my desk when Judyth, her penciled eyebrows drawn together in a furious frown, stomped off the elevator and headed toward me.

“In your office,” she hissed through clenched teeth. “I told you to keep your mouth shut!” she screeched as I scrambled to close the door behind her. An elderly man peeked in as he passed by.

“Calm down, Judyth, I have no idea what you’re talking about.” I motioned toward the chair beside my desk, but she ignored me.

She tapped one patent leather toe on the tile floor. “That lawyer, the one the Guardinos have. You talked to him, didn’t you? After I told you specifically, do not talk to anyone!”

“Yes, but it’s nothing to worry about. For godsakes, settle down and listen to me.”

She took a measured breath and motioned for me to get on with it.

“He told me he was only trying to appease the family by making a routine visit. Just so he could say he talked to someone at the hospital.”

“And you believed him? What planet are you on? You know damn well not to talk to a lawyer without our attorney present.”

“Of course I know that, and I didn’t tell him anything. In fact, he didn’t even ask me any questions. And besides, I said I wasn’t here when Mr. Guardino died.”

“So what made him want to see me, you tell me that.”

“What did he ask you?”

“I haven’t seen him yet. He’s waiting downstairs right now.”

“It’s probably the same reason he came to see me. He’s just trying to placate the family.”

She took a breath. “Maybe...”

“Are you going to talk to him?”

“It looks too suspicious if I refuse,” she said, biting a corner of her tongue. “But I’m going to have our attorney with me, that’s for sure.”

“It’s going to be all right, Judyth,” I said. She did have a tough job; everything that went wrong in patient care circled back to her eventually.

“Okay, Monika, I’ll let you go this time.”

Let me go?

“I won’t write you up for it, but you make sure you never talk to a lawyer without legal and me with you. Understand?”

Write me up? For what? My sympathy for her fizzled.

AS I NEARED the round table in the corner of the bar, the conversation dropped off suddenly. All the nurses from ICU had been invited to hear Serena’s boyfriend play in the band at Bubba’s Bourbon Street, a New Orleans-style hangout. On the mural behind the table a laughing jester cavorted among Mardi Gras revelers. Art Deco posters adorned the adjoining wall, interspersed with feather-decked masks, their delicate ribbons fluttering in the breeze of ceiling fans that kept the smoke-ladened air moving. A favorite of local St. Louisans, Bubba’s was crowded, as it was most evenings.

Only Serena, Tim, Laura and Peggy, who used to work in ICU, had shown up so far. The table was full so I pulled up a chair from the next table, and they squeezed together to make room.

I gave everyone a nod as I sat down, adding a small smile for Tim. He kept his face blank. Others shuffled in their seats or looked around the room. The band was apparently on break.

I broke the silence. “Glad you could join us, Peggy,” I said. Peggy had transferred from ICU to psychiatry after she had returned to St. T’s following treatment for drug dependency. She had said there were fewer narcotics in psychiatry and, more importantly, less stress.

“I gotta go,” Tim said, dropping a five on the table. He left with a quick glance at me.

“What’s wrong with him?” Peggy asked. Statuesque with a rosy complexion and aubum-hued brown hair, Peggy wore a turquoise short-sleeved camp shirt with white capri pants.

“It’s about the union,” Serena said, glancing sheepishly at me. “We were talking about it before you came in.”

“I figured as much,” I told her.

“He had just told us to not be swayed by the insurance that administration offered us,” Peggy said, referring to the announcement that had come with our last paycheck about how the hospital was now providing life insurance in the amount of our annual salary. “Tim said it was just a way to pretend they were trying to be fair. For myself, I’d rather have more money in my paycheck,” Peggy said to the table. “Not for my sister after I die.”

A blast of hot air hit us as the door opened and Bart walked in, his arm around a woman with short, dirty-blond hair cut pixie- style. She wore cutoffs, a snug yellow top that almost reached her waist and sandals. Bart’s navy T-shirt stretched tight across his muscular chest, and he wore khaki pants and loafers without socks. They pulled up more chairs and crowded around the table. Finally, Bart let go of his companion.

Laura said hello to them.

I introduced myself to the woman, whose name was Lisa.

“Lisa’s a nurse in the E.R. and helped us out one day last week when you were off,” Laura explained. “She’s Bart’s fiancee.”

“Girlfriend,” Bart corrected.

“Anyone else coming?” I asked.

“Jessie isn’t,” Serena said as a bored-looking waitress propped a small black tray on her hip and stood waiting, pencil poised over her order pad.

“Margarita,” Lisa said quickly.

Bart frowned.

Lisa’s chin went up. “I’m not working tonight. I can have anything I want.”

“Sprite for me,” Bart said. “I am going to work tonight,” he said, giving Lisa a sideways glance.

Laura and I ordered beers, and Peggy and Serena asked for Cokes.

“What do you think about the union, Bart?” Laura asked.

Bart kept his eyes on Lisa.

Laura repeated her question.

“I don’t. Think about it,” he said finally, turning toward the group.

“He thinks unions are just for the masses, the ‘worker bees’ as he calls them,” Lisa explained, giving him a too-bright smile.

“I just don’t think it’s very professional, that’s all,” Bart said with a note of defensiveness.

Laura spoke up. “What’s not professional is the way the hospital cuts staff and expects us to make up for it.”

“Yeah,” Serena said, turning to me. “You’re the boss. Why don’t you do something about it?”

How could I make them understand that I didn’t control the hospital budget, I couldn’t hire people when my budget had been cut, and I had next to no influence on administration about anything?

“She’s just middle management, Serena, she just manages on what she’s given,” Peggy said. “The best she can,” Peggy added with a smile to me.

“That’s why we need the union,” Laura said, looking around at each of us. “Then we’ll have some power. Collective power.” Bart snorted. “You’ve been listening to the propaganda. Only you can get yourself ahead.” He tapped a forefinger firmly on the table. “You can’t depend on anyone else to do it for you.”

“Maybe for the rest of you,” Laura said. She’d changed from her scrubs to a sleeveless white blouse and stone-colored pants, her clothes as nondescript as her hair and skin. “You’ve been in nursing for a while, but I’m just starting out. I need to pay off school loans. This job’s got to work out for me!”

“Listen, I know about unions,” I said, knowing I was probably going to say too much. “My dad was in the union all his life. At the brewery.”

“They have to belong, don’t they?” Serena asked. “If they want to work there.”

“That’s true. Everyone eligible has to pay dues.”

“Did they ever go on strike?” Serena asked.

“Once,” I told them. “I was pretty little, but I remember he said they needed the union to protect them from the big guys.”

“That’s why we need one, too,” Laura said.

“What worries me,” Serena said, “is what would happen to the patients if we ever went out on strike?”

“Nurses can’t strike,” Peggy told her. She turned to me. “That’s what I was arguing with Tim about. Why should we be getting in all this trouble when we don’t have the leverage of striking?”