Deadly Diversion: A Medical Thriller (8 page)

“That’s not exactly true,” I told them reluctantly. “Nurses can strike with notice. They have to give the hospital time to prepare.”

“For what? To fire us?” Laura asked, splotches of red creeping up her pale neck.

“Transfer patients, cancel elective surgery, train supervisors, that sort of thing. They can’t fire anyone.” I had slipped into my administrative role in spite of myself. I was torn between wanting them to know I understood how difficult it was to care for patients when we were understaffed, how afraid we all were that something would go wrong, and knowing that I couldn’t get involved.

A police officer came in, glanced our way, and straddled a stool at the bar.

“Lots of professionals are in unions,” Laura said. “Police.” She nodded toward the man at the bar. “Ball players, pilots.”

“Musicians,” Serena added, looking toward the empty stage. Tonight she wore low-rider jeans and a filmy black short-sleeved blouse open to reveal the scrunchy magenta tube top underneath. A row of gold and colored stud earrings marched up one ear, and a dangly earring of filigreed gold on the other ear swung wildly as she looked around. “Hey’d you see where police cars are gonna have ads on them?” she asked.

“Like taxis?” Lisa inquired.

Serena giggled. “Next thing you know we’ll have ads on our scrubs.”

Conversation drifted to Serena’s boyfriend as the canned music stopped and we turned toward the stage.

“They’re starting,” Serena said, bouncing on her seat. She squeezed my hand and smiled up at the stage.

Five young men shuffled up onto the stage perched on a wide pedestal behind the bar. They fiddled a bit with guitars and cords and speakers, and soon started up. Talk was impossible. The drinks arrived along with a basket of peanuts in their shells.

Lisa stood to excuse herself and reached behind her to snag her bag hooked on the chair, revealing a small gold ring in her navel. Peggy joined her and they headed toward the restroom. Bart stared at Lisa’s back until the restroom door swung shut. I leaned over and asked him if she was all right. He nodded and stirred his Sprite with the straw, glancing toward the restroom until Lisa and Peggy finally emerged.

Between songs, the talk turned back to the hospital. Accreditation was on everyone’s mind.

“We’ll do fine,” I tried to assure them. “Joint Commission’s just doing their job, and it really helps us.”

“Helps?” Serena asked. “How can it help to be on warning?”

“It makes the hospital do what they’re supposed to. Hire more people.”

“And pay them more than many nurses who have been there for years,” Peggy added.

“If that’s what it takes,” I said, defending administration.

At the next break, Serena introduced us to her boyfriend, Ray, the band’s drummer. Ray sported multiple piercings—nose, eyebrow—and a braid of brown hair dangling down his back. A straggly goatee marred what might have been a good-looking face. I thought I detected a glint of metal in his mouth and wondered idly what it would be like to kiss someone with a tongue stud. Ray apparently let his music do his talking; his mumbled answer was lost in the noise of the bar. He acknowledged the group with the briefest of nods. The sickly sweet odor of marijuana lingered after he left.

After another set, I told them I had to leave, and Peggy joined me when I stood up. Outside the smoky bar we stopped and took a breath of the still-hot evening air.

“What’d you think about Bart’s girlfriend?”

“What about her?” I asked, pulling my keys out of my shorts pocket.

“She’s on drugs,” Peggy said simply.

“Drugs? Maybe she just had too much to drink. You heard her. She doesn’t work tonight, and Bart’s driving.”

“I saw her in the ladies’ room. Her pupils were dilated.” Peggy’s hair, which she had let grow long, swung across her shoulders as she shook her head.

“She had just come from a dark room,” I said as we reached Peggy’s car. “They should have been dilated. Yours probably were, too.”

“Nope, this was when we were washing our hands. She’d been in there long enough for her pupils to constrict. I looked in the mirror. Mine were tiny slits. Hers were huge. She was acting funny, too.”

“Maybe she’s on some medication that dilates her pupils. I think she was just having fun.”

“It’s no fun,” Peggy said, unlocking her car door. As she slid into the driver’s seat, she looked at me and said, “Believe me.”

I didn’t say anything. I thought Peggy was seeing drug problems in others because of her own problem in the past, and now that she worked in psychiatry, maybe she was diagnosing mental illness all around her. Much like nursing students do when they develop symptoms of every disease they study.

“Addicted people will do anything to get their drug of choice. Anything,” she added, slamming her door.

After she left I climbed into Black Beauty and fired her up. Let Bart handle her, I thought as the top slid back and I looked up into the night sky. Earthbound problems seemed minuscule at that moment. A pickup truck squealed around the corner, spewing fumes. I reluctantly slid out from the curb and headed home.

SEVEN

Friday, 10 August, 0713 Hours

I HEARD THE PAGE announcing the code as I stepped off the elevator. I ran through the double doors to ICU and followed Laura, who was heading toward Huey’s room with the crash cart, hoping Huey had just pulled a lead off his chest.

I was wrong.

Huey lay still, his prosthesis uselessly hooked on the IV tubing and his amputated arm wrenched loose from its straps. His eyes were open, staring at the ceiling. A thought shot through my mind—if Huey died now, he’d be spared. Then the adrenaline kicked in and I shifted into automatic.

Oxygen hissed into his nose through a cannula but his chest didn’t move.

“Huey,” I said loudly. “Wake up!”

No response.

“Come on, Huey, wake up!” I shook him. I checked his carotid pulse. It was weak and fluttery.

Respiratory arrest.

I pulled on gloves, grabbed the reversal kit hanging on the PCA pump, pulled out the syringe of Narcan, and drew up two doses. I noticed that the foil covering was off the rubber end of the access port on his IV line that we use to inject additional medications, and that it was discolored from the other drugs Huey had been getting. I cleaned the port with an alcohol wipe that Laura tossed me and stabbed the needle in, pushing in the drug that should reverse the effects of excessive narcotics.

“Wake up, Huey, come on, come on, wake up!” I shook him again. His body felt flimsy and his good arm flopped on the bed until I let go.

A minute had passed.

I injected the second dose of Narcan and waited, watching the monitor. Uneven lines jerked across the screen, the alarm screaming.

“No respirations?” Laura asked.

I shook my head, then yanked Huey’s head back, slid an oral airway through his mouth and down his throat, grabbed the Ambu bag off the wall, hooked it up to the oxygen flow valve, and slapped the bag over his nose and mouth. I cranked the oxygen flow meter up as high as it would go—to fifteen liters— and began squeezing the bag, trying to push the hundred percent oxygen into his lungs.

His chest resisted.

I squeezed harder, pushing in as much oxygen as I could.

Tim came in, quickly surveying the scene. “V-tach,” he said, glancing at the erratic rhythm on the monitor.

Huey’s heart was in ventricular tachycardia.

Laura pulled Huey’s hospital gown loose from his body and bunched it up under his chin. She took over bagging him as I slapped the florescent-orange jelly pads on his chest, one on his sternum, the other over his left nipple, and put the defibrillator paddles over them firmly on his bony chest.

“Go directly to 360 joules,” I told Tim, “since he’s in V-tach.”

Tim nodded and set the defibrillator charge for the first jolt.

“Stand clear!” I yelled.

Pressing hard on the paddles, I pushed both discharge buttons simultaneously. I let up and looked at the monitor.

A single line bounded wildly up and down across the screen, its shrieking the only sound in the room.

“360 again,” I ordered.

“360 joules,” Tim responded.

“Stand clear!” I shocked Huey a second time.

No change.

A third jolt.

Nothing.

An anesthesiologist rushed in to intubate Huey. Laura moved to the head of the bed to assist, pulling an intubation tray off the code cart. She tore it open and tossed the equipment onto the bed while the anesthesiologist squeezed between the head of the bed and the wall. As the anesthesiologist called for equipment, Laura handed it to him.

The doctor struggled to get the tube down Huey’s throat and into his barrel chest distended by pulmonary emphysema. “What’s his 02?” he asked, glancing toward Huey’s hand where the pulse oximeter should have been clipped to a finger to record oxygen levels in the blood. The finger clip lay on the sheet.

“His clip’s off,” I told the doctor.

“BP? Pulse?”

Tim wrapped a blood pressure cuff around Huey’s arm and inflated it. It deflated downward quickly. “80 over 30,” Tim said, grabbing Huey’s wrist. “No palpable pulse,” he reported.

A squiggly thread rippled across the monitor’s screen. Asystole.

“V-fib,” I said out loud. Huey was in ventricular fibrillation now.

Four minutes had passed since the alarm had sounded. Huey’s face was bright blue, his eyes still staring at the ceiling.

Dr. Lord came through the door, breathless.

I reported our progress. “He’s in cardiac arrest. No pulse. Shocked 360 joules times three. No response.”

He glanced at the monitor. The wiggly line continued.

“Epinephrine,” he ordered. “One milligram, IV push.”

Tim was already drawing it up. Swiping the access port on the IV tubing with an alcohol wipe, he plunged the needle into the stopper and injected the epinephrine.

The screaming alarm was the only sound.

“Shock,” Lord ordered.

“Stand clear.” I shocked him again.

Nothing.

Frowning, Lord said, “Epi again.”

Tim gave it.

“Shock again, 360.”

No response.

“Stat blood gas,” Lord said.

Tim grabbed a blood gas kit off the code cart, turned Huey’s hand over and expertly inserted the needle deep into the inside of Huey’s wrist. Dark red blood backed up into the syringe.

“Is that venous blood?” Laura asked.

“Nope, I got the artery. His blood is so saturated with C02 it’s turned it dark.” Tim put the syringe in ice and handed it off to a student. “Get stat blood gases,” he ordered as she scooted out the door.

“Push epi again?” Tim asked Lord.

“Yes.”

We continued alternating shocks—360 joules—with epinephrine as Lord ordered it.

“Other drugs?” Tim asked finally.

“It won’t help now,” he said, rocking back on his heels.

“Don’t quit yet,” I said, my voice rising. “This is just what he worried about, that we wouldn’t keep trying if he coded.”

Lord shook his head.

“Please. Please keep trying,” I begged even as I stared at Huey’s still, blue face.

Cyanosis colored Huey’s arms and legs bluish-purple, and streaks of purple and blue mottled his chest. Even with the jelly pads, the paddles had left bum marks where I had shocked him.

The respiratory therapist came in to report on Huey’s blood gases that Tim had drawn. She handed me the lab printout strip.

“His 02 is 37, C02, 65,” I read.

Incompatible with life.

“How long’s it been,” Lord asked, “since the alarm?”

I looked at the clock. “Thirty-three minutes.”

“Too late now,” Lord said. “Stop drugs.” He moved to the bedside. He checked Huey’s neck for a pulse, listened to his chest and, finally, bent over with his ear next to Huey’s mouth. He shook his head and glanced again at the monitor now humming a straight line across the screen, whining our failure. “We’re calling the code,” he said.

“You’re calling the code.” I said, trying to keep my voice steady. I glanced at the clock behind me on the wall. “I have the time as 0749 hours,” I added, for the record.

“Yes, patient pronounced, 0749,” he said, and walked out of the room.

I stood a moment after the others had gone, feeling the emptiness. Even in death Huey looked somehow alive, as if his spirit was too strong to let go. He still stared at the ceiling, a surprised expression on his face. Sighing, I peeled off my gloves and threw them in the trash.

“You okay?” Jessie asked me back at the desk.

I clutched Huey’s chart to my chest and swallowed.

Ruby snorted.

“What?” I asked her.

“Now we got a room.”

“Huh?”

“Well, we do,” she said, lifting her chin. Loose flesh jiggled underneath. “They got a accident victim in the E.R. needs a room.” She picked up the phone.

I opened Huey’s chart and glanced at the record for the PCA pump. “He got a fresh morphine syringe on his pump right before he coded.”

“Wasn’t he due?” Tim asked

I checked. “Yep.”

“So what’s wrong?”

“I was wondering if it was too much. This is what he worried about, that we might not be able to resuscitate him.”

“We did all we could, Monika. The damage had been done. His brain was fried.”

“I know,” I said with a sigh.

I checked the night-shift report.

“Something else?” Tim asked.

“Could Bart had given him morphine, too, and not charted it?”

“What makes you think that?” Tim asked.

“Uh, he’s not always as accurate as he could be,” I explained, equivocating.

“I don’t blame him if he missed something,” Jessie said, coming through with a wash basin. “What with all the work we’ve got...” Her voice trailed off as she headed into Huey’s room to help Laura, who had started cleaning up Huey’s body for the morgue.

“Nah, Bart was gone before,” Ruby said. “With that Lisa.”

“Lisa? Was she in here?” I asked.

Ruby sat down, creaking the springs in her chair. “Yep. She came in right behind me and she saw him in the med room, but I stopped her. No, sir, I weren’t having her in there with all them drugs, not in my med room.”