Angels on the Night Shift (15 page)

“Can you tell us what happened?” I asked him.

Behind me, the radiology tech wheeled her portable machine into the room and beside the stretcher. She would be getting a chest X-ray to check on tube placement and for anything that might be going on in this little girl’s chest. The lab tech was drawing blood from her right elbow and Jeff was starting an IV in her left arm. It was controlled chaos, and there was a lot of noise. I stepped closer to the man so I could hear him.

He continued to wring his hands, and his eyes darted from place to place around the room, then focused back on his daughter.

He didn’t look up at me when I repeated, “Can you tell us what happened?”

“I was out in the yard, working…” he stammered. “I was just…I never thought it would…”

I leaned closer, trying to make out what he was saying.

“You were what?” I tried again.

“Dr. Lesslie,” Jeff called out to me. “Heart rate’s less than 30 and I don’t feel much of a pulse.”

I turned from the man and stepped back to the stretcher and the little girl. Her color might have been a little better, but she still wasn’t responding or making any effort to breathe. I looked over at the monitor. Jeff was right. Her heart rate was still dangerously slow. But why? With most kids, when you took care of their breathing, their heart rate would fix itself and improve. What was going on here?

“Look at her pupils,” Jeff said to me. He had raised both of her eyelids and was shining a flashlight into one and then the other. They were pinpoint and didn’t react to light. When the lids wouldn’t shut on their own, Jeff gently closed them.

“What do you make of that?” he asked me, searching my face for an answer. I wasn’t sure. Lack of oxygen usually makes a person’s pupils dilate, not constrict.

I was about to answer him when the X-ray tech came back into the room with the developed film and said, “Dr. Lesslie, you’ll want to look at this.”

She walked over to the view box, snapped the X-ray in place, then switched on the light.

As I quickly stepped across the room, I could tell from a distance that the endotracheal tube was in good position and where it should be. But as I got closer, I could see something was wrong—very wrong.

Her lungs were almost whited-out—full of fluid. It was the kind of chest X-ray you would expect to see in an elderly patient with end-stage heart failure. But her heart size was normal. What would—

I spun around and called out to Jeff, “Give her an amp of atropine! And then get ready for some more. She’s going to need a lot of it.”

Turning in the direction of the girl’s father, I walked over and got right in his face. “What were you trying to tell me?” I asked him, more forcefully now. I needed answers, and I needed them fast. “What were you doing out in your yard? And what was Trish doing?”

His eyes were glassy now, vacant. And he kept wringing his hands and sweating.

“We’ve got those army worms,” he said in a hoarse whisper. “They’ve killed most of the lawns in our neighborhood, and I was just trying to save ours. I didn’t think it would…” his voice trailed off and he just stared over at Trish.

“You didn’t think what?” I demanded, trying to get his attention. “Were you using some kind of insecticide? Some kind of poison?”

“Sevin,” he answered, almost mouthing the word. “The man at the hardware store told me to use Sevin dust. I was spreading it in the front yard and I…I wasn’t paying attention. There was a breeze blowing in my face, and no dust was getting on me. I just kept spreading it…and… and I didn’t know Trish had come out of the house and was walking behind me. I didn’t know…”

He stopped wringing his hands and tightly clutched both sides of his face. Then he started crying and rocking from side to side.

“She was lying on the grass,” he struggled between pain-filled gasps. “And there was dust all over her face and mouth and nose. And she was barely breathing. I grabbed her and jumped in the car and came straight here.”

He suddenly stopped, stood up straight, and started looking around the room.

“Where’s my wife?” he called out. “Where’s Fay?”

“Heart rate’s still around 40,” Jeff called out to me. “More atropine?”

I glanced at the monitor and then back to the man in front of me.

“Have a seat here,” I gently instructed him, guiding him to another stool in the far corner of the room. Then motioning to one of our techs, I said, “Stay here with him and try to keep him calm.”

Satisfied that he was being taken care of, I stepped back over to the side of the stretcher.

“Jeff, we need to get Amy to call the pharmacy for some 2-PAM. They’ll know what it is, and we’ll figure out a dose when we get it.”

Atropine was the first drug to be used for this poisoning, but 2-PAM was a more specific antidote. She might need a lot of it if she was going to make it out of the ER.

For the next hour and a half, we worked feverishly to save Trish. We were battling a potent enemy, and it looked like we were losing. Sevin belongs to a group of chemicals that are very effective in killing harmful insects. But in heavy doses they are also harmful to humans, especially children. They cause nausea and vomiting, muscle spasms, increased secretions, and a slow heart rate. Seizures and death can occur, especially in the very young, like Trish. Fortunately, the treatment is centered around the use of a couple of readily available compounds.

After two or three adult-sized doses of atropine, her heart rate got as high as 96 and she had a detectable blood pressure. We used the 2-PAM and things began to stabilize a little. She even began to make some purposeful movements with her arms and hands.

Her father (we found out his name was John Sessions) continued to sit on his stool in the corner of the room, staring blankly at his daughter. He didn’t get up when his wife, Fay, came into cardiac.

She immediately ran over to the stretcher and tried to hug her daughter, screaming her name and resisting Jeff as he gently kept her from disrupting our efforts. She finally calmed down when she was able to stand by the head of the bed and stroke Trish’s hair.

“I’m here, baby,” she whispered over and over.

Occasionally she would turn around and look at her husband, searching for answers and some support—
anything
from him. There was never a response. He just sat there, staring at the stretcher, his hands tightly clasping his knees.

By eleven o’clock we had done all we could in the ER, and Trish was on her way up to the pediatric ICU. She was stable, as far as her heart rate and blood pressure were concerned, and she was starting to make some efforts at breathing. But she continued to be mostly unresponsive, showing only the occasional movement of her hands. She didn’t respond to pain and her pupils still didn’t react to light, though they were larger now. We would just have to wait and see. It was a matter of time, and it was out of our hands.

John and Fay Sessions followed their daughter out of cardiac and down the hallway, leaving Jeff and me alone in the room.

He was trying to clean up the mess created by more than two hours of frantic activity, while I stood at the counter and tried to document what had just happened.

“I’m worried about the girl’s father,” Jeff quietly observed while reeling in dozens of feet of cardiac monitor paper strewn haphazardly on the floor. “He’s still in a daze. I’m not sure he knows what’s going on.”

“He knows,” I told him. “He just doesn’t know how to handle it. That was his daughter lying there, and in his mind, he caused this. Of course it was an accident, but I don’t think he sees it that way.”

“That’s what I mean,” he agreed, standing up straight and looking over at me. “I’m worried about how he’s gonna deal with it. I remember when I was teaching my daughter to ride a bike and she fell and broke her wrist. It was a simple greenstick fracture and did fine, but it killed me. I beat myself up about that for a long time. Still bothers me when I think about it. But this…this is a whole different thing. And I don’t know how I would…” his voice trailed off and he was silent.

I nodded my head in understanding. “Let’s just hope she recovers,” I sighed, turning once again to my charting.

The next morning, Ted Nivens was telling me about the elderly woman he was leaving me in ortho. She had tripped and fallen while getting up to go to the bathroom and had broken her right hip. We were waiting on her labs and for the orthopedist to come down and admit her.

“That’s all I’ve got for you,” he told me, and then headed toward the ambulance doors. He only took a few steps before he stopped and turned around.

“Oh, and you might be hearing something from the folks upstairs,” he added, moving closer and lowering his voice.

“The folks upstairs?” I asked.

“Yeah, the nurses in the CCU,” he began to explain. “Jane Plexico, specifically. The new charge nurse.”

“Why? What happened?” I was curious now.

“Darren was the nurse working with me last night, and we had two patients that needed to be admitted to the CCU. We were just waiting on beds, and as usual, it was taking a long time. But for some reason, it was really long last night, and Darren went upstairs to see what was going on. Apparently he found the staff sitting in their lounge, talking, and not getting either of the rooms ready. It had been more than four hours, and he exploded.”

Knowing Darren Adler, I could easily imagine that happening, and I probably wouldn’t have blamed him.

“What happened after that?” I asked Ted.

“Well, both of our patients were upstairs in the unit in less than twenty minutes,” he told me, chuckling. “But there will probably be some fallout. Just wanted to give you the heads-up.”

He turned around, and this time he made it through the doors.

They had just closed behind him when—“Code Blue! Pediatric ICU! Code Blue! Pediatric ICU!”

It was the hospital intercom, and there was an arrest upstairs in the unit. I looked down at Amy Connors and said, “Here—hold this!”

I dropped my briefcase on the countertop and hurried down the hallway toward the staff elevators in the back of the building. The pediatric ICU was on the fourth floor, and when I got to the elevator, one of the respiratory therapy techs was standing there holding the door open for me.

“Thought I heard somebody running this way,” he said. “Peds ICU?”

“Yeah,” I responded. “Thanks.”

The doors closed and I stood there, impatiently watching the panel of floor buttons as they lit up one by one.

“Must be that insecticide kid, the one poisoned by her father,” the tech said from behind me. I didn’t turn around, knowing he was probably right and not wanting to respond.

“Not many other children in the unit right now, and they’re all doing okay,” he added.

The elevator doors opened and we both hurried off to our right and to the nearby back door of the peds ICU.

There was a flurry of activity over in room 4, and one of the nurses there looked over, saw me, and motioned for me to hurry.

I made my way to the side of the bed and looked down. It was Trish Sessions. One of the unit nurses had her hands around the girl’s chest and was doing CPR, while another was pushing some IV medication through the tubing in her arm. Two of the staff pediatricians were standing at the foot of her bed, nervously looking at the various monitors on the wall and quietly conferring with each other.

“Is there anything I can do?” I asked them.

Trish had remained stable during the night, then had suddenly crashed a little over an hour ago. She lost her blood pressure and then her cardiac activity became very irregular. Her heart had been fibrillating for the past five minutes.

She was gone.

I didn’t speak to John or Fay Sessions that morning. Their family doctor had come in and talked with them about Trish and about how it was an accident and no one’s fault. And the doctor had stressed the importance of their supporting each other during this time and in the weeks and years to come.

Within six months they were divorced. It wasn’t long after that I saw John in the ER. He had come in with some multiple and vague complaints. He told me about the divorce and that Fay had moved back to Georgia to be near her family.

John Sessions was only a shell of the man I had seen that terrible morning in the ER. He had the same vacant, troubled eyes, but now he was lost. I wanted desperately to help him, but this kind of pain was beyond my healing. He needed to find forgiveness. And then he needed to forgive himself.

R
obert, if it’s under control when the 10 a.m. doctor comes in, Walter Stevens would like to meet with us in his office.”

Virginia had walked up beside me at the nurses’ station and spoke quietly, making sure no one heard what she said.

I looked up at the clock. That was a little less than an hour from now, and the morning hadn’t been too bad.

“Okay, Virginia,” I told her, signing the bottom of the chart in front of me and tossing it into the discharge basket. “I’ll do what I can.”

She turned without saying anything more and walked back to her office.

Great
, I thought.
That’s just what I need—another meeting with Walter Stevens.

Darren walked up and put the chart of the patient in ENT on the countertop.

“This is a good one,” he said, smiling.

Just then, I heard a loud holler from down the hallway in the direction of our ENT room.

“OH, LORDY!”

I looked down at the chart and asked him, “What’s the problem? Why the—”

“OH, LORDY! DO SOMETHING!”

“She’s got a bug in her ear,” Darren explained. “Looks like a candle fly, and it’s moving around. I thought I could grab it with some tweezers but it went in deeper. She thinks it’s going to lay eggs in there, and that’s really got her freaked out.”

“Come on,” I told him. “Let’s go rescue this gal.”

When Ted Nivens came in at ten, the bug lady was gone and there were only two other patients in the department. Virginia Granger was standing behind the counter. Her arms were folded across her chest and she was looking at me over the tops of her glasses.