Angels on the Night Shift (7 page)

“Wow,” Clara whispered, staring at me.

Jeff Ryan didn’t say anything, but he was nodding his head.

“I talked to Greg Hartley about this once,” I added. “He said every word of it was true, and that Rob was a new man from that moment on. I remember him grinning at me when he said, ‘Rob was bound and determined to never face that wolf again. And you know, Doc, he never will.’ ”

6:20 a.m.
The remainder of the night had remained quiet, and I told Jeff and Amy I was going up to the ICU to check on a couple of patients.

“Page me overhead if you need me,” I told them as I headed to the back of the department. “I won’t be very long.”

The staff elevator was empty as I went up to the third floor, to the ICU. I thought about Blaine Anderson and wondered what I would find there. And as the doors of the elevator opened, I remembered Ernest Shays and his torn aorta. I hadn’t heard any more about him.

I stepped out of the elevator and turned right, heading to the back entrance of the unit. Charlotte Stanley looked up as I walked through the automatic doors and toward the nursing station.

“Dr. Lesslie, what brings you up here?” she asked, pushing back in her chair from the desk. “We don’t have a code going on, do we?” she quipped.

Charlotte and I had worked together for a lot of years in the ER. She had wanted a change and was now the assistant director of the ICU. We missed her downstairs.

“Let me guess,” she answered herself, reaching over to the patient chart rack. “You want to see Mr. Anderson, I bet.”

She picked up the chart for room 6 and held it out to me. I could read “Anderson” on its dark-green front.

“Thanks,” I told her, taking the chart and sitting down in one of the rolling chairs next to her. “How is he doing?”

“Not too good, I’m afraid,” she answered quietly, glancing over in the direction of his cubicle. “He’s been on the vent since he got here, and we’ve had to keep him pretty sedated. Can’t keep his blood pressure up without a bunch of meds, and his kidneys have shut down. Dr. Dryer doesn’t think it will be much longer.”

I looked up from Blaine Anderson’s chart, suddenly struck by the finality of this statement. Bill Dryer was a good pulmonary specialist and knew his stuff. I had known when I saw Blaine outside the ER that he was in bad shape—but still, it wasn’t easy hearing this pronouncement.

“Hmm,” I sighed, standing and putting the chart down on the counter. “I’ll just take a look at him, if that’s okay.”

“Sure, no problem,” she told me, sliding her chair up to the desk again and continuing her charting. “Take your time.”

The overhead light was off in room 6 and it took me a moment to get used to the darkened cubicle. I tried to pull the curtain closed behind me as quietly as possible.

I was standing at the foot of the bed and was beginning to make out the slender, wasted form of Blaine Anderson, lying unmoving beneath his single sheet. Several kinds of muffled “beeps” were competing with each other from the head of his bed—the monitors of the ventilator and several other machines. Without thinking, I caught myself counting the number of his tubes. Somewhere along in my training, a senior resident had once informed me that if a patient had more than seven tubes exiting his body (IVs, Foley catheter, nasogastric tube, and so on), it was a sure sign they wouldn’t survive.
Six.
I counted six tubes, so Blaine might still have a chance, though only a very small one.

That was absurd, and I was wondering why I remembered stuff like that, when a movement in the corner of the room drew my attention. It was Mary Ellen Anderson, stirring in her recliner on the other side of the bed. An open book was lying in her lap, and her head hung sleepily on her chest. She must have somehow sensed my presence and was slowly looking in my direction and struggling to get her eyes open.

“Dr. Lesslie,” she whispered, glancing over at the clock on the far wall. “Good morning.”

I walked around the foot of the bed and stood in front of her. In hushed voices we talked for a few minutes about her husband. She remained hopeful that he would once more “pull through this” and that they would be going home in a few days. That wasn’t going to happen, but it wasn’t for me to tell her.

“You need to be sure to take care of yourself,” I said, stepping toward the curtain and taking it in my hand.

“I’ll be fine,” she answered. Then looking down at her husband, “We’ll be fine.”

I stepped out into the unit and pulled the curtain closed behind me. Charlotte was glancing over the counter at me and shaking her head. Then she looked back down at her work.

Halfway to the nurses’ station I was startled to hear, “Dr. Lesslie! Hey, Dr. Lesslie!”

The voice was coming from behind me, from room 4, two cubicles down from Blaine Anderson.

I turned and walked in that direction.

Ernest Shays was sitting straight up in his bed, his oxygen tubing secured to his nose and his IV attached to his left hand, which was now beckoning me.

“Come over here a minute,” he said in a forced whisper. He had seen Charlotte’s stern look when he had first called my name.

“I was askin’ about you the other day,” he told me, pointing to the lone chair in the cubicle. “Have a seat if you’ve got a minute.”

“I’ve got just a minute,” I told him, stepping over to his bed and shaking his hand. “Got to get back down to the ER, but I’m glad I got to see you.” I meant it—seeing him like this lightened my dark and heavy mood.

Ernest looked great. His color was good and his breathing was unlabored.

“Well, I’m glad you came by,” he said cheerfully. “I wanted the chance to thank you for what you all did in the ER. Wouldn’t be here today if it wasn’t for you guys. And hey, I’m supposed to be moved to a step-down unit later on today! How about that!”

He was grinning as he said this, and I found myself smiling as well.

“That’s great, Ernest,” I told him. “You look like you’re doing fine.”

“It’s a miracle, Doc, a flat-out miracle. Shouldn’t be alive, but hey, here I am!”

I glanced over at the wall clock—6:50.

“Ernest, I’ve got to get back downstairs,” I told him, moving away from the bed. “Don’t take things too fast now,” I warned him. “You don’t want to go backward.”

“Don’t worry about that, Doc,” he answered quietly, his eyes stealthily moving in the direction of Charlotte Stanley. “These nurses ride me like a bunch of bulldogs.”

“That’s what they’re supposed to do,” I chuckled, stepping out of the room.

“See ya later, Doc,” he called after me.

I had counted only four tubes. He would be okay.

As I turned the corner and headed for the nurses’ station, there stood Virginia Granger. It was an all-too-familiar pose, her feet apart, hands on hips, and her unwavering stare boring into me. If it was possible, it seemed that her starched white dress was brighter than usual.

“Good morning, Dr. Lesslie,” she said pleasantly enough as I walked up beside her. I glanced up at the clock—five ’til seven—about the time she usually arrived in the department.

“Good morning, Virginia,” I responded. “Is everything okay?” I always had the sense when I stood before her like this that she was going to bark, “Get down and give me fifty!” I couldn’t help it, but I had the same feeling this morning.

“Well, we’ve got a little problem,” she began, not removing her eyes from mine. “Darren Adler called in a little while ago. He’s scheduled to work tonight with you, but it seems he’s a little under the weather. Got the GI bug, he says.” Her eyes narrowed for just a second or two, as she studied my response. “Anyway, he won’t be coming in. Jeff has worked five nights in a row and needs a break, and Angie Weathers is going on vacation.”

She paused, letting this news sink in. Staffing was the thorniest problem we had, and every once in a while it became very difficult. We needed good people in the ER, twenty-four hours a day, especially lead nurses.

“What about Clara Adams?” I asked her, quickly glancing around to be sure she was not standing nearby. She wasn’t.

“Too young and inexperienced,” Virginia replied bluntly. “There’s really no one else at this point.”

I scratched my chin and looked down at the countertop. I was tired, ready to go home and go to bed. This problem would have to—

“What would you think about working with Patsy Wilson tonight?” Virginia asked, shifting a little and peering closer at me.

“Patsy Wilson…” I repeated slowly, the name bringing to mind a lot of memories. “Do you think she’s ready?” I asked her. “I mean, it’s been a couple of years, but—”

“Just got off the phone with her,” she interrupted. “She’s been working in a doctor’s office in Pineville and is off for the next few days. She wants to give it a try. Just tonight.”

“Wow, I never would have thought that,” I said softly, a lot of different emotions swirling in my head and coloring my thoughts.

“Sure,” I finally answered, standing straighter and taking a deep breath. “Patsy’s a good nurse, and if she…if you think she’d be okay, that’s fine with me.”

“I think it’s time,” Virginia said with finality, then turned and walked toward her office.

I stood there for a moment, still scratching my chin, and thinking.

Patsy Wilson had been one of the best nurses to ever work at Rock Hill General. She had grown up here in town and then got her nursing degree in Chapel Hill. She had spent some time in the CCU before coming to the ER, where she’d quickly become one of the shift charge nurses.

She was married, had two small boys, and had seemed to know every patient who came into the department. And just like Lori Davidson, she’d been calm in every circumstance, level-headed, and unshakable. That had all changed one early spring morning.

8:10 a.m.
“Rock Hill ER, this is EMS 3.” I was walking up the hallway from the ENT room and heard the radio squawk to life. Amy Connors quickly reached over and picked up the receiver.

“This is the ER, EMS 3,” she spoke calmly, sliding a pad of paper toward her and clicking her ballpoint pen. “Whatcha got?” She had switched off the speakerphone and was listening intently.

Patsy Wilson walked over and stood behind her, glancing down as Amy made notes on the pad in front of her.

40? yr old M—cardiac arrest—tubed—no pulse

That was all Patsy needed. She looked up at me and motioned to the cardiac room.

“Cardiac arrest,” she said calmly. “And a young guy, only forty or so.”

Amy hung up the receiver and looked up at us. “Three minutes out,” she said. “I’ll call respiratory and X-ray.”

“That
is
young,” I muttered. That was pretty close to my own age. Too close. We would need more information about this one.

I tossed the chart of the ten-year-old with tonsillitis onto the counter as we stepped across the hallway.

“ENT needs a strep screen,” I called over my shoulder to Amy.

Patsy quickly went to work in the cardiac room, opening an airway tray, just to be sure, and readying some IV fluids. Then she rolled the crash cart to the head of the stretcher, broke the seal, and opened the top drawer. The drugs we would need immediately were now accessible.

“That sounded like Denton Roberts on the radio,” she said to me, not pausing from her preparations. “Glad to hear that,” she added.

Denton was one of our most experienced paramedics, and we both knew this unknown and unfortunate man was in good hands.

Denton had said he’d already secured the patient’s airway with an endotracheal tube, but I found myself routinely checking the light on our laryngoscope, just to be sure. Then quickly glancing around the room, I was satisfied we were ready.

A couple of minutes later, we heard the automatic ambulance entrance doors open and then the clicking of the EMS stretcher wheels as Denton and his partner made their way toward us.

Denton pulled the stretcher into cardiac with one hand while methodically bagging his patient with the other. His partner was walking beside the stretcher, performing chest compressions. Patsy hurried over to his side and guided them to the cardiac bed.

The EMS monitor was on the foot of their stretcher, and I glanced down at the small screen. Nothing—just some undulating waves that moved with the chest compressions.

“Have you had anything?” I asked as we all helped move the man to our stretcher. It was awkward, and it took a moment to get him situated where we wanted him. Whoever coined the term “dead weight” knew what they were talking about.

“Just some agonal respirations when we got to the scene,” Denton answered, a little out of breath. “Nothing on the monitor. Never had a pulse. We’ve gone through the flatline algorithm a couple of times, but still no response.”

I looked down at the dusky face of this young man, then reached out and put my fingers over his left carotid artery. There was a faint pulse, keeping time with the chest compressions being delivered by the other paramedic.

“Hold it a second, Ben,” I told him.

He took a deep breath, stood up straight, gratefully put his hands on his hips, and waited.

I kept my fingers where I had placed them, feeling for any kind of pulse, any kind of cardiac activity. Nothing.

“Let’s go again, Ben,” I told him “Are you okay?”

“I’m fine,” he answered, resuming his position near the stretcher and carefully placing his hands on the man’s chest. Then once more he began his rhythmic downward thrusts.

Patsy had correctly anticipated the sequences of drugs we would use, and I listened to each side of the patient’s chest, making sure he was being adequately ventilated. Textbook.

“Any idea about this guy?” I asked Denton.

“Nope. We found him slumped over in his car. Looks like he just barely made it into the parking lot of the Y. Probably going to exercise, by the looks of his clothes.”

For the first time, I noticed his jogging suit and running shoes. His top had been cut open, exposing his chest. Maybe that’s why I hadn’t paid much attention to his attire when he first came in.