Code Blue (17 page)

Jane poked her head into the office and waved a chart."Ready?"

"I suppose so." Cathy pushed herself up out of her chair, feeling as though her spine had turned to mush. "And while I'm with this patient, would you total up our unpaid claims? Then start calling the insurance companies to see if you can speed up those payments."

"Is this about that letter?"

"I'm afraid the letter is only the tip of the iceberg. But right now, that iceberg's about to crash into our ship. I need to raise over five thousand dollars in a hurry if we don't want a repeat of the Titanic."

Cathy waited until Jane left before she swiveled around and pulled a dog-eared directory from the shelf behind her desk.
Please don't let it come to this,
she thought. But she had to find out. If everything fell to pieces, did she have a way out? Was there somewhere she could go and start over yet again?

She could only imagine the anguish pursuing this option might cause her. But it looked as though Cathy's chances of staying in Dainger were slim to none. Frying pan or fire? Bad choices, either way.

Before she could lose her resolve, Cathy punched in a series of ten numbers. An electronic voice invited her to enter an extension number or hold for an operator. What was the extension? Once it had been as familiar as her name. Could it have flown from her memory in such a short time?

Think, Cathy.
"Please hold for the operator." Was it 2732? Was that it? She punched in the numbers and waited as the call rang through.

"Family Practice."

When she heard the voice, the name of the secretary came to Cathy immediately. "Lisa?"

There was a brief pause. "Yes? Who's calling?"

"This is Cathy Sewell. Is Dr. Gross in?"

"Oh, Dr. Sewell. So good to hear from you. How are you doing?"

Just wonderful—someone wants to kill me, the bank is threatening to foreclose, and I'm sleeping in a guest room in the parsonage after my apartment burned. Couldn't be better.

"Fine," Cathy said. "Just fine. Now is Dr. Gross there?"

"Sure. Let me buzz her."

Cathy was relaxing to the strains of a classical piece when she heard the cheery voice of the department chair, the woman who'd been her mentor during her residency. "Cathy, good to hear from you. How can I help?" That was just like Amy. Right to the point.

"Amy, is that position at the school still available?"

The silence that followed gave Cathy her answer before Amy spoke. "We filled it right after you turned it down. Are there problems with your practice there in Dainger?"

Cathy assured Amy that everything was fine. Oh, there were a few glitches, but nothing unusual. She just wanted to explore her options. Maybe she'd come back for Grand Rounds next month and they could visit. Amy encouraged her to do that, perhaps stay over so they could have dinner together.

As she hung up the phone, Cathy felt her throat tighten, as though someone had just put a noose around her neck and kicked the horse out from under her. Pretty apt, she figured.

That door had slammed shut. There was no way out. No running away from Dainger.

The day seemed to stretch to infinity, but at last Cathy could head home. Well, not really home. Then again, where was home? Did she even have a home? Ugh, enough philosophy.

She had just buckled her seat belt when her cell phone rang. She fished it out of her purse and scanned the display: the hospital. Had there been an order she'd neglected to write? Was she behind on her dictation again? "Dr. Sewell."

"Doctor? This is Glenna in the ER. Isn't Ella Mae Mercer your patient?"

Bells clanged in Cathy's head. "Yes."

"The ambulance just brought her in—comatose. When Ella Mae didn't return from lunch, her secretary got worried and decided to check on her. She found Ella Mae on the couch in her living room, totally unresponsive. The secretary called 911. They brought her here."

Cathy threw the car into reverse and backed out of her parking space. "Is she breathing on her own?"

"Shallow. Blood pressure's down, pulse slow. Pupils a little constricted but equal. No signs of trauma."

"Get her on oxygen—mask for now, but we may have to tube her. Start an IV, draw blood for glucose, BUN and creatinine, liver panel, and a tox screen. Get some blood gases cooking. Alert radiology that we may need a head CT.Who's the ER doctor today?"

"Dr. Patel. He thinks she may have had a stroke."

Cathy accelerated, hoping she wouldn't encounter her nemesis, the black SUV. She squealed around the corner."Tell Dr. Patel not to do anything. I'll be there in two minutes."She took a deep breath.
Be diplomatic, Cathy.
"And thank him for me."

In a few moments, Cathy was at Ella Mae Mercer's bedside.Her examination was swift and focused. No cuts or swelling of the scalp. No stiffness of the neck. Pupils equal in size, maybe a bit constricted, but normal reaction to light.Tendon reflexes diminished generally. No evidence of head injury. A little young for a stroke. "Let's hold offon that brain CT for now."

"Radiology's on standby. I'll keep it that way until you're sure," Glenna said.

"See if one of the ambulance crew that brought her in is still around." Cathy heard the squeak of rubber-soled running shoes as Glenna hurried out of the room.

The lab work would help, but it would take a while. The physical exam suggested a few things. But if Cathy's suspicions were right, the EMTs should be able to confirm them.

"You wanted to ask me something, Doc?"

Cathy turned and saw a paramedic she didn't recognize standing in the doorway.

"Tell me what you found at Ella Mae's home."

"She was on the living room couch—lying there with her hands crossed over her chest— almost like she'd been . . .laid out."

"Any sign of drugs in the room?"

"Didn't I—?" He reached into the pocket of his jacket and pulled out a small amber vial. He held it out to her. "I picked this up offthe coffee table next to the couch. Thought I'd already given it to Glenna. Sorry. I'm coming offa double shift, and I guess I'm a step slow."

A glance at the label on the bottle confirmed what Cathy already suspected. Now she knew why Ella Mae was in a coma.

C
ATHY PUT THE VIAL IN HER POCKET. "BESIDES THE PILL BOTTLE, DID YOU see any liquor? Beer? Wine?"

"No." The EMT shook his head. "Nothing like that in the room. Just a half-full glass of water on the table next to the pills."

Ella Mae had said she didn't drink. Cathy hoped that was true. If so, it might make the difference between her living and dying. "Thank you. Now please send Glenna back in here."

Cathy turned back to Ella Mae, letting her eyes travel back and forth between the figure lying deathly still on the bed and the monitor displaying her vital functions. Respirations were shallow and slow, oxygen saturation dropping. Blood pressure down, although not at shock levels. Cathy needed to rid the woman's circulation of the tranquilizer as quickly and completely as possible. But before that, she had to make sure Ella Mae's breathing and circulation were adequate.

"So it's a drug overdose?" Glenna's voice came from behind Cathy, soft yet focused.

"I'm pretty sure it is, and I don't have time to wait half a day for the results of a tox screen. I'm ready to go with that diagnosis."

"What do you—?"

A sharp electronic screech made Cathy turn toward the monitor. The pulse oximeter showed a dangerous drop in oxygen saturation. When Cathy looked at Ella Mae's chest, she could hardly detect any motion there.

"She's quit breathing. We need to tube her." Cathy snatched up a laryngoscope from the equipment cart in the corner and moved quickly to the head of the gurney. She checked the light at the tip of the scope, then moved the plastic oxygen mask aside and opened Ella Mae's mouth.Cathy slipped the L-shaped instrument in, moving it carefully along the tongue, lifting the epiglottis. Pooled saliva obscured her view of the vocal cords.

"Suction," Cathy said.

The words were hardly out of Cathy's mouth before Glenna slid the tip of a suction tube into Ella Mae's throat and cleared the secretions.

"Endotracheal tube." Glenna slapped a large, curved plastic tube into Cathy's free hand.

Where did the vocal cords go? It had probably been a year since Cathy had done an intubation, but she hoped her instructors had been right when they said it was like riding a bicycle.

"Please, God." She didn't realize she'd spoken the words aloud until she heard Glenna whisper, "Yes, please Lord."

There! She saw the cords, the gateway to the airway she had to enter. Careful now, don't mess this up. Cathy eased the tip of the tube between the cords, and in a matter of seconds a mechanical ventilator pumped oxygen into Ella Mae's lungs at a regular fourteen breaths per minute.

Cathy taped the endotracheal tube in place. "How's her pressure?"

"Still ninety over sixty. Pulse steady at fifty- eight. Want to give her some Levophed?"

"Put some in a bottle of D5W and piggy-back it into the Ringer's lactate that's running. We'll try to titrate her pressure back up. And get me some Romazicon. I'll give her a dose IV. That should help."

"Right here," Glenna said. "I drew up 5 ml. in the syringe.That way you can give two doses if you need to."

Cathy swabbed the insertion port of Ella Mae's IV tubing with alcohol, inserted the needle, and injected 2 cc of Romazicon.

In a few minutes, Ella Mae's vital signs had stabilized, but she still was unresponsive. Time for the messy part— gastric lavage. Cathy rummaged in the cabinet until she found a nasogastric tube. She lubricated the long, thin tube and passed it through one of Ella Mae's nostrils, advancing it carefully until she was sure it was in the stomach. Then Cathy used a large plastic syringe with a rubber bulb at one end to draw up saline solution. She inserted the tip of the syringe into the tube and gently squeezed the bulb until all the liquid had been delivered. She waited a few seconds before releasing her pressure, letting the bulb expand to create suction that would pull the stomach contents back into the syringe.

The first washing yielded very little. On the second, Cathy hit pay dirt. When she applied suction this time, a number of small, white, oval tablets, still intact, floated into the syringe.She repeated the maneuver a dozen times or more until the return was completely clear. Good. Now to put something into the stomach to inactivate any drug still there.

"Let me have that activated charcoal," she said. "A hundred grams in half a liter of water should do it."

Cathy injected the mixture into Ella Mae's stomach and clamped the end of the tube. She'd leave it in place for a while, just in case.

How were the vital signs doing? She looked at the monitor and saw that Ella Mae's blood pressure had dropped again. Increase the Levophed? If she gave too much, she could give the woman a stroke from bleeding into the brain.If she let the pressure get too low, there could be damage to vital organs from inadequate blood flow. She decided not to let the pressure go any lower. She increased the flow of Levophed into the IV, her eyes glued to the monitor. After five minutes the pressure was at a level that Cathy felt was acceptable.

Cathy closed offthe Levophed drip. "Leave that hanging, but I hope she won't need any more."

"So what's next?"

"Now we wait," Cathy said. "Glenna, how long have you been working in the ER?"

"Since they opened this new hospital. I wanted to go to medical school, but my parents couldn't afford it. I went to nursing school on a scholarship, came back here, and this job opened up right about then so I grabbed it. I guess—"

There was a faint hiccup from Ella Mae. She moved her left arm, pulling weakly at the restraint that held it to the side rail of the gurney. Cathy picked up a rubber-headed reflex hammer and tapped at the bend of Ella Mae's elbow, first one and then the other. She thought that maybe the resulting jerk was a bit stronger than before. Or was that wishful thinking on her part?

Cathy put down the hammer. "She may be waking up. I'll hold offon more Romazicon for now."

Gradually, the numbers for blood pressure on the green monitor screen above Ella Mae's head climbed. Her pulse rate sped up slowly. She bucked against the tube in her throat. Cathy watched until she was sure that Ella Mae was breathing more rapidly than the programmed inhalations from the respirator. She flipped a switch and the respirator was silent.

"Let's keep the tube in until I'm sure she's okay. Why don't you call the admitting office and get a room for her? She probably should be in the ICU for the next eight hours or so. And do we have a psychiatrist on call?"

"There's one who comes from Fort Worth twice a week.He's not here today, but he'll drive down for emergencies."

"No," Cathy said. "It's not an emergency. I can handle it for now. But we need to ask him to see her in consultation.Suicide attempts aren't in my area of expertise."

Glenna sniffed and Cathy thought she detected a smile on the woman's face. "From what I've seen, Doctor, there's not much that happens around here that you can't handle.But I'll call and arrange the consultation."

"Thanks, Glenna." Cathy brushed her hair aside. "And if it helps any, I think you're doing a better job of helping your fellow man right here than a lot of the doctors I've run into.So don't feel bad about not going to medical school. You just keep on with your work in the ER."

Cathy settled onto a stool in the corner of the room and wrote an admitting note and orders. She marveled that there was so much talent here in her hometown. Glenna, Will, Jane. She hated to admit it, but she had to include Arthur Harshman. Cathy had thought returning to Dainger constituted an admission of failure, acknowledgement that she wasn't good enough for the big time. Now she wasn't so sure.Maybe the big time was overrated. Maybe coming back home had been a good choice.

Cathy slid her key into the lock and eased open the front door.

"Dear, is everything all right?" Dora Kennedy, her hair in curlers, her flannel robe pulled around her neck, sat in an easy chair in the front room, reading a Bible. "You were so late getting home, we were worried."

"I'm fine. I just had an emergency case that took quite a bit of time. I didn't mean for you to wait up for me."

"You missed supper, but I saved a plate for you. In the old days I would have put it in the oven on low heat to stay warm. Now, I'll just pop it into the microwave."

Cathy followed Dora into the kitchen. She wondered what it would have been like growing up in a home where the kitchen was a center of social life. She could imagine the smells that filled the house as Dora cooked and Pastor Matthew sat at the kitchen table watching her, the two of them sharing thoughts from their day. She envied Will for the chance he'd had to be a part of that experience. In her home, the maid had done the cooking while her mother spent her days sequestered in her room, often taking her meals there as well.

"Can you tell me about your emergency, or is it confi- dential?" Dora punched a few buttons and waited as the carousel inside the microwave spun and the square box did its electronic magic.

"A patient took an overdose of tranquilizers—pills I'd prescribed, incidentally—and was brought into the emergency room in a coma."

"Were you able to save the patient?" There was concern, not curiosity, in the question.

"Yes. It was a tough fight, but everything turned out okay.The nurses in the intensive care unit will call me on my cell phone if there are any problems through the night."

Cathy looked at the plate Dora set in front of her: lasagna, green beans, a piece of buttered French bread. Dora opened the refrigerator and pulled out a small plate of salad."Milk or tea?"

"Milk, please. And thank you for saving this for me."

"No thanks necessary." She poured a cup from a Mr.Coffee sitting on the counter, pulled out a chair, and sat opposite Cathy.

Cathy picked up her fork, then saw the expectant look on the older woman's face. She didn't know if she could pray over the food, but tonight she felt as though she should. She bowed her head and said, "God, thank you for this food and for the wonderful woman who prepared it. Thank you for these people who have opened their home and their hearts to me. Amen."

"Is there anything we can do for the woman who tried to commit suicide?" Dora asked.

Cathy paused with a bite halfway to her mouth. Had she said "woman?" She didn't think so. "Do you know about this already?"

Dora nodded. "Yes, we know it was Ella Mae Mercer."

Cathy chewed a mouthful of lasagna and followed it with a swallow of cold milk. Wonderful. "To answer your question, I don't know what any of us can do. I'll ask a psychiatrist to evaluate her. When people try to commit suicide, it's generally a cry for help. Maybe he can find out what triggered this."

"Would it be all right if Matthew and I went by to see her? After you feel she's up to it, of course."

Cathy's answer came out without conscious thought."Why?"

"Because we care about our neighbors, just like Jesus taught us to. And sometimes praying for them isn't enough.Sometimes it's necessary to put hands and feet to those prayers. Maybe we can do something for her. But we'll never know unless we ask."

Cathy started to speak, then changed her mind and took a bite of bread so she'd have time to think. She'd been content to dump the problem into the lap of a psychiatrist. The Kennedys were willing to get involved themselves.

"Please don't take this the wrong way," Cathy said, "but I have to ask. When you see tragedies, you don't seem to shy away from them. And you don't get angry with God when they happen. I can't understand it."

Dora went to the coffee maker and refilled her cup. She held up the pot with a questioning look and Cathy nodded.She wasn't about to sleep anytime soon.

After handing Cathy a cup, Dora settled back at the table."We've had our troubles. You were too young to remember, but Will had an older sister. She died when she was a baby.Nowadays they would have called it SIDS or crib death or something. Back then, it was just 'the will of God.' It broke our hearts."

Cathy felt a tug at her own heartstrings. "How terrible."

"Yes, it was. But it wasn't God's fault. And we came through it, with His help." Dora stood and put her cup in the sink. She took Cathy's dishes from her and did the same.Then she looked into Cathy's eyes and said, "God didn't kill your parents. God didn't make Ella Mae try to commit suicide.And God didn't break your heart. He doesn't cause bad things to happen. But, when they do, He's here to comfort us. Learn to lean on Him. Don't give up on God. He hasn't given up on you."