Code Blues (10 page)

"So what are we left with?"

"Cardiac."

"Anything else?"

"Well." I had to think. "It could be that
his electrolytes are off, or that he's orthostatic."

Slowly, our plan came together. Basic blood
work, in case it was anything that could be picked up simply.
Serial troponins, EKG, and cardiac monitoring for the heart
component. He'd still need a Holter monitor as an outpatient.

"Good," said Dr. Dupuis. "Do posturals, and
do a rectal exam next time. Make sure he's not bleeding out the
back end." But he didn't seem mad, or contemptuous, or superior.
More matter-of-fact than anything else. How I imagined Dr. Radshaw
would be.

I returned to the bedside to take the
posturals, the blood pressure and heart rate lying and standing.
The patient hated standing there in his shorts and hospital gown
with his skinny white legs sticking out, and I found it awkward to
balance the cuff and pump it up while he was standing. But we got
through it. There was no significant difference in readings.

Next, the rectal exam. Some people don't
mind doing it, but I dread the entire ritual, even just getting
them to pull down their shorts and roll over on their sides, with
their hairy bums sticking out. The patients hate it, too.

When I did my first few rectals, I worried
that I wouldn't be able to find the patient's anus, a secret fear I
confessed to no one. Luckily, I always did find it. But sometimes I
had to nudge around with a lubricated finger before I managed to
squirm it in. This was one of those times.

"You're hurting meeeee—" squeezed out the
patient.

"You're hurting him!" accused the son.

I hurt him even more when I dug
around a bit, to make sure I got stool and didn't have to go in a
second time. "I'm sorry." I checked the gloved finger. Yep, stool.
Mission accomplished. "All done, sir," I chirped, and ran off to
smear the sample on a little yellow cardboard card that looked kind
of like a matchbox. I flipped open one side, revealing two windows
for me to smear with stool. Then I closed that side and flipped
open the other, to squirt a few drops of developer. A positive
sample turned dark blue-green. Negative was no color change. Like
right now. No blue-green, just the paper turned translucent, so
that I could see the poo on the other side.

I washed my hands thoroughly, documented my
negative findings, and picked up the next chart. It was an elderly
lady with dizziness.

"Dave, Bed B is desatting,"
said a nurse with big brown eyes.

Dr. Dupuis and I took one look at each other and tore off to
the resus room. Mrs. Cartier was sitting bolt upright in bed. A big
oxygen mask covered her nose and mouth, but her eyes were wide
open, and she was using the muscles in her neck to help her
breathe. With every breath, a large, clear bag attached to her face
mask inflated and deflated.

Her sats were at 90, but only just. Even with a
non-rebreather mask, she was hovering.

I expected Dr. Dupuis to start barking
orders. Instead, he turned to me and asked, "So what do you want to
do?"

I blinked fast. "Uh...give her Lasix." That
would help her pee out the water in her lungs.

"Okay. How much?"

I was starting to sweat. "Forty?"

He
checked the chart. "She already got forty milligrams when she came
in, from another resident."

"Okay. Eighty."

"Good. Anything else?"

"Uh..."

"How about this?" He tapped a bottle of
nitroglycerine that was already hung up and attached to the IV in
her arm.

I smiled with relief. "Yeah. Turn it
up."

"Okay. The nurses can take care of that.
They titrate to pain, resps, and systolic BP. Anything else?"

I cast my eye around the resus room. The
respiratory technician was coming through the ER doors, pushing a
large, blocky machine on wheels. "CPAP?"

"Yes! Continuous positive airway pressure,
to splint the airways open. I knew you'd get it."

I hadn't been so sure, but I
smiled, relieved. Dr. Dupuis was on my side. He waited for me to
come up with the answers, instead of running it. He was a good
teacher.

The RT, a balding guy in a lab coat, fitted
a giant transparent mask over the woman's face and tightened the
straps at the back of her head. It gave her an astronaut look. The
woman in the bubble.

"I can't breathe!" she said, muffled behind
the mask.

"Just wait,
madame
," the RT said,
pressing some buttons on his machine. "When you get used to it,
you'll feel much better." Mrs. Cartier nodded and he turned to Dr.
Dupuis. "I heard about Kurt."

"Yeah."

"I never would have guessed he'd screw up
his insulin."

Dr. Dupuis indicated the patient with raised
eyebrows.

The RT nodded and lowered his voice.
"Sorry."

"Later," said Dr. Dupuis. "Come find me when
she's stable. We'll talk." With that, he left the room.

I followed. "So, uh, about Dr. Radshaw—"

His shoulders tensed. For a second, his
steps slowed. "Yeah."

"Do you really think it was an
accident?"

He stopped just shy of the nursing station
to face me. A muscle worked in his jaw. He lowered his voice.
"That's for the police to decide."

For the first time since I'd met him, his
eyes didn't quite meet mine. Maybe he'd gotten the lecture from the
police, too. "Yes, but I wondered what you thought?"

"You know as much as I do."

"Yes, but you knew him much
better than I did," I said. "All I knew was that he had a
moustache, he was a good doctor, and he answered all his
pages."

Dr. Dupuis's mouth twisted into a grin.
"Actually, that's a pretty good summary if you add in that we'll
all miss the hell out of him."

He was talking to me again. I pressed my
advantage. "So you agree about the pager, right? Don't you think
it's strange he wasn't wearing it? Or his cell phone?"

He sighed. "Yes, I do. But it's
not proof of anything."

"Dave!" called a nurse. "I need you to write
a Gravol for twelve!"

"Do it as a verbal," he called back. He
glanced at the charts piling up against the far Plexiglas wall of
the nursing station and started heading toward them. "Listen. Wait
for the autopsy. That'll give us more information."

That was true. They could approximate the
time and cause of death and take blood and urine samples. Maybe I
could even attend the autopsy. That would be cool, if unlikely in a
coroner's case.

Dr. Dupuis was already five steps away, his
bony hand stretched out for the first chart. "Here, have an
atypical chest pain."

Even as I took the chart, I chewed over his
words. Dr. Dupuis was one sharp clinician. I still got the feeling
he wasn't telling me the whole story, but when it came right down
to it, I knew he was right. We needed proof Dr. Radshaw had been
murdered. The autopsy would probably provide it.

But something in me wasn't content to sit
around and wait for the report. The more I found out about Dr.
Radshaw, the more I wanted to uncover the truth. I decided to talk
to the person who probably knew him the best. His girlfriend.

Chapter 8

When I got home, I picked up my phone and
checked the message. "Call me. No matter how late you get in."

Alex.

It was almost 1 a.m., but I didn't have to
work the next day, so I changed into my raggedy, mauve, Brown
University night shirt and called from my sleeping bag. He picked
up on the first ring.

I said, "So, you're alive?"

He groaned. "Barely. Listen. I'm so sorry
about Friday night. I want to make it up to you."

"What happened?"

He sighed. "Family emergency."

I tried to gauge his tone. It was hard over
the phone. I was still torn between anger and "seize the day, life
is short" forgiveness. What kind of family emergency crops up at 10
p.m.? But, as a wannabe emerg doc, I knew that anything could crop
up at any time. "Really?"

"Yeah. Listen. Can I take you out to lunch
tomorrow?"

I sat up cross-legged, propping my back
against the wall. A sleeping bag is not enough bum cushion against
a hardwood floor. "Maybe."

"If I grovel enough?"

"Yeah."

I heard a tap, like he'd put the receiver
down on the floor, then some creaks, a lot of swishing, and a few
groans. He picked up the phone again. "Was that good?"

I had to smile. "I prefer live
groveling."

"Ah. That was a mere taste! If you let me
take you out for lunch, I'll do real, live, up-close-and-personal
groveling."

"Hmm." He always made me laugh. On the other
hand, desertion and drunkenness were two serious strikes. "Are you
going to be sober?"

He groaned. "Believe me, after last night,
I'm going to be sober for the rest of my life."

"I find that hard to believe."

"Just find me an AA program, and I'm
there!"

There was a time, like a few months ago,
when I would have written him off right after the café. Unreliable.
Good-bye. But I'd been walking the straight and narrow my whole
life, and where had it gotten me? A medical degree. One serious
ex-boyfriend, and some forgettable dates. I was twenty-six years
old and living alone in a new city. I wanted to take some chances.
"Okay."

"Okay, you found me an AA program?"

I laughed. "No. Okay for lunch."

"You're the best."

I stretched out my legs. "Just don't forget
that."

***

At 10 a.m., I rode my bike up St. Joe's
semicircular driveway and bumped on to the grass under the poplar
trees. Early for lunch, but I wanted to ask Dr. Radshaw's
girlfriend some questions.

The receptionist told me that obstetrics was
on the fourth floor. I walked through the main entrance, where St.
Joe's had spent all its money on a face lift, what with the
aquarium and all. As soon as I walked down the main ramp, it was
all harsh fluorescent lights, fake tile floor, and yellowing
paint.

At least there were windows on each landing
as I climbed the four short flights of stairs. I pushed open the
door at the top of the stairs and glanced to my left and right. The
hall was lined with seemingly identical navy doors, all of them
closed. Which way would I find Vicki?

I flipped a mental coin and turned left,
following the mustard-yellow, '70s halls until I heard a woman
groan. I was walking toward the deliveries. The case room.

I paused. Maybe I should go the other way,
toward the ward, instead of invading these people's privacy. On the
other hand, I'd be doing OB soon enough. It looked more suspicious
to loiter, so I lifted my chin and carried on.

I passed two empty rooms on my right. In the
third room, I heard the same woman groan, and another woman saying,
"That's it. Keep going. You're doing a great job, Cecelia." I
walked faster, head averted.

A man stood in the hall with a Styrofoam cup
in his hand, scooping up ice chips from a cooler against the wall,
but he paid no attention to me.

I arrived at the nursing desk on my left. It
was a long blue counter that paralleled the hallway, and separated
me from a giant wooden table and some monitors.

"Can I help you?" asked a woman at the desk.
She had long, fuchsia, acrylic nails and wore black glasses on the
tip of her nose.

I doubted she was an OB nurse. Those nails
would really hurt on a vaginal exam. "Hi, my name is Hope Sze. I'm
an R1." Now the tricky part. "I'm working in the emergency room.
Yesterday, I was called for a code. It was Dr. Kurt Radshaw."

"Oh, yes," whispered the clerk. She leaned
forward with wide, avid eyes. "Poor Dr. Radshaw. What
happened?"

I was getting to be a pro at this. Briefly,
I described finding him, throwing her a gossip bone. I touched my
hand to my chest. "It was kind of shocking, to be interviewed by
the police. And on my first day!"

The clerk waved me in past the desk. "Sit
down, sit down." She pulled out a chair at the table and introduced
me to the two nurses sitting there. One had a chart, the other a
fetal heart strip, but both items lay spread out on the table,
temporarily forgotten.

I said, "After we found Dr. Radshaw, a nurse
came in, very upset. I understand that she was Kurt's
girlfriend."

The clerk nodded so vigorously that I
thought her glasses might slide off her nose. "His fiancée. Vicki.
She works here."

Interesting. No one else had said they were
engaged. "Is she here? She seemed very upset. I just wanted to make
sure that she was okay."

The younger nurse, with the fetal tracing,
said, "Well, I think she's all right. I talked to her on the phone
yesterday. But she's not here. She's not coming in this week."

The older, white-haired nurse cleared her
throat. The younger one glanced at her and fell silent.

The older nurse said, "What is your name,
dear?"

"Hope Sze."

"I see." She let that float in the air.
"Well, we'll tell Vicki you came by. It was nice of you to ask
after her."

Ding, dong, the investigation is dead. I had
laid all my cards out at once, inviting confidence. I wouldn't make
that mistake again. I tried to salvage what I could, with a sweet
smile. "That's too bad. She seemed very shaken. I wanted to give
her my condolences."

Silence again. No one except the older nurse
would meet my eye.

I scrawled my name, number, and e-mail
address on a scrap piece of paper. "If—when—she comes back, could
you give her this for me?"

The receptionist took it, folding the paper
in half. "I'll make sure she gets it, dear." She avoided the older
nurse's eye.