Imperfect Contract (11 page)

17

At twelve-fifteen, Vanessa was nowhere in sight.  After I scanned the tables and the food line a second time, I joined the queue, took my time deciding between the meatloaf—which looked scrumptious—and the soup-salad-sandwich special, and picked an empty booth near the window, thinking she'd see me when she walked in.  I finished my vegetable soup and was halfway through my salad when she walked in.  I still had a tuna sandwich to eat as well.  She waved, smiled, and joined the line leading to the salad bar.

Vanessa looked good.  She had twisted her blond hair into a simple bun at her neck, then tied it with a black silk scarf.  Unlike many of her co-workers in the respiratory therapy department, she shunned scrubs.  Today, she wore a long lab coat to protect her clothes—she special ordered her white jackets to get the length she preferred—over black boot-legged slacks, black boots, and a stunning black and white print spandex sweater.  Vanessa put her model's figure to good use, and now that she was free of her bastard husband, clothes were her main vice.  With a practiced eye, she scavenged bargains at sales and discount stores.

As she headed in my direction, the overhead paging system blared, "Code Blue.  Five Northeast.  Code Blue.  Five Northeast."  The beeper in my pocket squealed.  I scribbled
SAVE THIS
on a napkin and covered my food. 

Vanessa hurried toward me and slid her tray onto the table, butting it against mine, sharing my napkin-sign.

Together we scooted across the cafeteria, dodging tables, pulled-out-chairs, and employees with filled trays.  Out of the corner of my eye, I saw an emergency nurse abandon her meal to her code team duties.  In silence, we rode the elevator to Five.

As we trotted onto the unit, a patient care assistant pushed the crash cart containing the emergency supplies, cardiac defibrillator, and drugs through the doorway into Hutchinson's room.  A couple of nursing students stood back from the door peering in, looks of astonishment on their faces.

Hurrying past the nurses' station, I glanced over my shoulder to be certain someone manned the desk.  Our long-term secretary, Stella, sat at her place talking on the telephone.  Based on her hand gestures and the few words I caught, she had Hutchinson's physician on the line.  I went into the patient's room.  As the charge nurse on the unit, I had responsibilities during a code.

I paused upon entering the room, getting an overview of the activity.  Dr. Kravitz, the anesthesiologist who ran the code, stood next to Hutchinson's right shoulder.  One of the staff nurses, Samantha Davis, used an Ambu, an inflatable bag that works something like a bellows, to inflate Hutchinson's chest.  Out of the corner of my eye, I saw Vanessa slip by me.  She relieved Samantha and took over providing ventilations. 

Connie performed chest compressions.  She stood flatfooted on the left side of Hutchinson's bed and leaned over him, positioning her shoulders over his breastbone.  The fingers on her right hand interlaced with the ones on the left.  She checked her hand position.  They were positioned to avoid unnecessary injury.  Together, the ventilations and the chest compressions comprised CPR, cardiopulmonary resuscitation.

I slipped behind the crash cart and moved the patient care assistant out of the way by pushing gently on her back as I said, "Move, please."  I twisted the red plastic lock securing the drawers.  The only cardiac activity on the monitor was the motion from the CPR.  Sliding the top-drawer open, I reached for the first drug on the protocol and held it high.  "Doctor Kravitz?"

He smiled and nodded.  "Epi.  One milligram."

The epinephrine comes in a two-part syringe.  The barrel contains the medication.  The other half has the needle and a sleeve that fits over the barrel.  I popped a couple of plastic caps with my thumbs and fit the two parts together.  Abracadabra.  No fuss, no muss, no bother.  And no fumbling with syringes or vials and ampules.  I handed the medication to another staff nurse who was standing close to Hutchinson's intravenous access. 

The nurse pushed the epinephrine, and Connie continued chest compressions.  We all stared at the monitor. 

"Call ICU for the external pacer," Dr. Kravitz said.

"Yes, sir."  I motioned at the nursing supervisor who stepped into the room.  She left to make the phone call.

"Repeat the epi."  Kravitz continued on task.  He looked in my direction.  "Does he have a DNR or a living will?"

"No sir, his wife is the healthcare surrogate and hasn't made those decisions."  We continued to watch the monitor.

"Hold CPR," Kravitz said. 

There was a flicker of activity on the scope, an occasional beat.

"Atropine, one milligram," Kravitz said.

I prepared the syringe—it worked like the epi—and handed it to the medication nurse, watching as she jabbed it into the injection port on Hutchinson's IV line.

Connie resumed chest compressions to pump the medication through Hutchinson's body and into the coronary arteries.  Connie seemed tired.  Perspiration beaded on her brow, and her breathing was rapid.  She's not an active, athletic person.  "Relief, please," she said.  

I pointed to a tall, young respiratory therapist who was watching the activity.  "Can you relieve her on the chest?"

Without comment, he slipped around the side of the bed and held his hand in ready position next to Connie's.  She moved aside, and he took over.  They didn't miss a beat. 

Kravitz allowed him to continue CPR for a couple of minutes more.

"Hold CPR."  This time there was activity on the monitor.  Kravitz's fingers probed Hutchinson's neck.  "Good," he said.  "We have a pulse."

Thirty minutes later, the external cardiac pacer in place, Hutchinson was on his way to the procedure room adjacent to ICU.  He'd get a temporary pacemaker, one with a wire running through a large vein in his neck to his heart, and then go to ICU. 

I wondered how long he was in cardiac arrest before a staff member discovered him, and I wondered why he arrested.  The one sure thing about Hutchinson, and the only reason he was alive, was his strong heart.

I called Amelia, helped clean the mess from the code, then notified admitting of the vacant room.  It took a couple of hours to attend to the needs of the other patients who felt neglected during Hutchinson's code.  That's often the case during an emergency, but more so on a weekend.  Then I set about the task of trying to discover the details of what happened.

Under the pretense of finishing the documentation, I asked Connie to take charge of the unit for a few minutes and went downstairs to ICU to track down Hutchinson's chart.  He was in an ICU room in front of the nurses' desk.  Amelia sat next to the bed with a scowl on her face.  I'd expected to see her crying, given the major setback her husband experienced. 

I saw Hutchinson's neurologist with the chart and sidled over to her.  "Can I ask you a couple of questions?" 

Dr. Jennifer Staiger had the reputation of being a brilliant neurologist.  She was Boston born, Harvard trained, and married to medicine.  To my knowledge, she had no husband, no kids, no pets, and no life.  Now, in her early forties, she appeared matronly and overweight with shoulder-length, stringy blond hair. 

She nodded, but continued writing.

"What happened to Mr. Hutchinson?"

"He was fine this morning when I made rounds upstairs.  I'm trying to understand it now," Dr. Staiger said.

I looked to where her finger pointed.

"Everything was fine.  Vital signs stable, neuro exam stable, vent management on track.  Then he arrests."  She glanced at me.  "Any ideas?"

"No, but that's why I came down to read the chart.  It's a mystery to me, too." 

I've known Dr. Staiger for years.  She was my neurologist when I was injured.  She pays more attention to me than she does to most of the nursing staff, and she still ignores me about half the time.

"Were you on the floor when he coded?"

"No, sorry.  I was at lunch.  Connie responded when the monitor tech alerted her to the changes in Hutchinson's rhythm.  Another staff nurse beat her to the room and was attaching the Ambu when Connie arrived."

"Sophia, I talked to the other staff nurse already.  She told me she found the ventilator tube disconnected and lying next to his neck."

"I didn't know."

"It's here in the chart."  She pointed to the neat entry in the nurses' notes. 

"She should have told me."  I felt stupid for not knowing and wondered why a staff nurse would write it in the chart and not tell the charge nurse.  I planned to ask her later.

"Look at this."  Staiger flipped back a couple of pages to the ventilator management sheet.  "We started weaning him a couple of days ago."  She looked at me over her thick lenses.  "He was doing better, triggering the vent a lot on Thursday and Friday, rate way down, pressures . . ."  She pointed to a graph to show me his progress.  "Yesterday the pulmonary guys started trials off the vent.  He tolerated three or four minutes during the day, but last night he was up to almost six."

"Do you think someone took him off for the weaning and forgot about him?" I said, thinking about Vanessa, though I didn't believe she would harm him.

"That could be."  She leaned closer to me.  "But Sophia, you were a cop.  Someone tried to kill him before.  What better time than now to finish the job?"

"Did they?"

"Finish the job, you mean?"  She raised her eyebrows over the top of her frames.

I nodded.

"Yes."  She jerked her head in Hutchinson's direction.  "Anything he was recovering is lost and more.  I completed the physical examination for brain death.  He didn't respond to any of the tests.  I've ordered an EEG for confirmation and a consult with another neurologist.  I expect we'll declare him brain dead by tomorrow morning."

"Do you need to notify the medical examiner before you do anything?  I mean, this would make him a murder victim, even if the ventilator thing was an accident."

"I'll give him a call," she said.

"Let me know what you find out, please."

"Why are you so involved in this case?"

"Um, well . . .  Ray asked me to poke around.  And, to tell you the truth, Amelia asked me to see what I could do, too."

She waved me off.  She knew I wouldn't tell her the details.  She also knew I sometimes involved myself in things.

She picked up the phone to call the medical examiner. 

I called Ray to tell him his attempted murder case would upgrade to murder by this time tomorrow.  I left a message on his voice mail at the department.  While I was at it, I thanked him for the concern he had shown the previous night.

18

Dr. Staiger declared Barry Hutchinson brain dead early the next morning—Monday, the twenty-first of May.  It was one month after the first attempt on his life.  The clues on the drive-by shooting had grown very cold in my estimation. 

Ray paged me around eight.  After a moment's worth of small talk, he said, "Jamel has been dealin'.  One of our boys on the street was very convincing.  He's also has a history of bullying his parents.  The other occupants of the strip center heard raised voices a number of times."

"I thought you said you weren't going to spend anymore time on the case, that more recent homicides took precedence."

"That was before I got the story from the informant."

"I don't understand why he'd harangue his mother for money then.  It doesn't make sense to me.  If he's dealing, he should have enough money to buy and sell poor Amelia.  Does it make sense to you?" 

"You said on your message that Hutchinson was going to be declared dead.  Did that occur?"

He asked a detective-like question of his own rather than answer mine.  I couldn't tell if he didn't have an opinion about the money issue or didn't give a damn about my comment.  What was obvious was he wanted to get off the telephone and onto whatever it was on his mind.

"There are some things happening down in ICU, I think.  Why don't you give Dr. Staiger a call?  She can fill you in."

"Sophia, just give me the damned information."

"Sorry, Ray.  I'm a little busy right now.  I don't have the damned information."  I rattled off the extension for critical care.  "I'll try to transfer you.  Have a nice day."  I hit the switch hook twice and then hung up the telephone.

I decided to stroll to ICU.  My unit was quiet for a change, and I took a break off the unit—a rarity on the best of days. 

Amelia sat with Jamel in the ICU waiting room.  It's a cozy room, decorated in muted teals and mauves, with the chairs arranged in family-sized conversation nooks.  A couple of small windows opened onto the corridor leading to the unit. 

I slipped by, wanting to see what was going on inside before I spoke with them.

Though
officially
dead, Hutchinson's chest moved up and down with the rhythm of the ventilator, and the cardiac monitor showed a regular heartbeat.  There was a lot of activity near his room—organ donation, I thought.  Several people I didn't recognize as regular staff members hung around, one of them deep in discussion with the nursing supervisor.  Dr. Staiger sat in the dictation room with someone in a white coat.  I decided to check it out.

I tapped on the window.  Dr. Staiger glanced at me, didn't smile, but waved me into the small room.

"Sophia, this is Allison White.  She's a nurse from the University Organ Procurement Agency."  Staiger tipped her head in the direction of the attractive, mid-thirties, African-American woman sitting to her right.

"It's nice to meet you, Allison."

"It's never nice to be here, not in a situation like this," White said.  "However, we were glad to get this call."

"Dr. Staiger, I'm surprised.  I hadn't considered this as a possibility." 

"When I called the M.E.," Staiger said, "he suggested we pursue transplantation.  He said Medical Examiners provide a large number of healthy organs to the transplant programs.  They work with the teams all the time."

I looked at White.  "How can he determine the cause of death after you harvest the organs?"

"In this case the initial injury was to the head.  We never open the cranium, so that's not a problem.  We only take the undamaged organs.  We take pictures, and the M.E. still has an opportunity to do an examination.  Besides, we're very interested in donors like Mr. Hutchinson."

"Why?"  I had spent my nursing career working on medical-surgical units and in the emergency department, and I hadn't had much exposure to the organ transplant process. 

"A couple of reasons.  Mr. Hutchinson was stable for the month after his injury.  The accidental disconnecting of his ventilator . . ."

"If it was accidental," I interrupted.

"That doesn't matter to us in this case.  His kidneys and his heart are in very good condition.  His infections have all been resolved.  He's an excellent candidate.  The challenge is to get the family to consent."

"Why is it so important?  I know donor organs are in great demand, but one more or less?"

White gazed at me, her dark eyes snapping with life.  "Because, even though African-Americans comprise over thirteen percent of the population, they receive twenty-seven percent of the donated kidneys, but only donate a little over ten percent themselves.  Minorities suffer more end-stage kidney disease than do whites.  But whites donate the vast majority of the organs.  It's important to have donations from different races and ethnic groups.  People are more genetically similar to members of their own group, so they get a better match."

I gave her an
oh really
rise of the eyebrows.  It provoked her to continue her lecture on the ethnic issues of organ donation.  I listened while she dispelled the myths about racial discrimination in organ transplantation programs.

I asked, "If that's the way it is, why don't more African-Americans donate organs?"

"Good question.  Distrust of the system maybe, lack of knowledge about the problem, not understanding a normal funeral and burial can still take place.  We deal with those issues every time we make a request."  She raised one hand.  "That's why I'm here today.  We hope that by having the request made by someone culturally similar, we'll have greater success."

"I know the family well," I said.  "I'll be happy to help in any way I can."

"Thanks."  White faced Dr. Staiger.  "Is there anything else you can tell me?"

"No, I think it's all been covered."  Dr. Staiger stood.  "I'll come with you to make the request."

"Sophia, would you like to come along?"  White asked.

"Give me a minute to call my unit and see if it's a problem."  I used one of the telephones in the dictation room.  Everything was fine.  The charge nurse said she'd reassign my few patients to another nurse.  It took me about five minutes to give a report on my patients, then I was ready to go into the waiting room with White and Dr. Staiger.

The family knew Hutchinson was brain dead.  Dr. Staiger had spoken with them earlier.  They had had some quiet time to contemplate the situation.  Now was the opportunity to make the request.

Dr. Staiger introduced Allison White.  "She's from the University transplant team and would like to talk with you about making a donation." 

Amelia, with her nursing background, didn't seem surprised and appeared eager to agree.  Jamel acted wary of the process. 

I stood in the background and listened as White explained the program, the fact there was no cost to the donor family, and that something good would come of all this grief.

Jamel spoke first.  "You gonna pay us to take the old man's organs?"

"We can't do that, Mr. Hutchinson.  The law forbids it.  It would be an act of charity and kindness on your part.  We
desperately
need organs for other African-Americans.  It reduces the risks of rejection."

"You probably want to stick my old man's insides into some rich white dude."

"We try to get the best tissue match possible."  White sat next to Jamel and explained the facts about organ donation.

"Seems to me we should get paid."  He pointed to the ICU unit's door.  "Besides, who's going to pay for all of this?" 

"That's not the family's responsibility," White said.  "Any charges entered after your father was declared brain dead are paid by the program."

The conversation continued with assurances the family could have an open casket funeral, promises to let them know about the organ recipients, and more firm refusals to consider paying the family for the organs. 

Jamel, to Amelia's obvious relief, finally gave up the notion.  He said, "Do whatever you want.  I'm outta here."  He left.

I thought he left the hospital, but I found him a few minutes later standing outside the men's room, tears flowing over his cheeks. 

It was good to see some emotion from the punk.  I asked him to come back to his mother.  He shuffled in the direction of the room, and I kept pace with him.

Dr. Staiger was gone, but two ancient women had arrived during my absence.  They wore flowered dresses, white gloves, and white hats.  A folder chrome walker with tennis balls on the tips of the legs leaned against an empty chair.

"Sophia," Amelia said, "these ladies are my distant cousins Clara and Martha Lee.  They're about the only kin I have around here." 

White excused herself, saying she'd be back in a few minutes with the papers.

I sat with the family until it was obvious they no longer desired or welcomed my presence.  When I returned to my nursing unit, they didn't need me either.  The South Florida population is seasonal, and the hospital census fluctuates.  Glad to be free for the rest of the day, I clocked out and went home.