The Moon is Missing: a novel

by Jenni Ogden

  “Have you got enough medical staff?”

  “No, not by a long shot. A lot of doctors have left town, and everyone here is exhausted. None of us got any sleep last night.”

  “You could help out, Mum,” said Lara.

  I felt a flutter low in my stomach—excitement? “Is there a way I can help without going against your licensing regulations?”

  “No one cares about licenses right now,” Stork said. “It would be jolly helpful if you could do a round with one of the junior residents, especially with the neurosurgery patients. All the Memorial Neurosurgery Attendings were either on holiday or at a meeting in New York when Katrina decided to call. So you could give specialist advice and the neurosurgery resident could act as the official doctor.”

  I turned to Lara. “Are you sure you’ll be OK at the hotel without me for a while?”

  “Duh. I’m sixteen, mother.”

  “She can help me entertain these two,” Marcie said, her gaze straying to her kids squatting down by a cage with a cat in it. “Stay as long as you’re needed. Poor Stork looks as if he could do with some help. If you can’t get back to the hotel tonight, Lara can stay with us. We’ve got two adjoining rooms so Jamie and I can have one and Lara and Isabelle the other.

  “Thanks Marcie.” I looked up at Stork, towering above us. “Tell me where to go.”

  “I’d better check it out with the CEO first, just to cover you.” He turned to Marcie. “Can you guys get back to the hotel by yourselves? I can’t leave; there’s still so much to do before it gets dark again.”

  “We’ll be fine, honey.” Marcie stretched up to kiss her husband, and he cupped her face in his hands and gazed in her eyes for a long moment before kissing her very gently and very lingeringly on the lips. The bridge of my nose tingled and I squeezed shut my eyes. Adam and I used to be like that. Can we ever be like that again?

  “Come on kiddoes, time to go,” Marcie said, looking flushed.

  I shook my thoughts away and fished in my pocket for my hotel key card. “Here, Lara, take our room key.”

  “What about you? Won’t you need it if you get back late and I’m with Marcie?”

  “I thought I could stay here. Is that possible, Stork?”

  “Sure it is.” He winked at his wife, then turned back to me. “You’ll have to bunk on a mattress in my office with me though.”

  “Good grief, that’s a lot to ask. But if you promise not to snore…” I fished around in my shoulder bag, and pulled out a fat wallet. “I’ve got my Massachusetts Practicing License with me if the hospital needs some ID.”

  Within thirty minutes, identified by a coded wristband, I was in the corridor outside the sixth floor Intensive Care Unit, listening to a tired junior neurosurgery resident as she summarized the case histories of the patients they hadn’t been able to discharge before Katrina hit. The patients, many attached to beeping life-support equipment and a few to noisy mechanical ventilators, were crowded side-by-side in the corridors and other common areas. They’d been shifted there last night when the large glass windows in the adjacent ICU shattered, covering the unit with glass. The crowded spaces also housed other less critically ill patients from wards damaged during Katrina. Pauline, the resident, who looked not much older than Lara, was struggling to keep the frightened and distressed patients as safe and comfortable as possible.

  On our bed round, we had difficulty hearing each other over the dissonant sounds of the monitors, pumps, and ventilators, and the worried voices of family members who were trying to still the patients’ fears in spite of their own. We arrived at the bed of an elderly woman, whose labored breathing could be heard even above the racket. She lay motionless, her weathered, wrinkled arms lying outside the white sheet, an IV snaking from the inside of her right wrist, and an emerald ring adorning a thin brown finger on her left hand. From the end of her bed I could see her long, white hair, but her face was obscured by the covers stretched over a cradle that spanned her from waist to knees. She had no one with her, and Pauline flipped through her notes.

  “I don’t know this patient. She was brought in from orthopedics early this morning and I haven’t even had time to say hullo.” Pauline’s shoulders slumped; she was close to tears.

  “Take your time,” I said quietly. “You’ve been doing an amazing job. No one is expecting you to be able to do everything. Why don’t I look at her notes?”

  I saw Pauline’s shoulders straighten a little, and her eyes closed briefly behind her glasses as she took some deep, shuddering breaths. She managed a tremulous smile as she handed me the file. “I lost it there for a minute. I’m so tired…”

  “As soon as we get through here you should take a few hours sleep. I can manage by myself for a while.” I began to read the summary page at the front of the file.

  Mrs. Leaumont is an 89-year-old woman who underwent a total right hip replacement on August 24th. Prior to her surgery she was an exceptionally healthy woman for her age with no major risk factors and no previous significant medical problems apart from a total left hip replacement in February of this year. Her recovery from that was excellent.

  As I scanned down the page, the patient’s name slowly penetrated my buzzing thoughts. Of course, I’d known who it must be. I was going to meet her after all. I checked the patient label at the top of the page.

  Savannah Leaumont; DOB April 12th, 1916.

  Chapter 17

  My eyes blurred as I took in the rest of the label: Fourth Street, Garden District. Next of kin: Luke Leaumont. For a second I didn’t move, didn’t breathe, didn’t think—and then I slowly turned the pages until I came to the most recent entries in the old lady’s file. I waited until the words on the page stopped moving. They’d been written by a nurse at ten this morning.

  Elderly woman previously recovering satisfactorily from hip replacement transferred from orthopedics at 9:30am and requiring close monitoring because of concerns about her rapid heart rate of 119 and breathing of 25 times per minute. Assessment by resident requested.

  “Let’s check her over,” I said, moving to the head of the bed. Pauline wheeled over a screen, and did her best to conceal the old lady from the other patients nearby. Kat, you old witch. This is your best trick yet. Mrs. Leaumont was lying with her eyes closed, her chest rising and falling rapidly under the pale blue bodice of her cotton nightgown. My throat ached as I looked at the lined face, her coffee skin contrasting with the pure white hair flowing defiantly from a central part to lie untidily on the pillow. She still possessed the fine beauty I remembered.

  “Mrs. Leaumont?” My voice was louder than I intended. “Can you hear me?”

  Her eyelids fluttered open, and she looked up at me, her dark eyes sunken and unfocused. “Yes,” she said, croakily. Her breath caught as she spoke.

  “I’m the doctor and I’d like to check your heart, if that’s all right?” I said, leaning close to her.

  “Yes.” She blinked and seemed to look at me more intently. My heart was in my mouth. “You’re not Dr. Sullivan. Why isn’t he here?”

  “Your own doctor isn’t able to look after you for a while. Do you remember there was a hurricane last night? The windows in your ward were blown out, and you were brought over here to the ICU so we could keep a close eye on you.”

  “Oh, I do remember. Is the hurricane over yet?”

  “Yes, it is, and luckily it doesn’t seem too bad. But I’m afraid the hospital is short of medical staff, so that’s why you’ve got me to look after you. Is that all right?”

  “Yes, thank you, I don’t mind.” Her eyelids fluttered and closed.

  I used my watch to check Savannah’s breathing rate—twenty-six breaths per minute; still too fast. Borrowing Pauline’s stethoscope, I positioned it on the old lady’s chest. Her lungs sounded clear, and I could detect no heart murmurs or abnormal beats, but her heart rate of 122 was too rapid.

  “You’re having some trouble with your breathing,” I said, as I handed the stethoscope bac
k to Pauline.

  Savannah—Lara’s habit of calling her Savannah had infected me—Savannah opened her dark eyes again. “I do feel a bit short of breath.”

  “Is there a portable oximeter here?” I asked Pauline. “And can you check her temperature and blood pressure?”

  “I’ll go and see what I can find.” Pauline rushed off.

  Poor girl. But she was looking slightly less fragile, probably because she no longer had to take sole responsibility for twenty-five critically ill patients. Turning down the covers I gently examined Savannah’s hip wound. It was healing well with no obvious infection, and her legs weren’t swollen. Pauline arrived back with a small battery-powered oximeter, and I attached it while Pauline took the patient’s temperature and blood pressure. Damn, her blood oxygen saturation was too low; eighty-nine percent. It should be up around ninety-eight percent.

  I smiled at my new patient. “Pauline and I will take a look at your results and then we’ll see if we can help with that rapid breathing of yours. We’ll be right back.”

  Moving along the corridor, away from the crowded beds, we discussed our findings. Savannah had no fever, but her rapid breathing and accelerated heart rate, along with a relatively low blood pressure and low blood oxygen saturation, suggested that she might have a pulmonary embolus. “So, what should we do now?” I asked Pauline, unable to stop myself from using even these desperate circumstances as an opportunity for teaching.

  Pauline rose to the occasion and answered confidently, “We need some more tests: a blood gas to get a precise reading of her blood oxygen, and radiology at least. Then a respiratory therapist would give her any supplemental oxygen she required using a nasal cannula, and we would start her on blood-thinning medication, perhaps by an intravenous pump.”

  “Well done. But I don’t think any of those diagnostic procedures are going to be feasible any time soon.” I surveyed the chaotic scene before us. “We need to go ahead on what we have, and give her oxygen and blood-thinning medication via injection. We’ll have to keep a careful eye on her breathing and blood oxygen saturation. That’s about the best we can do.”

  “Right. I’ll set that up.” Pauline looked almost happy. “Do you want me to tell Mrs. Leaumont?”

  “No, I’ll do that. You get the oxygen set up and see if you can locate this medication.” I wrote rapidly in the patient notes and handed the file to Pauline to authorize as the licensed medical practitioner, before returning to Savannah.

  “Hullo again.” Her eyes snapped open and I smiled at her.

  “Hullo,” she said, her voice surprisingly clear. “Have you decided what’s going on with me?” She seemed almost amused in spite of her labored breathing.

  “I think so. Your wound is healing nicely, so that’s good. But you might have a small blood clot that has traveled from your leg to your lungs as the result of your surgery; it’s quite common after a hip replacement. It’s important to treat it without delay, so we’re giving you some oxygen to help your breathing, and an injection that will thin your blood and stop the clotting.”

  “I thought that’s what you got on long plane trips?”

  “Some people are at risk of embolism in that situation as well.”

  “It seems unfair that I’m not even flying somewhere exotic. At least that might have compensated for all this carry on.” Her eyes twinkled.

  “Ah, but think of how much easier it will be to run around, now you’ve got a new hip,” I countered. “Exotic places aren’t much use if you can’t walk about and explore them.”

  “That’s true. Don’t mind me, I’m just a grumpy old woman,” she said, her amused expression back. “I’m very grateful really. But I need to get home and see if my house is all right.”

  “I know you must be worried, but first you have to get yourself properly better”—I looked around me—“although I agree that’s a tough ask in this situation.”

  “Oh well, it could be worse, I suppose,” Savannah said, her breathing rasping in and out.

  “Do you have any family in New Orleans?”

  “My son Luke is here. I think he came in and saw me this morning—I’m a bit confused. Perhaps it was last night. But he had to go and check on the house, and he has his own family to look out for.”

  “Perhaps he’ll get back in later today.” I turned as Pauline appeared, wheeling the oxygen equipment, a nurse behind her with a covered bowl. I touched Savannah on her shoulder. “I’ll come back later. When the nurse has given you the injection, try and get some rest.”

  “Thank you, doctor, I will.” Her Southern drawl transported me back seventeen years.

  The remainder of the day flashed past as I checked patient after patient. A more senior resident had arrived soon after we’d left Savannah’s bedside, and I’d sent a relieved Pauline off to find somewhere to sleep. Fortunately, none of the other patients in the crowded unit had developed any serious complications, and everyone appeared stable on their current medications. The main problem was the unbearable heat. Without any air-conditioning and with the temperature outside in the nineties, it must have been close to one hundred degrees in the hospital. Family members sponged down burning patients with cold water, and staff stripped down to the minimum they could wear and still stay decent. I considered transforming my jeans into shorts by hacking around the legs with scissors, but decided the more they covered the better, given the filth accumulating everywhere—especially in the toilets.

  I had barely a moment to think about my strange meeting with Danny's grandmother, except to feel relieved that Savannah hadn’t recognized me. How much she knew about my involvement in Danny's death, I had no idea, but given her poorly condition the last thing I wanted to do was upset her. I kept an eye out for Luke. Danny’s uncle. Not that I had a clue what he looked like. I wasn’t sure whether I’d approach or avoid him if he did show up. But as the afternoon wore on, Savannah remained alone.

  I was feeling better than I had for months. I’d slipped back into my old habits without a trace of anxiety. It was like coming home. There was a moment when I felt my heart beginning to race, but within seconds it steadied as I focused on the patient in front of me. Janet McKenzie was a twenty-six-year-old woman who had been admitted to Memorial on Saturday, in labor with her first child. Feeling extremely unwell and with her contractions five minutes apart, she experienced a sudden unbearable headache within an hour of arriving and became confused and drowsy.

  A probable subarachnoid hemorrhage precipitated by her labor was diagnosed, and she was rushed into theater for an emergency caesarean section. The baby was delivered full-term and healthy, and within two hours of the delivery, Janet’s confusion and drowsiness had resolved, and she become conscious and alert. She had no focal signs, and subarachnoid blood was confirmed in her CSF. A fifteen-millimeter anterior communicating artery aneurysm was observed on an MRI brain scan, and she had been scheduled for surgery on Sunday. The impending hurricane had put paid to that, and the surgery postponed until after the hurricane had passed. Now any surgery was impossible, given the outage of power, the disappearance of neurosurgeons, and the impoverished nursing and theater staff.

  Patrick, the senior resident, had come from internal medicine and had no experience of neurosurgery, let alone the treatment of cerebral aneurysms. His relief was palpable when he discovered my specialty, and he watched intently as I examined Janet and pronounced that I was satisfied she was in no immediate danger. She was still alert with a Grade 1 subarachnoid hemorrhage, and delaying the clipping of the aneurysm was a reasonable approach in the circumstances.

  Brad, Janet’s husband, sat on the bed trying to comfort her. Sobbing quietly, she lay with a wet towel across her eyes in an effort to reduce her throbbing headache, afraid for her newborn baby who was being cared for in the better-staffed and less crowded obstetrics ward. I advised an increase in her pain relief, but otherwise she was on the same suite of medications I would have had her on herself. I stayed at her bedside after comp
leting my examination, carefully answering the anxious couple’s questions. I could almost see Janet’s swollen breasts and empty arms tingle as she begged me to let her feed her baby. Writing a quick note for Brad to take to Obstetrics, suggesting that the child be brought to her mother for each feeding, I was surprised by a tingle behind my eyes. I must be tired, or getting soft. I’ve been away from patients too long. I handed over the note, smiling at Brad as I explained he would need to sit with Janet while she was feeding their daughter so he could alert the nurse immediately if Janet felt unwell. As if wild horses could drag him away.

  When a grinning Stork appeared at my side and gave me permission to knock off, I glanced at my watch in surprise. “Good heavens, eight o’clock. I hadn’t realized it was so late. How’s your day been?”

  “OK I suppose, although I’ve had better ones. But I’m getting a bit peckish, and if we don’t get to the fourth floor where they’re hopefully still handing out fodder, we might miss out altogether.”

  “Mmm, you’re right. I was wondering why my stomach was making all those strange noises. Patrick’s back from a break, and I think everything’s under control here.” I pushed away a strand of hair stuck to my cheek.

  “Right. Let’s go check out with Patrick and see if you can be spared for the rest of the night. Georgie-girl, you’ve been bloody marvelous.” Stork draped a long arm around my shoulders and gave me a quick hug.

  “No problem; I’ve enjoyed it. I’m not too good at holidays.” I realized as the words left my mouth how callous I must sound.

  “No, you never were, I seem to recall.” Stork appeared unfazed by my thoughtless remark. “Hopefully tomorrow we’ll be able to transfer most of our patients to hospitals that haven’t been damaged, so you’ll be able to get back to your lovely daughter and on with your R and R whether you want to or not. At least your neurosurgeons’ tedious meeting has been cancelled.”