by Barbara Ebel
Mason rushed to the couch and jostled the man as hard as he could. He was the last person to understand anything about medical matters, so with a small cry, he rushed to the landline phone which had been placed on the floor.
“911,” the operator said after he pressed the numbers.
“Send an ambulance right away.”
The operator waited. “Where to, sir?”
“Stay Long Hotel on north Hospital Road, near the beginning of Erie Trail.”
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Viktoria changed into street clothes after Dr. Nettle gave her the green light to leave for the day at 3 p.m. Mrs. Turner, her partocrat patient, had successfully gone home, and Mr. Abrams was recuperating overnight on the floor with his new hip. She would see him herself the next day, and since it was Monday, she had no patients to do postanesthesia rounds on up on the floor. Any of last week’s patients who’d stayed in the hospital had been discharged.
She grinned at her luck to leave on time. Now she would not need to rush a walk and playtime with Buddy, or rush to get ready to meet Jeffrey Appleton at five o’clock. She passed the women in the locker room changing shifts and headed down the staircase to exit through the ER entrance since her car was parked in the back.
Doctors, physician’s assistants, and nurses were walking in and out of rooms and sitting at the main desk. Techs rolled monitoring equipment around for medical testing and a visitor rapped on a patient’s room and went in.
As she passed the desk, she nodded to a familiar physician. “Mind if I grab a cup of coffee on the way out?”
“Go for it, Dr. Thorsdottir,” he said.
“Thanks.”
Down the short hallway to the automatic doors, she made a right turn into the small kitchenette. A pot was half full, so she filled a small Styrofoam cup and dumped in a creamer. It was the perfect temperature, fresh and strong, and she was glad for the easy access. Now her energy wouldn’t dwindle for the upcoming activities she had planned.
She heard a commotion from the back door before she stepped to the doorway. When she turned around, the first paramedic was passing, so she hastened to watch. He was wheeling a stretcher with a male, skinny patient, and another paramedic brought up the rear. The second man was ventilating the patient with a mask and oxygen.
They passed in a flash, yet Viktoria squinted her eyes at the patient. He seemed all too familiar, and then it dawned on her. Was it one of the workers from the Stay Long Hotel? She could swear he was the one with the burgundy truck who smoked all the time. All she’d have to do is verify the scar he wore on his cheek.
Holding her cup tighter, she tailed them into the acute care room meant for significant emergencies coming in by ambulance. A previously alerted ER physician and staff rushed in.
A paramedic began rattling off information for all to hear. “Got a 911 call, guy barely breathing and not responsive, at the Stay Long Hotel. Some kind of worker. We found IV drug paraphernalia smack dab in front of him.” He kept assisting the patient’s breathing while respiratory therapy began setting up a ventilator, ready to assist.
“Here’s the thing, doc,” the other paramedic said. “We tried to insert an LMA, and both of us tried to insert an endotracheal tube, but he’s difficult to intubate. We tried our best, but that’s why we’ve come in ventilating him with an oxygen mask.”
The ER physician gritted his teeth.
“I’m not trying to step on anyone’s toes,” Viktoria spoke up, “but I’d be happy to try,”
“I don’t mind, Dr. Thorsdottir,” the ER physician nodded. “I’m darn proficient at procuring airways, but everybody knows an anesthesiologist is the airway expert. If these two guys, who are damn efficient at what they do, couldn’t intubate him, I know he’s going to be a significant challenge.”
“Say no more.” Someone stuck out their hand and grabbed her coffee, and she stepped to the head of the table. In a flash, the airway cart was beside her.
“I’ll take a size 3 curved, Macintosh laryngoscope blade, and a size eight endotracheal tube.”
She checked the cuff on the tube, inserted a stylet, and signaled the therapist to stop what she was doing. With the mask away from the man’s face, the last thing she saw before opening the patient’s mouth was a prominent facial scar.
As Viktoria began inserting the laryngoscope blade into Fred’s mouth, she recognized the difficulty the EMS providers had faced. The patient’s teeth protruded and his larynx was located in an extreme anterior anatomic position making it difficult to position the blade to move the uvula up and to visualize the vocal cords to insert the endotracheal tube. With her proficient set of skills, she managed to advance the tube down and inflate the cuff. But she still could not be sure it went into the trachea and not the esophagus, so she auscultated his lungs and heard bilateral breath sounds.
The respiratory therapist hooked up tubing to the end of the endotracheal tube and ventilated with an Ambu bag. Immediately the staff saw Fred’s lungs rise. She sighed with relief and securely taped the tube in place along his mouth. The ER doctor gave orders for ventilator settings and Viktoria snapped off her gloves.
“Thanks for helping out,” the ER doctor commented.
“Any time,” she said, and glanced at the paramedics. “I know this guy. What happened?”
“Appeared to be an IV drug overdose. We concentrated on him, but glass vials were scattered around, I bet not the run-of-the-mill cheap stuff. Cops were showing up when we left. I wonder if the matter will end up with the DEA.”
“Let’s get internal medicine down here right away,” the ER physician said. “They should be the ones to admit him and start drug screening, toxicology, and a medical workup.” He began examining the man, and meanwhile made inquiries to the ER staff going through his personal items from his blue jeans. “Anybody find any information for next of kin?”
“Not a thing in his wallet,” someone said, “but we’re checking his cell phone.”
“He’s always working with two other guys.” Viktoria glanced at the EMS staff. “Were they around when you picked him up?”
Both paramedics shook their heads, and the taller of the two responded, “The guy from the front desk directed us in but, otherwise, we didn’t see anybody.”
The activity in the room settled down as each person continued their area of expertise. More paperwork was generated, the paramedics wheeled out their ambulance stretcher, and an X-ray technician sidled next to the bed to snap a chest film, especially to check the endotracheal tube placement. As she noticed the round wall clock, Viktoria realized that she had stuck around much longer than she wanted to. She had been useful, but now needed to hurry to meet Jeffrey Appleton on time.
As she exited the automatic back doors, she couldn’t help wonder about the Stay Long Hotel laborers. Thinking back, she had seen Fred outside the breakfast diner last week. Sitting in his vehicle, he seemed hung over or too groggy. The guy had probably been a drug overdose just waiting to happen. At least, so far, he hadn’t managed to kill himself.
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Viktoria turned the handle to her Stay Long Hotel room to find Buddy wagging his tail and tapping his toenails on the entrance floor. Not aware that his actions qualified as a full dog trick, he spun around with delight that she was home.
Snatching the leash off the counter, she knew his bladder screamed to empty, so they went straight out. Buddy marked every tree planted in the grassy parking lot areas on their way to building 2 where one of the doors had a crisscross yellow ribbon strung across the front. Otherwise, no extra vehicles or law enforcement were around.
A brisk wind blew which caused Viktoria to button the top button on her blouse. She obliged the dog with a two-block walk and returned to talk to Mason in the front office.
“Miss Viktoria,” Mason said as he tucked in his hotel shirt. “There was all sorts of excitement here this afternoon. Bet you coulda helped, you being a doctor and all, if you’d been around. One of those guys working here pass
ed himself out and needed an ambulance. I’m going to be complaining to the management to get rid of that guy, if he lives to fight another day. I don’t tolerate no shooters or spikers around here. Fred and his tourniquet and syringe injectables are not welcome here.”
“I got wind of what happened because he ended up in our ER. He’s in good hands and on a breathing machine.”
“I wouldn’t have discovered him if it weren’t for his coworkers calling me to ask what was taking him so long getting out of here. He’s gonna make it, huh?”
“I’ll check on him in the intensive care unit tomorrow. He’s not out of the woods by any means.” Craving attention, Buddy gazed at her with his big brown eyes, so she crouched down and petted him.
“He’s a good one. Keep telling myself I should own a dog to keep me company. Could double as a guard dog for the weirdos that sometimes walk in here.”
“Yes, you should consider that. By the way, do you know where Fred’s buddies are? I would be happy to give them a medical update on their friend’s status.”
Mason rubbed his mustache and shrugged. “Perhaps still over at the diner. Don’t know.”
“Okay, thanks.”
Mason came around and stepped to the door behind her. He stretched out his arms and inhaled the clean, fresh air. “I should ask the owner of this joint if I can tack on a sign under the Stay Long Hotel billboard stating ‘Drug-Free Hotel.’”
“Most hotels these days are tobacco free, no smoking allowed. There is merit to your idea, but don’t try to ban their alcohol!”
“I wouldn’t dream of it.”
“See you later,” Viktoria said and hurried away with Buddy.
CHAPTER 25
Half jogging with Buddy, Viktoria scrambled to the breakfast diner to scout around for Ben and David. She felt it her duty to let the men know about Fred, in case they had not yet followed up with questions after their friend’s hospital admission. But she saw no evidence of their trucks, and didn’t spot them near any of the window booths.
“Jiminy Cricket!” Viktoria exclaimed to Buddy. “I’m practically taking my medical job home with me, and I’m running late for dinner. No, we are running late because you were invited too.”
Buddy sat on his hindquarters and cocked his head to the side. His tail brushed along the asphalt, but he was ready to pop up and resume their pace. She gave a tug on the leash, and they sprinted forward.
In the hotel room, she took care of her pet first and put down his dinner. Scanning down at her clothes, she frowned. In ten or fifteen minutes, Jeffrey Appleton would be knocking at her door, and she wasn’t a bit ready.
Hastily, she rummaged through the top drawer and grabbed an off-white pretty top with a nautical design. After substituting tops, she hung a pair of white beads on her neck and matched the necklace with earrings.
Finished eating from his bowl, Buddy scoured the surrounding kitchen floor for any residual crumbs while Viktoria considered what she needed to bring. She had the dogs to think about and wasn’t so sure that Mr. Appleton would be prepared for them, so she scooped the bowl into a canvas bag and dropped in a bottle of water. With just enough time before a knock sounded at the door, she used the restroom and ran a moist lipstick across her lips.
Buddy raced to the entrance upon hearing a car door slam outside. After one rap, Viktoria opened the door.
“Good evening,” Jeffrey said. He looked fresh and crisp like he’d just showered and dressed. The sleeves of his blue and white striped shirt were rolled up and an expensive watch graced his left wrist. His tan pants fit like a charm and ended at a pair of sneakers that appeared to be brand new.
“I apologize,” she stumbled. “I’m a shabby dinner mate who has run behind ever since leaving the OR.”
“You may be playing catch-up, but you don’t look shabby to me.”
“You are too kind.”
“And this must be Buddy.” Jeffrey squatted and let the dog sniff him. Buddy neared the new man, gave him a nuzzle, and received a good rubbing with two hands in his furry white neck coat.
“He is a beauty, an absolute beauty.” He stood, face-to-face with Viktoria.
Viktoria gulped in her air. He was flirting with her, catching her off guard. She tried not to show any embarrassment; it had been awhile since a man had complimented her in one way or another.
“Thank you. Yes, he’s gorgeous, and never deserved what happened to him. Not that any dog deserves to be abused.”
“An eye for an eye, they say. I believe animal abusers should be faced with the same treatment that they deliver.”
“That would solve all animal abuse.” She slipped on Buddy’s leash, and grabbed the canvas bag and her purse.
“This place looks comfortable enough for a month’s stay, but if you’re missing something, please don’t hesitate to ask. You’re free to borrow a thing or two from me. I look after the hospital’s OR staff and, personally, would love to see you comfortable.”
“Thank you. If need be, I’ll take you up on that.”
They stepped out and Viktoria pulled shut the door. Jeffrey opened the back of his maroon Jeep and let Mattie jump out. “Better to let them meet on equal terms,” he said.
A smile erupted on her face. “She’s gorgeous!” The Golden Retriever’s coat was picture perfect, and she was young and vibrant. “How old is she again?”
“Three, but sometimes I think she’s one.”
The two dogs play bowed and tugged on their leashes. There was nothing more they wanted to do but take off and run together. With the dogs loaded into the Jeep, Jeffrey Appleton took off in a northwestern direction towards Ricky’s Grill and Bar.
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Jeffrey pulled past the large sign by the road announcing “Ricky’s Grill and Bar,” and into a half full parking lot in front of a dark wooden building with welcoming steps and a porch. On the outside right side were hedges, and beyond that a patio with tables and a sprinkling of customers. Mature trees were abundant as well as several areas of perennial bushes which had lost their flowering petals late in the season.
Jeffrey tried to open the door for Viktoria, but she had already stepped out. They grabbed their respective dog’s leashes and sprung the canines from the Jeep.
“Let’s spin them for a walk first,” Jeffrey said.
Viktoria kept from commenting on the dogs peeing ritual, but each time one of them peed, the other one had to mark over it, Buddy more so than Mattie.
“I think they like each other,” Jeffrey said.
“I agree. Do you let her swim much?”
“Quite a bit. I bring her up here at least one day a week. She loves it.”
“I’m not sure if Buddy likes the water or not. So far, his favorite thing is playing ball in the back of the hotel.”
“That’ll do. You need to keep working dogs busy. They are not your average sit-around lap dog. If you put him near cattle, he’d be herding them to the barn.”
“That would be a blast to watch. Unfortunately, Long Island is overpopulated. The days of spacious farms are long gone.”
They turned around, walked back to the restaurant, and opened the iron gate to the patio.
“Two for dinner and two dogs to keep you company?” asked a young woman.
“Yes ma’am,” Jeffrey said.
“We usually keep customers with dogs at this end.” She plopped down two menus and utensils on the nearest corner table. “Your server is Melody. Enjoy your dinner.”
“Jeffrey, please pick your spot,” Viktoria said.
“Right here is fine. And, please, call me Jeff.” He tethered Mattie to his own chair and sat down.
“Jeff it is.” Viktoria secured Buddy on the back leg of her chair and scooted in. The dogs immediately inched towards each other, tails wagging.
“There’s not much not to like here,” Jeff said. “I’ll order some cheese sticks while you decide.”
Melody arrived with a broad, pink lip-sticked smile and rattled off the
ir specials.
“How about a chardonnay and those crab cakes you just mentioned?” Viktoria said.
The woman nodded and Jeff asked for the appetizer, a local craft beer, and a sirloin steak. “Be back in a jiffy,” Melody smiled and turned on her heels.
“This is a beautiful evening,” Jeff said. “How about we knock off business before pleasure?”
“Sure thing.” Viktoria avoided eye contact. He was a handsome man, just her type, and she’d be better off not feeling a further attraction than she already felt.
“We didn’t get too far when we were discussing anesthesia services and reimbursement. Even though the hospital is thorough and expansive when it comes to the business of billing for services, they can’t double check on everything. But eventually, reimbursement should filter back to the hospital.”
“I understand. At the risk of sounding like a snoop or poking my head into business I have no part in, I can’t help myself. Promise me this discussion stays between us.”
“We have a deal.” He nodded and leaned in like they were business partners.
“Since Masonville General Hospital pays the anesthesia department staff and bills all their cases for themselves, have you ever considered that there may be double dipping going on?”
Melody stepped over and placed their drinks and appetizer down from her tray. “Can I bring you anything else right now?”
“We’re good,” Jeff said.
The waitress gave Buddy and Mattie a pat on the head and stepped to another table.
“Double dipping? I don’t follow.”
“What if the paperwork for some after hour emergencies went under the radar and never made it to the hospital’s list of OR cases? If indeed that is happening, it may be a rare occurrence, and it may only involve one person cheating the system.”
Jeff squinted his eyes and squirmed. “Someone is billing cases themselves?”
Viktoria twisted her lips and raised her eyebrows. She took out her cell phone and scrolled to the pictures. She found the photo she’d snapped in Jay Huff’s office. “Maybe you can check if this case went through the hospital’s billing network.”
