by Rada Jones
“Fine. Be that way. They got soggy anyhow!” She put the bowl on the floor next to the sofa. “You happy now?”
The dog stared at her.
“What?”
The dog stared.
“What are you staring at me for? Eat it!”
The dog gave a short happy bark and cleaned the bowl in a blink. He sat in front of it and gave a quick bark. He looked at Taylor and wagged his tail. Once.
“Thanks.” He went to lie down by the door.
Taylor scratched her head.
She got herself another bowl of cereal and watched for the dog to come back. He didn’t.
She finished her cereal and went to clean up. Brushed her teeth, took a shower, got dressed.
The dog waited by the door.
He needs to go out.
There was no leash—they hadn’t had a dog in years. Taylor found a soft belt. She walked slowly toward the dog. She wasn’t sure he cared to be touched.
“Want to go out?”
The dog wagged his tail.
She slipped the loop of the belt over his head. She tightened it. He didn’t seem to mind. She opened the door. The dog waited. For what?
“Let’s go,” Taylor said. The dog leapt out. He smelled the bushes, the stones, and the grass. He squatted at the gate.
“You’re a girl!”
The dog looked at her and smiled. They took a long walk. Taylor hadn’t done that ever since she’d tried to kill herself. She was surprised to see it was still spring. It felt like ages ago.
Back home, Taylor removed the belt. The dog looked at her. She scratched her behind the ears. The dog smiled again.
Back in the bedroom, her phone rang. She had forgotten her phone. Unbelievable. She never forgot her phone. Five missed calls. One was Mother, one was Father, three were Eric.
“Call me.”
47
Guinness
They’re screwed up, these people. There’s something wrong with their lives. The Shaman needs help. That’s why I came with her. Her spaghetti sauce? Pulleaze! You’d better rub it on against vampires and mosquitoes than eat it! But she’s OK.
Why Shaman? She smells like healing and dark magic. She knows things others don’t.
On the way home we stopped at McDonald’s. She ran out of the car as if she chased someone. I got ready to help her. But no, she just needed to pee. That’s the problem with humans. Women, especially. Men—they’d go for a nice bush, but women? They’re crazy about toilet paper. Can’t imagine why. I tried it. It’s not good. It tastes just like cardboard.
She came back more together. She brought a couple of Big Macs and an order of fries. Not my favorite, I’d rather go for a Bacon Quarter Pounder, but she tried. I licked her hands to show my appreciation. Greasy and salty. They tasted good.
It took us forever to get to her den. It smells like her. And the girl. The girl is trouble. I know trouble when I smell it. And she’s not even in heat.
A few man smells. Not many. A coward, I think. Then another one, a while ago. Both running away. But I digress. There was no dog bed, so I slept in the armchair.
This morning Shaman microwaved some frozen waffles. She poured butter over them. Never had waffles before. Not bad, especially if you haven’t eaten in a week. I didn’t feel like it.
OK, OK, I was worried they’d poison me. Yes, I could smell it, but still. How would you eat if you were on death row?
She left me a bowl of water and told me to be quiet. I looked for the girl. I found her. She looked at me as if I wasn’t real.
Oh, girl, I’m real, all right. Your stuff isn’t real. All those things you ruminate about. We eat, we love, we shit, we die. That’s all there is to it.
She came around a little, but she needs a lot of work. They both do. What’s wrong with people? As long as you’re together, you’re OK. Stop thinking about all these maybes and maybe not and such nonsense. I’m glad I’m not people.
The doorbell. I jump off the sofa, where we’re watching TV as she’s scratching my ears. I rush to the door.
“Back off!”
The girl grabs my collar and opens the door. A man. Shocked. He stares at me. Stares at her belly. Stares at me. She jumps in his arms, crying.
I growl. She turns around and tells me he’s OK.
“Then why are you crying?”
She cries some more. They hold each other and kiss. It’s gross. They sit on MY sofa! Humans! I watch them.
“This is Eric,” she says, amongst tears.
I give him a paw to shake. They stare at me. They laugh. Eric shakes.
“Hello…What’s his name?”
“She’s a girl.”
“Oh. What’s her name?”
She looks at me. She doesn’t know. She texts her mother.
“Guinness. Her name is Guinness. Hi, Guinness!”
I give her my paw again. She shakes it. They laugh. What’s so funny?
Whatever. It beats crying!
48
After squaring away the brain bleed and the drunk and the other challenges of another lousy shift, Emma sat in her office.
She finally got to think about the quality meeting. Her jaw clenched, she started fuming. They told her to mind her own business! As her patients died in her ER. Inconceivable.
She logged in the computer to have another look at the charts. She had perused them so many times that her eyes started glazing over them. To focus, she started a list, looking for similarities.
Death #1. Monday, April 9. Room 5.
Patient: Old nursing home patient with hip fracture.
Doctor: Alex. Nurse: Brenda.
Mechanism: Unknown. Opiate overdose, maybe? The woman’s vitals got better just before she died. Opiates would give her pain relief and normalize her vitals. At first. Then they’d put her to sleep. For good.
Coroner’s report: Pulmonary edema. The toxicology report was still pending. She got morphine, so she’s going to be positive for opiates no matter what. Carlos worked that day. George didn’t. That doesn’t mean much. He could stop by, for one reason or another. We all do. For a meeting, to return a book, whatever.
Death #2. Wednesday, April 11. Room 20.
Patient: Old woman with dehydration and rash.
Doctor: Kurt. Nurse: Carlos.
Mechanism: Hypoglycemia. Insulin? Maybe that ordered for another patient? She wrote herself a note: Who took out that insulin? Who gave it? When? Ask Sal.
Coroner’s report: Nothing. Tox report is pending. This one may help. An abnormal C-peptide will confirm that she received insulin she had no business getting.
Case # 3. Saturday, April 14. Unknown room. This one didn’t die.
Patient: Old woman with a urinary tract infection. Discharged back to the nursing home. Returned next day with severe unexplained dehydration.
Mechanism: Lasix overdose? That would make her pee a lot. That would get her dehydrated. Would anyone notice at the nursing home? The urinary tract infection made her pee a lot anyhow. Hypertonic saline? That would scar the vein. But whoever gave it didn’t give a damn. Dead people don’t need veins.
Doctor: Alex. Nurse: Ben.
Coroner’s report: None yet.
Death #4. Sunday, April 15. Room 5.
Patient: Middle-aged man with back pain.
Doctor: Me. Nurse: Carlos.
Coroner’s report: Not yet.
Mechanism: Who knows? Maybe I missed a dissection or an aneurysm. I almost hope it’s that, rather than someone killing a healthy patient. My patient! But if they did, how? The meds I wrote for him were removed from the pixies. Carlos says he left them on the counter. Did anyone give them? But they weren’t enough to kill him anyhow.
A knock at the door. Emma threw her notes in the drawer and minimized her computer screen. She’d been told to mind her own business. She didn’t want to get caught detecting. Not before she found the answers.
“Come in.”
Faith came in, glowing and full of life, fillin
g her scrubs in all the right places. Her warm indigo blue eyes embraced Emma.
“You’re still here?”
“Catching up on some work. How are you, Faith?”
“I’m good. You?”
“Hanging in there. This work is beating me lately.”
“I bet. All these deaths.”
Emma cleared her voice. “What’s up, Faith? What can I do for you?”
“I wondered if you’d like to go for a hike on Tuesday? Or maybe to a spa?”
“I’d love to, but I can’t, Faith. Not until I catch up a little.”
“Who do you think is killing all these people?”
“I don’t know. I don’t think anybody does.”
“Well, they are dying!”
“Is there anything I can do for you, Faith?”
Faith’s smile faded. “I’ll let you be. I can see you’re busy. Let me know if you have some time and want to do something.”
The door slammed shut. I must have hurt her feelings. I’m sorry. I’ll talk to her tomorrow.
Death #5: Thursday, April 18. Room 15.
Patient: That was the demented patient with pneumonia whose daughter wanted everything done. She looked better after treatment, then she coded. What a mess that was.
Doctor: Me again. Nurse: George. Relieved by Carlos.
Mechanism: Who the hell knows?
Autopsy: Pending.
Case #6?
No Case #6. Not yet. The way things are going, there’ll be one soon. Five cases in less than a month. She had no proof that they were related. Some may have been unrelated. Natural deaths. Accidents.
Still, four died. Two of them were hers. The back pain and the pneumonia. That was weird. Different nurses, different rooms, different meds.
What did they all have in common?
They were all old, impaired, demented nursing-home patients. Except for the back pain.
They all seemed to be medication related. There were no stabbings, no shootings… But…she remembered Alex’s case, the old smoker on bipap he had had to intubate. He got detached from the vent. Shit. That’s six. Case six already happened. I need to find out more.
None of them was anywhere close to dying.
There was no family present, except for the blind husband of the hypoglycemia and the irate daughter of her pneumonia patient.
None screamed, or asked for help. In fact, they all looked better just before getting dead.
That’s it. I don’t know where to go from here. If there’s anything they have in common, it’s me. I had two of them, and I was there for two more. What the hell does that mean? And the back pain? That one doesn’t fit. Maybe that’s where the answer is.
She made a list.
Get data about Alex’s bipap case.
The insulin.
Who gave the meds to the back pain?
The back pain is an outlier. What if he’s the only target and the others just obfuscate? Did he have an enemy in the ER? An ex-wife? A rival? A competitor?
Her head was spinning. She was ravenous. She had to check on Taylor. She grabbed her coat.
Shit! I have a dog! I hope Taylor let her out! And gave her something to eat! I was going to text Taylor. I forgot!
She flew out the door.
49
Carlos watched the patient in Room 2 like a hawk. Bad things kept happening to his patients. He wasn’t going to let this one go bad on him.
The old man had smoked his last cigarette. His bony chest heaving, he sat up propped on his arms to get more air. He fought hard, but he wasn’t winning. He was on continuous nebs, he’d already received steroids, magnesium—the whole kit and caboodle, but he wasn’t going anywhere good.
His oxygen sats dropped. Carlos turned the oxygen all the way up.
“Let’s prepare to intubate,” Dr. Crump said, chewing on his lip.
He didn’t want to intubate. The man was already hypoxic. His CO2 was through the roof. The few seconds he had to be without ventilation could be enough to stop his heart. But they didn’t have a choice.
The respiratory therapist took over the mask. Carlos went to the locked medication room to get the RSI kit, the sealed bag of intubation drugs. He opened it and waited for orders.
“Thirty of etomidate, then ten of vecuronium,” Dr. Crump said. He turned to the RT: “Let’s have the nasal canula at 15 liters for apneic oxygenation.”
Carlos pushed the drugs. One minute later, the patient stopped breathing. Smooth as silk, Dr. Crump slid the tube in. The oxygen saturation stayed unchanged. The RT started bagging. The sats went up.
Carlos sighed. Thank God. Maybe the evil spirits following me got the day off today.
He’d been having a rough time lately. First, the back-pain guy. He took out the meds but never gave them. Then the guy died and the meds disappeared. That bugged him ever since. That, and the feeling that someone was watching him. It was unsettling. Dr. Steele watched him too. She double-checked his meds. She followed him in patients’ rooms. Even George was getting weird. He went to bed early. No more sitting and chatting. It was like a heavy cloud hung over him. Always waiting for something bad to happen. Not today.
He grabbed the blood vials to send them to the lab. He stopped by the pixies to get another breathing treatment for his patient. He came back and rechecked the vitals. Everything looked OK, except for the RSI kit.
The RSI kit was gone.
50
That morning Emma woke up to Guinness staring at her. One tail thump.
“Good morning.”
“Good morning. We have the day off.”
Guinness thumped her tail again.
“What would you like to do?”
Guinness smiled.
“After breakfast.”
She smiled wider.
I’ve never seen a dog smile before. Her eyes shine, her mouth’s wide open, her pink tongue’s reaching her knees. And those teeth. I’m glad I’m not her dental tech.
Emma went to the fridge. The dog followed.
Empty. So much for breakfast! No dog food either.
“McDonald’s?”
Tail thump. Emma opened the car door. The dog stared.
“OK.”
Guinness jumped in. Emma closed the door and climbed in to find Guinness in the front seat. There now, as the surgeons say instead of Oops! I guess she’s not a back-seat person.
Emma put on her seat belt. Guinness stared at her.
“What?”
One bark.
“You want the seat belt?
Bark.
Emma shrugged. She bent over to click her seat belt. It didn’t fit well.
“I’ll get you a leash, a bed, and a seat belt. And dog food. You can’t live on fast food forever.”
“Why not?” Guinness cocked her head.
They shared the Egg McMuffins, but Guinness declined the coffee. They went to the pet store. Guinness chose a black collar with shiny metal spikes and a six-foot long, heavy leash.
“I didn’t know you were into Goth.”
Guinness pretended not to hear. She inspected the dog food and settled for a hypoallergenic rice and lamb formula.
Their shopping done, they drove to the park. An overgrown old farm crisscrossed by trails between rocky lakeshores, the park was a joy to explore. Guinness checked the doggie mail. She squatted over rocks. She spotted squirrels in the trees and chipmunks under logs. She ran away. She came back. She ran again.
“You love your freedom.”
Emma did too. She felt lighter than she had in a long time. She forgot the ER, the deaths, Taylor, Victor. She forgot everything but the blooming trees, the breeze singing through the branches, the heavy scent of moist earth and spring. Emma delighted in the beauty of nature and in Guinness’s undemanding company. The dog understood things without being told and had no expectations—beyond breakfast. They played frisbee. Guinness went swimming, then shook, giving Emma a shower. They laughed.
The phone rang.
> They needed her in the ER. They had a mass casualty incident. A school bus had hit a truck, then rolled over in the river. Two died at the scene. The rest were on their way.
51
Back in Room 2, Carlos had to hold on to the counter to stay upright. He felt faint and sick to his stomach. His heart pounded in his head like a hammer.
The RSI kit was gone. He left it on the counter and went to send the labs. Five minutes ago. Now it’s gone.
He checked the patient. He was alive. He repeated his vitals. They were OK. But the kit was gone. Full of everything, but the vecuronium and the etomidate they had used for intubation. Sedatives, putting people to sleep. Opiates. Ketamine. Paralytics, paralyzing every muscle in the body but the heart. Every one of them dangerous. Every one of them lethal.
A single dose of succinylcholine is enough to paralyze you. You wouldn’t be able to move. You couldn’t breathe. You couldn’t scream for help. You’d watch yourself die. Same with the rocuronium. All in all, there’s enough stuff there to kill half a dozen people.
He had taken the kit out under his ID and he had signed for it. Now he had lost it. He was already in trouble after losing the meds for the back pain. This was bad news.
If they find out. What if they don’t? I can just sign that I discarded them. Nobody knows.
But what if whoever took the kit uses the meds to kill someone?
They won’t. They only took them to get high. They’ll just use the fentanyl, the ketamine, and the propofol. They’ll throw away the rest. What else could they do with them?
Carlos snuck to the med room. Nobody there. He hesitated. I shouldn’t do this. But I have no choice. I can’t tell them that I lost the kit. He charted the meds as discarded. The paralytics, the ketamine, the propofol, the lot. He logged out and sighed with relief. He was done. He went to the bathroom to splash cold water over his face, and looked in the mirror. He looked terrible.
