by Rada Jones
Then he remembered the cameras in the med room and broke into a cold sweat.
52
From the park, Emma drove straight to the ER. She locked Guinness in her office and went to work. The ER was in overdrive. They had lined the hallways with the existing patients to make room for the traumas. That gave them more empty rooms, but it set the visitors free to wander in the hallways and get in everybody’s way.
The wounded arrived every which way: by ambulance, by private car, on foot. Scared parents came looking for their children. Volunteers came to help. The waiting room was clogged. Harried staff moved from one patient to the next, checking pulses, holding pressure on bleeding wounds, giving reassurance.
Triage had moved to the ambulance bay. Good. Triage is not a place, it’s a process.
Ann and Kurt rocked. They glanced at patients, treating the sick, sending the others to waiting areas. The first case was already in the OR. Two more were waiting.
The whole hospital came to help. Environmental workers cleaned the rooms. Father Murphy comforted families in the waiting room. The residents looked for something to do. The place roared like a Boeing 747 on takeoff, fueled by the adrenaline rush.
Judy and Ben triaged, calling the docs for emergencies. Emma assigned them two residents to help. The kids are awesome, but they don’t have fifty years of ER experience like those two have between them. They’ll learn a lot today.
She went to check on the old patients. Ann and Kurt were too busy with the traumas to get a chance to reassess them. She tried to clear the hallways, inviting the visitors to the waiting room. They stared at her and resisted. It’s the jeans and the hoodie. I wish I had my white coat! As always, the clothes are more important than the person. She called Security to escort a particularly reluctant couple. She moved from stretcher to stretcher, checking vitals, handing out water, making sure they stayed alive.
She stopped by Room 3. An intubated patient. A kid, whiter than his sheets. Monitors alarmed like a pinball machine. She couldn’t get his blood pressure or his oxygen sat. She tried to listen to his lungs, but the disposable bedside stethoscope didn’t work. What a piece of shit! Taylor had better stethoscopes in her toddler’s doctor kit.
The beeping stopped just as she bent over him to check for a pulse. The crazy zig-zag on the monitor gave way to a straight line. The heart had stopped. He’s in asystole. Emma hit the code button to call for help. She looked at him, trying to figure out what happened. She knew nothing about him, except that he was intubated. And young. And dead.
Out of nowhere, her frozen brain replayed the voice of Ghazala, her mentor. That pediatric airway lecture, she’d listened to it a dozen times.
“People say: If an intubated patient arrests, think DOPE: Displaced tube, Oxygen, Pneumothorax, Equipment. I disagree. DOPE isn’t cool. The families don’t like it either. You standing there, looking at their loved one, mumbling DOPE, DOPE. You look like a dope. Think POET. That’s a nice mnemonic. Better than DOPE.”
POET. Pneumothorax, Oxygen, Equipment, Tube. Let’s see.
The tube looked OK. The oxygen was on. She detached the tube from the ventilator to check it. The vent worked. She laid her hands on his chest, pressing with all her weight to force out the trapped air. Nothing.
The room filled with help.
She untied the endotracheal tube, deflated the balloon, then pulled it out of the airway. The tube looked patent. Judy took over the airway and started bagging. Amy got ready for CPR.
The trachea may be a little to the left. A tension pneumothorax? Air outside the lungs, creating so much pressure that the blood can’t return to the heart. That’s deadly, unless you decompress it fast.
I hope he’s lucky.
“Scalpel.”
Emma uncovered the right chest. She pulled on sterile gloves. A scalpel landed in her right hand.
Somebody splashed iodine on the chest, baking the white skin to brown.
Emma bent over, looking for the right spot.
“What do you think you’re doing?”
Ann.
Emma didn’t look up. She didn’t have time.
“This is my patient!” Ann shrieked.
Emma found the space. Anterior axillary line, just lateral to the nipple. With her left index she found the soft space between the ribs.
“Let go of him!”
Emma opened the scalpel. She took a deep breath and cut into the chest. The silver blade went through skin like butter. She made a long cut. An inch and a half. This isn’t the time for pretty. This is the time for fast.
Blood oozed. Fat glistened yellow, exposing dark red muscle. I need a clamp.
No time. Her finger punctured the flesh between the ribs to break the pleura and release the air. The flesh resisted. Emma pushed harder.
The pleura, the thin membrane lining the chest, broke with a pop. Like a champagne cork.
Air burst out around her finger. She pulled her finger out. Warm blood sprayed her face.
The chest was decompressed. The heart restarted.
Emma straightened. Ann’s eyes, dark embers in a ghostly face, burned into hers.
She’ll never forgive me for this.
“Your patient.”
53
Taylor woke up smiling that morning. She felt happy for no reason. Then she remembered that Eric was back, and the day got even brighter.
They had talked about everything and nothing. About the past, the present, and the future. They learned new things about each other.
“I’ll be a better lover. You need to tell me what makes you happy,” he said.
“What are you talking about?”
“I’ll try to be enough for you.”
Then it dawned on her. He thought she had been with other men while dating him. She didn’t know whether to laugh or to cry. She did both.
“I love you, Eric. You. Nobody else. This happened way before we met. I didn’t tell you, since I didn’t want to lose you. That was wrong. I’m sorry.”
He held her like he was never going to let go.
“I don’t need anyone else but you. I love you. But I’m pregnant. I’m responsible for this child who didn’t ask to be born. I did drugs. I don’t know what that did to the kid. But it doesn’t matter. Whether he’s normal or not, this is my kid. At least until I bring it into the world.”
“And then?”
“I don’t know. I struggle with that. Keep it? Give it up for adoption? I don’t know.”
“I love you.”
That was all she needed.
“I need to grow up and get my life together. I’ll get a job. Maybe in the hospital.”
“That’s where you grow up fast.”
“I’ll speak to my father.”
“Your father?”
“Yes. He works there. He’s a cardiologist.”
Eric laughed. “I know. But if you want to grow up fast, speak to your mother. You’ll grow up faster in the ER.”
“My mother may not want me there.”
“Of course not. Her plate is full. I’ve never seen anyone busier. But if you’re serious, and if you want to make a difference, that’s where you should go.”
“Why aren’t you there, then?”
“I’m not good enough yet. I’ll go when I get better. I can’t wait to work with your mother. There’s nobody like her.”
Taylor grimaced. “I never thought I’d date my mother’s fan.”
Eric laughed. “You’ll be OK. She’ll take good care of you.”
54
The next day Emma and Sal were working through charts in Emma’s office. Her coffee got cold, Sal’s Coke got warm, but they still weren’t getting anywhere.
“The broken hip looks legit. Nothing weird there,” Emma said. “Let’s move on to the second case.”
“The hypoglycemia?”
“Yes. The labs are back. The C-peptide is low.”
“Yep. That means she received insulin. There’s no order for it,” Sal said
.
“How about the order for the patient next door?”
Sal checked. “Thirty units of regular insulin. Dr. Crump’s order.”
“Who took it out? And when?”
“George did. At 11:55.”
“Did he administer it?”
“Yes. He gave it at 12:48.”
“George did?”
“Yes.”
“It’s a long time from 11:55 to 12:48.”
“It sure is. What did he do with that vial for almost an hour? Carried it in his pocket? Left it on the counter? Why?” Sal wondered.
“Something happened. He got sucked into something else.”
“That’s why his glucose was unchanged an hour later. He had just received the insulin; it didn’t have time to work.” Sal went back to the computer.
“What are you looking at?”
“I’m checking who wasted the rest of it. He took out a 100 units vial. He gave 30 units. He’s supposed to discard the rest. With a witness.” He went through screen after screen, his nimble fingers falling over the keyboard like hail. “I can’t find documentation of it being discarded.”
“Seventy units of insulin just disappeared?”
“It looks like it.”
“Strange.”
“Yes. When did the woman die?”
Emma checked. “The code was terminated at 2:03.”
“That fits. If she got the insulin IV, she’d get hypoglycemic in minutes.”
Emma wrote herself a note. Ask George.
“Next case is my back pain. Carlos got the meds for him.”
Sal checked. “He did. At 2:31.”
“Were they even given? By whom?”
“He gave them at 2:45.”
“He said he left them on the counter.”
Sal shrugged. “That’s not what the computer says.”
“What identifier do they use to record giving meds?”
“They can use their ID card and a PIN. Or a fingerprint.”
“Same with discarding meds?”
“Yes.”
Weird. Carlos said he didn’t give the meds. And he couldn’t have. At 2:45 we were working on the arrhythmia in Room 2.
“I’ll have to speak to Carlos.”
“You have a lot of talking to do.” Sal looked at his watch.
“Something still bugs me about the first case,” Emma said. “Can you have another look?”
Sal looked at the orders. He confirmed the meds.
“It looks OK. Brenda got her meds at 3:35. She gave her the Toradol and the morphine at 3:47…”
“Morphine?”
“Yes. Morphine, 4 milligrams. As prescribed.”
“But…” Emma went back to the chart. “The tox report says she was positive for fentanyl.”
“Fentanyl?”
They looked at each other. They remembered February.
The time of many deaths. The time of fentanyl.
55
That evening, Emma drove home thinking about February. That had been the worst month of her life. She hoped the fentanyl was just a coincidence.
She got home. Guinness was waiting.
“How was your day?” Emma dropped her bag on Victor’s chair.
One tail thump.
“OK? Just OK?”
“What did you expect? I was locked in the house the whole day. How was your day?”
“It sucked. But I made a little progress. I figured out the insulin. I also know that Carlos couldn’t give those meds…”
Guinness left.
“That’s rude. You don’t just leave in the middle of a conversation!”
She went to choose a wine. The best part of her day was about to begin.
The Rioja? A little sharp on an empty stomach. The Californian Oaked Chardonnay? She hated oak. She didn’t think much about Chardonnays either.
That’s got to be a gift from a beer lover.
She found a new St. Emilion. Chateay Puy Blanquet St. Emilion Grand Cru 2012. That should be interesting. She pulled out the cork with a satisfying pop and filled a crystal glass. Everything tastes better in crystal. Even water. It gives you a feeling of luxury and decadence. She lifted the glass, looking through it into the light. A little transparent for a Bordeaux. Glowing red. Like a pinot noir. She sniffed it. Hints of fennel and black raspberry. It smelled tart. She tasted it. Quite an edge for a Bordeaux. Not smooth. Her mouth puckered. It’s sour. Decadent, my ass.
Guinness dropped the leash at Emma’s feet and stared, thumping her tail.
“What are you saying?”
“Let’s go for a walk.”
“Seriously! Now?”
“Yep. Right now.” Guinness barked twice and headed to the door.
“I guess it’s urgent.” Emma sat down the glass. “Let me get changed at least!”
“Not necessary.” Guinness said, dancing in front of the door.
I wanted a dog. It’s almost as bad as being married! Not quite as bad as having children, though. She glanced at Taylor’s closed door.
“Let me have a glass of wine at least.”
Guinness disagreed.
The phone rang.
Amber?
Victor’s wife was no longer a rival. She wasn’t exactly a friend, but she was Taylor’s stepmother. And, deep in her heart, Emma felt sorry for her.
“Hi Amber.”
“I’m sorry to bother you.”
“No bother. What’s up?”
Long pause. “You got a minute?”
“Sure. I’m just walking the dog.”
“Can we meet?”
“Now?”
“If possible.”
It’s late, it’s dark, and I have a dog that needs walking. The marina down the road has a terrace and margaritas. And they love dogs.
“Dizzy Alligator?”
“I’ll be there in fifteen.”
56
Angel
I love kids.
Pretty kids. Nice kids. Normal kids.
Not this. This is not a kid.
This is thirty pounds of human flesh kept alive by devices. Peg tube, tracheostomy, ventilator. He’s got contractures everywhere. He’s so folded he’d fit in my carry on. Not that I’d want to take him anywhere.
I check his chart. Evan. He’s twelve. He can’t see, he can’t talk, he can’t eat, he can’t breathe.
What’s the point of being alive? If you call this alive. He doesn’t know he’s alive. He can’t think.
Can he feel? Let’s find out.
I stick a #18 needle in his heel.
He pulls away and tries to scream. He can’t. He snorts.
He feels pain. That sucks. I wouldn’t have my dog live like this! Any dog! And he’s human, if only in name.
I look around. They’re all busy.
I turn off the alarms and I detach his tracheostomy from the vent. I cover it with my palm, pretending I’m cleaning it. I wait for the heart to stop.
It takes forever.
I reconnect the vent and leave.
Bye-bye, Evan. If they ask, tell them Carlos sent you!
57
Emma threw a jacket over her scrubs and headed to the Dizzy Alligator to meet Amber. Guinness stopped by the hydrants to check her mail.
What the hell is this about? It’s got to be about Victor. I hope it’s not bad. He may be a pain, but he’s my best friend.
Emma sat at the corner table. Guinness lay at her feet. Emma watched the couple next door gazing at the moon shimmering across the water. Guinness watched them eat their nachos.
It’s a full moon. It’s going to be another fun night in the ED.
The waiter, old and shriveled under his red baseball cap, stopped by to take their order.
“Two margaritas and a water dish.”
Guinness barked.
“What?”
Guinness stared at the neighbor’s nachos. Her dinner was late. Emma shrugged. “And an order of nachos.”
Emma’s margarita vani
shed almost as fast as Guinness’s nachos. She grabbed the second glass.
“Hi, Emma.”
She sat the glass down.
“Thanks for coming.”
“Of course.” Emma signaled the waiter for another drink. Make it two. It looks like a long night.
“I couldn’t think of anybody else,” Amber sighed.
Emma smiled. Thinking had never been Amber’s strong point.
“It’s about Victor. Things aren’t going well at home. He works all the time. He barely sees the kids. They spend more time with the babysitter than they do with him.”
Emma nodded.
“He’s so distant. We used to do foolish little things, like dancing in the kitchen after the kids went to sleep. Not anymore. Now, it’s just work, sleep, and more work.”
“I’m sorry,” Emma lied. You stole my husband. Now you’re stuck with him.
“Thank you. You’re generous.”
Not really.
“You must be wondering why I’m telling you this.” Amber wiped her dry eyes. “You know him. You’re his friend. He’ll listen to you. Something is happening. He’s in trouble. Financially? Professionally? I’ve even wondered if he’s doing drugs.”
Emma shivered.
“Or if he found somebody else.”
That day in the cafeteria, he hinted at getting back together. I’d rather have a root canal.
“That’s awful, Amber. Maybe he’s just overwhelmed. Did you talk to him?”
“I tried. I prepared a nice dinner. I got wine and candles. Even some nice lingerie—you know what I mean… He didn’t come home that night. He said he had to switch call with a colleague.”
My ex-husband’s wife complaining to me that he’s not interested in her. You can’t make this shit up.
“Have you thought about counseling? Lots of couples swear by it.”
“Maybe… He’s so remote… I wondered…” She gave Emma a speculative look. “Would you talk to him?”
“Me?”
“He respects you. He cares about your opinion.”
Not so much. He left me for you, remember? But what’s the point? That was long ago.
