Angels on the Night Shift

by Robert D. Lesslie, M. D.

  “That sounded like Denton Roberts on the radio,” she said to me, not pausing from her preparations. “Glad to hear that,” she added.

  Denton was one of our most experienced paramedics, and we both knew this unknown and unfortunate man was in good hands.

  Denton had said he’d already secured the patient’s airway with an endotracheal tube, but I found myself routinely checking the light on our laryngoscope, just to be sure. Then quickly glancing around the room, I was satisfied we were ready.

  A couple of minutes later, we heard the automatic ambulance entrance doors open and then the clicking of the EMS stretcher wheels as Denton and his partner made their way toward us.

  Denton pulled the stretcher into cardiac with one hand while methodically bagging his patient with the other. His partner was walking beside the stretcher, performing chest compressions. Patsy hurried over to his side and guided them to the cardiac bed.

  The EMS monitor was on the foot of their stretcher, and I glanced down at the small screen. Nothing—just some undulating waves that moved with the chest compressions.

  “Have you had anything?” I asked as we all helped move the man to our stretcher. It was awkward, and it took a moment to get him situated where we wanted him. Whoever coined the term “dead weight” knew what they were talking about.

  “Just some agonal respirations when we got to the scene,” Denton answered, a little out of breath. “Nothing on the monitor. Never had a pulse. We’ve gone through the flatline algorithm a couple of times, but still no response.”

  I looked down at the dusky face of this young man, then reached out and put my fingers over his left carotid artery. There was a faint pulse, keeping time with the chest compressions being delivered by the other paramedic.

  “Hold it a second, Ben,” I told him.

  He took a deep breath, stood up straight, gratefully put his hands on his hips, and waited.

  I kept my fingers where I had placed them, feeling for any kind of pulse, any kind of cardiac activity. Nothing.

  “Let’s go again, Ben,” I told him “Are you okay?”

  “I’m fine,” he answered, resuming his position near the stretcher and carefully placing his hands on the man’s chest. Then once more he began his rhythmic downward thrusts.

  Patsy had correctly anticipated the sequences of drugs we would use, and I listened to each side of the patient’s chest, making sure he was being adequately ventilated. Textbook.

  “Any idea about this guy?” I asked Denton.

  “Nope. We found him slumped over in his car. Looks like he just barely made it into the parking lot of the Y. Probably going to exercise, by the looks of his clothes.”

  For the first time, I noticed his jogging suit and running shoes. His top had been cut open, exposing his chest. Maybe that’s why I hadn’t paid much attention to his attire when he first came in.

  “Are you sure he was on his the way into the Y?” I asked Denton. “Maybe he was working out and—”

  “No,” he interrupted. “His car was barely pulled into the parking lot and stopped at a funny angle—like he knew he was having trouble and was trying to get off the street and out of the way. And his clothes weren’t sweaty.”

  I reached down and felt the torn T-shirt. It was dry, and Denton was probably right. It didn’t make any difference at this point, though. He wasn’t responding to any of our efforts, and I was about ready to call the code. Still, I wanted to make some sense of this and figure it out if we could. If he had been working out and developed chest pain, then tried to make it to the hospital, I could understand that. But why wouldn’t he have asked for help in the Y? That would have been the logical thing to do. No, I thought, Denton had it right. He was on his way to exercise and must have had a heart attack, or maybe a stroke.

  “Anything else, Dr. Lesslie?” Patsy asked.

  I looked up at the clock on the wall. We had been working on this man for more than forty-five minutes, and there was still no response.

  “Anybody with him?” I asked the two paramedics. “Any family members or friends?”

  Ben looked over and without missing a compression said, “No ID that we could find. We didn’t have time to check the glove compartment of the car or anything like that, so we don’t know who he is.”

  Patsy stepped to the head of the stretcher and looked up at Denton. “Here,” she said, reaching with both hands for the ambu bag. “Let me do that for a while. Why don’t you give Ben a break.” Then she looked over at me, obviously wondering how long a while was going to be.

  This guy was young and appeared to be healthy. I was reluctant to give up on him, but it was time.

  “I’m fine,” Ben told Patsy. Then to his partner: “Why don’t you check his pockets? Maybe there’s something there.”

  As Denton moved around the stretcher and began searching the man’s pockets, I asked him, “Who called this in?” I had just thought of that. Maybe someone at the Y knew this man and had followed the ambulance to the hospital. Maybe they were out in the waiting room right now.

  “Don’t know that one,” he answered, now leaning over the man and reaching into the back pocket of his sweatpants. “You’ll have to check with dispatch. When we got there, a few cars were parked out in front, but there was nobody around. We just got going and didn’t have time to check it out.”

  He was about to stand up, when he leaned over a little farther and said, “Wait, here’s something.”

  He fished a small leather wallet out of the man’s pocket, then held it up for us to see. “Let me check this out,” he said, stepping over to the counter behind the head of the stretcher and opening the wallet.

  I looked up at the clock once more and was about to call the code, when Denton exclaimed, “Well, look at this!”

  He was studying a small card of some kind, flipping it back and forth to get better light on its shiny surface. “Looks like he’s got some kind of surgical problem, or something,” he mused.

  “What do you mean?” I asked, puzzled by this new information. Maybe there was some clue here, some unrevealed pathology that might guide us in this man’s care. Maybe there was something we were missing.

  “Yeah, it looks like he has an appointment with Stuart Lowry. At least, that’s the name on the card.”

  Stuart Lowry—“Stu” to everyone on the hospital staff—was a general surgeon in town. He was a great guy—funny, easygoing, always cheerful. And he never minded coming to the ER when we needed him.

  “Is there any diagnosis on the card, or any reason for his appointment?” I asked Denton. “Sometimes they’ll have that on there.”

  He looked at the front and back of the card once again. Suddenly he looked up at me, wide-eyed and pale. “Doc,” he stammered. “This is an ID card.”

  I was stunned and for a split second just stared at him, trying to understand what he had just said.

  “It’s what?” I whispered.

  “Oh my Lord!”

  It was Patsy Wilson, and she was looking down at the face of the man on the stretcher.

  She took a step back from the bed and cried out, “It’s Stu Lowry.”

  It couldn’t be. This was impossible.

  I looked down now, studying the features of this man lying before us. Flat on his back, his facial muscles now slack, and with a tube in his mouth and oxygen prongs in his nose. It was easy to understand why no one had recognized him. But it was Stu. There was no doubt about that.

  But nothing had changed. We were still not getting any response, and though we worked with him for another twenty minutes, it was only becoming more obvious. He was gone.

  “Let’s call it,” I sadly told the people in the room.

  I held a Code Blue clipboard in my hand, waiting for Patsy to give me the official time so I could write it down. When she didn’t say anything, I looked over in her direction. She was staring down at Stu, unblinking, and not moving.

  Denton looked over at her and then at the clock by
the head of the stretcher, which was just out of my sight.

  “9:12,” he told me, reaching out and putting a hand on Patsy’s shoulder.

  “Come on,” he gently told her. “Let’s go.”

  Later that morning, I stepped into Virginia Granger’s office.

  “Have you seen Patsy?” I asked her.

  She looked up from her desk and said, “I sent her home. She’s pretty upset about Dr. Lowry.”

  Then she told me why.

  Stu and Patsy had grown up together in Rock Hill, had attended the same elementary and high schools, and had even dated before they had gone off to different colleges. They had managed to remain close friends, and now their children played together, and they and their families all went to the same church.

  “This is really quite a blow for her,” Virginia said quietly, slowly shaking her head. “I don’t think I’ve ever seen her so upset. That’s why I sent her home.”

  That was the last shift Patsy Wilson had worked in the ER. She hadn’t been able to get over the shock of that morning and the loss of her friend.

  And now she was going to be working with me tonight. That would be good, but maybe a little strained and awkward. Maybe more than a little.

  But by the time I got home and into the shower, I knew the good would outweigh any of the negatives, and I was looking forward to her return.

  6

  When Angels Cry

  6:58 p.m. The ER parking lot was full and there were three ambulances stacked up at the emergency entrance. Not a good omen for what lay in wait for me behind those doors.

  It was like stepping into a frenzied nightclub. People were moving around everywhere, and the noise was chaotic, the voices incoherent.

  “Excuse me, Dr. Lesslie!” someone called out just to my right. It was one of our techs, and she was trying to push the EKG machine down the crowded hallway.

  I quickly moved out of her way and thought about stepping outside. Maybe if I closed my eyes, counted to three, and came back in… No, that never seemed to work.

  Amy Connors caught my eye from behind the nurses’ station. She shook her head and silently mouthed, “I’m outta here.” Then she stood up and made her way to the lounge to pick up her things and head home.

  Liz Kennick was standing at the counter, writing on a chart. She looked up as I approached her.

  “It has been absolutely crazy!” she said in understatement. “Just look at this place,” she added, her right hand sweeping around the department for effect.

  “Don’t worry, Liz,” I told her. “It happens.”

  Then setting my briefcase on the floor, I asked, “Have you got anything to turn over to me?”

  Just then, a stretcher came out of major trauma, guided by two paramedics. There was a bundle of clothes on its foot, along with a large, stuffed-full folder, the kind we used for medical records. The twentysomething young man lying there was being transferred out of the department, and when the paramedics came up beside the nurses’ station, they stopped.

  “Have we got everything we need?” one of them asked Liz.

  She spun around, looked down at the young man, and said, “He’s ready to go. They’ll be expecting him in the ER at CMC. Good luck, Mr. Tucker,” she added, patting the man on his left arm.

  “Thanks, Doc,” he replied, smiling up at her.

  I took a good look at him as he lay there before me. He seemed to be in no distress, with normal color and what seemed like a normal neurological response. The only significant thing I noted was a large bandage wrapped around his head, covering an odd horn-like shape sticking up from the top of his skull. I wondered why he was being sent out to a trauma center.

  The paramedics wheeled him toward the ambulance entrance and Liz suddenly put her pen on the counter and looked up at me.

  “Come over here, Robert,” she told me. “I want you to see something.”

  She quickly stepped over to the X-ray view box and I followed.

  “Take a look at this!” she said, flipping on the light and illuminating the film that was hanging there.

  Wow—now that was something! It was the lateral view of the skull of an adult—nothing unusual in and of itself. What was unusual was the large nail driven through the top of this person’s head—half on the outside of the skull, and half in the brain.

  I glanced at the closing ambulance entrance doors, now understanding the pointed bandage on the top of that young man’s head. But he had been wide awake, and acting as if there was no problem.

  “What happened?” I asked Liz while looking at some of his other X-rays. It seemed that the nail went right into the middle of the top of his brain.

  “Nail-gun accident,” she said matter-of-factly, as if she had seen hundreds of these in her short career. “He was working on a construction site, downstairs, minding his own business, when someone on the floor above him fired his gun into some plywood. The nail went all the way through the floor, hit him in the head, and knocked him down. But he never lost consciousness. It’s amazing, but he’s completely intact. No deficit that I can find. But that nail has to be sitting in his brain. We started some antibiotics and called one of the neurosurgeons in Charlotte. He’s going to see him up there in the ER. Should do okay.”

  “Wow,” I remarked as we walked back to the nurses’ station. “I’ve never seen anything like that before.”

  Answering my earlier question, Liz said, “There’s only one patient I need to leave you with, Robert. There’s a two- or three-year-old in 4. Minor head trauma. He fell and hit the back of his skull about dinnertime, and is around in CT now. Shouldn’t be much longer. No loss of consciousness, but he’s got a big goose egg there, and his parents think he’s not acting quite right. Anyway, should be negative, and he should be able to go home.”

  With that, she closed the chart in front of her, tossed it into the discharge box, and with one hand slapped the top of the counter.

  “And I’m gone,” she said, smiling. Then glancing around the department, she added, “Good luck.”

  From across the room, the door to Virginia Granger’s office opened, and out she walked. I looked up at the clock on the wall, a little confused. She was here every day during the week, but usually left around five o’clock. What was she doing here now?

  A few steps behind her walked Darren Adler, dressed and apparently ready for work. Virginia saw me and started over in my direction.

  When the two stood in front of me at the nurses’ station, I was better able to see Darren’s face. He was a pale green, and the corners of his mouth were turned down. Looking closer, I noticed some small beads of sweat on his forehead. He was sick, and obviously didn’t feel too well.

  “Darren called earlier this afternoon,” Virginia began to tell me. “He said he was feeling a little better and wants to try to work.” She paused and looked doubtfully over at the nurse. “I’m not so sure, but he’s insisting he’s okay.”

  “Darren, you don’t look so good,” I told him honestly. “We’ve got someone else to work for you tonight, and it won’t—”

  “I’m fine, Dr. Lesslie,” he said, trying unsuccessfully to muster a little bravado. “Things turned the corner around noon, and I haven’t had any more vomiting since then. I really want to work, and I’ll… I’ll be fine.”

  I looked over at Virginia for some help. She raised her eyebrows, pursed her lips, but didn’t say anything.

  “What about Patsy Wilson?” I asked her, hoping that she might have already come in.

  “I explained things to her, and she’s sort of on standby. She understands—and if we don’t need her tonight, she still wants to try working sometime.”

  I studied Darren’s face again and thought about the state of the department. It was going to be tough for him, but I knew he was on thin ice. And I knew Virginia was leaving the decision up to me.

  “Do you think you can handle it?” I asked him.

  “I can do it, Doc.”

  I looked at him
for another moment and then, with some trepidation, relented. After all, Patsy Wilson was out there if we needed her.

  “Okay, Darren. Get going then.”

  “Thanks, Doc,” he said, mustering a smile. “And thanks, Ms. Granger.”

  He turned and walked toward the nurses’ station. I was about to follow him when Virginia said, “Dr. Lesslie, I need to speak with you for a moment.”

  It was not a request. She turned and walked back into her office, and I followed, closing the door behind me.

  “I know you need to get out there,” she began. “But this will only take a moment. You need to know that we have a problem with our medications.”

  I already knew about the Vistaril business. Now what?

  “The narcotics count has been off twice this week,” she calmly explained. “We’re missing four vials of Demerol.”

  “What? Are you sure?”

  “You know the procedure, and yes, I’m sure,” she answered flatly.

  At the beginning and ending of each shift, two of our nurses would go through the narcotics cabinet, counting each unit of each drug, making sure that what was in the cabinet matched what was in our log. It was a state and federal requirement, and something we took very seriously.

  “How does something like that happen?” I asked her, my mind turning on recent events and possibilities.

  “On Monday there was one missing,” she explained. “And Lori Davidson brought it to my attention. We’ve had that happen occasionally in the past, and it usually shakes out in a couple of days. Once the pharmacy made a mistake in their count, and another time the pharmacist found the missing vials stored in another location. I was hoping that would be the case this time, since there was just one vial unaccounted for. But this morning, three more turned up missing. We’ve looked everywhere, but nothing so far. I just wanted to make you aware, and ask that you keep your eyes open for any unusual activity or behavior. I’ve notified the administration, and they will have to start their own investigation.”

  Great! I thought. That’s all we need, someone from admin poking around the department, creating a stir and solving nothing.