Angels on the Night Shift

by Robert D. Lesslie, M. D.

  For a split second Liz seemed to want to stiffen her neck, but instead she looked up sheepishly. “Yes, that’s right. And I should have known better. But it was five in the morning, and I was tired, and he seemed legit, and—”

  “And let me guess again,” I interrupted once more. “There was no name on the medical records. Not his, not anyone’s.”

  She jerked her head up at this apparently new and shocking revelation. “I don’t know, Robert! I didn’t even look. But come to think of it, I didn’t notice anybody’s name on those records. Just his on the outside of that folder. And he could have—”

  “Of course he did,” Amy jumped in. “He wrote his own name on it, if it was really his name.”

  “But he would’ve had to have some kind of ID to present at the drugstore, wouldn’t he?” Angie asked. “I mean, the pharmacist wouldn’t have filled the prescription without a picture ID of some sort, right?”

  “You wrote him a prescription?” I asked Liz, a little surprised. She was fresh out of her residency, but she seemed to be way too savvy to have fallen for this kind of ruse.

  There was that sheepish look again.

  “Just for a few,” she answered quietly.

  “A few?” Amy exclaimed. “How about 40? And then he tried to change the 4 to an 8!”

  “What?” I asked, only a little surprised by his brazenness. I had once had a drug-seeker change my prescription for pain meds from 12 to 120. Fortunately the pharmacist had caught that one, just like someone must have caught this guy.

  “Yeah, pretty crazy, right?” Amy said, chuckling and shaking her head. “The pharmacist out near the interstate called and asked us about that. And then he proceeded to tell us he did some checkin’ online and found that Mr. James Wiley III has been quite busy. This was his sixth prescription in the past 24 hours, all for oxycodone and all from different ERs.” She folded her arms across her chest, smiled, and with feigned condescension looked over at our at newest ER doctor.

  “Don’t feel bad,” Angie began. “He must have—”

  “Well I do feel bad!” Liz interrupted. “I should have been paying more attention. I should have known from the very beginning that something was up.”

  She was getting angry again, and her face was starting to flush. I needed to rescue her.

  “Liz, it happens to all of us,” I tried to calm her. “Some of these folks are pretty clever, and they know we’re busy and trying to take care of a lot of people as quickly as we can. And just so you know, his coming in at four in the morning was not just by chance. It was carefully calculated on his part. He was hoping you would be tired and would just want to get him taken care of as quickly as you could.”

  “And he was right,” she admitted. “But still, I should have known better.”

  Her eyes once again focused on Wiley’s chart, and she didn’t say anything. Then suddenly she must have thought of something and she looked up at me. “What about you, Robert? If it happens to everybody, then when was the last time someone pulled one over on you?”

  “Me?” I responded in mock surprise.

  “Yeah, you, Dr. Lesslie,” Amy interjected. Then she turned to Liz and said, “But hoodooed would be more like it.”

  “What exactly do you mean by ‘hoodooed’?” I inquired, glaring at the secretary.

  “You know what I mean,” Amy replied with an eyebrow raised. “Tell them about Charlene Saunders and Adelle.”

  She had me, and I quietly surrendered. “Oh…Charlene.”

  It had been the middle of winter and an ice storm had just blown through York County. At two in the morning, most people were home in their beds and were not venturing out onto the treacherous roads. For those of us in the ER, the quiet was welcome. We had only seen a handful of people since seven in the evening, and it looked like we might be done for the night.

  Then the triage door opened and Jeff Ryan led a young woman into the department. She was carrying a four- or five-year-old girl in her arms, and Jeff led them to room 5.

  “Well, so much for it being too icy to be getting out,” said Susan, our unit secretary. She sat up in her chair and reopened the ER logbook, preparing to make a new entry. “It did look like that child was pretty sick, though,” she added.

  Jeff walked back over to where we sat and dropped down into his chair. Then he handed me the chart of room 5 and said, “I don’t think we’ve ever seen this one. Mother says they’re new to town and don’t have a doctor yet. The child has some kind of cerebral palsy and has run out of her medication.”

  I held the chart in my hands and scanned the front page. The girl’s name was Adelle Saunders and she was five years old. Jeff had written down the chief complaint—“Out of medicine—chloral hydrate. Now agitated.”

  “Agitated?” I asked him. “She looked like she was asleep when you walked by the counter,” I observed.

  “Hard to say,” Jeff answered slowly. “She doesn’t walk, and when her mother put her down on the stretcher, she sat there leaning against the rail and then started banging her head against the wall. Not hard or anything, just kinda…well, I guess she was banging it. Her mother says she does it all the time when she’s out of her medicine.”

  Chloral hydrate. Now that was an old drug. During my training, some of the pediatricians on staff would use it to sedate kids before procedures that required them to be calm and still. It was effective, but sometimes difficult to dose correctly. And it had the potential to be abused.

  “I wonder where she’s been getting the chloral hydrate,” I mused.

  “Isn’t that the old ‘knockout drops’?” Jeff asked. “Like you used to see in the movies?”

  “Yeah, you’re right,” I responded, reminded of this romanticized use of the drug. “It’s the old ‘Mickey Finn.’ ”

  “Mickey Finn?” Susan asked, curious. She was too young to know anything about this. “What in the world is a ‘Mickey Finn’?”

  I thought for a moment but couldn’t remember where this name had come from. Then realizing I probably had never known, I stood up and looked down at her.

  “Jeff will explain that one,” I told her. “I’ve got to go see the child in 5.”

  The mother of Adelle Saunders looked up as I entered the room.

  “Ms. Saunders,” I greeted the young woman. “I’m Dr. Lesslie. And this is your daughter?”

  “Yes,” she answered, smiling. “This is Adelle, and I’m Charlene Saunders.”

  I walked over to the stool at the head of the stretcher and sat down.

  “Tell me what brings you to the ER this morning,” I began.

  Charlene Saunders proceeded to share with me her daughter’s complicated medical history and her problems with cerebral palsy.

  “She has the mental age of a one-year-old,” she patiently explained. “About a year ago, she became very difficult to manage. That’s when she started this head-banging of hers.”

  I had noticed this persistent, rhythmic movement of Adelle’s but hadn’t said anything about it yet. She was slowly rocking back and forth and tapping her head against the wall beside the stretcher. Not hard, and I don’t think it was hurting her. But I thought it a little peculiar that it didn’t seem to be bothering her mother very much. Maybe she was used to it. After a few minutes though, it had started to get to me.

  “Why don’t you hold her in your lap,” I suggested, hoping her mother would be able to control the compulsive behavior.

  “No, she’s fine,” Charlene responded, smiling at me again. “Anyway, the only thing the doctors in Raleigh found that would help her was chloral hydrate. It was like a miracle! When she takes it, she’s just as calm and sweet as can be. And she never does any of this,” she added, tilting her head toward Adelle.

  “So she’s been taking it for a year?” I asked. That was a little odd, and you would have to worry about the potential for dependence, if not addiction.

  “That’s about right,” she answered, nodding her head. “And if we ever run
out, then this starts again. That’s what happened today. We haven’t been able to find a doctor in Rock Hill yet, and she took her last dose about twelve hours ago. That’s why we’re here now, to get enough to last her until we can get in to see a pediatrician. Probably a week or so.”

  She sat there, and waited for my response.

  “Well, let’s take a look at her,” I said, standing up and moving beside the bed.

  She didn’t have any fever and I couldn’t find evidence of any significant trauma. The right side of her head was a little red from where she had been hitting the wall, but nothing else.

  She was a pretty girl, with curly blonde hair and light blue eyes. The cerebral palsy had left her with contorted limbs, with her left arm drawn up to her chest and her legs permanently flexed at the knees. She was able to use her right arm to move herself around and shift positions.

  “Can she speak?” I asked Charlene, looking down at the child and smiling.

  “She’s never said a word,” her mother answered flatly. “The doctors say she never will.”

  We talked a little more, and I gave her some advice about who I thought would be the best pediatricians for her daughter. When they left the department, I gave her a prescription for a week’s worth of chloral hydrate. No refills.

  “Thank you, Dr. Lesslie,” Charlene said as they passed the nurses’ station and went back out to the waiting room.

  The rest of the night passed uneventfully, and no one else seemed willing to brave the dangerous roads. We soon forgot about Charlene and Adelle Saunders.

  About two weeks later, we knew we might have a problem. One of my partners, Ted Nivens, had seen Charlene and Adelle during the middle of the night. He thought it a little unusual, and he told me about it when I relieved him at 7 a.m. Jeff had not been working, nor had Susan. If they had been, they might have been able to tip Ted off.

  The visit had been a carbon copy of the first. Charlene was asking for enough chloral hydrate until she could see a pediatrician. “Just enough to get Adelle by,” she had persisted. Ted had the old record in front of him and could read what I had done.

  “I was reluctant to do this again,” he told me. “But she was begging me, and that poor child just kept banging her head on the wall. Finally I gave in and wrote her enough for three days only. I told her that was all we could do, and that she needed to have her medication refilled by Adelle’s doctor. What else could I do?”

  There wasn’t much else he could have done. It’s one thing to refuse an adult who is demanding narcotics, but it’s something entirely different when a child is involved. Especially a child who is so dependent on her mother.

  “You did the right thing,” I told him. “Hopefully she’ll find her daughter a pediatrician before she runs out of medicine again.”

  She didn’t. And a few days later they were back in the ER. This time, they saw another doctor, and again they got more medication. Lori Davidson showed me the record the next morning and asked what I thought we should do.

  “Let’s give Charlene Saunders a call,” I told her, searching the ER record for a phone number.

  I dialed the number and waited.

  “The number you have dialed is not in service. Please—”

  I pressed the receiver button down and tried again.

  “The number you have—”

  Angrily, I hung up the phone.

  “You’re not surprised, are you?” Amy Connors asked, having heard the story and watched my futile efforts.

  “I guess I shouldn’t be,” I sulked. “What do we do now?”

  “I suppose we’ll have to wait until she comes back in,” Lori said calmly. “Then we’ll address this with her and make sure she understands. If she comes in during the day, we can arrange for a pediatrician to see her right then.”

  That sounded perfectly reasonable, but thus far, Charlene seemed to know the best time to come to the ER for something like this, and it wasn’t during regular office hours.

  “We’ll see,” I said doubtfully.

  We didn’t hear from the Saunderses for a while. Several weeks went by, and I had almost forgotten about them. Then it started again. Charlene would bring Adelle to the ER during the middle of the night and ask yet again for chloral hydrate. She would beg the ER doctor on duty while her daughter banged her head against the wall of the exam room. Ted tried once or twice to be firm with her, but ultimately relented. She seemed to be intentionally avoiding me though, and while I heard about their visits, they never showed up while I was working. Not until the week before Easter.

  It was the middle of the night again, and into the ER walked Charlene, once more carrying Adelle. It was the same story, but with a little different twist this time. Charlene had managed to find a pediatrician for her daughter, but he was vacationing out of the country and couldn’t be reached. It was 3 a.m., and how were we going to confirm or refute that? She needed enough chloral hydrate for two weeks and we were her only hope of getting it. No one else in town would write it for her.

  “Look at her!” Charlene had pleaded, pointing to her daughter. “It’s getting worse, and I can’t control her. This goes on all night.”

  Adelle did seem to be more agitated this time, and there were bruises on the side of her head, not just some faint redness. Against my better judgment, I gave her a week’s worth of the medicine and said, “This is it, Charlene. No more. Do you understand?”

  “I understand, Dr. Lesslie,” she said, taking the prescription and stuffing it in her purse. “And thank you. This will be the last time I ever ask you to do this. Ever.”

  She turned and walked out of the department. Jeff Ryan was standing on the other side of the counter, looking at me and shaking his head.

  But Charlene kept her word. She never asked me again for chloral hydrate. It would be Ted Nivens, and it was two days later. This time, the gig was up.

  “I couldn’t believe it,” Ted had told me. “She came in during the afternoon, right in the middle of the day when we were really busy. They were in room 4, and when I walked in I almost fell over. There was this sickeningly sweet odor in the room, and Charlene had this reddish liquid on her chin and it was spilled all over her blouse. Her eyes were glazed and her speech was slurred. And there was Adelle on the stretcher like she always is. Then the woman had the audacity to ask for more chloral hydrate for her daughter! I just looked at her and knew I was about to blow. She started demanding that I write her a prescription and stood up and shook her finger in my face. She almost fell over on the floor. It was all I could do to get her back on the stretcher so she wouldn’t hurt herself.”

  Now it all made sense. This woman had been taking Adelle’s medicine all along, if in fact it had ever been given to her daughter in the first place.

  “What did you do with her?” I asked Ted.

  “Well, we put her in observation for a couple of hours,” he explained. “And one of our techs watched Adelle. Then when Charlene could walk straight, we called a cab. I had a word of prayer with her and told her that if she ever came in again asking for chloral hydrate, we would call the police, or something worse. She seemed to understand, though. And before she left, we gave her some information about where she could get some help for her addiction. I was going to call DSS, but she was gone before I could. But I don’t think we’ll be seeing her again.”

  “We need to call DSS anyway,” I suggested. “Adelle doesn’t need to spend the rest of her life like this.”

  Less than a week later, we learned that she wouldn’t. Adelle was dead. We didn’t find out about it until the afternoon Charlene was brought to the ER by EMS. She had called 9-1-1, hysterical and totally out of control. A day or so earlier, her daughter had had a seizure and apparently aspirated. Charlene blamed herself and was inconsolable.

  “When we got to her apartment building,” Denton Roberts told us, “she was walking up and down the sidewalk, waving her arms in the air and screaming. The neighbors couldn’t get her calmed down, a
nd we were barely able to get her to lie down on the stretcher.”

  Ted Nivens had been on duty when she came in. It took him a while to get her to the point where he could talk with her. She had no family in the area and no friends, but she didn’t want to be admitted to the hospital.

  “I’ll be okay,” she had tried to convince him. “It will take a while, without Adelle, but…”

  And then she broke down all over again. Ted was worried she might try to hurt herself. After all, she hadn’t proven herself to be the most dependable and upright of people. But in the end, she calmed down and he was able to send her home. He gave her something to help her rest, but it wouldn’t be chloral hydrate this time.

  A week later, I was finishing up a night shift when Ted Nivens walked through the ambulance entrance doors.

  I told him about the patient in room 5 who was over in radiology getting a chest X-ray for a possible collapsed lung. And I told him that Charlene Saunders had come in during the middle of the night.

  “She told me she was doing okay, but that every once in a while, she just lost it,” I told him. “I refilled the Valium you gave her and told her she needed to follow up with somebody at the mental-health clinic.”

  I thought Ted was going to explode. His face turned red and steam started pouring out of his ears.

  “You gave her more Valium?” he exclaimed. “Why that…”

  He sputtered for a minute, searching for the right words. Then he took a deep breath and said, “I’ve been off for a couple of days and haven’t had a chance to talk with you. I guess I should have called, but I’ve been busy.”

  “Call me about what?” I asked, curious about his reaction and now this last statement.

  “Well, Robert, let me just tell you about our Charlene Saunders,” he began. “About a week ago, I was out at Wal-Mart picking up a couple of things and just looking around. I think I was in the sporting goods department when I turned a corner and started down an aisle. I wasn’t paying much attention and almost ran into the back of a woman who had stopped in front of some fishing tackle. I said, ‘Excuse me,’ and when she turned around, doggone if it wasn’t Charlene. Her eyes got real big and she looked like she had seen a ghost or something. She started backing away, pulling her cart, and that’s when I looked down.”