Angels on the Night Shift

by Robert D. Lesslie, M. D.

  As I passed an endotracheal tube through Missy’s throat, I was shocked by the amount of swelling and damage I was seeing. Her mouth and pharynx were puffy and red, and her vocal cords were already swelling and purple. I was lucky to get the tube through and in place.

  “Doc,” the officer said, standing right behind me. “The mother wants to come back.”

  Suddenly it seemed that every eye in the room was on me.

  My face was flushed and I was trembling with anger. I wasn’t sure Missy was going to survive this, and even if she did…

  “No!” I said, my voice tight, and as controlled as I could make it. “Not yet.”

  I knew the anger I was feeling was doing me no good, and it wasn’t helping Missy.

  Somehow I was able to put it behind me—at least for two days. Then Missy died, and I became angry all over again. This time it didn’t go away.

  One day Virginia Granger called me into her office and closed the door behind us. She didn’t sit down behind her desk, but took the chair right beside me, pulled it close, and leaned toward me.

  “Robert, when I was in the army, stationed overseas, I worked with a surgeon, Major…no, his name doesn’t matter. What does matter is that he was one of the best trauma surgeons I had ever been around. Great ability and a great attitude. But one day we had three young recruits injured in a training accident. It was a freakish thing, and these boys were really mangled. The problem was that it had been caused by an officer who had been out drinking the night before. That really set off the surgeon, and it was all I could do to keep him calm and focused on the injured soldiers.

  “He told me later that his younger brother had been killed by a drunk driver. He apologized and told me he thought he had gotten over it, but it was obvious he hadn’t.

  “We worked with those boys all day and night, and early in the morning we lost one. The other two were eventually shipped back to the States. But they were never going to be the same. One lost both hands, and the other lost an eye and part of his face. It was awful.

  “The surgeon never recovered from that night. He just was never the same. We tried to help, but all we could do was watch as he became more and more angry, and more withdrawn and sullen. Finally he transferred out of there. I don’t know what happened to him. In fact, I don’t even know if he stayed in medicine.”

  She was looking at me intently now, studying my face, and for a moment she didn’t say anything. I knew what she was telling me and what she was trying to do.

  “Here, I want you to have this,” she said, handing me a folded slip of paper. “Keep it with you.”

  She got up and walked out of the office, closing the door behind her. I sat there alone with my thoughts, staring at the paper in my hand. I unfolded it and started reading. The first part had been carefully typed, and it was clear and legible. Underneath those words was something in Virginia’s own handwriting, and it took a little longer to make out.

  Anger is a killing thing; it kills the man who angers, for each rage leaves him less than he had been before—it takes something from him.

  —Louis L’Amour

  If you don’t have something in you that’s above you, you soon give in to the things around you.

  I knew she was right, and that Louis L’Amour was right. What I was feeling was killing me and taking something from me. Just like the army surgeon’s anger had taken something from him. And I realized my anger was changing me too. I needed to release this to the One above me.

  I folded up the paper and slipped it in my pocket. This wouldn’t be the last time I would need to read it and be reminded.

  Ted Nivens and Lori Davidson were still standing by the stretcher, working with Cindy, who was lying quietly now. I turned and walked out of the room.

  I was on my way out to triage to find Cindy’s mother, and as I passed the nurses’ station Darren looked up at me. His eyes still burned with anger. I recognized myself in those eyes. He needed Virginia’s wisdom.

  I caught his eyes and said, “Darren, when I get back, let’s sit down.”

  17

  Busted

  7:35 a.m. In less than a week, it started all over again.

  “Dr. Lesslie, can you come here a minute?”

  Lori Davidson was standing in the doorway of the medicine room, motioning for me to join her.

  When I got there, she was standing in front of the narcotics cabinet, unlocking one of the doors with her keys.

  “I need to show you something,” she said, reaching into the cabinet and picking up a box of medicine. It was the same type of container Walter Stevens had shown me a few weeks earlier. This time, I knew exactly where to look.

  “Hmm,” I murmured, stunned at this development. “More Demerol.”

  I counted six tiny perforations in the bottom of the box, neatly spaced for proper balance, just like before.

  “Do you have any idea when this might have happened?” I asked Lori, putting the box of Demerol down on the counter and reaching into the cabinet for another. My mind was racing and I was trying to get a handle on this.

  “That’s the only one,” she told me. “I checked twice. But look at this.”

  She reached to another shelf and picked up an open box of morphine vials. Before she handed it to me, she pointed down to the narcotics logbook on the countertop. Then with her index finger, she moved down to today’s date and the morphine column. The number “9” had been written in the small space, indicating there should be nine vials of morphine in the open box.

  I glanced at the container in her hand and counted nine. That matched. So what was the problem?

  Lori moved her finger over just a little, to the place where the counting nurse puts their initials. D.A.

  “Okay?” I asked, puzzled. At least this part seemed to be in order.

  “Now look at this,” she said, handing me the box of morphine.

  Once again, I counted nine vials, all unopened and all intact. Then I withdrew one of the vials and rolled it around between my thumb and index finger.

  “What! How did this happen?”

  The vial in my hand was Vistaril, not morphine. Someone had intentionally switched it out and pocketed the narcotic.

  “I just noticed it a little while ago,” Lori explained. “I don’t know what made me do that, but I took a couple of them out and saw they had been changed. From the top, they all look the same.”

  “How many…?” It didn’t matter. My mind was reeling and a hundred thoughts were screaming for my attention. But almost immediately, I latched onto one pressing realization.

  “Amy!” I exclaimed. “This will clear Amy! Whoever’s been doing this has finally tipped their hand, and it can’t be her!”

  I’ll get Virginia, and we’ll go to Bill Chalmers and set this straight!

  I must have been turning toward the doorway because Lori stopped me.

  “Hold on, Dr. Lesslie,” she said patiently. “There’re some things we need to think about.”

  I turned to face her and then glanced over again to the narcotics cabinet.

  “No, that’s all that’s been tampered with,” she said, following my gaze. “But we need to be careful about a couple of things. I’ve already talked with Ms. Granger and told her about this. She had to go to a mandatory management meeting this morning and won’t be back ’til around noon. And she asked me to tell you about this, but to be sure you didn’t do anything—not until you two can talk.”

  She was looking up at me, and seemed to be waiting to be sure I was listening.

  I had heard what she’d said, but my brain was in overdrive. We needed to get in touch with Amy, and there was the matter of the switched medicines. You can give morphine intravenously without any problems, but IV Vistaril will burn a person’s veins and can cause other problems. If an unknowing nurse reached into the morphine box and took out a vial of Vistaril…

  As if Lori was reading my mind, she said, “I’ve been off for two days and just noticed this a l
ittle while ago. But I checked, and we haven’t given much morphine over the past forty-eight hours, so I don’t think anyone has been given the wrong medicine. No one has said anything, and that’s something that would stand out, don’t you think?”

  “It should,” I mused, considering other possibilities. If the person who had switched the two drugs was also the person dispensing them, it would be a simple matter to disguise their actions. But that person—almost certainly a nurse—wouldn’t always be working. And that left open the possibility of one of our patients being given the wrong medicine by mistake. That would be a disaster, and I felt my face flush with anger as I thought about it.

  “Here,” I said to Lori, handing her the medicine box. “We need to put this somewhere safe, where no one can get their hands on it.”

  She took it from me and said, “I’ve already thought about that, and I’m going to take it to Ms. Granger’s office.”

  I looked down again at the narcotics logbook and studied the last entry.

  “D.A.,” I said softly.

  “I know,” Lori whispered, a note of sadness in her voice. “I don’t want to think Darren could be doing this, but…”

  Her voice trailed off. She was coming to the same conclusion I was now being forced to face. I had supported Darren Adler through all of his troubles and had championed his return to the ER. I thought I knew him, and I would never have thought he was capable of stealing and abusing narcotics. But he had become a little unpredictable lately, with more and more frequent outbursts of anger. And there had been that little girl the other night with the burns…

  “What did Ms. Granger have to say?” I asked Lori, needing to put those thoughts away, at least for a while.

  “She had the same response you did,” Lori said, nodding her head. “Her first reaction was to clear Amy’s name, but then she started considering other things. She still doesn’t know who is doing this, and she doesn’t want to do anything to jeopardize catching them. But she had to go to that meeting, and she said she wasn’t going to talk with anyone until she had a chance to talk with you.”

  “Okay,” I sighed, closing the logbook and looking out into the department. “I guess we’ll have to wait. That’s hard for me to do. I want to handle this thing head-on and get it over with. But Virginia’s right. I need to hear what she has to say. And it looks like we have work to do.”

  I was almost at the nurses’ station when I heard it. Stopping cold in my tracks, I cocked my head toward the hallway and listened.

  “Yep, you heard it,” Susan Everett said, looking up from behind the counter.

  Then there it was again.

  Woof! Woof! Woof! It was high-pitched and definitely of canine origin.

  “It’s a dog, and he’s in ENT,” she informed me matter-of-factly. “Or she. I couldn’t tell which.”

  “What’s a dog doing in the ER?” I asked her, looking down at the clipboard in front of me. Elva Wilson—69 yr old F. It was the clipboard for the patient in ENT, and the chief complaint written at the top of the paper was “Nerves tore up.”

  “You’ll have to figure that one out,” she chuckled.

  I picked up the chart and headed down the hallway.

  My hand was on the doorknob, when the dog started barking again. Actually it was more of a yelp or a yip, not really much of a bark. It must be something small, I thought.

  Stepping into the room, I was assaulted by the odor of mothballs and garlic. Sitting on the stretcher was Elva Wilson, and in her lap was a King Charles spaniel, its eyes now focused unflinchingly on me.

  “Ms. Wilson, I’m Dr. Lesslie,” I told her, closing the door behind me.

  Elva was…well, she was unusual. Her hair was died a bright orange-red, and her ruby-red lipstick had been applied with less than consummate skill. It was smeared onto her cheeks and chin, though she didn’t seem to mind or even know. Mascara had streaked down her face, and she was only making it worse by dabbing the tears from her eyes. She wore a navy-blue housecoat and bright pink slippers.

  “Hello, Dr. Lesslie,” she sobbed out. “I’m Elva Wilson, and this is Princess,” she added, looking down at her pup. Her accent was heavy, eastern European—maybe Hungarian.

  On cue, the tiny dog wagged her tail and yipped at me.

  “Ahem!”

  Startled, I turned around to see an elderly man standing in the corner of the room. I hadn’t noticed him when I came in, and until now he hadn’t made a sound.

  “This is my husband, Barney,” she introduced us.

  The man took an Atlanta Braves baseball cap from the top of his head, crumpled it in his hands, and bowed slightly to me. His attire was eclectic—a multicolored paisley shirt, pants that were checkered light blue and dark blue, and much-worn leather sandals over white socks.

  “Mr. Wilson,” I said, bowing in turn. “Nice to meet you.”

  Elva let out a loud wail and began drying her eyes again. Princess looked up at her, confused and upset. Not able to think of anything better to do, she looked back at me and started yelping.

  I looked down at the chart and again read “Nerves tore up.” Where should I start?

  “Dr. Lesslie, you need to do something for Elva.” Barney spoke clearly, with no accent and with obvious concern for his wife. He stood there, wringing his cap in his hands and looking at me with pleading in his eyes.

  “Tell me what’s going on,” I asked.

  Elva let out another wail, and this time Princess looked up at the ceiling and howled.

  “You need to x-ray the dog,” he said, and then just stared at me.

  “The dog,” I said, trying as hard as I could to appear serious. “Why do we need to x-ray Princess?”

  “Oohhh!” Elva moaned. This time I didn’t turn to her, but kept looking at her husband.

  “Yes, you need to x-ray the dog,” he began to explain. “A little while ago, Princess ate one of Elva’s rings, her favorite, the diamond that her grandmother gave her.”

  “Aaahh! Grand Ma-ma!” Elva cried.

  “She what?” I asked, wanting to be sure I had heard him correctly.

  “The dog ate her ring and she is terribly upset, as you can see!” Barney answered, glancing over at his wife. “If we don’t get that ring, I don’t know what will happen!” he added, nodding at her.

  “Oh, my ring!” Elva wailed, clutching Princess to her chest and rocking back and forth.

  “Did you think about taking Princess to a vet?” I asked, struggling for some plan here.

  “Elva won’t have anything to do with that,” he answered, shaking his head and looking down at the floor. “She demanded that I bring her here and have the dog x-rayed. What could I do?” he asked, shrugging his shoulders, clearly helpless to disagree with his wife.

  “Well, Mr. Wilson, we don’t routinely x-ray animals here in the ER,” I explained.

  “Ooohhh! What will I do? Grand Ma-ma!”

  So there we were—Elva was wailing, Princess was howling, and Barney continued to plead with me.

  “You see, Doctor? What am I going to do?”

  Then I did what any prudent ER doctor would do.

  “Mr. Wilson,” I told him. “Try to calm your wife down, and I’ll be back in just a few minutes.”

  I escaped into the hallway and quickly closed the door behind me. I could still hear Princess as I hurried back up the hall to the nurses’ station.

  Jeff Ryan was standing there. He was the triage nurse this morning and had taken the Wilsons back to ENT.

  He was writing on a chart and without looking up said, “Doc, there’s a depressed cat in room 2, a horse with bronchitis in 5, and a strung-out orangutan in Ms. Granger’s office.”

  I wasn’t amused.

  “What were you thinking?” I scolded him. “Why didn’t you send them to one of the vets in town?”

  “You saw Elva,” he answered, teasing me. “Her nerves are ‘tore up.’ What was I supposed to do? She needs some help.”

  “That’
s for sure,” I agreed, shaking my head. “But what am I supposed to do? Send them around to X-ray for a ‘doggie view’?”

  “How about a ‘small doggie view’?” Susan quipped, not looking up at us.

  I glanced down at her and frowned.

  “Well, Doc, we’ve x-rayed stranger things,” he said, stroking his chin knowingly.

  “What do you mean?” I asked.

  “There was that guy a couple of years ago who was sure his two-year-old had swallowed his car key. He was stuck with no transportation and was desperate. We x-rayed the little guy then, remember?”

  “I remember,” I said. “And right after we did, this father found the key in his back pocket. Now how does that relate to the Wilsons?”

  “Well, remember when we had the Halloween candy scare and had all those parents bringing their kids’ candy in to be x-rayed? Somebody had heard on the news that people were putting razor blades in candy bars. How many bags of candy did we x-ray?”

  For two or three Halloweens we’d had people lined out the door, waiting to have their children’s candy x-rayed. The hospital even had to call in extra staff. Finally they refused to do it anymore, and it stopped.

  “You’re right. I do remember that,” I said, beginning to wonder if there might be some precedent for x-raying Princess. After all, it didn’t seem we were going to be able to help Elva until we determined whether or not that ring was in her dog’s gut.

  “And I seem to remember that someone on duty that night managed to confiscate a fair amount of Milk Duds,” Jeff said, cutting his eyes at me accusingly.

  “I don’t know who you’re talking about,” I said innocently. Milk Duds were my favorite candy…it was all coming back to me now.

  “And what about Jeremy Fowler?” he asked, again nodding his head.

  “Jeremy Fowler.” I said the name slowly, unable to keep from smiling.

  Halloween, 1986. 9:45 p.m. The back hallway was lined with ghoulies and ghosties and all manner of strange and frightening creatures. Scattered amongst them were a few princesses and pirates, and at least a half dozen Elvis Presleys. They were all impatiently waiting to have their candy x-rayed so they could go home and begin devouring the sugar-laden treats. At one point, I glanced back there and saw an Elvis sneak some bubble gum out of his bag and into his mouth.