Code Blue

by Richard MD Mabry

  "You wanted to ask me something, Doc?"

  Cathy turned and saw a paramedic she didn't recognize standing in the doorway.

  "Tell me what you found at Ella Mae's home."

  "She was on the living room couch—lying there with her hands crossed over her chest— almost like she'd been . . .laid out."

  "Any sign of drugs in the room?"

  "Didn't I—?" He reached into the pocket of his jacket and pulled out a small amber vial. He held it out to her. "I picked this up offthe coffee table next to the couch. Thought I'd already given it to Glenna. Sorry. I'm coming offa double shift, and I guess I'm a step slow."

  A glance at the label on the bottle confirmed what Cathy already suspected. Now she knew why Ella Mae was in a coma.

  15

  CATHY PUT THE VIAL IN HER POCKET. "BESIDES THE PILL BOTTLE, DID YOU see any liquor? Beer? Wine?"

  "No." The EMT shook his head. "Nothing like that in the room. Just a half-full glass of water on the table next to the pills."

  Ella Mae had said she didn't drink. Cathy hoped that was true. If so, it might make the difference between her living and dying. "Thank you. Now please send Glenna back in here."

  Cathy turned back to Ella Mae, letting her eyes travel back and forth between the figure lying deathly still on the bed and the monitor displaying her vital functions. Respirations were shallow and slow, oxygen saturation dropping. Blood pressure down, although not at shock levels. Cathy needed to rid the woman's circulation of the tranquilizer as quickly and completely as possible. But before that, she had to make sure Ella Mae's breathing and circulation were adequate.

  "So it's a drug overdose?" Glenna's voice came from behind Cathy, soft yet focused.

  "I'm pretty sure it is, and I don't have time to wait half a day for the results of a tox screen. I'm ready to go with that diagnosis."

  "What do you—?"

  A sharp electronic screech made Cathy turn toward the monitor. The pulse oximeter showed a dangerous drop in oxygen saturation. When Cathy looked at Ella Mae's chest, she could hardly detect any motion there.

  "She's quit breathing. We need to tube her." Cathy snatched up a laryngoscope from the equipment cart in the corner and moved quickly to the head of the gurney. She checked the light at the tip of the scope, then moved the plastic oxygen mask aside and opened Ella Mae's mouth.Cathy slipped the L-shaped instrument in, moving it carefully along the tongue, lifting the epiglottis. Pooled saliva obscured her view of the vocal cords.

  "Suction," Cathy said.

  The words were hardly out of Cathy's mouth before Glenna slid the tip of a suction tube into Ella Mae's throat and cleared the secretions.

  "Endotracheal tube." Glenna slapped a large, curved plastic tube into Cathy's free hand.

  Where did the vocal cords go? It had probably been a year since Cathy had done an intubation, but she hoped her instructors had been right when they said it was like riding a bicycle.

  "Please, God." She didn't realize she'd spoken the words aloud until she heard Glenna whisper, "Yes, please Lord."

  There! She saw the cords, the gateway to the airway she had to enter. Careful now, don't mess this up. Cathy eased the tip of the tube between the cords, and in a matter of seconds a mechanical ventilator pumped oxygen into Ella Mae's lungs at a regular fourteen breaths per minute.

  Cathy taped the endotracheal tube in place. "How's her pressure?"

  "Still ninety over sixty. Pulse steady at fifty- eight. Want to give her some Levophed?"

  "Put some in a bottle of D5W and piggy-back it into the Ringer's lactate that's running. We'll try to titrate her pressure back up. And get me some Romazicon. I'll give her a dose IV. That should help."

  "Right here," Glenna said. "I drew up 5 ml. in the syringe.That way you can give two doses if you need to."

  Cathy swabbed the insertion port of Ella Mae's IV tubing with alcohol, inserted the needle, and injected 2 cc of Romazicon.

  In a few minutes, Ella Mae's vital signs had stabilized, but she still was unresponsive. Time for the messy part— gastric lavage. Cathy rummaged in the cabinet until she found a nasogastric tube. She lubricated the long, thin tube and passed it through one of Ella Mae's nostrils, advancing it carefully until she was sure it was in the stomach. Then Cathy used a large plastic syringe with a rubber bulb at one end to draw up saline solution. She inserted the tip of the syringe into the tube and gently squeezed the bulb until all the liquid had been delivered. She waited a few seconds before releasing her pressure, letting the bulb expand to create suction that would pull the stomach contents back into the syringe.

  The first washing yielded very little. On the second, Cathy hit pay dirt. When she applied suction this time, a number of small, white, oval tablets, still intact, floated into the syringe.She repeated the maneuver a dozen times or more until the return was completely clear. Good. Now to put something into the stomach to inactivate any drug still there.

  "Let me have that activated charcoal," she said. "A hundred grams in half a liter of water should do it."

  Cathy injected the mixture into Ella Mae's stomach and clamped the end of the tube. She'd leave it in place for a while, just in case.

  How were the vital signs doing? She looked at the monitor and saw that Ella Mae's blood pressure had dropped again. Increase the Levophed? If she gave too much, she could give the woman a stroke from bleeding into the brain.If she let the pressure get too low, there could be damage to vital organs from inadequate blood flow. She decided not to let the pressure go any lower. She increased the flow of Levophed into the IV, her eyes glued to the monitor. After five minutes the pressure was at a level that Cathy felt was acceptable.

  Cathy closed offthe Levophed drip. "Leave that hanging, but I hope she won't need any more."

  "So what's next?"

  "Now we wait," Cathy said. "Glenna, how long have you been working in the ER?"

  "Since they opened this new hospital. I wanted to go to medical school, but my parents couldn't afford it. I went to nursing school on a scholarship, came back here, and this job opened up right about then so I grabbed it. I guess—"

  There was a faint hiccup from Ella Mae. She moved her left arm, pulling weakly at the restraint that held it to the side rail of the gurney. Cathy picked up a rubber-headed reflex hammer and tapped at the bend of Ella Mae's elbow, first one and then the other. She thought that maybe the resulting jerk was a bit stronger than before. Or was that wishful thinking on her part?

  Cathy put down the hammer. "She may be waking up. I'll hold offon more Romazicon for now."

  Gradually, the numbers for blood pressure on the green monitor screen above Ella Mae's head climbed. Her pulse rate sped up slowly. She bucked against the tube in her throat. Cathy watched until she was sure that Ella Mae was breathing more rapidly than the programmed inhalations from the respirator. She flipped a switch and the respirator was silent.

  "Let's keep the tube in until I'm sure she's okay. Why don't you call the admitting office and get a room for her? She probably should be in the ICU for the next eight hours or so. And do we have a psychiatrist on call?"

  "There's one who comes from Fort Worth twice a week.He's not here today, but he'll drive down for emergencies."

  "No," Cathy said. "It's not an emergency. I can handle it for now. But we need to ask him to see her in consultation.Suicide attempts aren't in my area of expertise."

  Glenna sniffed and Cathy thought she detected a smile on the woman's face. "From what I've seen, Doctor, there's not much that happens around here that you can't handle.But I'll call and arrange the consultation."

  "Thanks, Glenna." Cathy brushed her hair aside. "And if it helps any, I think you're doing a better job of helping your fellow man right here than a lot of the doctors I've run into.So don't feel bad about not going to medical school. You just keep on with your work in the ER."

  Cathy settled onto a stool in the corner of the room and wrote an admitting note and orders. She marveled that there was so m
uch talent here in her hometown. Glenna, Will, Jane. She hated to admit it, but she had to include Arthur Harshman. Cathy had thought returning to Dainger constituted an admission of failure, acknowledgement that she wasn't good enough for the big time. Now she wasn't so sure.Maybe the big time was overrated. Maybe coming back home had been a good choice.

  Cathy slid her key into the lock and eased open the front door.

  "Dear, is everything all right?" Dora Kennedy, her hair in curlers, her flannel robe pulled around her neck, sat in an easy chair in the front room, reading a Bible. "You were so late getting home, we were worried."

  "I'm fine. I just had an emergency case that took quite a bit of time. I didn't mean for you to wait up for me."

  "You missed supper, but I saved a plate for you. In the old days I would have put it in the oven on low heat to stay warm. Now, I'll just pop it into the microwave."

  Cathy followed Dora into the kitchen. She wondered what it would have been like growing up in a home where the kitchen was a center of social life. She could imagine the smells that filled the house as Dora cooked and Pastor Matthew sat at the kitchen table watching her, the two of them sharing thoughts from their day. She envied Will for the chance he'd had to be a part of that experience. In her home, the maid had done the cooking while her mother spent her days sequestered in her room, often taking her meals there as well.

  "Can you tell me about your emergency, or is it confi- dential?" Dora punched a few buttons and waited as the carousel inside the microwave spun and the square box did its electronic magic.

  "A patient took an overdose of tranquilizers—pills I'd prescribed, incidentally—and was brought into the emergency room in a coma."

  "Were you able to save the patient?" There was concern, not curiosity, in the question.

  "Yes. It was a tough fight, but everything turned out okay.The nurses in the intensive care unit will call me on my cell phone if there are any problems through the night."

  Cathy looked at the plate Dora set in front of her: lasagna, green beans, a piece of buttered French bread. Dora opened the refrigerator and pulled out a small plate of salad."Milk or tea?"

  "Milk, please. And thank you for saving this for me."

  "No thanks necessary." She poured a cup from a Mr.Coffee sitting on the counter, pulled out a chair, and sat opposite Cathy.

  Cathy picked up her fork, then saw the expectant look on the older woman's face. She didn't know if she could pray over the food, but tonight she felt as though she should. She bowed her head and said, "God, thank you for this food and for the wonderful woman who prepared it. Thank you for these people who have opened their home and their hearts to me. Amen."

  "Is there anything we can do for the woman who tried to commit suicide?" Dora asked.

  Cathy paused with a bite halfway to her mouth. Had she said "woman?" She didn't think so. "Do you know about this already?"

  Dora nodded. "Yes, we know it was Ella Mae Mercer."

  Cathy chewed a mouthful of lasagna and followed it with a swallow of cold milk. Wonderful. "To answer your question, I don't know what any of us can do. I'll ask a psychiatrist to evaluate her. When people try to commit suicide, it's generally a cry for help. Maybe he can find out what triggered this."

  "Would it be all right if Matthew and I went by to see her? After you feel she's up to it, of course."

  Cathy's answer came out without conscious thought."Why?"

  "Because we care about our neighbors, just like Jesus taught us to. And sometimes praying for them isn't enough.Sometimes it's necessary to put hands and feet to those prayers. Maybe we can do something for her. But we'll never know unless we ask."

  Cathy started to speak, then changed her mind and took a bite of bread so she'd have time to think. She'd been content to dump the problem into the lap of a psychiatrist. The Kennedys were willing to get involved themselves.

  "Please don't take this the wrong way," Cathy said, "but I have to ask. When you see tragedies, you don't seem to shy away from them. And you don't get angry with God when they happen. I can't understand it."

  Dora went to the coffee maker and refilled her cup. She held up the pot with a questioning look and Cathy nodded.She wasn't about to sleep anytime soon.

  After handing Cathy a cup, Dora settled back at the table."We've had our troubles. You were too young to remember, but Will had an older sister. She died when she was a baby.Nowadays they would have called it SIDS or crib death or something. Back then, it was just 'the will of God.' It broke our hearts."

  Cathy felt a tug at her own heartstrings. "How terrible."

  "Yes, it was. But it wasn't God's fault. And we came through it, with His help." Dora stood and put her cup in the sink. She took Cathy's dishes from her and did the same.Then she looked into Cathy's eyes and said, "God didn't kill your parents. God didn't make Ella Mae try to commit suicide.And God didn't break your heart. He doesn't cause bad things to happen. But, when they do, He's here to comfort us. Learn to lean on Him. Don't give up on God. He hasn't given up on you."

  16

  CATHY HURRIED INTO HER OFFICE AND CLOSED THE DOOR BEHIND HER.

  "Sheriff, I'm sorry to keep you waiting. Busy morning."She leaned across the desk to shake hands with the man, sitting in the patient chair before easing into her own. "What do you have for me?"

  J. C. Dunaway waved away Cathy's apology and opened the large manila envelope he held. "There are sixty or so Ford Expeditions in Summers County, and most of them are black. I brought you the list. Take some time to go over it and see if any of these are folks that might be out to do you harm." He handed her two sheets of paper.

  "I really appreciate this. I'll have to look at it later, though.Then I'll give you a call."

  Dunaway took his Stetson offhis knee, where it had been resting. "Glad to help. Now I don't want you to think we'll haul in everyone who owns a black Ford Expedition, put them under a bright light, and try to wring a confession out of them." He gave a wry grin. "Can't do that. But we will keep looking into it. I don't suppose you've had any more run-ins with that vehicle?"

  Cathy thought of the near miss in Will's pickup. He'd thought it was probably just a speeding driver caught by a short yellow light. She shook her head. "No, but if I do I'll call your department right away. I drive with my cell phone on the seat right beside me now."

  A disturbing thought flashed through Cathy's mind.There'd been no appearances of the mysterious black SUV since Ella Mae was hospitalized. Was hers one of the names on that list of owners? She couldn't help but sneak a peek, then felt a chill when she saw the name at the bottom of the first page: Ella Mae Mercer.

  Cathy rose and Dunaway followed suit. She walked him to the door, ignoring the stares of patients in the waiting room, who were obviously curious about what business the Sheriffof Summers County could possibly have with their doctor.

  Cathy turned around and started toward the exam room where her next patient waited, but Jane stopped her outside the door. "Will Kennedy wants you to call him when you have a break."

  "I'm busy until this afternoon. Did you tell him that?"

  "Yep, and he just said, 'Please ask her to call me when she can. It's not urgent, but I need to speak with her before the end of the day.' So I'm telling you."

  As it turned out, thanks to a fortunate combination of patients with simple problems and the combined efficiency of doctor and nurse, at ten minutes after twelve, Cathy and Jane looked out on an empty waiting room.

  Cathy patted her nurse on the shoulder. "Thanks. That went well."

  "I guess we're a pretty good team. Would you like to go with me to the Dairy Queen for a chicken sandwich?"

  "No, thanks," Cathy said. "I think I'll have a Power Bar here at my desk while I return some of these phone calls. See you at one."

  Cathy shuffled through the half-dozen pink slips, glancing at the names and messages, automatically placing them in what she considered their order of importance. The bottom slip simply had a notation: Call Will
Kennedy. That call was probably as important as any of them, but she wanted to be able to take her time with it. She set that one aside.

  Twenty minutes later, she had answered the questions of two patients and made office appointments for two more.Then she dialed Will's private number. It was noon and she didn't expect to catch him in, but maybe she could leave a message. Lately, they seemed to play a lot of phone tag.

  "Will Kennedy."

  His voice brought her out of her reverie. "Will, this is Cathy. What's so important?"

  "You are." He laughed. "At least, that's my opinion. I think it's time you and I had a quiet dinner, not an attorney-client meeting, just a social occasion. I propose that you break free from that antiseptic-scented prison of an office at a reasonable time tonight. We can have an early dinner, then see if there are any movies worth seeing."

  "But—"

  "No buts. I've even spoken with my mother, and she promises not to wait up with the porch light on. That way I can have some privacy when I walk my girl to the door."

  Cathy did some quick mental calculations. She should be finished in the office sometime after five. She'd seen Ella Mae this morning, but she decided she'd pop in again this evening to make sure her patient was okay.

  "Are you still there?" Will asked.

  "Sorry, just thinking. I guess I can get away. Why don't I meet you somewhere at six thirty?"

  "RJ's at six thirty it is. Be there—"

  "Or be square." Cathy laughed and hung up. It felt as though she were a senior in high school again. And it felt good.

  "Nice meal." Cathy dabbed at her lips, then folded her napkin and tucked it under the edge of her plate.

  "That's because of the company," Will said. He lifted his cup in a toast, and Cathy responded in kind.

  They sipped their coffee in silence, until Cathy turned serious. "I know we promised not to talk business tonight, but you need to know about the letter I received from the bank."