by Barbara Ebel
She opened her eyes and considered the end result. The eighteen-year-old had died a shocking, terrible, unforeseen death. Magnesium sulfate had been the premier drug of choice for her preeclampsia, which in and of itself, was a dangerous situation and diagnosis, but it went without saying that safety in the use of of all drugs was paramount … especially in a hospital!
CHAPTER 13
Roosevelt Harvey mustered up his courage as he took off down the hallway. Sometimes the responsibilities of being the attending doctor in a teaching hospital were enormous. It was better to be straightforward with the Chandlers about what had been discovered than procrastinate to buy time. The chances of them not suing the hospital and the doctors involved were slim. Honesty and timeliness were paramount and he would maintain the ethical and moral standards he believed in and always practiced.
After being given instructions by Dr. Harvey, Ling and Caleb had their own tasks to perform. They huddled inside the supply room to make a game plan and split up their chores. Ling spotted a stepping stool and sat down on the top step. She swept her hand back to grasp her ponytail, her ring gemstone lacking its luster as she changed her expression into a deep frown.
“I’m as tired as a bear in a den,” she said.
Caleb leaned in. “You should be perky. They say women often look rosy with an ‘afterglow’ after good sex and last night was felicitous, if I must say so myself.”
A moment of silence ensued. “Maybe for you,” she quipped.
Caleb felt a twang of ridicule besides being surprised. “Do you really mean that? I had no idea.”
“I’m just tired, that’s all.”
“You’re tired after getting adequate rest? We managed at least seven hours, which is a windfall for residents.”
“Yeah, well, for once, I’d like to be a normal person who sleeps that much every night.”
“There are a ton of people working other jobs and doing other things who get less than seven or eight hours a night. It’s not just us, you know.”
“Don’t you think you’ve pontificated enough?”
“I’ll shut up.”
She tilted her head and stopped fiddling with her hair. “I’m half sorry. Half the time, I feel defeated.”
“Defeated about what?”
“This case, for instance. A dead patient. No. A dead patient and baby. We’re not in it for that. Being a doctor in and of itself means to ‘do no harm.’”
Caleb maintained eye contact with her, trying to relay some empathy. “In actuality, you did not harm her. A mistake was made, which is what you are going to go talk to the head nurse about. Health care is run by humans, and although our record of safety is almost clean as a whistle, humans will make mistakes.”
Caleb extended his hand, hoping to help her down. She clasped it and stood in front of him. “You go see the new patient Kristin told us about, especially before the stupid bleached dark-blonde medical student goes in there.”
Dr. Gash let go of her hand. “Ling, you were a medical student once. I hope no one belittled you like that. Rumor is Annabel Tilson is far from stupid.”
“You can stick up for her. What? Have you become enamored with her?”
Caleb frowned. “I’d better go take care of our new patient.” He turned and glanced back over his shoulder. “And I don’t think she colors her hair. She’s as natural as the sunrise.”
Ling fumed as Caleb disappeared down the hallway. But forget about him, she thought. She marched past the elevator area and waiting room to the gynecology section and knocked on the first door.
The tall woman who swung the door open was the hospital’s head nurse and administrator of OB/GYN. “I just housecleaned that chair and alleviated it of a backlog of files. Have a seat. You’re Dr. Watson and, of course, I’m Elaine Rice.”
Ling wondered if the woman’s nasal voice had anything to do with her crooked nose. “I’ll sit, if you don’t mind.” She looked at the chair like it was a piece of chocolate cake. “A plushy, upholstered seat cushion is a rarity for a resident. I guess the hospital reserves that for their own main employees rather than the doctors and residents who keep hospitals afloat.”
Mrs. Rice threw her a dirty glance. “Feel free to speak your mind, Dr. Watson.”
“The reason I’m here is to discuss Mary Chandler. You must have been informed of her death yesterday.”
“Yes. My hand is on the pulse. It was an awful occurrence and I was informed immediately.”
“Have you been told yet what killed her?”
Mrs. Rice squinted. “Apparently not.”
“We only just found out. I’m sure diligent hospital employees will be calling you any minute.”
“Please lay the groundwork, Dr. Watson.”
“Your staff screwed up the labels and contents of two IV fluid bags yesterday on Ms. Chandler’s treatment of preeclampsia. Magnesium sulfate was bolused and dripped into our patient at an obscene rate … which was the rate of the hydration we had ordered for normal Lactated Ringer’s solution.”
Elaine Rice gripped her hand into a fist and placed it on the desk.
“Sherry was the nurse working yesterday who was taking care of her and her unborn child. She’s not here today, but I believe it was her actions that led to the demise of our patient. Poor Dr. Harvey is dealing with the patient’s parents as we speak. He spoke to the mother before, but now the father is here. Mike Chandler is spending an inordinate amount of time in the basement with his dead daughter before the medical examiner begins his autopsy.”
Elaine Rice squirmed and her hyponasal speech became worse. “I’ll talk to our laboratory immediately as well as do a thorough nursing investigation.”
“I’m new to such matters, but I’m sure that’s what your hospital attorneys are going to advise. Keep us abreast of what you find out.”
“I agree. It would be unwise if the medical team and the hospital staff do not directly communicate. Misinformation could jeopardize getting to the bottom of this.”
“Or put you in a worse situation.”
Ling rose and was at the door. “Nice meeting you, but the nurses you hire leave a lot to be desired.”
Mrs. Rice stared past the open door. What ever happened to tactful, non-accusatory, professional speech from a resident, she thought. Not only did she have a possible overtly negligent nurse on her staff to deal with, but a bitchy resident was running loose too, who basically thought she was mightier than the attending physician.
-----
With Melba Fox, RN finished with her last round of dispensed drugs, Elaine Rice found the medicine cart stashed in the supply room. She hovered over the book that would incriminate and hold accountable a formerly trustworthy and dependable nurse. She licked her index finger and skimmed to Mary Chandler’s page. The doctors had clearly written the mag sulfate order as well as her maintenance fluids. Ms. Fox had also checked off and logged in a time when she had carried out the orders.
Someone can check off doing something as much as they want, Elaine thought, but if they aren’t doing it correctly, then what good is it? Except that it set a more accurate timeline of administration and death to the patient.
Sometimes she hated her job; this was one of those times. Next stop was administration and, no doubt, their decision would be to put the middle-aged nurse on a leave of absence when she showed up for work the next day.
-----
Glad to get away from the drama on the ward, Annabel strode into Room 4, where her new patient and husband were settling in. The man wore a T-shirt and blue jeans, which defined his muscular build. He unpacked a navy nylon bag with his wife’s things in them and neatly stashed clothes and toiletries on tables and in drawers like they were away on vacation.
Already dressed in a hospital gown, the woman sat with a pleasant smile in the room’s comfortable chair as she watched and directed her husband. Annabel nodded at them as she perched herself on the end of the vacant bed.
“I’m Dr. Tilson, on
e of the medical students. One of the residents will be in shortly. May I ask you some questions?”
“Sure,” the woman said. “This is a teaching hospital, so we expect students. They were loitering around for my first baby too. I’m Amy Wagner and this is my husband, Harry.”
Annabel had read the woman’s limited paperwork which functioned as her ticket for admission. The thirty-one-year-old had last been seen in the clinic a few days ago. Despite her large girth from her pregnancy, she appeared to be in excellent condition like her husband: her legs and arms slender, firm, and shapely. Her skin glowed like all she did was eat fruits and vegetables and take fast-paced walks on nature trails.
She was just the patient she needed to work-up, Annabel thought, to fend off the cloud that had fallen on the rotation.
“So this is not your first baby?”
“Second one. We have a little girl at home. This one’s a boy.”
“Any other pregnancies at all?”
“No.”
Annabel grabbed an index card from her pocket and wrote G2P1. “I read you had a previous C-section. What was the reason?”
“Ha! My outlet was too small for a big girl!”
Harry placed a framed picture of his wife, his daughter, and himself on the nightstand. The family huddled close to each other in front of a Christmas tree.
“I tell it differently,” he interjected. “There was no way Amy was going to spill out our daughter, who was as plump as a honeydew melon.”
“You must have welcomed the C-section.”
“We did,” Amy said.
Annabel thought about follow-up questions about this pregnancy while Harry crouched down, slid off his wife’s hospital slipper socks, and put on the ones they’d taken from home.
“What did the obstetricians in the clinic tell you about this baby’s size?”
“He’s not as huge as our Susan was. They’ve monitored me by ultrasound. You know, years ago, they used to automatically do follow up C-sections on women who had their first baby by surgery. Nowadays, they decide on each case separately.”
“Yes, they have you down for a trial of labor after cesarean section or TOLAC,” Annabel said. “And why did they admit you now?”
“I’m overdue, so no sense in letting little Wagner grow any more!”
“What about the last nine months? Any problems we need to know about or any medical history?”
“Not at all. I’m pretty healthy too.”
“She’s a skier,” Harry said.
“What kind?”
“Both,” Amy said. “Snow and water.”
“She’s being modest,” Harry said. “Snow includes downhill and cross country and water depends on how many feet she wants to put in skis … or not … and get pulled by a boat at a hundred miles an hour.”
“I bet you have that short blonde haircut to fit it snugly under a winter ski cap,” Annabel said. “Much of what you’re talking about sounds exciting. Has little Susan stood on skis yet?”
“Amy is going to see to it,” Harry said, beaming.
Caleb made an appearance at the door and came straight in wheeling an ultrasound and a fetal monitoring machine on a cart.
“Mrs. Wagner, I presume,” he said. “I’m Dr. Gash. I saw you in clinic once or twice.”
Harry shook his hand and introduced himself.
“Dr. Tilson,” Caleb said, “are you almost finished with your H&P?”
“We’re making progress, but I still need to examine Mrs. Wagner.”
“You can close the door and watch while I do an ultrasound. Since Mrs. Wagner underwent a previous C-section, we’ll assess her lower uterine segment one more time to determine whether sufficient thickness is present to support labor.”
Amy took the clue and wiggled up on the bed. Caleb prepared the patient’s lower belly and was soon rolling the ultrasound around. He nodded and pointed out the black and white picture to Annabel as he went along.
“That’s my son in there,” Harry beamed. “He’ll be on this side of that incubator by tomorrow.”
“Since when is my uterus an incubator?” Amy commented.
“It counts as a controlled environment; it most certainly is an incubator.” He took her hand and kissed it.
Caleb stopped and wiped off the gel on Amy’s abdomen with a hand towel. “You’re set to go with our original plan.”
“Easy for you to say. I guess the next item on the agenda is an IV.”
“Precisely.”
“May I start it?” Annabel asked.
“Caleb raised his eyebrows. “If Mrs. Wagner allows it …”
“I’ll give you one chance,” she said. “Two tops.”
“With the few that I have inserted, I’m not too bad. I’ll ask the expert anesthesiologist to help me out if I fail, so as to avoid the tech as the middleman. I do need to wrap up my H&P, however, and listen to your heart and lungs.”
-----
Annabel still needed to write up the H&P on Mrs. Wagner, but the IV was the first priority to start her patient on oxytocin to begin inducing labor. She grinned; she was finally learning some obstetrics.
She familiarized herself with the supply room and grabbed what she needed. A large-bore IV was not needed, but she didn’t want something too small either. She chose an 18-gauge IV catheter knowing that a 20-gauge was a backup plan for a smaller vein. After shoving more supplies in her pocket, she headed back to Amy’s room.
Harry ambled from one side of the bed to the other, forcing his wife to smile as he clicked cell phone pictures of her.
“You are the proudest father I’ve come across so far,” Annabel said, “and your baby isn’t here yet.”
She realized her first and second patients were not so lucky; one with an uninvolved father who only donated his sperm, and the second with a father who wanted to be involved, but the woman was not letting him.
“I’m sure Amy will have this one on skis early too. I am active in sports, too, and I’m a health fanatic. Little Bobby is going to be a chip off the old block.”
“You hope so,” Annabel said. “Sometimes kids don’t follow their patents’ agenda. I bet you two are stellar examples, however.”
Annabel set her supplies on the tray table and tightened a tourniquet around Amy’s arm. A straight, plump vein popped up on her hand. She leaned in, wiped it with alcohol, and opened the IV packaging.
“We also have a dog at home,” Amy said. “His name is Blue. He’s a German Sheperd and is baby number one. He plays with Susan and he also is the protector of all of us like he’s the house sentry.”
“He sounds marvelous. It turns out that I may be getting my own dog later today. Your enthusiasm over Blue makes me all the more excited.”
Over the dog discussion, Annabel had pricked the area with local anesthetic and had slipped in the IV to make its mark with a quick blood return. She heplocked it and secured it with tape to Amy’s hand. It wasn’t going anywhere when she finished.
Harry’s big tall frame peered over her shoulder. “Way to go for a medical student.”
“Thumbs up,” Amy said. “And you’re really getting a dog today?”
“Yes, with a friend. We’re going to take care of the dog together, even though we don’t live together. As students, our schedules fluctuate.”
“Good luck with that. Dogs shouldn’t be experimented with, but you’ll probably do fine. As long as you and your friend are cooperative with each other.”
Annabel trudged to the door, where she dumped the needles into the sharps container. “He may be my best friend ever. We’ll never know unless we try.”
“Dr. Tilson,” Harry said, “you must tell us tomorrow what happened.”
“Sure thing.”
Annabel took one step into the hallway. Emmett came zooming out of the next room and grabbed Annabel by the arm.
CHAPTER 14
Emmett’s bushy eyebrows stood out over his wide-open eyes. He grasped Annabel’s white coat by the sl
eeve and yanked her from the hallway straight into Bonnie Barker’s room.
For just two days of being on the rotation, Annabel trusted Emmett even more than some of the other medical people working in obstetrics. He seemed trustworthy, did his job without fanfare, and treated the patients and staff with respect. With curiosity and concern, she let him pull her next door.
“You’re the closest one,” he said as they turned at the doorway. “I walked into her room and … look.”
As Annabel approached the bed, she thought Bonnie was dead. Her own heart jumped like a car’s ignition had just been turned on. Her heartbeat raced as she simultaneously docked her fingers on Bonnie’s carotid to feel for a pulse. Please, not again, she thought.
“Emmett, get help.”
The orderly took off and she zeroed her attention on her patient. She felt it. A faint pulse under her fingertips. She exhaled, allowing herself the small relief of that discovery. But there was still a crisis as she watched the woman’s chest and tried to discern her respiratory rate. There wasn’t much of a rise to her chest, so she grabbed the nasal cannula off the wall oxygen device and stuck the prongs in her nostrils. It was a band-aid only because her patient had little in the way of respiratory effort. She needed help; otherwise, surely in a minute or two, she would need to do chest compressions.
She heard them barrel in before she saw them. Kristin Fleming appeared to her side and then Dr. Gash. Emmett followed with the crash cart.
Dr. Fleming’s actions were quick as thought as she unlocked the bed and moved it away from the wall. “Emmett, see if any nurses are around or get me respiratory stat.”
Kristin waved at the cart. Annabel pushed it closer and, reading the anesthesiologist’s thought process, she opened the drawers for airway equipment. She handed her a laryngoscope blade, one she knew was of an appropriate size for an adult, and then laid three sizes of endotracheal tubes at the top of the bed. Caleb listened with his stethoscope to Bonnie’s heart.
