“Get the nurse, stat. Something’s happening to my husband,” Lois shouted, “and page Dr. Byrnes now.”
By the time the nurse arrived, Arnie’s breathing had become gasps. He struggled to breathe with his chest and neck muscles straining to assist. His lips were now a bluish-purple.
“Get him on oxygen,” Lois yelled.
When the nurse returned and placed nasal prongs for oxygen delivery, Arnie’s breathing eased slightly.
Suddenly, he coughed and choked. Bloody foamy fluid dripped from his mouth. His color worsened.
Jack entered, took one look at Arnie, listened to his chest, examined his legs. “He’s having pulmonary emboli, blood clots to the lung. I need him in ICU right now.”
Jack picked up the phone, dialed ICU. “Get bed one ready. I’m bringing a patient with acute pulmonary emboli. Call Sharon Brickman. Tell her to get up here stat.”
Lois grasped Jack’s arm. “Tell me what’s happening?”
They transferred Arnie to a gurney, attached his oxygen lines, and wheeled him out of the room toward the elevator.
“Come along, Lois,” Jack said. As they hurried along with the gurney. “Lying in bed and sitting in a chair without movement, caused blood clot formation in Arnie’s leg. Part of the clot came loose and traveled to his lungs.”
The elevator doors slid opened and they pushed the gurney inside. Jack, Lois, and two nurses stood around Arnie watching him gasp and choke. Blood sprayed over the white sheets each time he coughed. His lips and nail beds were deeply purple and his neck veins were tense from high pressure. Jack shuffled his feet into position like a sprinter in the starting blocks waiting for the elevator doors to open.
Finally, when they reached the sixth floor, Jack gave the gurney a violent push thrusting it down the hallway, and through the ICU doors held open by the ward clerk.
They lifted Arnie by grabbing the gurney sheet and swinging him in one movement into bed one.
Sharon Brickman suddenly appeared next to Jack.
“It’s a big one, Sharon. He’s going down quickly. Look at those neck veins. His heart can’t take the load. We’ve got to get that clot out of his lungs; extract it or dissolve it, right away, or he’s had it!”
Chapter Fifty-Nine
This is a nightmare, Lois thought as she and Beth Byrnes, Arnie’s nurse, sat at the bedside. Lois held Arnie’s cool hands. His fingers had dusky colored nail beds and his lips were still purple-blue, showing the lack of oxygen in the circulating blood.
Jack Byrnes and Sharon Brickman stood before the x-ray viewing box looking at Arnie’s films.
“I don’t know which way to go, Sharon,” Jack said as he grabbed an IV infusion bottle sitting on the bedside table containing about 8 ounces of a straw-colored fluid, Activase, a powerful clot dissolver.
“It’ll take me thirty minutes to get ready,” Sharon said, “then I’m pretty sure we can remove the clot with a catheter passed into his lung.”
“I don’t know if we have thirty minutes, and I’m not crazy about your ‘pretty sure’ part of that comment.”
“Jack,” Beth cried. “His BP’s falling and his breathing’s getting worse. We’re going to wind up coding and intubating him any second.”
Jack quickly examined Arnie, and then turned to Beth. “Push the Code Blue button, get the intubation tray, and start infusing the Activase.”
“Jack!” Lois cried.
“Have someone take her outside, Beth. She can’t watch this.”
“Jack. Please let me stay.”
“No, Lois. If you want to help Arnie, don’t give me something else to worry about. Leave now. Beth will let you know what’s happening.”
Lois bent over Arnie, kissed his icy-cold lips, turned, and backed slowly from the ICU.
Jack slipped his hands into sterile gloves, grabbed the endotracheal tube, and after visualizing Arnie’s vocal cords over the arched stainless laryngoscope blade, passed the tube into a trachea choked with bloody foam. They inflated the tube’s balloon cuff to fix it in place and breathed for Arnie with an Ambu Bag attached to an oxygen line.
Jack squeezed the bag between his strong hands to inflate Arnie’s lungs. “This is requiring too much pressure. His lungs must be stiff.”
Jack passed a plastic suction tube into Arnie’s lungs and pulled out large bloody clots. During the intubation, the room filled with the Code Blue team and other physicians who were nearby.
“Set up the ventilator,” Jack said to the respiratory tech. “Get an arterial blood gas and a portable chest x-ray stat.”
Twenty minutes later, they let Lois return to Arnie’s bedside. A sense of calm had replaced the frenzied scene of a few minutes ago. Arnie lay immobile in bed with fresh sheets, the bloody ones stuffed in the soiled linen basket. The nurses encased his wrists and ankles in leather restraints and tied them to the bed frame.
Lois looked expectantly at Jack. “He’s not so blue now. Tell me what’s happening.”
Arnie’s blood showed as brown stains on Jack’s green scrub suit. Perspiration soaked the area around his neck, back, and underarms.
“His breathing’s much easier and his blood gasses are better. I gave him a sizable dose of Activase that should dissolve the blood clots everywhere, especially in his lungs.”
“What if they don’t dissolve? What if the clots come back?”
“The chance that another big clot will go to the lungs is remote. If smaller ones recur, we might have to tie off a vein or put a filter into the large vein in his abdomen. We have lots of things we can think about, and now, thank God that he’s stable, we can deal with them in relative calm.”
“I’m frightened to ask, Jack, but what’s next?”
“The next few days will be critical. If he has no further clots to his lungs, he should heal quickly and we can get the tube out. Later he may need to take anticoagulants so he won’t form clots again.”
“What about his depression?”
“Right now, if we can get to the point when we can focus on Arnie’s depression that will be a major victory.”
Chapter Sixty
Henry Fischer had aged ten years in two months. The court’s concern for his heart had kept him out of jail. He’d lost twenty pounds from his already lean body. His hair had turned white, and his flat affect reflected a total emotional meltdown.
“Pull yourself together, Henry,” said Harrison Pollard, his attorney. “No way are we letting this case go to trial. The sooner we make a deal to settle these charges, the better it will be for everybody.”
“That’s not the outcome I’m paying you for.”
Harrison laughed, “If we can’t settle this soon, you won’t have enough money left to defend a DUI charge, especially if the public forces the DA to pursue murder or manslaughter charges, to say nothing of all the civil litigation you face.”
“Murder…manslaughter. I don’t see any way he can prove that we injured anyone. Those people had fatal diseases.”
“The EPO cases involve issues of fraud and misbranding, but the dilution of the pneumonia vaccine presents additional problems. If even one patient who got your bogus Pneumovax developed bacterial pneumonia and died, I think they can make a case for manslaughter, maybe murder two.”
“Whose side are you on?”
“Don’t put me on your side,” Harrison said, standing. He turned to face his client. “I’m representing you although what you two did makes me sick. Feel free to fire me.” He paused. “Nevertheless, I suggest you heed my advice before it’s too late.”
“Whatever you say,” Henry said in defeat.
Harrison Pollard sat with Karl Hirsch, Brian Shands’ attorney outside the DA’s offices.
“Brian’s no fool,” Karl said. “He wants the best deal he can get. What about Henry?”
“Henry’s terrified of murder or manslaughter charges. He’s fully on board with the negotiation. How do you read Kevin Walters?”
“He wants this to go away quickly
, as much or more than we do. The murder/manslaughter charges are problematic for him. He knows that whatever we do here or in court won’t satisfy the public.”
“Come in, gentlemen,” Kevin said as he opened the door to his office.
Kevin pointed to the two stuffed leather chairs in front of his large oak desk. “Have a seat.”
After Kevin returned to his high-backed desk chair, he sat and tilted back. “What can I do for you gentlemen?”
“As if you didn’t know,” Karl said. “I sat behind that desk longer than you have, Kev.”
“Then you’ll understand what I’m up against, Karl. Emotions are running high. If the public had its way, your boys would be hanging from the gallows right now.”
“Look, Kevin,” Harrison said, “they’re both ready to plead this out, so let’s put it to bed.”
Kevin looked at each attorney. “If I’m to have any future in this business, I must go for big time jail sentences, especially if I can’t make murder or manslaughter work. They’re going to be old men when they get out.”
“How old?”
“When you add up the charges, the number of patients involved, and the state and federal violations, I expect that they’ll serve thirty years each.”
Harrison Pollard paled. “Thirty years?”
“That’s it, gentlemen, thirty years. Take it or leave it.”
“I’ll take it,” Karl said. “It’s what they earned, and between you and me, it’s a better deal than they deserve.”
“I’ll present it to Henry,” Harrison said. “I’ll make it clear that he’d better grab the deal while it’s on the table.”
At his press conference two days later, Kevin Walters announced the terms of the plea agreement to an overflowing conference room: “Both defendants have agreed to a thirty-year sentence for multiple offences regarding the misbranding, adulteration, and the dilution of several medications. By statute each defendant will pay a fine of $25,000 each…”
The room filled with groans, gasps, and boo’s. The crowd surged toward the front, held back by a group of uniformed officers.
“…if you’ll allow me to continue,” Kevin shouted. “In restitution, Mr. Shands will pay an additional fine of $ 2.4 million, and Mr. Fischer will pay $8.3 million.”
“You’re letting them get away with murder,” shouted a woman from the back of the room.
“They’re killers. How could you agree to such a sentence?” said a man in the second row.
“I’m sorry,” Kevin said. “I can only file charges when I think we can sustain them in court. This conference is over.”
As Kevin departed through a line of protecting policemen, he heard, “You won’t get away with this.”
“Don’t bother filing for reelection.”
“How much payoff money did you take?”
“How do you sleep at night?”
That wasn’t too bad, Kevin Walters thought.
When the last of the crowd left through the conference room’s rear doors, one elderly man, Irving Hodges, remained seated, his mind whirling with this newest insult.
Kevin Walters knew that the plea agreement with Henry Fischer and Brian Shands would not end his problem. Maybe he should have pursued the manslaughter charges and let the jury take the heat if they failed to convict. If I were fifteen years younger…
Kevin heard a soft knock on his outer door. His secretary must be away from her desk. He opened the door to a well-dressed man in his late 70s or 80s.
“I’m sorry to bother you, Mr. Walters,” said Irving Hodges, in a soft voice, “but your secretary wasn’t here. Can I have a moment of your time?”
Kevin retreated into his office, his usual respectful reaction when dealing with people of advanced age. “Of course. Please have a seat. What can I do for you?”
“My name is Irving Hodges, I’m the husband…I was the husband of Beatrice Hodges. Does that name ring a bell?”
“Of course, Mr. Hodges, and thanks to you, Brian Shands is in jail where he belongs.”
“I was talking about Beatrice, my wife.”
“Yes, she was one more unfortunate victim of the Horizon Pharmacy scandal. I’m so sorry for your loss.”
“Excuse me, sir, but to talk of Beatrice as an unfortunate victim demeans her and horribly distorts the disgusting actions of Fischer and Shands.”
“I’m sorry, sir. A bad choice of words.”
“If you knew what this did to me, did to all the others who put their lives in the hands of these men, you couldn’t let them off so lightly.”
How can I make him understand? Kevin thought.
“I’ll assume you don’t know me, but if you ask around you’ll find that I’m considered a tough district attorney. While I’m not a victim, I share your outrage at the despicable actions of these defendants, and like you, I want them punished to the maximum of what the law allows. That’s the problem.”
“Please, sir. Beatrice would be alive today, as would many others, if they’d received the proper medication. Depriving patients of lifesaving drugs is tantamount to murder.”
“My folks are about your age. If this happened to one of them, I’d want revenge, too, but we live in a country of laws, imperfect laws that don’t always provide a true measure of justice.”
“Some true measure of justice,” Irv said, “what an idea. Was this plea bargain the best you could get? Prison and fines?”
“Thirty years is a lifetime for men their ages.”
“How long will they actually serve? Will they enjoy the taste of food, the delights of reading, music, movies, and the company of friends and relatives?”
“I’m sorry. It’s not fair or just, but I did the best I could.”
“I’m sorry too,” Irv said his dark brown eyes boring into Kevin’s, “but it’s not enough, not nearly enough.”
Chapter Sixty-One
It’s not déjà vu, thought Lois Roth, as she sat by Arnie’s bedside. It’s happening again. She was reliving the trauma of those ICU days before Arnie awakened from encephalitis.
Beth Byrnes came over and placed her hand on Lois’s shoulder. “How are you doing?”
Lois grasped Beth’s hand. “It’s worse this time. The ventilator, the depression, the clots…I think we may lose him.”
“Don’t do this to yourself. We’re optimistic, and you should be, too.”
Lois watched as the ventilator’s yellow light glowed before each breath. She knew this was Arnie’s breathing center triggering the ventilator, a good sign. Arnie’s chest expanded and contracted. The clear plastic hose that connected to the ET tube still showed bloody mucous, but the heavy bleeding and the clots had disappeared.
Jack came to the bedside. “His tests show much better levels of oxygen in his blood and his chest x-ray this morning is clearing.”
Jack removed the leather restraints so he could examine Arnie. He listened to his heart, lungs, and felt his extremities without comment. He then did a neurological evaluation that also was normal except that he was unable to awaken him.
After he completed his examination, Beth reapplied the restraints.
Lois stared at Beth. “Is that necessary? It looks horrible.”
“It’s absolutely necessary. If he should awaken and grab at the ET tube in his airway or his IV lines, he could do a lot of damage.”
“I can’t find anything wrong in Arnie’s nervous system,” Jack said, “except of course, that he won’t wake up. I don’t know what to make of that. Maybe he’s still catatonic. I’m ordering an EEG to measure his brain waves. Maybe that’ll clarify the situation.”
“Are you still treating his depression?” Lois asked.
“No. His case is complicated enough as is.”
Lois grasped Arnie’s hand. “Has Ross Cohen been in to see him?”
“Not yet. I’ll call him today to see what he thinks about the depression and where we go from here.”
Lois stared at Jack. “You’re not still thinking about
shock therapy, are you?”
“I can’t rule it out.”
For the next two days, Arnie’s condition remained stable. Everything except his mental status had improved.
Jack returned Arnie’s chart with new orders to the rack. “I’m going to repeat his chest x-ray and blood gasses this afternoon. If they’re as good as I expect, I’m going to remove the breathing tube.”
I’m swimming through warm tropical waters. The rays of bright sunlight slant through the water at a thirty-degree angle illuminating the overabundance of marine life. As I move across the coral’s surface, small brightly colored fish scatter away. I look up to see the twinkling of the small surface waves forty feet above, enchanted to be a part of a world so few ever experience.
Suddenly, I try to inhale. Nothing! Panicked, I look up for salvation. I kick hard for the surface, but something’s holding my leg. I struggle to escape, my mind in the full flight of terror. Unable to hold my breath a second more, I inhale the salty water, hoping it won’t take too long.
Lois was asleep in the chair next to Arnie. When the bed’s rattle awakened her, she raised her head. Arnie was struggling to sit upright. The muscle fibers of his arms were taut as he fought against the restraints to reach for his breathing tube.
“No, Arnie,” Lois screamed as she grabbed at his arms to prevent him from removing the ET tube.
In an instant, two pairs of arms joined Lois trying to restrain Arnie’s powerful arms.
Arnie’s eyes bulged and watered with tears as he fought. His face puffed out red as he tried to speak and pointed repeatedly to the tube in his throat. His strength was enormous.
“Get me Valium stat,” shouted Jack as he released the pressure on the ET tube’s cuff in preparation for its withdrawal.
Suddenly, Arnie’s right arm came free and moved with lightning speed to the ET tube as Jack shouted, “No Arnie! Don’t do it! I’ll have it out in a second.”
A moment later the bloody airway tube lay on the bed as Arnie coughed repeatedly.
The Sixth Sense (Brier Hospital Series Book 3) Page 26
