Sleight of Hand

by CJ Lyons

  Morris' grip on her wrist was bone crushing. Cassie bit her lip with the pain but said nothing.

  "Okay, bitch, just you and me. Go ahead and give me the good stuff." He held out his arm, releasing his grip on her wrist and grabbing a handful of her hair instead.

  Searing pain raced across her scalp, bringing tears to her eyes. She applied the tourniquet, drew up the drug and quickly injected it. He wrenched her head back when she finished.

  "Now you and me are walking out of here," he said, rising to his feet. "We'll find someplace quiet and have ourselves a little party."

  Succinylcholine had been around for years. Cassie had never seen it fail. She prayed this wouldn't be the first time.

  "How long before this stuff starts to work?" he asked.

  She said nothing, counting the seconds in her head. Just about...now.

  "Whoa, I feel a rush coming on already–" His voice faltered. He stopped, slumping against the gurney, pulling her down to the floor with him. Cassie reached up and pried his fingers from her hair. Now paralyzed, unable even to blink, Morris watched her with reproachful eyes.

  "I need some help in here!" she shouted, going for the oxygen.

  Quickly, the room swarmed with medical personnel and police. "Get him up on the bed, set up for intubation."

  She began to use the bag-valve mask to force oxygen in and out of his lungs. Morris' eyes remained open, staring at her as he lay helpless on the gurney.

  "Hey doc, that's good stuff–how long does it last?" the younger cop asked as he applied handcuffs to both of Morris' arms.

  "Long enough for him to have brain damage if we don't breathe for him," she snapped. "Get that pulse ox and monitor on him. Let's go people!" She looked up to see Rachel frowning at her from the doorway.

  Cassie felt a twinge of guilt. What she had done was in violation of the Hippocratic oath and principles of medical ethics. Her job was to heal, not to harm.

  She focused on her task, quickly intubating Morris and ensuring that he was getting oxygen. Once Morris was stabilized and headed up to the ICU, she went out to the police officers.

  "He'll be here overnight, then he's all yours," she told them.

  In truth, they could have allowed him to wake up and extubate him in the ER, but she didn't think it was fair for her staff to have to deal with Morris anymore. Let the ICU handle his crap.

  "Not bad for an amateur, Hart," Spanos told her grudgingly. "Still, would have been easier just to shoot him."

  "Not in my ER. Next time you guys might want to notice if a guy's right handed or left handed when you cuff him."

  She ran her fingers through her hair, massaging her sore scalp. Her hands were trembling, but she'd be damned if she'd let Spanos see that.

  Johnson, the younger one, looked down. "That was on me. It won't happen again. He seemed so out of it–"

  "Just do me a favor and make sure that he stays locked up for a good, long while this time, okay?"

  The two officers headed toward the elevators leading to the ICU. Cassie went back into the nurse's station and handed Rachel the remaining vial of succinylcholine.

  "You want to dispose of this for me?"

  Rachel took the vial with a look of distaste. "Certainly, Doctor," she said in a frosty voice.

  Damn, here we go, Cassie thought. Confrontations with nurses were bad enough, but get on the wrong side of a charge nurse and you were in for hell.

  "Want me to call the Critical Incident Team?" Cassie asked, referring to the multi-disciplinary team that helped to defuse the stress of traumatic events on medical personnel. It might be helpful. Lord knew, she was feeling pretty shaky after her confrontation with Morris. Contrary to popular media images, having your life threatened was not an ordinary part of working in the ER.

  "I don't feel that is necessary," Rachel replied.

  "It might help Juanita and anyone else to talk about things, review security procedures so this doesn't happen again, vent any feelings–"

  "Don't you dare try to blame this on my nurse!"

  "I'm not. I just thought–"

  "That's the problem, you didn't think, Dr. Hart. You rushed in to play hero, totally ignoring the fact that you were placing my nurse and your patient in jeopardy. I hold you responsible for everything that happened today and don't you think for a minute that I won't report your actions to Dr. Castro and administration. Your callous disregard–"

  "If you had a better idea, you should have said something!" Cassie snapped, her temper flaring now. "I had less than five minutes to come up with a plan that wouldn't get anyone killed."

  "And did you ever consider the consequences if your plan hadn't worked? We're here to serve our patients, to help them get better–whatever their illness or injury. I took an oath in nursing school: First do no harm. Tell me, Dr. Hart, what about your oath?"

  Cassie was silent. Rachel had hit a nerve with that one, but what else could she have done? Stand by and let the police handle things? The outcome could have been bloody.

  Or everything might have been fine. She should have trusted the police to do their job. They were trained for these things, she wasn't. She'd overstepped her bounds and in doing so, she had violated one of the fundamental principles of her profession.

  She started to apologize to Rachel, but the charge nurse turned her back and walked away.

  <><><>

  "Hey, Drake. Got a case for you."

  Drake looked over as he and Jimmy moved through the front lobby of the station house. Tony Spanos leaned against the desk, talking to a girl about ten and a younger boy who clung to her hand.

  Behind Spanos, his partner had the thankless task of writing up a report.

  "Here you go, folks," Spanos said. "This is Detective Drake, he specializes in your kind of case." Spanos moved away, leaving the two children with Drake.

  He sent a glare toward the uniformed officer. Spanos returned it with a mocking salute. Then Drake crouched down so he was at eye level with the kids. "Hi, guys. What can I do for you?"

  "Will you help us?" The girl was the spokesman for the duo. Drake watched as she looked over her shoulder at a man who stood just behind her. Their father, Drake guessed, nodded his encouragement, and she turned back.

  "First of all, what's your name?"

  "I'm Katie Jean and this is my little brother, Nate."

  "Pleased to meet you, Katie Jean and Nate." Drake extended his hand and shook Katie Jean's. When he offered it to Nate, the boy flinched away, moving so that his sister shielded him. "And is that your dad?"

  The man moved closer and took Drake's hand. "John Trevasian." He looked down on his daughter. "Go on, Katie Jean."

  She straightened and stared up at Drake with an intense expression that reminded him of Hart. "It's my job to talk to you, 'cause Snickers is our responsibility." She stumbled on the last word, and he realized she had rehearsed the speech. "We need you to help us find him. Nate drew pictures and we left them all over, but no one's seen him and he's just a puppy and what will happen if no one knows how he likes his belly rubbed or what kind of food to get him?" The last came out in an explosion of fear.

  Drake rocked back on his heels. He could hear Spanos' laughter from behind him but ignored it. Katie Jean sniffed back her tears and tried to continue.

  "Anyway, Daddy always says the police are here to help us, so I asked him to bring us here today. So will you? Find Snickers and bring him home? Please?" She looked up at him with an earnestness that was mirrored on her brother's face.

  How could he say no? He nodded solemnly. "I'll do my best," he assured them. "You said you have a picture?"

  Katie Jean turned to her brother who withdrew a sheet of paper from his pants pocket and silently offered it. Drake unfolded the paper and smoothed it. He glanced up at the boy in surprise. It was a detailed rendering of an Australian Shepard done in pencil except for two blue smears of crayon for the eyes.

  "Did you draw this?" he asked Nate who merely shrugged. The boy
looked to be only eight or so, but the artwork was that of an advanced talent.

  "He drew it 'cause we didn't have any new pictures of Snickers, only when he was a baby," Katie Jean continued her role as spokesperson. "Nate draws lots of things."

  "I'll bet he does," Drake told her. "You kids wait here a minute while I talk to your father, all right?" He glanced over at Spanos who was still lounging nearby. "Officer Spanos will get you both some honorary police badges." Spanos looked up at that, but it was too late, Katie Jean had already marched over to him and began tugging on his arm.

  "Thanks for talking to them, Detective," John Trevasian said. "I know there's nothing you can do, the dog's probably long gone. But Katie Jean was determined." His voice trailed off as he looked over at his children.

  Drake smiled. "I can see that. You've got a couple of great kids there, Mr. Trevasian. Did Nate really draw this by himself?"

  A cloud passed over the father's face. "Yes. Since Snickers disappeared, drawing has been his only form of communication. He loved that dog so much."

  "He's very talented. You should look into classes for him. Maybe it would give him something to concentrate on now that Snickers is gone."

  "Yeah, that's what the people at school say. We don't know what to do. He refuses to talk to anyone–not even Katie Jean. First the school said he was hyperactive and needed medication, then once he started taking the drugs he got moody and sullen. And since Snickers has been gone he hasn't said a single word, not to anyone. We even have the school psychologist working with him."

  Drake turned and watched the boy clutching his sister's hand. "What's your address?"

  "It's on the back of the picture. You're not really thinking you can find Snickers, are you?"

  "I told Katie Jean and Nate that I'd do my best. Let me talk to some of the guys who patrol near your house. Who knows, maybe we'll get lucky."

  Trevasian smiled and took Drake's hand once more. "Thank you, Detective. I–we–really appreciate this. Come on kids, it's time to go."

  Drake watched the family leave, ignoring Spanos' approach. He remembered being a shy kid, his only solace the pictures he'd draw, scribbling over any scrap of paper he could find. But Nate seemed more than shy, the boy was lost somewhere, wandering alone without comfort.

  "Figured you're the only one not actually doing any real work around here so you had time to tackle a tough case like that. By the way, I just got back from seeing your girlfriend," Spanos told him, a sneer twisting his mouth. "Guess she learned better than to try to do a cop's job."

  Drake narrowed his eyes at the patrolman. "What are you talking about?"

  "You haven't heard? Me and Johnson took this crackhead over to Three Rivers, and he got hold of a nurse. Hart went in and almost got herself killed."

  "Is she all right?" Drake felt his fists clench even as he fought to keep his voice level. "What was she doing in the middle of a hostage situation? Why didn't you follow procedure?"

  Spanos shrugged as if they were talking about the weather. "Hart's fine. She pulled rank–said it was her ER and she knew what she was doing. What was I supposed to do, shoot her?"

  "You were supposed to do your job!" Drake started toward the door.

  As much as he disliked Spanos, he felt certain that the patrolman was telling the truth–it was exactly what Hart would do. Rush in, not think twice about the consequences or the fact that someone else might be better equipped to do the job. Why could she never learn to stand back and observe from the sidelines where she'd be safely out of harm's way? It was just like last time, just like before. Sooner or later, someone was going to get hurt.

  "At least I'm allowed on the streets with a gun," Spanos shouted at his back.

  Drake slammed the door behind him, tried not to flinch at the sound that reverberated through his memory like a gunshot.

  CHAPTER 9

  Cassie pulled her yellow Tyvek trauma gown closer around her, shading her eyes from the bright April sun. She heard the ambulance before she could see it. The constant howl of the siren was punctuated by a screech of brakes and scream of a horn as they reached the intersection. Med Five was bringing in an unresponsive child, Code Three, no other report given.

  The guys working Med Five were good; time-tempered pros who'd seen the worst the streets of Pittsburgh could offer. If they were too busy to call in report, there was reason for her to worry.

  Time to rock and roll.

  The squad pulled into the Emergency Department's drive and quickly backed up. Cassie already had her staff preparing the resuscitation room, but she preferred to meet critical patients herself. It gave her precious extra seconds to assess her patient.

  When Med Five stopped moving, Cassie rushed forward to open one of the rear doors. "Glad to see you, doc," the medic said, jumping down and pulling the gurney forward.

  "What've you got?"

  "Three year old, healthy until Sunday when he complained of cold symptoms, ear ache and low grade fever. Developed progressive fever and vomiting. Today was unable to retain any fluids. Mother found him unresponsive this afternoon. Responds only to pain for us, went apneic in route, so we started to bag him." He gave her the bullet as they hurried down the corridor into the critical care room.

  She focused on her patient. A skinny little boy, his pulses weak, abdomen distended from the oxygen forced down his throat, eyes wide open but not focusing on anything.

  "Let's move him, gently now," she instructed her team. "Set up for intubation, five-oh ET tube. Two of Versed and give him two grams of ceftriaxone."

  Cassie assessed her patient from head to toe. His neck was rigid, his pupils sluggish but equal. Other than the abnormal vital signs, the only other finding was a ruptured right ear drum with purulent material coming from it.

  "Foley, monitor, he'll need a head CT. Let's draw a CBC, blood culture, lytes, glucose and call for a chest X-ray. Who's on for Peds today?"

  "Sterling again."

  Oh great. Another chance to irritate the patronizing department head. Well, she wasn't going to give him anything to complain about with this resuscitation. "Call him."

  She moved to the head of the bed and prepared to insert the endotracheal tube. Cassie hated it when kids were this sick–it just didn't seem natural. He was a cute kid, too.

  Then she looked again and realized she recognized him. Antwan was his name. He had smiled when she gave him a sticker yesterday morning. He'd been her first patient of her first shift back.

  Could she have missed something? Her stomach dropped as she remembered Adeena's warning that she wasn't in any shape to be caring for patients.

  Cassie glanced away, trying to regain her perspective, to slow her racing thoughts. Focus. She raised the bent metal blade that would hold Antwan's tongue out of the way while she intubated him. Before she could proceed, a banshee's wail came from the hall.

  "Antwan!" a thin woman in her early twenties screamed as she rushed in. "My baby!" She tried to go to her son, but Jason, the ward clerk, intercepted her.

  "Please, Mrs. Washington, you have to let the doctors work on him." He tried to gently move her from the room, but she refused to leave.

  "Mrs. Washington, Antwan is very ill. We're doing everything we can for him, but we need a few minutes before you can see him. Go with Jason down to the family room, and we'll let you see him as soon as possible." Cassie tried to make her voice as firm and level as possible.

  "My baby, take care of my baby," the mother sobbed, but she allowed Jason to move her.

  "I'll call social services," Jason said over his shoulder.

  Cassie merely nodded, she didn't have time for anything else. She quickly pulled the oxygen mask off Antwan's face and inserted the metal blade. Cassie held her breath. It wasn't as easy as it looked on TV, especially in kids. They tended to have big tonsils that could bleed easily. And lots of secretions, like now.

  "Suction," she called. She cleared the mucus from Antwan's airway and his vocal cords popped into view.
Cassie slid the silastic tube through them into his trachea. The respiratory tech secured it and took over ventilating him.

  "Get a gas in five minutes," Cassie ordered. She glanced up at the monitor. Heart rate was up, blood pressure was down, all good signs. She checked his pupils again, much more reactive now. "Did he get the antibiotics?"

  Rachel nodded. "And CT is ready anytime you are."

  "Let's get a chest X-ray first. I'll go talk to the mom, let me know when that's back."

  Cassie moved down the hall to the family room. She paused before entering, trying to squelch the churning in her gut. What had gone wrong? Why had this happened? When she'd seen Antwan on Monday morning, he'd been a happy boy with a cold and ear infection. How could he be lying in her ER now, fighting for his life?

  She took a deep breath and pushed the door open. The family room was a tiny, claustrophobic space containing four chairs, their upholstery peppered with cigarette burns, and a telephone. There wasn't enough room to pace, but this forced people to sit while speaking with staff–a simple intervention designed to prevent violent outbursts. The room was sound-proofed, to give grieving family privacy, but there was also an emergency panic button tied directly to security. You never knew what might happen in here where circumstances forced people to the extremes of emotion.

  Over the years Cassie had noticed that no matter what the outcome for the patient, there were always two dominant emotions in their family members: guilt and anger.

  Adeena was already there, trying to calm Mrs. Washington. Both women looked up when Cassie entered.

  "Is my boy okay?" Mrs. Washington asked, her voice strained and cracking with tears.

  Cassie pulled a chair close to the mother and reached over to touch her hand. Mrs. Washington was young, but her face had a pinched, guarded look that told Cassie that she'd already been through a lot.

  "Antwan is very, very sick," Cassie started. "I think he has a serious infection called meningitis. It's an infection of the tissue around the brain, and sometimes the brain can swell because of it. This can be very dangerous."