Warning Signs

by C. J. Lyons

  His words barely reached her. She was numb, protected by her Kevlar. He stared at her, waiting for a response. He was going to be waiting a long time. She spun on her heel and walked away. Her shift had three hours left, but the hell with that. She was finished.

  Gina thought about Lydia and the way she fought for every patient that came into her care, the passion she exhibited every time she took someone’s life into her hands. Did she have that passion? That strength? The courage to get involved no matter the risk or odds against you?

  Maybe her parents were right, she should just quit. She wasn’t cut out for this job. She pushed through the doors, hitting a wall of humidity and storm-tossed wind. Maybe it was Jerry who was the fool, blind to the truth everyone else seemed to see. Blind to the kind of person she really was: a no-good, gutless coward.

  BEING A PATIENT WAS PRETTY MUCH THE MOST boring thing Amanda had ever done—worse than shucking pecans or helping her mama polish the silver.

  She couldn’t sleep, not with everyone poking and prodding and machines yipping all around. She couldn’t do anything but sit there, ice-cold fluid seeping through her from the IV, which was basically a straw floating around inside her vein, jabbing her from the inside every time she moved her hand. She had no books, no music, nothing but time to ponder her situation. She tried the TV, but it carried only the local channels and they all had the afternoon news on, which made her even more depressed. She clicked it off and forced herself to sleep, managed to doze for a short while, only to wake to find Lucas sitting beside her—wearing the same worried expression he had when he’d held vigil over Tracey.

  “What are you doing here?” she asked, coughing out a frog the dry air had left in her throat.

  He stood and reached across her for a small plastic glass of water with a bendy straw. The bedside table was on the same side as her hand with the IV, so he held the glass for her as she leaned forward and drank. “Thanks.”

  “How are you feeling?”

  She started to force a smile, realized he would see right through it, and decided it wasn’t worth the effort. “Okay. A little scared. Maybe. How’s Alice? I didn’t hurt her, did I?”

  “It wouldn’t have mattered. The scan showed no blood flow.” He looked away, concentrating on centering the cup exactly back in the water ring it had left behind. “Her parents are deciding on organ donation and when to withdraw support, but she’s essentially gone already.”

  Amanda fell back against the pillow, her eyes sinking closed, fighting against the overwhelming wave of grief. She squeezed the tears back. She didn’t want to cry, not in front of Lucas—besides, she was supposed to be a professional. She took a deep breath and managed to look back up at Lucas. “I’m sorry.”

  “We did everything we could.”

  “Does Lydia know?”

  “Unfortunately, yes. The father practically attacked her in the middle of the hallway outside the PICU.”

  “I tried to explain to him that it wasn’t her fault, that babies’ brains are delicate—”

  “He doesn’t want an explanation. He wants a target. And Lydia makes an easy one.” He stopped fiddling with the cup and turned back to her.

  “Are you mad at me? For choosing Dr. Nelson instead of you?”

  “I was. Then I realized you were trying to protect me in some kind of misguided gesture. That’s why I came, to let you know that there’s nothing to protect me from. I haven’t done anything wrong, Amanda.”

  “I know. But this way so will everyone else.”

  He frowned at her logic but then shrugged. “I called your parents. Told them you’d call yourself when you could.”

  “Lucas, how could you!” She grabbed the bed rail and hauled herself up straighter, trying without success to erase the disadvantage that lying in bed, being seen as a helpless patient gave her. “Fine time to start breaking the rules. That’s a HIPAA violation, you know.”

  All she needed was Mama or one of her older brothers showing up, trying to persuade her to come home. Daddy wouldn’t come or call. Since the stroke he didn’t drive and never called. “Seriously, Lucas, you shouldn’t have called them.”

  “Why not? You’re obviously close; they call you all day long. What’s the problem? Don’t tell me you’re upset because of any silly patient privacy regulations.”

  “You wouldn’t understand.”

  “Try me.”

  “Do you have brothers or sisters?”

  “One of each.”

  “But you’re the oldest, aren’t you?”

  “How’d you know?”

  “Believe me, after a lifetime of being told my brothers got to do things I didn’t because they were the oldest, I’ve made a study of birth order.”

  “Baby Girl,” Lucas murmured. “That’s what your brother—one of them—called you. His voice carries.”

  “Yeah, I’m the baby. But also the only daughter. Which means I was pampered, treated like china—”

  “Why do I get the feeling you rebelled against that?”

  “Much to my mother’s dismay. You see, I was her last and only chance. She wanted to make me into a proper lady, someone she could be proud of, who would take care of the family when she’s gone.”

  “A lot to ask. What if you wanted to live your own life?” Amanda sank back against the pillows, her breath escaping in a sigh. “Exactly. Which is why I’m up here among strangers a thousand miles away from home.”

  “You miss your home, don’t you?”

  “Yes. And I miss my family—even though they can never understand me or what I want or why I do what I do. I can’t help but hurt them, but I need to live my own life.

  “Last Christmas I finally made it home for a visit. The day after Christmas, my daddy had a stroke. Not too bad—he’s back at work, motor skills are fine. His speech is still a bit weak, so now he just about never talks, especially on the phone. Not that he ever talked much to start with—Mama always did all the talking for him.”

  “I’m guessing they wanted you to stay home, help take care of him?”

  “Yes. He was fine, already walking and doing most everything on his own when I left to come back to school, but—”

  “They thought you were betraying them by leaving.” His tone made it sound like he knew exactly what he was talking about.

  “Abandoning them, that’s what Mama said. Said no job was more important than family. But it’s different for my brothers—they all work at our marina, live less than a mile from home. They never want to leave; to them life is perfect just the way it is.”

  “But you have bigger dreams. You want more.”

  “Mama says that’s my failing. Always wanting more. Guess she’s right.”

  “Amanda, don’t you ever let anyone try to box you in. Some people need to dream big, to work for those dreams even when no one else around them understands—or forgives.” A shadow crossed his face.

  She remembered what Nora had said about Lucas’s father, the garbageman with the genius son. Lucas did understand what it was like not being able to explain his dreams to his family, the sense of betrayal that leaving them behind entailed.

  “Anyway, I can’t ask them to come up here. Daddy never leaves the marina or talks to outsiders, and Mama couldn’t leave him behind alone. She doesn’t even let him go out on the boat anymore, not after the stroke.”

  “I’m sorry I called them. I just didn’t want to see you go through this alone.”

  “I’m not alone. I have Dr. Nelson and Faith, my friends, and you.” She paused while she screwed up the courage to ask what she really wanted to know—the reason behind the fake smile plastered on Dr. Nelson’s face. “Besides, it’s not that bad, is it? I mean, Tracey stabilized and I’m nowhere near as bad as she is.”

  He was silent for a long moment. Then he did the one thing that proved to her that things were worse than she thought. He reached over the bed rail and cradled her hand in both of his, his face lined with concern. “Tracey’s in a coma
.”

  “The locked-box syndrome?” She shivered and pulled the covers tighter.

  “No. A real coma. Her EEG shows diffuse slowing.”

  She looked away. She’d thought there was nothing worse than the locked-box feeling, but she was wrong. If she had told Lucas about her symptoms sooner, could he have helped Tracey? But he hadn’t been able to help Shelly or Becky.

  “Dr. Nelson will find something,” she said, placing her hope where she could. “You’ll help him, won’t you?”

  Lucas stared at her, his eyes clouded. Then he dropped her hand and walked away, his shoulders rigid. He didn’t even bother to stop and wash his hands.

  He didn’t look back before disappearing out the door, either.

  Amanda sank back against her pillows, realizing for the first time just how alone she was.

  THIRTY-NINE

  Friday, 7:22 P.M.

  ONCE SHE’D CONVINCED EMMA’S NURSE THAT IT was in her patient’s best interest to let Lydia sneak Deon in for a quick visit, he’d seemed like a new boy, bouncing with energy. Afterward, Lydia had taken him to Diggers, the restaurant/bar across the street from the hospital with a menu laden with comfort food, and let him order anything he wanted, even down to the banana split for dessert.

  Then they’d walked the two blocks to her house, and he’d discovered another treat: No Name. Lydia had been cautious at first, knowing how the cat treated Trey, but No Name had taken to Deon immediately and soon the two were racing around the backyard, playing a strange variation of tag. Deon had even christened No Name with a new name: Ginger Cat.

  “ ’Cuz he looks like a gingerbread cookie, all sorts of shades of brown,” he explained, stroking No Name until the cat released a loud roaring sound that was his attempt at a purr.

  She watched Deon and the cat and felt a bit guilty. What if No Name—er, Ginger Cat—scratched or bit the boy? She’d be responsible. But it wasn’t her cat—or was it?

  The cat was a stray, had lived here before she did. What right did she have to take a free animal and put it in a cage, torture it with trips to the vet, needles, and the like?

  The thought of being responsible for a living creature—not just for the few minutes that patients were under her care in the ER, but for … forever? … sent chills through her.

  When she was little she used to beg Maria for a pet, longed to take care of something, someone other than her mother. But now she was an adult and she knew how heavy a burden that was.

  “Bedtime,” she announced at seven thirty.

  Deon didn’t protest; in fact, he looked ready to fall down where he stood. He shuffled off to the bathroom to brush his teeth and change into a pair of Toy Story pajamas that were worn thin at the seams. Freebies from the shelter, no doubt. Lydia made a note to take him shopping before they went to see Emma in the morning.

  In the bedroom, Lydia flipped back her sheets, a soft mauve and made of Egyptian cotton. Even getting them on sale, half off, marked for clearance, she still felt a thrill of extravagance every time she touched the softly brushed cotton. It was the first time in her life she’d ever had sheets that matched—and she hadn’t even slept in them yet. Deon would have that honor.

  Before climbing into bed, Deon prowled around her room, stroking the handmade quilts and burlwood furniture she’d bought at a farm auction, much as he’d stroked the cat. Ginger Cat followed, his nose almost touching Deon’s calf.

  “I like the swirls in the wood,” Deon eventually announced in approval. “It’s like going to bed surrounded by nebulae and galaxies.”

  “Why, thank you,” Lydia said, adding a trip to the bookstore to their itinerary for the morning. “Climb on up.”

  “Not yet. Prayers first.” Deon bowed his head and folded his arms on the bed. “Dear God, please watch over Gram and keep her safe. And help out Lydia’s friend—”

  “Amanda.”

  “Amanda, and let everyone know how special they are and how lucky they are to be alive, and oh, please let Mrs. Bradley not be mad that I’m turning in my science homework late. Thank you. Amen.”

  “Amen,” Lydia echoed with a smile.

  Deon climbed into the bed and snuggled down. The cat leaped up next to him and perched with its front paws on Deon’s hip, watching over the boy with a fierce yellow-green stare. Didn’t look like she’d have to worry about the cat getting in any trouble tonight. Or anything bad happening to Deon. Not with Ginger Cat on the job.

  She turned and closed the door partway, then crept down the stairs, leaving the hall light on in case Deon woke up.

  “NORA, HEARD YOU DID THE NEW SCHEDULE,” Melody, the night-shift charge nurse said. “Thanks for getting me that Sunday off I needed.”

  “No problem,” Nora said with a grin, remembering how excited Deon had been about finishing her “puzzle.”

  “Not that I mind the help, but what are you doing here so late?”

  “Just finishing a few things before I go visit a friend upstairs.” Nora emptied her pockets and found Amanda’s pill bottles. She’d forgotten all about them. Well, she had to finish her nursing notes anyway and get them into the computer.

  She quickly transcribed her nursing assessments, reproducing what she’d written by hand on the paperwork that had gone upstairs with Amanda. Computers—seemed like they tripled the paperwork she had to do despite promising to cut it in half.

  When she finished, she grabbed the pill bottles. She tipped one of the research pills into her hand. Tiny. Amanda said she was taking the placebo, but if the real pill contained the same amount of supplements that Nora gagged down daily with her horse-pill-sized vitamins in such a small package, then Dr. Nelson had another gold mine on his hands.

  Amanda had said this study was targeted specifically at women of childbearing age, with a supplement designed to increase energy, stabilize hormones, prevent osteoporosis, and help maintain a desired weight. Hell, if it did all that, Nora would be the first to sign up to try the pills. Of course, they’d probably be priced out of her range, like most of Dr. Nelson’s products.

  She replaced the small perle back in the bottle and examined the other prescription bottle. Potassium, twenty milliequivalents. Strange, the pills didn’t look like any potassium supplements she’d seen before. She shook a few into her hand, turning them over. They were large white tablets, scored into quarters.

  “Melody, could you hand me that PDR?”

  Melody handed her the thick Physician’s Desk Reference manual. The book contained information on prescription medications including a section that had colored photos of the pills. Nora quickly scanned the pages until she found the pills Amanda had been taking.

  That was weird. They weren’t potassium supplements at all. Instead they were a diuretic: Diamox.

  How on earth had the pharmacy mixed the two up? There was no way. She grabbed the phone and dialed the pharmacy.

  “I’m trying to help a patient, Amanda Mason, with what appears to be a medication mix-up,” Nora told the clerk who answered. “She has a prescription from Dr. Nelson for potassium chloride, but the pills she received are actually Diamox. Could you check on it, please?”

  “Sure, hang on.” She heard the sound of computer keys clicking as the clerk hummed. “You’re right, ma’am, there was a mix-up.”

  Nora relaxed. At least she could cross conspiracy theory off her list of possibilities.

  While she waited for the pharmacist, she kept reading the PDR description of Diamox. It was more than a diuretic, it also was used to prevent altitude sickness by causing hyperventilation and raising the blood pH.

  That explained Amanda’s high blood pH. She tapped her finger on the pill bottle. But it didn’t explain why Amanda’s symptoms got dramatically better once the pH was returned to normal.

  She grabbed the medication orders from Becky’s and Michelle’s charts. She’d been carrying the damn things around all day, but now she finally knew where to look. Flipping the pages, she scanned them. There. Both had recei
ved infusions of bicarbonate—a drug designed to raise the blood pH. Both patients deteriorated shortly afterward.

  The high blood pH was linked to Amanda’s symptoms—and if so, could someone have slipped the Diamox to her on purpose?

  Maybe the same someone who had cut the brakes to Amanda’s car?

  “Yes, ma’am.” The pharmacist returned on the line. “The prescription for Diamox was meant for Norman Nelson. I’m so sorry; if you have the patient bring the bottle back, we’ll correct the situation immediately.”

  “Has Dr. Nelson picked up his prescription yet?”

  “Let me check. We sent both prescriptions directly up to his office. We often do that for his study patients. That must have been why the mix-up occurred. Wrong label on the wrong bottle.”

  “Thanks.” Nora hung up the phone, stunned. She shivered, wrapping her arms around her. Someone had switched the medications. Someone who knew that increasing the pH of a patient with these symptoms could be deadly.

  Dr. Nelson had tried to kill Amanda.

  She sprang to her feet, grabbed the bottles and her paperwork, and ran down the hall to the elevators, arriving at Amanda’s room at the same time as Lucas. He was smiling for the first time in days. They entered together.

  “I think Ken Rosen and I have this about figured out,” he told Amanda. “He found trace levels of mercury in Becky’s tissues—part of those protein deposits we saw. You and Tracey have tested positive for mercury as well. Not as high as Shelly, but it’s still detectable.”

  Nora hovered in the doorway, listening, hoping he’d found something to disprove her theory. After all, why would anyone want to hurt Amanda? It made no sense.

  “The protein deposits are an idiosyncratic reaction; we found oversulfated chondroitin sulfate in Nelson’s supplements. It’s the same contaminant that caused problems with reactions to heparin last year, but combined with the other ingredients in his supplements and the low levels of mercury you and the others have in your system, it’s causing different symptoms.”