Code Blue pft-1

by Richard L Mabry

  Cathy spun around in her chair to look at the books behind her. She didn't know everything that was in each one, but she knew most of it. She was a good doctor-as good as any other doctor in Dainger, probably better than some of them. Why did she have to go through all this? Who was behind it? Maybe it wasn't one person. Could there be two? Three? Apparently there was no lack of people who had something against her or her family.

  "Penny for your thoughts," Will said.

  "Just wondering whether we should lump all these incidents together. Is it possible that the person driving the black SUV, the one who almost killed me, is a different person from the one who set the fire? And could a third person be responsible for the altered prescription? Are there two or three people-even more-who are in some sort of a conspiracy to drive me away?"

  Everyone else had gone to bed, but Cathy couldn't sleep. She decided to curl up in bed with a book and read. She was about to turn out the light when her cell phone rang. The caller ID showed "Marcus Bell." She didn't really want to talk with him, but she was on call tonight. Maybe she was needed at the hospital.

  "Dr. Sewell."

  "Cathy, this is Marcus. I hope it's not too late."

  Too late for us, she thought. She tried to put a smile in her voice. "Not at all. How can I help you?"

  Marcus cleared his throat. "Actually, I think it's the other way around. As I've told you before, you seem to have impressed the doctors on the credentials committee who voted against giving you extended privileges. Now I think you have the votes you need to get everything you've requested. The committee meets next week. All I need from you is a verbal request for them to revisit the issue."

  "And if the vote ends up tied, does the Chief of Staffplan to abstain again?"

  "Cathy, you have to understand. I can't take sides. Why don't you just depend on the impression you've made on the committee members to give you a solid majority?"

  Her gut instinct told her to hang up on the man. How could she have let herself be attracted to someone this selfcentered? Instead, she said, "Yes, please ask the committee to reconsider my privileges. Maybe this time I won't have to depend on your support."

  "I can understand how angry you must be."

  "Not really, Marcus. You're an honors graduate of a prestigious medical school. You got your surgery training at a top-notch program. You came here with all sorts of recommendations. And, besides that, you're a man. No, you can't possibly understand how angry and frustrated I am to be treated this way." Cathy heard the shrillness creep into her voice. Well, let it. It was time Marcus heard this. "I've heard doctors refer to female colleagues as 'pushy broads' when all they asked for was respect. Well, I've tried not to be a 'pushy broad,' but no more. I intend to stand up for myself-with or without your help."

  Marcus started to respond, but she ignored him. He was still talking when she pushed the button to end the call, wishing for an old-fashioned black Bakelite instrument- one she could slam down into its cradle with a satisfying bang.

  Jane put a slim number ten envelope on Cathy's desk."This came for you this morning."

  "There's no stamp. How did it get here?"

  "Myra Johnson, one of the tellers at the bank, brought it by."

  Cathy noticed the return address printed on the envelope: First State Bank of Dainger. Was this about the lawsuit? Why would Nix have a teller hand deliver it? Why not his lawyer? She reached for the envelope, but stopped with her hand hovering in the air. Letter bomb? Don't be silly. Now that's paranoid.

  She slit the envelope with the brass opener that rested inside a mug on her desk, along with a collection of pens and pencils. Inside was a single sheet of bank stationery. The letter, only three paragraphs long, was signed by Milton Nix, President and Chairman of the Board. Although most of it was "legalese," she had no trouble understanding the last paragraph. It began with a sentence that brought her world crashing down around her.

  "The Loan Board has reviewed your circumstances and believes that there is an undue element of risk present in the loan as it stands. Therefore, we must ask that you reduce the principal balance of your indebtedness by at least five thousand dollars, as well as paying the interest to date, before we can continue the loan."

  Her stomach churned. She swallowed hard to force down the bile and acid she tasted. She hadn't counted on this. The note she'd signed wouldn't mature for another nine months. Several times over the past few months the thought of a seventy thousand dollar debt hanging over her had brought her to the edge of panic. But Nix had assured her: "Simply pay the interest, and we'll renew it for another year." How could the bank do this?

  More importantly, how could she pay? Cathy knew, almost to the penny, the balance in her bank accounts. Her personal account was almost nonexistent. The separate account she maintained for the practice had just enough to cover this month's expenses and perhaps a small salary for her. It would be a struggle to come up with the interest payment, but how could she raise an additional five thousand dollars? How long did she have? She read the final paragraph of the letter again and again, each time swiveling her eyes between her desk calendar and the letter. She had less than a week.

  Jane still hovered nearby, apparently sensing the letter had delivered bad news. Cathy turned to her.

  "Did Ms. Johnson say why she delivered this by hand? And why I'm just getting it? I should have had this at least two weeks ago."

  "She said they'd tried to mail it to you twice, but it came back."

  "What is it with those people?" Cathy fumed. "First they bounce a check for my insurance premium. Now they can't get my address right. You'd think-"

  "What?"

  "Nothing. Give me a few minutes before you put the first patient in."

  Cathy sat tapping the letter opener on the desk. At first she thought it was far-fetched. The longer she thought about it, the more logical it seemed. Was there someone at the bank who didn't want her to succeed? Was the person so anxious to see Cathy leave town somehow connected with the bank? She ticked offthe suspects on her fingers.

  Milton Nix? He'd been helpful, gone out on a limb to give her the loan in the first place. Why the change? Cathy could think of one reason-her next suspect.

  Gail Nix? She was the one who'd badgered her husband into filing the lawsuit. And wasn't there an SUV in their garage? Was this because of the death of Gail's sister, a death she still blamed on Cathy's father?

  Ella Mae Mercer? Cathy hadn't figured her out. Why would she go to the trouble of making sure Cathy received the money to cover her loss after the car crash, and then do this? Or did Will put pressure on the woman so that she had to appear to help. And what had been Ella Mae's relationship to Nolan Sewell? Could that have a connection to this?

  Then it struck Cathy. There was one more person with possible access to the digitalis prescription. If Nix went back to his office and left his prescription lying on his desk, what was to stop Ella Mae from snatching it, making the alterations, and returning it before Nix had a chance to get it filled? Cathy couldn't believe the woman would have the knowledge to change the prescription, but then again, with the Internet there was a lot of information out there for the taking. It was a long shot, but it was possible. Or could someone else at the bank have altered the script?

  Jane poked her head into the office and waved a chart."Ready?"

  "I suppose so." Cathy pushed herself up out of her chair, feeling as though her spine had turned to mush. "And while I'm with this patient, would you total up our unpaid claims? Then start calling the insurance companies to see if you can speed up those payments."

  "Is this about that letter?"

  "I'm afraid the letter is only the tip of the iceberg. But right now, that iceberg's about to crash into our ship. I need to raise over five thousand dollars in a hurry if we don't want a repeat of the Titanic."

  Cathy waited until Jane left before she swiveled around and pulled a dog-eared directory from the shelf behind her desk. Please don't let it come to thi
s, she thought. But she had to find out. If everything fell to pieces, did she have a way out? Was there somewhere she could go and start over yet again?

  She could only imagine the anguish pursuing this option might cause her. But it looked as though Cathy's chances of staying in Dainger were slim to none. Frying pan or fire? Bad choices, either way.

  Before she could lose her resolve, Cathy punched in a series of ten numbers. An electronic voice invited her to enter an extension number or hold for an operator. What was the extension? Once it had been as familiar as her name. Could it have flown from her memory in such a short time?

  Think, Cathy. "Please hold for the operator." Was it 2732? Was that it? She punched in the numbers and waited as the call rang through.

  "Family Practice."

  When she heard the voice, the name of the secretary came to Cathy immediately. "Lisa?"

  There was a brief pause. "Yes? Who's calling?"

  "This is Cathy Sewell. Is Dr. Gross in?"

  "Oh, Dr. Sewell. So good to hear from you. How are you doing?"

  Just wonderful-someone wants to kill me, the bank is threatening to foreclose, and I'm sleeping in a guest room in the parsonage after my apartment burned. Couldn't be better.

  "Fine," Cathy said. "Just fine. Now is Dr. Gross there?"

  "Sure. Let me buzz her."

  Cathy was relaxing to the strains of a classical piece when she heard the cheery voice of the department chair, the woman who'd been her mentor during her residency. "Cathy, good to hear from you. How can I help?" That was just like Amy. Right to the point.

  "Amy, is that position at the school still available?"

  The silence that followed gave Cathy her answer before Amy spoke. "We filled it right after you turned it down. Are there problems with your practice there in Dainger?"

  Cathy assured Amy that everything was fine. Oh, there were a few glitches, but nothing unusual. She just wanted to explore her options. Maybe she'd come back for Grand Rounds next month and they could visit. Amy encouraged her to do that, perhaps stay over so they could have dinner together.

  As she hung up the phone, Cathy felt her throat tighten, as though someone had just put a noose around her neck and kicked the horse out from under her. Pretty apt, she figured.

  That door had slammed shut. There was no way out. No running away from Dainger.

  The day seemed to stretch to infinity, but at last Cathy could head home. Well, not really home. Then again, where was home? Did she even have a home? Ugh, enough philosophy.

  She had just buckled her seat belt when her cell phone rang. She fished it out of her purse and scanned the display: the hospital. Had there been an order she'd neglected to write? Was she behind on her dictation again? "Dr. Sewell."

  "Doctor? This is Glenna in the ER. Isn't Ella Mae Mercer your patient?"

  Bells clanged in Cathy's head. "Yes."

  "The ambulance just brought her in-comatose. When Ella Mae didn't return from lunch, her secretary got worried and decided to check on her. She found Ella Mae on the couch in her living room, totally unresponsive. The secretary called 911. They brought her here."

  Cathy threw the car into reverse and backed out of her parking space. "Is she breathing on her own?"

  "Shallow. Blood pressure's down, pulse slow. Pupils a little constricted but equal. No signs of trauma."

  "Get her on oxygen-mask for now, but we may have to tube her. Start an IV, draw blood for glucose, BUN and creatinine, liver panel, and a tox screen. Get some blood gases cooking. Alert radiology that we may need a head CT. Who's the ER doctor today?"

  "Dr. Patel. He thinks she may have had a stroke."

  Cathy accelerated, hoping she wouldn't encounter her nemesis, the black SUV. She squealed around the corner."Tell Dr. Patel not to do anything. I'll be there in two minutes."She took a deep breath. Be diplomatic, Cathy. "And thank him for me."

  In a few moments, Cathy was at Ella Mae Mercer's bedside. Her examination was swift and focused. No cuts or swelling of the scalp. No stiffness of the neck. Pupils equal in size, maybe a bit constricted, but normal reaction to light. Tendon reflexes diminished generally. No evidence of head injury. A little young for a stroke. "Let's hold offon that brain CT for now."

  "Radiology's on standby. I'll keep it that way until you're sure," Glenna said.

  "See if one of the ambulance crew that brought her in is still around." Cathy heard the squeak of rubber-soled running shoes as Glenna hurried out of the room.

  The lab work would help, but it would take a while. The physical exam suggested a few things. But if Cathy's suspicions were right, the EMTs should be able to confirm them.

  "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 t
aped 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.