by Rob Horner
Tina reached for the patient’s right arm while the doctor grabbed her left. Pinning the arm to the rail with his left hand, he reached into his shirt pocket for a metal penlight. “This might hurt her a little, Miss, but it’s what we must do.” He pushed the penlight in between Kristie’s teeth, through the gap at the side of her jaw. “As soon as she lets go, please pull away.” Then he began to pry, pushing down on the penlight slowly but forcefully. A second later, Mrs. Burleson was free.
Tina was pulled toward the bed as the girl tried to withdraw her arm. At the same time, her upper body came off the mattress, teeth snapping at the air like a dog pulled away from a fight. Dr. Patel kept hold of her left arm, pulling back, not allowing her any leverage. Still calm despite the madness of the situation, he said, “Tonya, bring two of Ativan, five of Haldol, and 50 of Benadryl, please. Tina, you have to work with me. Don’t let her arms rest on the rails, or she can push herself up. When she pulls my side, pull back. Otherwise just resist her.” His continuing instructions overrode Tonya’s response.
“I don’t understand it,” the mother said. “One minute we were talking about going to see the new superhero movie next month, and she was telling me how the movie she saw last week was feeding into it, then she just stopped in mid-sentence, like a switch flipped.” The woman still hovered near the bed. “Is it something to do with her sugars? Those have been good for months. I just don’t—”
“We don’t know yet, ma’am,” Patel said a little more forcefully than normal. He was having to strain to keep the thin girl in the bed.
Tina didn’t understand it either. Nothing about diabetes should force a reaction like this. Neither should anything with a stomach bug, be it viral or bacterial. Nobody in the hospital had seen Austin attack Buck, but this seemed to fit, except that Kristie was awake and talking before it happened.
“I got the pediatric restraints,” Brandon said, appearing in the doorway. “Tonya thought you might need them.”
Another scream and crash sounded out in the hall.
“What is that?” Dr. Patel asked. “I can’t see from here.”
Tina looked. Room fifteen opened out on the center of the nurses’ station, with rooms seven, eight, and nine visible to the left. From Patel’s position on the opposite side of the bed, he’d be able to see the trauma rooms on the right. The scream repeated, followed immediately by an elderly black lady staggering out of room eight, yelling for help, that her husband had gone crazy.
“What the hell?” Brandon said. “I’ll leave these here. If you need them, Tonya can help put them on when she gets back with the meds.”
“Be careful,” Tina called after him.
It was 8:05 in the emergency department, and Tina didn’t know where to begin charting everything that had happened in the last forty-five minutes. Just trying to put it in chronological order in her head was difficult.
Austin Wallace was dead of cardiac arrest, apparently caused by dehydration. Death by doo-doo, as Brandon joked. Gallows humor was a tried and true method of coping with the daily stresses of their job, but even with that as a justification, the joke felt forced.
Then came Kristie Burleson’s sudden change in personality, from sweet girl to raving psychotic. Mrs. Burleson could give no history that might offer any clues. They hadn’t run a drug screen on her initially, but one had been added. Both Tonya and Kristie’s mother had mild abrasions from their contact with the aggressive girl, and the mother had several small punctures in her shoulder. Both had been treated. The mother didn’t want to check in as a patient and, considering the assailant was her own daughter, Tina didn’t blame her. She and Dr. Patel held her steady for a full five minutes while the B-52 cocktail went to work. Once she fell unconscious, they secured her to the bed with the restraints.
More paperwork. More charting.
The patient in bed 8, Derek Butler, had suffered a similar change in mental status, whipping his head to the side as Mrs. Butler bent in to give him a kiss. He’d scored a glancing nip on her cheek, but it was just a minor skin tear. The bleeding had already stopped by the time Brandon, Billy, and Caitlin got Mr. Butler medicated and restrained.
Dr. Crews, Marcus, and Josh emerged from Trauma 1 right about the time Mr. Butler was slipping into Haldol-land. Despite their best efforts—and Tina had no doubt, with Dr. Crews in the room, those had been Herculean efforts—Mr. Sprugg had died. The damage to his trachea was too great and too extensive to properly patch. Even with oxygen running as fast as they could pump it, they couldn’t save him. The on-call surgeon hadn’t even made it to the hospital before he was called and told to go home.
Dr. Patel had just begun giving report to Dr. Crews when the last patient went crazy. Sonny Cranston, the smelly frequent flyer who liked to ogle the nurses’ breasts but never said or did anything wrong, burst out of his room like a man running from his own death. One second there was just the steady buzz of too many people collected in a small space, and then came a shriek best described as from the mouth of madness. The door to room seven was yanked open, and out came Sonny in all his naked glory. The greasy mane on his head matched the blood-matted gray hair on his torso, legs, and his pubic mound. He had his arms spread wide, like he was embracing the world or welcomed it to come to him. The smell that followed him out was horrendous, a combination of stool and blood and old sweat and fresh urine. He was grinning, that’s the part that Tina couldn’t forget. There was a smile on his face to rival that of the Cheshire Cat. Lips and half-rotted teeth were stained with blood, and fresh marks on his lower arms and legs matched the particular pattern of nubbed and missing teeth in his mouth. His chest was streaked with fresh gouges, like Wolverine got an itch even his claws couldn’t scratch. Blood rolled down his stomach and dripped from his dangling manhood as he staggered out into the hallway, uttering words that made no sense even when they could be understood.
“Al-eye e-e-come, come ah be wih me!”
Fresh diarrhea, liberally streaked with blood, covered the bed and floor behind him.
“Oh…my damn!” Brandon said, mouth open in a perfect O of shock.
And that got everyone moving. China ran up to Med-Surg to grab another set of restraints while Dr. Crews, Marcus, Brandon, and Josh wrestled Sonny into room 6, with only Marcus receiving a scratch on one arm. Everyone else gowned and gloved up to begin cleaning the mess.
“On the bright side,” Billy said, “the night can’t get any shittier.”
Tina hoped he was right.
Chapter 18
“Hey, wasn’t her knee bent?” Cliff asked of no one in particular. The photographer was done with his pictures, and the time had come to move the nurse’s body to the morgue. SOP was to leave it in situ until the coroner arrived, but there were two doctors here who could attest to time of death. And as much as protocol might dictate that any business where a death occurred be closed until an investigation was completed, that didn’t apply to a health care facility, especially not an emergency department. Having the coroner on site would make things better, of course, for paperwork’s sake, but you could wish on a star until your head hurt and all you’d have to show for it was a headache.
The radio on his hip squawked, and Cliff reached to silence it. The world, or at least his small corner of it in Gaffney, South Carolina, was falling to pieces. The county had a methamphetamine problem, worse up toward the state line and Shelby beyond it, but generally bad everywhere, so hardly a day passed without a disagreement over cut, quality, supply, or payment turning into a fight, usually with fingernails or small knives. Burned out though their brains might be, the meth-heads knew not to break out the irons. The pot growers were the same way. Maybe it had something to do with the kind of high they got off the drugs. Coke and crack dealers would shoot at anything, but meth guys scratched, and tokers just stared at you like you were the bad guy for stopping them from relaxing.
But tonight was different. He could feel it.
Already they’d had more minor assa
ult complaints in just a few hours than over any similar time frame he could remember. Most of the complaints were domestic, meaning a son or a husband or a wife just going batshit for a few minutes and scratching or biting someone else in the family. They seemed sick too, like stomach virus sick. So far no one had to be arrested, which was good. They already had a lock-up full of junkies detoxing; they didn’t need a raging case of the runs to make things worse.
Cliff hated stomach viruses. Put him in a homeless shelter during flu season and he’d be fine. But let someone throw up anywhere in the same building as him and he’d be down for two days with stuff coming from both directions. Ass on the toilet and aim for the tub, as his stepdad used to say.
“You ready, Cliff?” the night shift nurse, Marcus, asked.
“Yeah man, let’s do this.”
I swear her left leg was bent at the knee, Cliff thought. But it was straight now and too late to worry about it. Someone wasn’t being careful and nudged it with a foot, he decided. It wouldn’t matter in the end. The old guy responsible was dead, his body being photographed right now. The guy who killed the old man was out cold and strapped down, high as a kite or crazy as a loon, or a damn good faker. Maybe he’d stand trial or maybe not. What it meant was Cliff would be here most of the night, filling out paperwork or standing guard on a guy charged with murder.
In the end, no one would care that the lady’s foot had been bumped by a careless cop or nurse before she could be toe-tagged, placed on a stretcher, and covered with a sheet.
Buck’s ear hurt.
The lidocaine had worn off an hour before as they were delivering the Butlers to Trauma 1, right when everything went off the rails. He’d thought about asking Dr. Patel for another dose, unsure if that was allowed, or if he was supposed to be taking the pain pills now. Maybe some ibuprofen…he could ask for that.
Thinking about his ear was a distraction, painful but welcome. It beat looking into Room 10, where Danny lay strapped to the bed.
A murderer.
Was there a clue somewhere in Danny’s files, or in how he’d acted earlier in the shift? Had he missed something that could have prevented this?
Buck shook his head. Thinking like this wasn’t good for anyone.
He’d saved the CNA, Kenja.
Had he saved her, or had saving her been a fortunate accident?
He certainly hadn’t seemed to care about anything by the time Buck got to him, digging into the old man’s throat with his teeth, even dragging a piece of it out when Buck tried to pull him away. That look in his eyes. Like there was nothing human left in there. It was terrifying.
And familiar.
The man’s eyes snapped open, no longer roving but fixed and staring straight at Buck. There was something there, a hatred, or a hunger, but nothing that spoke to recognition.
Danny had looked at him the same way Austin did before the attack. There were other patients in the department doing the same thing, according to the nurses. People acting completely out of character, going from normal to mindless aggression, even in the middle of a conversation, if what Tonya said was true. They’d all come in with abdominal complaints like Austin and Derek.
But Danny didn’t have any of those symptoms.
All he had was a broken arm.
The entire arm felt hot, a pus-filled abscess surrounded by otherwise-normal skin, as though a massive infection had set in sometime between when they met that morning and now.
There was something wrong! It might have nothing to do with the stomach problems that drove the others to violence, but it didn’t need to. What if an infection caused him to flip? He’d dealt with little old ladies acting like they were Joan of Arc ready to kick England out of France with pure spit, vinegar, and shaking blue-veined hands. Little ladies who’d been fine the day before, planning their next game of Bridge. If a urinary tract infection could cause changes like those, what about a deep tissue infection?
“Where you goin’?” Gus asked. He was the hospital security guard standing watch over Danny. They had a cop assigned to them too, but he was on his smartphone, texting his wife.
“I’m going to go talk to the docs,” Buck said. “I might have an idea what happened with Danny.”
“I saw the weird stuff on his arm when I splinted it,” Jordyn said. “But I figured you guys already knew about it and were more concerned with getting him restrained.”
“What did it look like?” Dr. Crews asked as they reached Room 10.
“Like a bad infection, I guess. It didn’t have a smell though.”
Dr. Crews waved that away. “Buck, do you mind coming in with us, just in case?”
“No problem.”
The police officer, a young guy Buck only knew as Tim, slipped his phone in his back pocket. “Is this necessary, doc? You already splinted his arm, right? I thought we were just keeping him in there until transport arrived to take him to the station.”
“Pretty sure I haven’t discharged him, Officer,” Dr. Crews said. “Can’t do that until the meds wear off at the earliest.”
“How long will that be?”
“Haldol can last six to eight hours,” Jordyn answered.
“Crap,” the officer muttered.
“We also don’t know why he flipped,” Buck said.
“Some people just go bad,” Tim offered.
“They don’t go from ambulance crew to murderer,” Buck said, his voice dropping.
“Well, maybe you’re on to something with this infection idea, Buck,” Dr. Crews said. “And even if not—” he looked pointedly at the police officer “—you are right in that this isn’t a normal change in personality. So, if I decide to keep him here and MRI his head in the morning, that’s what I’ll do.”
As they pushed past the officer and the security guard, Dr. Crews muttered, “Plus, I’d love to find at least one answer tonight.”
The stretcher trundled down the back hallways of the hospital, wheels bumping and clicking noisily whenever they rolled over a crack in the floor tiles. Maybe it was the lockdown, or just the time of night, but Cliff didn’t think he’d ever been a hospital that felt this empty. Past crossing hallways and doors leading into other departments, he kept expecting to see someone—a nurse running to a vending machine for a snack, or a CNA carrying a bunch of tubes to the lab.
“Is it always this dead at night?” Cliff asked.
“Good one,” Marcus replied.
It took Cliff a moment to realize his pun, then he chuckled. “Seriously though, is it the lockdown?”
“Only the ED is in full lockdown,” the nurse answered. “The rest of the hospital is just…quiet.”
“You guys really don’t like that word, do ya?” the cop said, chuckling again. “I thought it was just an urban legend.”
Marcus laughed as well. “It’s pure superstition, and we’re all aware of it. Just as we’re aware of the irony involved in following it. You usually won’t catch us using the ‘Q’ word, the ‘S’ word, or the ‘B’ word, either.”
Cliff puzzled over that for a moment, but before he could ask was the ‘S’ and ‘B’ words were, they turned down a final short hallway that dead-ended in a wide, single door.
“This is it,” Marcus said, swiping his ID badge across a reader on the wall before the door. The door responded, swinging open silently. A rush of air colder than anywhere else in the hospital flowed out to meet them.
The morgue in a small hospital isn’t like what people think. There’s no surgical-steel operating table dominating the center of a large, open space, with gutters along the sides to collect blood and other bodily fluids. There’s no expensive camera setup, no audio microphone hanging from the ceiling or elaborate recording hardware. There’s just a counter with two log books on it—one to document the patient’s arrival, and one for the funeral home or Medical Examiner to complete when they remove the body—four small safes for storing any patient belongings, and four larger compartments, those infamous cadaver drawers wi
th the sliding inserts for holding the bodies while they awaited transport. The room was kept at a chilly fifty-five degrees, not cold enough to be dangerous, but more than enough of a difference in temperature to bolster the awareness of the presence of death. Cold as the grave and the chill of death were two phrases that popped into Cliff’s mind as they pushed the stretcher up to the closest morgue drawer.
“It doesn’t matter which one we use,” Marcus said, “because they’re all empty. But I’d advise leaving the closer ones for the two guys we’re going to have to bring down here next.”
“Why’s that?” Cliff asked.
“Because they’ll be heavier and harder to move, especially old man Sprugg.”
The two men lined up the stretcher with the farthest door, and Marcus undid the latch to pull out the sliding tray.
“Your arm okay for this?” Cliff asked, noticing the narrow band of Coban wrapped around the nurse’s bicep.
“Just a scratch,” Marcus asserted, flexing his hand for the cop’s benefit. “I’ve had worse bathing my dog.” Truth was, Marcus had already forgotten about the attack by Sonny. It was just another thing that happened in the ED.
“Okay. So, how do we do this?”
“We’re going to use the sheet under her to roll her body just enough to slide this under her.” Marcus held up a thin board made of what looked like plastic. “Once it’s under her, we’ll pull from the other side of the tray, and she’ll slide right across.”
“You guys think of everything, don’t you?” Cliff asked.
“Okay, stand on the side of the bed there, and help me roll her up a bit.”
There was something not-quite right about leaning over a dead woman, Cliff thought, but Marcus was doing it willingly enough. Probably does it every day, he thought. Guess you really can get used to anything.
“One. Two. Three,” Marcus counted, and on three, they pulled the sheet under Lisa enough to get her right shoulder and hip up off the stretcher. Her right arm flopped toward her left side, a log moving under the covering sheet, pulled by gravity. Cliff almost dropped his part of the sheet when it moved, but he managed to keep control of his nerves. “Now, spread your grip a bit, so you’re taking my load as well. You don’t have to move her anymore, just keep her balanced for a second while I get the slide.”
