Desperate to Die

by Barbara Ebel

  “Do you mind if I poke around, Mrs. Pratt?” Dustin asked nonchalantly.

  Gloria frowned, but it was not aimed at Dustin. Sadness welled up in her throat that her mother was finally gone and would be taken away by the paramedics.

  “No,” she said, “and if you officers want a bite to eat, help yourself to some birthday cake.”

  “Thanks for the offer,” Edgar said. “Whose birthday is it?”

  “Mine,” Gloria said, “but celebrating makes no difference now.”

  Edgar nodded as Dustin continued to pry around. An emesis basin was also on the nightstand, a diaper bag on the counter, and a jacket on a chair. In the kitchen, he opened some cabinets to find dishes, paper products, and the shelves with food items. On a low shelf, he spotted what he liked to think of as old people’s drinks. He opened one up and sniffed. Just a light fragrance of vanilla.

  Over in the big room, the paramedics still had Gloria engaged with questions, which Dustin listened to as well. His partner was doing his own police work and making mental notes of the corpse.

  Dustin stepped into the laundry room, the first door off the hallway. The dirty cloth that permeated his senses verified the fact that Darlene Pratt had been sick. Vomit usually smells pretty bad, he thought, but the cloth smelled ten times more potent. Nothing that a good police lab couldn’t figure out, he thought. It’s probably nothing, but it wouldn’t hurt to check.

  He sauntered back into the big room and watched as Gloria helped the paramedics take the pillow out from behind her mother’s head and tied a string at the neckline of her pajamas. As the male and female medic moved her to the edge of the bed, Gloria clunked into the kitchen, dabbed her eyes with a tissue, and then squirted sanitizer on her hands.

  Officer Lowe’s instincts were nagging at him as he watched Gloria and contemplated questions for her. His hunch at the moment was that there was something potent smelling in those cups besides vanilla drink.

  “Mrs. Pratt,” he said, “did you say there was a caretaker here all day?”

  “Yes. I usually work a long shift two or three times a week and someone else stays with mother. Otherwise, I take care of her 24/7.”

  “That must have been taxing for you day after day.”

  Gloria waved her hand at him. “People say things like that to me. I take a break by working a little bit but, no, I never complained about minding and doing for my mother. It was my duty. She would have done the same for me.” She worked at massaging her hands and scowled at him like he should know better than to make such a remark.

  “I’m sorry. What I do want to ask you is about the woman who was here today.”

  “She has been here before. Today, she worked a good twelve hours.”

  “Before we go, please write down her name and where we can reach her.”

  Gloria nodded and stepped over to be closer to her mother. She put an extra bed linen on her as the paramedics readied to place her on the stretcher.

  Dustin contemplated the sweet smell again and went back to investigate further. He opened more cabinets below the counter. Mostly pots and pans and towels and plastic containers. He checked under the sink. Strange items like a toilet bowl cleaner and brush, disinfectants, and bug and rodent traps. Antifreeze too.

  Antifreeze?

  He grabbed the silver liter container, put it on the counter, and unscrewed the cap. After sniffing it, he jerked his head back and frowned.

  “Officers,” the male paramedic said, “we’re leaving unless you need something from us.” They had hoisted the stretcher up and were ready to approach the door.

  “No,” Edgar Banks said. “We’ll track down what we need or make the necessary calls.”

  Gloria scribbled down Marabeth’s name and number, hustled into her jacket, and picked up her purse and car keys. “I know this sounds crazy, but I’m following you boys to be near my mom. Wherever you’re bringing her, I can provide more information about her if someone needs it. Honestly, I’m not ready to leave her side until someone tells me to.”

  The paramedics shrugged; it didn’t matter to them. They all left after Gloria told the officers to lock the door behind them.

  Dustin Lowe rubbed his chin as he scanned the room one more time and stood next to his partner. “Along with legal permission, let’s have one of the lab specialists come over quick and take a few things I’m curious about.”

  “Don’t see the need,” Edgar said, “but if a morsel of interest exists in that thick skull of yours, I don’t mind.”

  “And,” Dustin said, “let’s pay the aide a visit. The deceased was sick today. I wonder how concerned she was or how tired she may have been nursing the deceased.”

  “Whatever you say,” Edgar said, knowing that the two of them worked well together and fed off of each other’s hunches. “I’ll make the lab call.”

  -----

  With a strong sense of self-esteem, Annabel used her stethoscope to listen to Mick Rhoden’s breath sounds. His lungs went up and down with the respiratory therapist squeezing on the Ambu bag and she smiled at Dr. Burg.

  “My first intubation,” she said, “and I nailed it.”

  “Nice job,” Melody said.

  “I spent extra time with anesthesia on the surgery rotation and it panned out.” She rarely took delight in her own accomplishments, but she was all too aware of the necessity of airway skills and what it meant to save someone’s life by establishing a patent method to breathe. She felt like she had taken a huge step.

  “Let’s go sit down and talk about the ventilator settings in more detail,” Melody said. “The ER doctor is also going to pump Mr. Rhoden’s stomach.”

  For the interim, Melody gave the therapist the orders she wanted and then considered their patient. “We also have the dilemma of a patient without a medical history. That’s a problem and leaves us with writing a lot of ‘unknowns’ on our H&Ps.”

  The nurse in the closed-draped area listened while she removed the used airway equipment from the patient’s bed. “Someone called Mr. Rhoden’s mother,” she said. “She’s in the waiting room.”

  Before leaving the ER, Melody sat down with Annabel and gave her a mini course on ventilators in addition to what she had already learned. “There are always questions on the internal medicine exams about respiration, ventilators, and settings.” She crossed her legs and Annabel was all too aware that she was in her teaching and on-call mode. She had substituted her heels for sneakers.

  “Tell me about PEEP,” Melody said.

  Annabel bit the inside of her lip. “I hope I explain it correctly. It’s the alveolar pressure in the lungs above atmospheric pressure which is present at the end of expiration.”

  Melody nodded. “And how does it come into play in a mechanically ventilated patient like Mr. Rhoden?”

  “You residents order it as a setting almost all the time,” Annabel said. “But I honestly don’t understand why.”

  “We order a small amount of PEEP to mitigate end-expiratory alveolar collapse. Usually five centimeters of water.”

  “Makes sense,” Annabel said. “Thanks.”

  “You’re welcome. Let’s go find Mr. Rhoden’s mother.”

  -----

  Middle-aged with hunched shoulders, Mrs. Rhoden paced the waiting room like an expectant father during his wife’s delivery. She stood still when Dr. Burg introduced herself and Annabel.

  “Is my son going to be okay?” Mrs. Rhoden asked.

  “His most immediate problem has been addressed,” Melody said. “The need to breathe.”

  “If he hadn’t been found by his roommate, he could be dead.” Her eyes grew bigger. “Which is what he wanted anyway.”

  “It appears he’ll be fine, but we’re not out of the woods yet,” Melody said. “Once we have him stabilized and over this hump, he’ll need to be under the psychiatry department’s care.”

  “I can’t imagine. A shrink. For my own son.”

  “In the interim, we’ll be taking care of
his medical care. Can you help us out with his history? Illnesses? Medicines? Surgeries?”

  “Easy enough. No surgeries. No medical problems except seasonal allergies and recent depression. And only allergic to sulfa drugs.”

  “And family history?”

  “Negative except for a history of depression.”

  “Anybody ever try to take their own life?”

  She looked away. “Me,” she said.

  -----

  After leaving Mrs. Rhoden, Annabel and Melody thought about the same thing – a cup of coffee - before tackling their paperwork. ER staff did their best to keep fresh coffee available through the night shift, so they ducked into the small kitchen. The aroma of a rich Columbian roast wafted through the room. Annabel picked up the pot and poured some into two clean ceramic cups.

  “Thanks,” Melody said, taking a sip. “What do you think about Mick Rhoden?”

  “My last attending on psychiatry told us that the National Institute of Mental Health says that a family history of suicide is a prevalent risk factor for suicide.” She leaned against the counter. “So there we go.”

  Melody warmed her hands with the toasty mug. “You make us upper residents proud.”

  “What do you mean?”

  “You quoted what one of your previous teachers told you, which means that you were paying attention and you remembered what he had to say. You have developed excellent listening skills early on in your training.”

  “Thanks,” Annabel said. “It’s easy to be stashing all of this information away when Bob and I are learning from excellent clinicians.”

  They took their coffee with them and sat at the ER desk where the activity after midnight slowed down. Since there was little in her new patient’s history, it took Annabel no time at all to write up his history and physical. In a few hours, she hoped he would be in the ICU.

  Mick Rhoden’s case was too ironic for Annabel to make sense of and she wished she could follow his care when he made it to the psychiatry department. Mick took prescribed tricyclic antidepressants for depression and yet he almost succeeded in committing suicide on the very drug used to lessen his depression. She looked back at Melody’s orders and it was clearly stated that he would be on suicide precautions, particularly when he came off the ventilator. However, she sighed, she knew from her limited clinical experience that suicide precautions didn’t always work.

  Too tired to think about patients wanting to hurt themselves with such finality, she placed her head in her hands and rubbed her eyes, her forehead, and the rest of her face to rejuvenate herself. It was time to head to the call room for some sleep. She straightened out her white jacket, which could use a washing and an ironing, while being glad about wearing scrubs. So much more comfortable than the street clothes she wore earlier in the day.

  After rinsing off the two mugs they’d used, Annabel sauntered away to the call room. With her beeper within a few inches of her pillow, she fell asleep without further thoughts about patients and new admissions. There were only a handful of hours to sleep, but when she startled awake in the morning before her alarm, she realized Robby Burk had been in her dreams. She pictured him doing surgery in a remote hospital in Africa and she was by his side, handing him his instruments and wiping his brow from the heat.

  As she leaned over to find her clogs from under the bed, she wondered why, in her dream, she had followed him overseas instead of pursuing her own course of medicine and why she was his helper instead of functioning as an independent doctor. Interesting, she thought … what a strange scenario had surfaced from her subconscious. It made her uncomfortable, but was that truly any different from their last encounter or messaging?

  CHAPTER 24

  Annabel freshened up in the bathroom, gathered her overnight bag from the call room, and stashed it in the office. She needed her first cup of coffee. Mick Rhoden was now in the ICU, which was the second best place in the hospital to grab some. The morning shift was coming alive with staff going in and out of patients’ rooms, but she found the coffeepot empty. After setting up a batch of a Hawaiian brew, a nutty odor began filling up the room, luring Mick’s nurse in for a cup herself.

  “I’m the student taking care of your patient with the effective overdose,” Annabel said. “How’s he doing this morning?”

  The nurse reached over and grabbed two disposable cups. “In report, they told me his stomach was suctioned out in the ER. He’s starting to wake up and, without other medical problems, I bet you all get him out of here fast.”

  “He has that in his favor.” Coffee stopped dripping from the coffeemaker and Annabel poured for the two of them.

  “I never thought this would be a big part of my job,” the nurse said.

  “What?”

  “So many young people trying to kill themselves. I’m only twenty-five and my whole first year here, I nurse one to two patients like this every week. So I looked it up. Did you know that suicide is the second most common reason why adolescents die, after traffic accidents?”

  “I believe it. You and I are young. I would never think about that for a second. How can people our age get to that point? I took psychiatry, but I still can’t wrap my head around the idea.”

  “I had a classmate who did it,” she said. “Compared to other students, I always thought she magnified her problems. Things I perceived as minor inconveniences, she considered to be major problems. She told another student one day that life was painful.”

  Annabel swallowed and shook her head. “My psychiatry attending said that some depressed patients see no alternative other than death. The sad part is that, most of the time, no one else is attuned to that and helping them. Part of giving these patients help is to be asking them the right questions. And if that isn’t happening, they’re not getting the right answers.”

  The nurse sighed. “You and I may not be helping them beforehand, but at least we’re helping in their after-care.”

  “But then it’s as important that they get the psychiatric help they need and never attempt it again. That they realize life doesn’t have to be so cold and so dark.”

  With a magic marker, the nurse marked her Styrofoam cup and snapped on a lid. “I’ll finish it in a little while. Thanks for being our barista.” She took a step. “Nice talking to you.”

  “Likewise,” Annabel said.

  -----

  Instead of expeditious rounds, Dr. Schott announced to the team that their attending was joining them. Annabel sunk into the desk chair, subtly took out espresso beans, and shared them with all the students.

  “Thanks for these,” Jordan said, “but bummer that Dr. Mejia is coming along.”

  “I would think his cardiology input is always useful to you,” Stuart said.

  “Less so than getting a letter of recommendation from him when I apply to residencies.”

  Bob squinted his eyes. “How can you be thinking of that already?”

  Sebastian Mejia showed up at the doorway. His eyes settled on Dr. Schott and he made a small “follow me” gesture. Donn pushed himself off the couch and they all followed in single file. The senior doctors talked among themselves as they swept through the medicine hallways. Dr. Mejia was calling the shots of who he wanted to see and in what order. He summoned over the main desk for May Oliver’s chart, thumbed through it, and paraded into her room.

  A cot was set up on the other side of May’s bed and the white hospital blanket stirred from someone underneath. May’s mother, Louise, peered over the bunched-up sheets by her neck.

  “Oh, so sorry,” Louise said. She threw off the covers and sat on the side of her make-shift sleeping arrangements. “Even though my husband and I are staying at May’s place, I decided to stay with my daughter last night.”

  “That’s fine with us,” Dr. Mejia said. “Don’t consider it an imposition on staff either. We want our patients to have as much support as possible from loved ones.”

  “Thank you,” she said, staying put where she was.

>   “May,” Dr. Schott said, “let’s check your thoracotomy incision and make sure your lungs sound fine. Annabel, in the meantime, update us with any new information this morning.”

  “Mrs. Oliver remains afebrile and her other vital signs are stable. The thoracic surgeon saw her last night and is satisfied with her incision and progress.” Annabel stepped closer to the bed and held May’s hospital gown to the side while Dr. Schott untaped her bandage. “He tapered down on her narcotics as well because her pain is subsiding. And today is May’s first day for chemotherapy over in the cancer center.”

  “How is her hemoglobin?” Dr. Mejia asked.

  “It’s twelve,” Annabel said.

  “That level will suffice,” Dr. Mejia said. “I don’t want you to be anemic for your treatment. We’ll leave you now as both Dr. Schott and I are satisfied with your wound healing.”

  “Think of any questions you might want to ask the cancer doctor,” Donn said to her. “Especially side effects of treatment.”

  Annabel lingered, wanting to be the last person to leave May’s side. Mrs. Oliver was at her heels by the time she slipped through the doorway.

  “Dr. Tilson,” Louise said, “thanks for all you’re doing for my daughter. She trusts you a lot. I’m worried, though. I understand her moods like no one else. It didn’t help that her Misty died, but now the cancer problem and treatments are tying up her life, leaving room for nothing else. She’s so much more despondent and even talked about not being a ‘guinea pig’ for chemotherapy.”

  “The most important role for you,” Annabel said, “is to be a really good listener and to ask her lots of questions about what she’s thinking. I’ll do the same as much as I can. If you don’t mind, I’ll also ask the other doctors about prescribing her an antidepressant which may help her mood.”

  “Thank you,” Louise said and took Annabel’s hand and gave it a squeeze.

  Annabel smiled at Louise and hurried to her group. The encounter warmed her heart; it was as important as all her book knowledge and clinical rounds.