Trapped

by Lawrence Gold

  “I’ll think about it,” Sandy said.

  Lisa knew she’d never do it.

  After graduation, Phoebe took an ICU position at Brier Hospital in Berkeley.

  With Lisa’s high grades, and her contacts at Enloe Medical Center, they offered her a position on the pediatric ward following graduation. Lowest on the totem pole, she worked the night shift, but found sleeping in the daytime nearly impossible. Working nights, however, allowed her to take additional courses that went toward her ultimate goal, neonatal intensive care. Eventually, when she put the course work behind, Lisa would find an NICU position in Chico, or somewhere else.

  Lisa had her head down on the table in the nurse’s lounge.

  This night shift is going to kill me.

  The intercom buzzed, and the ward clerk said, “Dr. Whitney is on his way up with a new admission. Your turn.”

  Lisa had been on the pediatric ward for three months. It had only taken a week for her to discover, by observation or reputation, which pediatricians were trouble. Sheldon Whitney was, by acclamation, pediatric enemy number one.

  “Watch out for him,” Annie Katz, the pediatric head nurse said. “Let the charge nurse know if you see anything peculiar in his care of babies.”

  “He seems nice enough,” Lisa said. “He’s been practicing for forty years, hasn’t he?”

  “That may be a decade too long,” Annie said. “Watch out for him.”

  Lisa worked with him on several cases, and, except for a patrician and dismissive attitude, she’d seen no problems. His attitude matched his appearance. He was tall and thin with a full head of grey hair combed back. He dressed beautifully, and, even in the middle of the night, wore a jacket and tie.

  When Lisa entered room 212, she had to force her way through a group of six or seven adults to get to the crib.

  Jessica Kern, a two month old, screamed while her mother, Judy, tried to pacify her with soothing sounds and rocking. The father, David, stood by her shoulder.

  “Please,” Lisa said, “just the immediate family.” Turning to Judy, she added, “Please put the baby in the crib so I can examine her.”

  “Where’s Shelly—I mean, Dr. Whitney?”

  “He’s on his way.”

  Lisa examined the baby carefully. Her pulse and respirations were increased, and she had a temperature of 103.4 degrees. Her skin was flushed, and her cry, though dramatic, wasn’t particularly strong.

  This is one sick kid.

  Lisa called the lab, and had a set of routine blood drawn, including blood cultures for bacterial infection.

  After the lab tech left the room, Whitney entered.

  Judy grasped Whitney’s hand. “Oh, Shelly, I’m so glad you’re here.”

  “Now, now, take it easy. I’ll have a peek.”

  Whitney looked up at Lisa.

  She opened Jessica’s chart to the vital signs graphics, and handed it to the doctor.

  “Babies get high fever at the drop of a hat, Judy. It’s probably a virus.”

  To Lisa’s distress, Whitney did a rapid and too casual examination. He then picked up the chart, and walked to the nurse’s station.

  Lisa followed. “I don’t like the looks of that baby, Sir. What do you think?”

  “How long have you been out of school, Ms. Cooke?”

  “Three months.”

  “I’ve been at this for a while. I’m not concerned.”

  “We tried to order the chart from the baby’s birth, but the record room can’t find it.”

  “No big deal. I was there, you know.”

  “Yes, Sir. Maybe I am not used to such sick-looking babies, yet.”

  “Let’s see what the lab and the cultures show,” he said, closing the chart.

  “Can’t we start treatment? She looks so bad to me.”

  “Treatment for what? Young doctors throw antibiotics around like they’re water. That’s why we have so many problems with bacterial resistance.”

  Whitney spent a few moments reassuring the parents, and then he walked back to the nursing station where he completed his admitting orders. “I’ll be home. Call me if there are any problems.”

  “Yes, Doctor,” Lisa said.

  When Lisa returned to the room, Judy was caressing Jessica’s head. “She feels so hot to me.”

  Lisa stood on the opposite side of the crib. “That’s how it is with high fever in a baby so young. How was your delivery?”

  “Everything was fine.”

  “No problems with the baby?”

  “Hell, no. She was eight pounds, ten ounces, and she came out screaming. They did give her something…I’m not sure what it was. Maybe antibiotics.”

  “Why antibiotics? Did she have an infection?”

  “Not that I know of.”

  Where is that damn chart? Lisa asked herself.

  Lisa returned to the nursing station, and said to the ward clerk, “I need that baby’s birth chart.”

  “I called medical records twice. They can’t find it.”

  “What do you mean they can’t find it?” Lisa said, her voice rising. “They must keep a record of its location at all times.”

  “It’s not where it should be. They’re looking.”

  Medicine is full of aphorisms. Lisa recalled this one: “When three things go wrong, prepare for the worst.” They had a really sick baby, a marginal pediatrician, and now a missing chart.

  Lisa returned to Jessica’s crib, and found that her fever had increased to 103.8. The baby was less responsive.

  She rushed back to the nursing station, and called Whitney. “Judy Kern said something about an infection on delivery, Doctor. Do you recall anything?”

  “No, not a thing. How’s the baby doing?”

  “I think you’d better come in.”

  “You didn’t answer my question.”

  “I don’t like the way she looks. Her fever’s up, and she’s more lethargic.”

  “Don’t take this personally, Ms. Cooke, but I want your charge nurse to make an assessment, and then call me.”

  “I don’t know if we have time for that. We need to do something.”

  “Do as I ordered, damn it,” Whitney yelled, and then the line went dead.

  Lisa repeated Whitney’s orders to the night charge nurse, and then said, “I’m going to medical records. We must have that chart.”

  The medical records room was a trip through manila canyons, with charts piled on shelves floor to ceiling, and stacked on virtually every horizontal surface.

  “I’ve looked everywhere,” the night records clerk said. “I can’t find it.”

  Lisa looked at a glassed-in room in the corner. “What’s that area for?”

  “That’s where the doctors do their medical records work, signing charts, and doing dictations. I checked the chart sign-in sheet, but nobody signed it into that area.”

  When they entered the room, Lisa noted stacks of charts in bright red covers. “What are the red ones?”

  “Those are the charts that are way overdue for completion. It’s a gentle reminder to the docs to get those done first.”

  “Where are Dr. Whitney’s charts?”

  The clerk pointed to a shelf filled with perhaps fifty charts. About half of them were red-covered.

  “I’ll start on the right, you start on the left,” Lisa said.

  After about ninety seconds, the clerk held up a red-covered chart, and shouted, “I found it.”

  Lisa scanned Jessica’s chart, and found the culture report, which showed heavy growth of group B streptococci, a potent and potentially lethal bacterial infection.

  She dialed the hospital operator. “I need Dr. Whitney, stat.”

  Lisa listened as the phone at the doctor’s residence rang and rang.

  “I’m sorry, nobody’s answering.”

  This baby’s going to die.

  “Get me the chief of pediatrics, stat.”

  “I’m not supposed to disturb Dr. Harding unless it’s an emergency
,” pleaded the operator.

  “Get him on the line before this baby dies.”

  When Richard Harding was fully awake, Lisa outlined the situation.

  “That son-of-a bitch,” Harding shouted. “I’ll be right in.”

  “How long will that take Doctor?” Lisa asked. “Give me orders and I’ll get things started.”

  “I live a hundred yards from the hospital. Will that be quick enough?”

  Lisa grabbed the chart, and returned to the pediatric ward. As she approached Jessica’s room, the charge nurse was leaving. “She looks terrible. I can’t get Whitney. That baby is going to die if we don’t do something.”

  “I found the birth chart, and Dr. Harding will be here in a minute. This has got to be streptococcal sepsis, or meningitis.”

  The door to the stairway slammed open, and Harding, in sweatpants and t-shirt, yelled, “Draw up the penicillin. I’ll give it.”

  When Harding barged into the room, Judy and David stared wide-eyed at Richard. “Who…what?”

  “This is Dr. Harding,” Lisa said. “He’s the chief of pediatrics. We’re here to help Jessica.”

  “Where’s Shelly—Dr. Whitney?” David asked.

  Harding looked around the room, and then said, “Lend me your ears, Lisa.”

  Lisa handed him her stethoscope.

  Jessica’s skin was bright red. Her pounding heart fluttered through her thin chest wall, and the space between her ribs retracted with each breath. When they moved Jessica’s arms and legs, they were flaccid.

  He turned to Judy and David. “This is one sick little girl. I need to do a spinal tap. Please wait outside.”

  “Wait one god damn second. We don’t know you from Adam. Where’s Dr. Whitney?”

  “I don’t know, but listen to me carefully. I’ve practiced pediatrics for twenty-five years. I’m chief of pediatrics, and if you don’t get out of my way, you’re going to have a dead baby.”

  David barely managed to catch Judy as she screamed and slumped to the floor.

  Richard completed the spinal tap in two minutes. He felt his entire body relax as clear fluid dripped from the spinal needle.

  As he finished, the charge nurse returned with the penicillin. Richard calculated the dose, and administered it slowly by intravenous drip.

  “Have somebody cover Lisa’s patients,” Richard said. “She’ll be with me for a while.”

  Lisa worked into the morning shift with Dr. Harding, and gradually the baby’s temperature fell. As they stood outside the room sipping orange juice, a baby’s strong cries echoed from within. Harding and Lisa and smiled and hugged.

  “You had a good night, Lisa. You saved that baby’s life.”

  Lisa was warm all over as she prepared to leave. She approached the nurse’s station where two white-coated men were standing in the transcription room. A red-faced Harding stood over a pale Dr. Whitney, pointing his finger and yelling. Lisa couldn’t hear the words. She didn’t need to.

  Lisa Cooke and Phoebe Davis had, in spite of the distance, maintained their friendship. They’d visit each other whenever possible, and talked on the phone once or twice a week.

  “Hold on to your hat, sweetie,” Phoebe said. “I found a job for you at Brier NICU.”

  “Fantastic! Who do I call?”

  Phoebe gave Lisa the phone number of Eileen Baker, the nursing care coordinator of the NICU, and they arranged an interview.

  Lisa used her day off for the trip to Berkeley.

  Brier Hospital was a study in contrasts, a turn-of-the-century Victorian mansion as its administration center, and a modern six-story hospital.

  She found her way to the NICU and asked for Eileen Baker.

  They hit it off at once.

  “We’d love to have you, Lisa. You’re just what we’re looking for,” Eileen said.

  “That’s great. I’ve always wanted to be in pediatrics, and especially in NICU.”

  “I can offer you a night shift position starting as soon as you can get here.”

  The balloon of Lisa’s happiness deflated. “I’m so sorry, Eileen, but I can’t work the night shift. I’ve tried before, but I can’t sleep during the day.”

  “I’m sorry, too,” Eileen said. “You’d fit in here. Think about it, and remember that we’re looking for someone who will be with us for the long haul.” She hesitated for a moment, and then continued, “My real problem is seniority. New hires usually start on the night shift. I want you, but I don’t want a revolution on my hands.”

  “I understand perfectly,” Lisa said. “Everyone I met here is great, and this being a referral center for preemies, it’s perfect for me. I’d do it, if only I could sleep, but I can’t. I appreciate the offer, Eileen. Keep me in mind if anything else comes up.”

  Lisa stopped by the ICU to see Phoebe, and brought the news.

  “They’re out of their minds,” Phoebe shouted. “Letting you go because of a shift problem… that’s nuts. They need a longer term perspective. Let me apply the Phoebe magic.”

  When Lisa returned to her apartment in Chico, the light was flashing on her answering machine. She pushed the play button, and heard Eileen’s voice, “Call me, Lisa. I’ve managed to find a day position for you.”

  Lisa picked up the phone, and dialed Phoebe’s number. When she answered, Lisa said, “Make room for me, I’m moving in.”

  Chapter Five

  Dr. Michael Cooper was the medical director of the NICU. He sat on the hard dressing room bench in his usual green scrub suit and cap, and reached for the matching special-ordered size 18 shoe covers. He groaned as he struggled to put them on, and then he entered the unit.

  I’ve got to get back to the gym, he thought.

  Mike and his partners, Kenneth Dillard and Bradley Rosin, after many years, had finally obtained an exclusive contract from Brier Hospital to provide pediatric care to the most desperate of newborns.

  Mike arrived this morning to make rounds on five preemies. He walked into the central nursing station, which they’d decorated with pale yellow wallpaper, pastel pink and blue ribbons, and scrolls of nursery rhymes. A large white board listed the name of each baby, the assigned nurse for the shift, and any scheduled treatments.

  In spite of the name, “Neonatal Intensive Care”, this unit, like medical, surgical, or coronary intensive care units, shared a characteristic ambiance; days of peace and quiet could yield, in an instant, to the frenzy of the approaching storm, a tiny, premature infant.

  Although the unit had modern ventilation, the unit still smelled of antiseptics, antibiotics, Desitin, and the distinctive aroma of meconium, the intestinal contents of newborns. Soft-soled shoes permitted the staff to move silently around the room, and monitors, ventilators, and vacuum suctions blended together as white background noise.

  Sharon Bridges was a veteran neonatal nurse. She gave Mike an update on the condition of three level-one (the healthiest) babies, and assisted in his examination. Mike watched them breathing through the transparent hood of their incubators, and then extended his arms through the portals to examine them. The head of his pediatric stethoscope loomed large over their tiny chests as they struggled to breathe. Their chests would rise and fall with the assistance of the respirators. Today, they were all doing well.

  Mike looked at his patient list. “Who’s taking care of babies Kramer and Goldstein?”

  “Lisa has them, today,” Sharon said. “She’s on break in the nurse’s lounge.”

  “Lisa? I don’t know her. How long has she been with us?”

  “Two weeks. Lisa Cooke. She’s a recent graduate. You’ll love her; she’s great. Do you want me to get her for you?”

  “No,” he said as Sharon caressed their last little patient, “you’re busy enough. I’ll get her.”

  The day-to-day expression of maternal love that these nurses gave so freely never failed to move Mike. He had become part of a team that shared the same goals, to steer these babies through the tumultuous rapids of being born t
oo soon, and to ready them for the calm waters of home.

  Mike grabbed the two remaining charts, and walked to the back of the unit. He knocked softly on the door of the nurse’s lounge. He knocked twice more and then entered.

  The room had a large rectangular table in the center, as well as several easy chairs. A faded brown sofa filled most of the remaining space. Baby pictures, graduates of the NICU, and charts showing the stages of delivery decorated the walls. Schedules, announcements, and a variety of ‘must read’ forms and regulations covered several bulletin boards.

  Mike scanned the room, finally locating a head of auburn hair just below table level in the rear. As he neared, a young woman was sitting on a foam-rubber mat with her eyes closed, legs crossed, and her arms at her side. She held her palms open, and the tips of her thumbs and index fingers formed a perfect circle.

  Mike coughed, but there was no reaction.

  He coughed again.

  Real subtle, he thought.

  He had the sudden urge to shake the woman, but thought better of it, and decided to sit at the table to read the charts.

  Moments later, a soft voice said, “Oh, I’m so sorry. I didn’t know anyone was here. Can I help you?”

  Mike didn’t know if it was the voice, the sensual smile, or maybe those green eyes, but he suddenly became nervous.

  “I’m Mike Cooper. You’re Lisa?”

  “Yes, Doctor. My name is Lisa Cooke,” she said formally. “It’s nice to meet you.”

  The room temperature suddenly dropped twenty degrees as her words belied her sweet appearance.

  What was that all about? He thought.

  “I’m sorry, but I knocked several times. I hope I didn’t disturb you. That was some sort of yogi meditation?”

  “Yes, Doctor. The correct term is ‘Yoga’.”

  Ouch, he thought.

  “We call that the Dhyana Mudra position for meditation.”

  “If I could ever get myself in that position,” he said, smiling, “I’d need a crane to get me up.”

  Her face remained impassive.

  Well, this is going especially well, he thought. Better get to business.

  “I’d like to make rounds on the Kramer and the Goldstein babies, if you’re free.”