by Rada Jones
MERCY
An ER Thriller
Rada Jones MD
apolodor
This book is a work of fiction. Names, characters, places, and incidents are the product of the author’s imagination or are used fictitiously. Any resemblance to actual events, locales, or persons, living or dead, is entirely coincidental.
Copyright © 2019 by Rada Jones MD
All rights reserved.
No part of this book may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without written permission from the author, except for the use of brief quotations in a book review.
APOLODOR PUBLISHING
Print ISBN: 978-1-086-83550-2
Printed in the United States of America
Price: $9.99
Cover design: GermanCreative@Fiverr
Author photograph: Joanna MacLean
Contents
Acknowledgments
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
Chapter 21
Chapter 22
Chapter 23
Chapter 24
Chapter 25
Chapter 26
Chapter 27
Chapter 28
Chapter 29
Chapter 30
Chapter 31
Chapter 32
Chapter 33
Chapter 34
Chapter 35
Chapter 36
Chapter 37
Chapter 38
Chapter 39
Chapter 40
Chapter 41
Chapter 42
Chapter 43
Chapter 44
Chapter 45
Chapter 46
Chapter 47
Chapter 48
Chapter 49
Chapter 50
Chapter 51
Chapter 52
Chapter 53
Chapter 54
Chapter 55
Chapter 56
Chapter 57
Chapter 58
Chapter 59
Chapter 60
Chapter 61
Chapter 62
Chapter 63
Chapter 64
Chapter 65
Chapter 66
Chapter 67
Chapter 68
Chapter 69
Chapter 70
Chapter 71
Chapter 72
Chapter 73
Chapter 74
Chapter 75
Chapter 76
Chapter 77
Chapter 78
Chapter 79
Chapter 80
Chapter 81
Chapter 82
Chapter 83
Chapter 84
Chapter 85
Chapter 86
Chapter 87
About the Author
Afterword
Overdose excerpt
About Mercy
People are dropping like flies in Dr. Emma Steele's ER, and nobody knows why. A new disease? Medication errors? Poisoned oxygen? She must find out, even though her job is in peril, her daughter disappeared, and she'd rather be home, drinking wine.
Is it a mercy killer? But why kill a healthy patient? Is somebody framing her nurses? Or herself?
More strange things happen. A patient's death by stolen medications, her orders corrupted by lethal mistakes, her nurse killed. What happens to her daughter? That's worse than death.
Dr. Steele risks her career and her life to stop the murders. She gets closer and closer to the answers. Until she gets too close.
If you like Patricia Cornwell and Tess Gerritsen, you'll love Rada Jones. Mercy is a fast-paced medical thriller packed with ER action, flawed characters in ever-changing conflict, crisp dialogue, and wine.
PRAISE FOR MERCY
"It was a real page-turner, and I enjoyed it very much! I hope there are more books to come in The Steele Files!"
"MERCY is a delight to read. It's even better than OVERDOSE. I do love the wine talk. I'm mostly a beer drinker, but reading Mercy almost made me want to rush out and look for those wines. It left me with loads of interesting word images. Definitely a good read!"
"It is fast-paced, and I like all the threads - the ex-husband, the cranky Dr. Ann, the new dog Guinness and the wine of course. I love the commentary of Guinness on his new humans."
"The only problem is, it ended, and all I could think was: No! Don't go! It was clever to add a grownup working dog that thinks as a character."
If there was justice in the world, this book should be dedicated to a dog. Two, in fact.
Gypsy Rose Lee, my shadow, my soul. The world is emptier since you left it. And Kirby, my irreplaceable friend. She adopted us like Guinness adopted Emma, and enriched our lives.
But since most dogs can’t read, this book is dedicated to dog lovers.
If you speak to your dog, thinking she understands you, you’re on track. If you know she can read your mind, you’re with me. If the smile of a dog makes you whole, this book is for you.
Acknowledgments
My very special thanks to those who made this book possible.
Mauri Rex shook me out of my doctorly jargon so that normal people can enjoy this book. She even remembered the dog food that Emma forgot. She had me remove most “WTF?s” Still, there’s plenty left… Thank you, Mauri.
Joyce Jeffrey spent long rainy hours combing through my draft for inconsistencies – there were many – and told me to fix Boris. If you like him, it’s because of her. If you don’t, it’s because of me. Thank you, Joyce.
Joanna MacLean warned me about being “on the nose” with some names and prevented me from giving a villain our friend’s name. She was there from the first draft’s muddy struggles to the chiseling of the final draft. Thank you, Jo.
And finally, my husband Steve. He suffered through it all, good moods, bad moods and downright disasters. He fought valiantly to eliminate the extra comas and to prevent me from capitalizing fentanyl and propofol. He stuck with me through it all.
For now. But POISON, Book 3, is coming.
1
Death: A friend, that alone can bring the peace his treasures cannot purchase, and remove the pain his physicians cannot cure.
Mortimer Collins
Sitting in front of the huge mahogany desk, Dr. Emma Steele hoped her boss would get to the point. This week. She’d been listening to him for ten minutes. An eternity, in ER time. He wasted her time while her patients waited. To distract herself, she imagined him as a worm. She didn’t mind being a robin, but eating him? Disgusting. Maybe deep-fried and crusted in Montreal seasoning? With a spicy dip?
“Emma, you know how much I appreciate you,” he said, moving the tchotchkes on his desk to avoid her eyes.
She smiled, waiting for “But…” Nothing before “But…” really matters. It’s just lube, helping slide in the message. Like the KY in rectal exams.
“But your metrics aren’t good. The ER costs are going through the roof. The board grumbles. I can’t hold them off much longer.”
It’s not them. It’s you, Emma thought. You’ll throw me under the bus, just to say you’re doing something. The metrics can’t get better overnight. You know it, but you’ll step over me to hold on to your job.
“I understand.”
&nbs
p; “You have a month. If your ER’s metrics don’t improve significantly in a month, I’ll have to let you go. I had to pull a lot of strings to give you that, you know. That’s all I can do.”
“Thanks, Gus.”
Dr. Gus Gravelle, vice president of medical affairs of Venice Hospital, nodded without meeting her eyes.
On her way back, Emma checked her watch. Eight more hours. Today is Vincent’s birthday. He’d be nine. She remembered his red hair, spiking out like a hedgehog. His scent of spoiled milk and baby powder. Her throat tightened. She bit her lip to stop her tears and rushed back to the ER.
2
Angel
I hate Mondays. They suck. The noise is deafening. Monitors alarming, phones ringing, drunks cursing. Still, I hear her moaning as I pass by her room. I glance in. She’s alone. Screaming.
“Help! Help! Help!”
“What do you need?”
“Help! Help!”
White eyes that used to be green. Thin, greasy hair stuck to her skull. She stinks.
“What can I do?”
“Help! Please! Help!”
“What’s your name?”
“Gladys.”
“OK, Gladys. How I can help you?”
“Help me!”
She sobs. Tears run down through her deep wrinkles. Her lizard-like hands reach for me.
I step back.
She struggles to sit up. She falls back, screaming.
I grab a pair of gloves to help her up.
She shrieks, burying her dirty nails in me.
I pull away and check my hands. Red crescent marks. That’s what I get for helping her.
“Help me.”
“I’ll be back.”
“Don’t go, please, don’t go.”
She wails.
I wash my hands twice. I sign into the EMR, the electronic medical record, looking for her.
There she is. Room 5. Gladys Vaughn, 86. Hip fracture.
I’d like to look inside her record, but I don’t dare. Thanks to HIPPA, the patient information protection act, if they catch me I’m screwed.
The computer behind me is on. Whoever used it last didn’t log out. Good.
I find her record. She’s a wreck. Nursing home. Dementia. Atrial fibrillation. Coumadin.
She’s screwed. Her expected mortality is 50 percent per year. She only has a few months. Maybe. Bad ones. She’ll hurt when they change her diapers. The flesh of her back will grow holes from lying, rotting in her own urine. It sucks to be her.
I check her orders. A whiff of morphine. Toradol, Tylenol. They won’t help much.
I look around. They’re all busy, dealing with their own shit.
I go to the break room to get my special vial. I draw it, all five hundred micrograms, in a syringe. It’s crystal clear and full. It’s happiness in a vial.
I head back. She stares like she never saw me.
“Who are you?”
I smile. “I’m here to help you.” I attach the syringe to her IV and push the plunger.
“How’s it going, Gladys? Good?”
Her anguish softens. She smiles. Gums only, no teeth. She’s happy.
“I know you. You’re the Angel.”
Me? The Angel? Then it dawns on me.
I’m the Angel of Mercy. I’m the Angel of Death.
I’m the angel.
Her eyes glow.
Then they close.
3
Emma punched in the code to get back in the ER. It was cold. Air conditioners working overtime, as usual. The light, blue and ruthless, was cold too. Emma checked her phone, looking for an answer from Taylor. She hadn’t heard from her in two days. That was bad news. I wonder what she’s up to. It’s never good.
She wanted to call her, but she didn’t have time. Full stretchers lined the hallways. Every room must be full. Monitors beeped, patients moaned, phones rang. It smelled like chlorine and blood. Emma waved her ID over the reader to log into the computer system.
A blood-curdling scream split the heavy background noise. Then another. The circus had started.
Judy, the charge nurse, touched her shoulder.
“Dr. Steele, can you go to Room 1?”
Emma didn’t ask why. She threw her stethoscope over her shoulder and headed to Room 1.
Monitors screaming. An old woman. Very old. Cyanotic. Eyes closed. Sharp cheekbones pushing parchment skin. She hasn’t had a steak in a while, Emma thought.
She stepped in.
Faith, the nurse, a big, beautiful girl, looked up from placing an IV. The other nurse, Brenda, tiny and brown, killed the alarms.
Emma’s nemesis, Dr. Ann Usher, stood at the foot of the bed, watching the resident intubate. She saw Emma and her gray eyes darkened.
The resident, a new one, was bent over the patient. He pushed the laryngoscope blade in the half-opened mouth, moving the tongue out of the way to make room for the endotracheal tube.
The blade is bloody. He’s already tried and failed. Maybe more than once.
The RT, respiratory therapist, held the ET tube for him. The alarms screamed. Emma glanced at the vitals. The blood pressure’s low. The oxygen sat is in the 80s. Too low to intubate.
She moved closer. The RT saw her. His face brightened.
Emma cleared her voice. “You guys need help?”
The resident looked up. The few remaining teeth clicked as they clamped on the blade.
“We’re fine, thanks. Let’s go!” Ann said, turning her back to Emma.
The alarm got shriller, calling danger.
Oxygen sat 73.
Emma smiled politely. “You may be. The patient is not.”
“I can handle this,” Ann snarled.
“Of course you can. Can she, though? What’s the story?” Emma asked.
Ann crossed her arms. Her lips tightened.
“Nursing home patient. 98. Demented. They sent her here for low oxygen and fever. She had an old DNR, but it wasn’t signed,” Brenda answered.
Emma looked at Ann. “You think she needs intubation?”
“She’ll die without it, doctor!”
“She’ll die anyhow. She deserves to die in peace.”
“The resident needs to learn. This is a good opportunity. No family, no DNR. It’s an excellent case.”
Emma’s smile vanished.
“She’s not a case. She’s a person. She deserves comfort and kindness. The resident can learn on other patients.”
“She has no DNR. We need to do everything, anyhow. We may as well get something out of it.”
“She’s 98, demented, and dying. She’s not here for our convenience. You have a case for futility. You don’t need to do anything but be kind.”
Ann’s voice rose. “Have you gotten soft? Have you lost your spark? IF you ever had it? I knew they were wrong the day they put you in charge!”
Emma’s eyes narrowed, but her voice stayed soft. “She’s your patient. It’s up to you. I’ll review the case. There’s nothing that says patients should suffer so that doctors can learn. She’ll die, no matter what. Soon. The one thing you can do for her is to give her a good death. Put the patient first. That’s the whole point of being a doctor, isn’t it?”
Ann grimaced as if she’d stepped in a pile of dog poop. “And you call yourself an emergency physician! You may as well be a psychiatrist.”
“What I call myself is not your problem. What you do is.”
Her bright red cheeks marring her white face, Ann turned to the resident.
“Thanks to Dr. Emma Steele, our ED director here, we’ll just let this patient die. That’s how she chooses to practice medicine. I hope you’ll do better.”
Hands shaking, the resident sat down the laryngoscope. His face flushed, he glanced at the door.
“She needs comfort. Did you give her anything for pain? For sedation?” Emma asked.
He shook his head.
“Try fentanyl. One hundred micrograms to start. Ativan too, if she’s still uncomfo
rtable. We don’t do things just because we can. When we can’t forsake death, we must at least alleviate suffering. That’s why we’re doctors. We always put the patient first. You understand?”
He nodded.
Poor kid. He’d like a hole to crawl in. There’s none. I checked.
Emma left the room. Ann’s shrill voice followed her.