by Rada Jones
That was close. “Blood pressure?”
“95/60.”
Joy flooded the room. They breathed. They celebrated. They had saved her.
Emma smiled and touched the old man’s shoulder. “She’s OK.”
Slow tears ran down his sunbaked wrinkles. He touched her hand.
Emma took it. She hugged him. She held him tight to give him strength.
“Good work, team.”
They smiled. That’s what they lived for.
Emma went back to her desk to check the board. An eerie feeling fluttered inside her, chasing away the joy. Something, somewhere, was wrong.
The back pain in Room 5? She went to check on him.
He was no longer hurting.
28
It was almost tomorrow by the time Carlos got home. The death of Room 5 produced a shitstorm like nothing he’d seen before. They interviewed him for hours, asking him countless stupid questions. All of them. Mike, Risk Management, the lawyer, some other suits he didn’t even know.
None of them ever touched a patient. They didn’t know what it was like to live in the trenches. To wear shit-stained scrubs. To wonder if you’d make it to the bathroom. To get abused every single shift. The suits inhabited a different world.
He parked his Subaru behind George’s Ford and rested his forehead on the steering wheel. George was home. He could use a drink and a friend. But the lawyer had warned him: “Keep mum. No talking. Anything you say can be used against you. All communications, except those with your lawyer, are discoverable.”
This death was likely to go to court. His patient, a healthy man, had died for no reason. They had worked on him for an hour. Nothing helped. Nobody understood what happened.
“Heart attack? Stroke? Dissection?” Dr. Greene asked.
“I don’t know,” Dr. Steele said. “Nothing makes any sense. He was fine an hour ago. His back pain was purely mechanical. He had strained his back, moving furniture. Unless I’m wrong. I hope the autopsy helps us understand.”
Dr. Usher was passing by. She laughed.
“That’s how you diagnose your patients, Emma? Via autopsy? What’s wrong with a good old CT scan? If you figure it out before they die, you may even save them, you know?”
Dr. Steele smiled. Not a nice smile. Carlos hoped she’d never smile at him like that. Like a barn cat seeing a mouse on crutches.
“Thanks, Ann. I’ll keep that in mind. Carlos, when did you see him last?”
“Before you called me for the arrhythmia. I was about to give him the meds you ordered.”
“Did you give them?”
“No. But I got them out of the locked med room.”
“Where are they?”
“I left them on the desk, but they’re gone. Maybe somebody gave them as we worked on the A-fib patient?”
“What does the computer say?” Dr. Steele asked.
The computer said nothing. Nurses helped each other with meds, IVs, or labs, when it got busy. But this time nobody had offered to help.
“We’ll have a root case analysis,” Mike said. “We’ll find out who’s responsible.”
Somebody was going to face the music. Either Dr. Steele for missing the diagnosis, or him, for losing track of the meds. Carlos hoped it wasn’t him.
He sighed, got out of his truck, and opened the door. George was in the living room, watching a game.
“Grab a beer and come here,” he shouted.
Grateful, Carlos grabbed a Bud Light, George’s go-to beer: “It’s good for the kidneys. Keeps them afloat. Good exercise too. Every ten minutes, it gets you off the sofa to the bathroom.”
Carlos sat in Mary’s old rocking chair. He took a swig. Piss-like. But cold.
George glanced at him. “Bad day?”
“Yeah.”
“Want to talk about it?”
“I can’t.”
“Legal?”
“Yeah.”
“Want to talk about the game then?”
Carlos sighed. George was a decent man and a good friend. He’d taken him in without asking questions. He never pried. He was always there.
“I don’t know much about the game,” Carlos said, looking at the score of well-fed men stumbling over each other.
“Neither do they. It’s not worth watching, but it’s company.”
“You must be lonely since Mary died.”
“Yep. She was my high-school sweetheart. I’ve never cared about another woman. I never will.”
“You’re lucky.”
“I guess I am. You?”
Carlos shrugged “I found out that Faith was seeing someone else. She had us move here so she could be with him. Now it’s too late to go back.”
“Is she still with him?”
“No.”
“If she dragged you here, she cared about you. Maybe she still does. Did you speak to her?”
“I’m not interested.”
“Why not? If you love her…”
“I can’t.”
He remembered the morning after. Faith approached him at work. She took his hand. He pulled away.
“Don’t touch me.”
“Why not? That’s not what you said last night…”
“You make me sick.”
Faith paled. Her indigo blue eyes swallowed her face, making her look like an alien. “Really!”
“Really. Don’t ever touch me again.”
She smiled.
“You might change your mind.”
“Never.”
“Never is a long time.”
“Not long enough.”
He left. Her eyes burned his back like embers. He shivered and took another sip of beer.
“Never again.”
29
Taylor walked back home from the forest. It took hours. Her feet hurt and her throat was scorched with thirst, but her baby was alive. She laid down in her bed, thinking about Eric and the things she should have told him. She waited for the baby to move again.
The doorbell rang. She ignored it.
It rang again. Taylor pulled the pillow over her head.
Her phone vibrated. She huffed. What’s wrong with people? Why can’t they leave me alone?
But what if it’s Eric? Calling to tell me that I’m still the love of his life?!”
She threw the pillow and grabbed her phone. Dad.
She loved him, but she wanted nothing to do with him right now. She went back to bed.
The doorbell rang again.
What if it’s Eric at the door?
She went to the mirror. Her swollen eyes looked like overripe plums, her hair like a snake nest. I can’t see him like this! But what if he leaves? I won’t even know if it’s him! She splashed cold water over her face and rubbed her skin till it burned. She looked in the mirror again. Her burning cheeks made her eyes look OK. She opened the door.
It was her father. It was April and mellow, but he looked like a man in a snowstorm. His eyes were no better than hers: wet, muddled, sorrowful. He sobbed. He pressed her to his heart. He let go. He held her at arms’ length, looking her up and down.
“Where is it?”
“Where is what?”
“My gun. You took it. Where is it?”
“How do you know it was me? Maybe…”
“Cut the crap, Taylor. You’re the only one who knows the code. If I had any sense, I’d have changed it last time. You were gone, so I thought it was safe. I was wrong, and I was lazy. Where is it?”
Taylor shrugged. “What do you need it for?”
“I don’t. I need you not to have it. Where is it? Who were you going to shoot this time?”
Taylor felt hurt. It’s not like I walk around shooting people on a regular basis. I never shot anyone yet. The one time I was close, I had good reasons. Just like Father to overreact!
“It’s in my room.”
Secretly, she was relieved. She had been close. She didn’t want to go back. She couldn’t afford to. She had a responsibility. Sh
e had to go on until her baby was born. Afterwards, she could give it up for adoption. Or she could bring it up on her own. She had hoped it was going to be with Eric. No more. Either way, she was going to stay alive long enough to give the kid a chance to live. Five more months. After that, I’m free. Mother will do her best for the kid, if I’m not here.
Victor headed toward her room like he still lived there. He went straight to the wardrobe and opened the lowest left drawer. He pushed the button unlocking the secret compartment and grabbed the gun and the ammo. He removed the magazine, checked there was no bullet in the chamber, and stuffed everything in his pockets.
He went back to the living room and sat in his old green armchair. He took off his round glasses and wiped them with the bottom of his shirt. He put them back and looked her in the eye.
“What’s this about?”
This wasn’t her father. Her father was always kind and patient. He never blamed her for anything. When she messed up, he hugged her, telling her she’d do better next time. Now this.
“What do you mean?”
“You know damn well what I mean. Why did you elope? Why didn’t you tell me? And why did you steal my gun?”
His words held no softness. He was straight and matter-of-fact. Like her mother, for fuck’s sake! She looked in his eyes, forcing out a tear.
He frowned. “Get to it, Taylor! I’m on call. My beeper’s about to go off. Unless I’m sure you’re safe, I can’t leave you alone. I’ll have to call 911. I’ll tell them that you stole my gun and you’re suicidal. They’ll come and they’ll take you to the ER. Your mother may or may not be working. I don’t know which is worse. Get to it, and get to it now!”
This side of him she’d never seen. She told him about the failed abortion. About Eric. About her mother’s advice. She told him that Eric ditched her. She told him how she wanted to end her life but couldn’t.
He listened.
“You love Eric?”
She sobbed.
“Are you sure?”
She came undone over that one. She cried and cried. He held her to comfort her. His hold was love and safety. But it wasn’t Eric.
“Listen, Taylor. I’ll tell you something you can never tell anyone.”
Taylor nodded.
“If you do, a lot of people will get hurt. Including me.”
“OK.”
“I still love your mother.”
Taylor’s jaw fell. Are you kidding?
He wasn’t.
“Ten years ago, I was infatuated with Amber. She was young, pretty, submissive. She was everything your mother wasn’t. We had an affair. She got pregnant. I thought I was being honorable when I left you and your mother to marry Amber. We had Opal. Then Iris. I never worried about you. I knew your mother was going to look after you. I loved you, I wanted you to be happy, but I never worried about you.”
Taylor nodded.
“I never worried about your mother either. She’s the strongest person I know. She survived Vincent’s death alone. She didn’t need me. That’s hard to take, for a man who wants to be a man. She was who she was. I was who I was. We broke apart.”
Taylor nodded.
“It took me a couple of years to realize that I didn’t really love Amber. She was pretty. Men envied me. But she wasn’t your mother. Nobody is like your mother.”
That, Taylor knew.
He took off his glasses and started wiping them again.
“Your mother…”
The beeper went off.
“I need to go.”
He hugged her.
“I love you. I’m glad you’re alive. I’ll change the code on that damn safe. Maybe even get rid of the damn gun.””
“Father…”
“Yes?” He climbed in his old Subaru.
“What are you saying?”
“I’m saying that there is no end to love. If Eric loves you, he’ll be back. If you love him, you’ll take him back. I’d take your mother back in a heartbeat.”
“Would she?”
“She won’t, baby. She’s smarter than that.”
Taylor had never thought about her mother as an object of love. She’s old and always tired. Her hair’s a mess. And her clothes! And still, she’s attractive and desirable. Or so Father thinks.
More than Amber.
Really?
30
Hours after her shift, Emma was still in her office. Her back hurt and her stomach grumbled as she combed through chart after chart. Something bad was happening. Her patients were dying. She had to figure out what it was and stop it. She didn’t care what Mike, Gus, or the Risk Management people had to say. This last death, her back pain patient, forced her to get involved. No matter what, she had to stop the deaths.
Her stomach burned with hunger. Another half hour. She took another sip of water, pulled her jacket closer, and returned to her charts.
Four cases. What did they have in common?
The first one was the rash. Kurt’s patient. She combed through the EMR. Vitals. Triage note. Nurse’s note. Repeat vitals. Orders. There was nothing wrong. The glucose was fine. No insulin order.
Still, she died. Her last glucose was abysmal. Somehow, she got insulin. But how? Insulin is locked in the med room. You need the code, then two IDs: one for the patient, one for the nurse. It’s a tight system. Nobody but nurses and pharmacists can remove meds.
But insulin is easy to get. Many have it at home. Including Carlos. And George, his roommate.
Kurt had ordered insulin for the patient next door. What happened to it? She went through chart after chart looking for a hyperglycemic male in Room 21. She found him. Bob Sexton. Blood glucose 550. Normal is 100. An order for 30 units of insulin. His glucose was unchanged an hour later.
She had to speak to Sal to find out who gave it. She took a screen shot, though she knew she was violating HIPPA. If they catch me, I’m toast. People got fired for less. So? I’m the medical director. Patient safety is my responsibility, no matter what Mike says.
She looked for the second case. Oops! This was the second case! The first case was Alex’s hip fracture. Finding the chart was easy. The only hip fracture who died that day. She combed through it. She found the autopsy report. Broken hip, arteriosclerosis, aging brain, yada yada. The tox report isn’t back.
The vitals bothered her. The initial pulse and blood pressure were high. Then, the last set of vitals were normal. It looks like she’s getting better, then, half an hour later, she’s dead. Why?
She took another snapshot. She started a list.
This is patient #1.
Patient #2 is the hypoglycemia.
Patient #3 is Alex’s dehydration with altered mental status. She didn’t die, but she was close. The chart looked fine.
Patient # 4 is my back pain. Normal vitals. No labs, no radiology. The autopsy will take a while. This one was neither old nor sick. Just a run-of-the-mill back pain. Carlos said he left the drugs on the counter. They disappeared. Where? Did somebody give them? Did I miss some pathology that killed him? A dissection? An aneurysm?
She went back looking for similarities.
Three different doctors: Alex in the first case, Kurt in the second, Alex again in the third. The last case was hers.
Three nurses: Brenda. Carlos. Ben. Carlos again.
Four patients: #1: Female, 86, nursing home. #2: Female, 88, married. #3: Female, 90, nursing home. #4: male, 50s, healthy.
That back pain doesn’t fit. Is there a pattern? Or just bad luck? A string of unrelated things? People die in the ER all the time. They come because they think they’re dying. They’re often right.
Her stomach grumbled again, loud enough to hear it from the parking lot. The water bottle was empty. It was late. She had another shift tomorrow. Taylor was home alone.
She grabbed her bag and headed home, leaving the door unlocked for the cleaning crew.
31
Angel
That was perfect. I couldn’t do any better.
Too bad he had to die. Well, at least he’s no longer drug-seeking.
Poor Emma. She wonders if she missed something. I wish I could tell her.
Getting away from the pattern was good. It keeps them on their toes.
Did you like that, Carlos, you stupid spic? You shouldn’t leave your meds on the counter! I had to give him a little extra, of course. There wasn’t enough there to kill him.
As I head out to lunch, I see the guy in Room 3. He’s on a bipap mask. The ventilator’s breathing for him as he sleeps. He’s Carlos’s patient. I take his mask off.
Actually, I can do better. I put the mask back on his face but I detach it from the vent.
I watch the oxygen saturation plummet. 90. 85. 79.
He’s turning a nice shade of purple.
74.
I’d better leave before they find me here.
68.
32
As she came in for her evening shift, Emma found Faith playing with the baby in Room 4. She smiled. Beautiful and vibrant in her ironed green scrubs, Faith looked like a light had turned on inside her. No more sadness, misery, and tears. Happy Faith was back.
“How are you, Faith?”
“I’m great, Dr. Steele. You?”
“Good. Thanks again for the other day. I wouldn’t be here if it wasn’t for you.”
“Yes, you would. I took you on that mountaintop. The least I could do was to get you back.”
Emma laughed. “If you put it that way…”
“Are you…are you up to doing something again?”
“Absolutely. If you’ll keep an eye on me.”
“I always do, Dr. Steele! You’re my hero!”
Emma blushed.
“Just tell me when and where.” I can use the exercise. And a friend.
“Dr. Steele to Room 1.”
The patient in Room 1 wasn’t having a good day. Neither were Judy and Suzy, trying to get her from the wheelchair to the stretcher. Her purple left foot hung by the skin. She wailed as they tried to move her. Emma went to help. She bent over to hold the foot as Judy and Suzy grabbed her arms. On a count of three, they got her on the stretcher. The foot flipped sideways, flat on the bed. The woman hollered in agony.