“I’ll walk you over.”
The two young women rose and started back into the main body of the conference hall.
“I suppose you’ve been here all week?”
Ginny nodded. “But I have to leave after this session. I’ve used up all my time off.”
“Which means I’ve got no one to sit with at the lecture tonight.”
“You could sit with Alan,” Ginny teased.
Caroline made a face. “I hate you.”
“He’s a nice guy.”
“He gives me the creeps.”
“I don’t think he’s actually dangerous, just inept.”
“You wouldn’t think that if he were following you around. Besides, you’ve got Hal to protect you.”
Ginny nodded half-heartedly. “Yes, I suppose so.”
Caroline stopped walking. “What did you mean by that?” She caught Ginny’s arm and pulled her to a halt. “Is there something wrong between you two?”
Ginny shrugged. “I don’t know.”
“What’s up? Come on, Ginny. Give!”
Ginny squirmed, unsure what to say. “Well, he’s been acting strange.”
“Like what?”
“Oh, I don’t know. Bad mood. Unsociable. Like he’s worried about something, but he won’t talk about it.”
“How serious are you two?”
“He hasn’t asked me to marry him, if that’s what you mean.”
“But would you, if he did?”
“I haven’t decided.”
“Don’t you like him?”
Ginny raised her eyebrows. “What’s not to like? Tall, dark, handsome, rich.” Her mocking smile faded into something more genuine. “It’s just that I liked his mother so much. When she died, it was almost like losing my own.”
“So?” Caroline demanded.
“Well, I’d hate to think I was a marrying a man because I liked his mother. I want to be sure it’s really Hal I’m fond of.”
Caroline shook her head. “You’re weird, you know that?”
Ginny nodded. “You’ve mentioned it once or twice.”
“Well, if you decide against him, I get first dibs, okay?”
“It’s a deal.”
Caroline’s smile faded. “There’s something I’ve been wanting to talk to you about. When can we get together?”
“I have to work the next two nights, then there’s the fund raiser on Friday and I’ve promised to help Hal with that.”
“What about Saturday? We could go get margaritas.”
“That sounds perfect.”
“Good. I’ll call you.” Caroline started off.
“Wait!” Ginny caught her elbow. “Aren’t you going to give me a hint what this is about?”
Caroline grinned. “Nope. You’ll just have to wait until then. ’Bye.” She hurried off, leaving Ginny wondering what her friend could be up to this time.
An hour and a half later, Ginny made the rounds of the hall, saying her official goodbyes to the other volunteers. She was glad she’d been able to manage at least part of the week. Worthwhile, even if she had to make up a shift or two at work.
She joined the lecture-sated throng headed towards the main door, wondering how many of these ancient faces might have secrets they would rather not share with Professor Craig. She smiled to herself at the absurdity of the thought. A more unlikely group of miscreants she could not imagine. They could be tedious, ignorant, even foolish at times, but in her experience, genealogists were by nature harmless. She would find no school for scandal here.
* * *
Chapter 2
Wednesday / Thursday
The night shift had started at Hillcrest Regional Medical Center. In the Adult Medical ICU, the charge nurse, Margot, set the phone back in its cradle. The blue scrubs that were the uniform for registered nurses at Hillcrest, caught the light as she moved and made pools of azure against her coffee-colored skin.
“Ginny,” she called. “That was 4 West. They got an admission earlier this evening. Now he’s in respiratory distress.”
“How long?”
“Ten minutes.”
Ginny had drawn the short straw for the first admission. She acknowledged the assignment and quickly brought her charting up to date.
The Respiratory Therapist looked up as Ginny entered the room. “Hey girl. How’s it going?”
“Ask me again in an hour, Dee.”
“I hear you, sister.” Both heads turned as the elevator arrived. “Here he comes.”
Ginny reached up to the talisman she always wore while at work and touched wood. The carved disc was very old, having been handed down in her family from her great-great grandmother. It was made from a rowan tree that had stood on the grounds of Castle Forbes in Scotland. She silently invoked the ancient magic, then turned her attention to her new patient.
The transport crew pushed the bed over the ICU threshold, around the central nurse’s station, and down the nearer side of the unit. Ginny fell in beside them, joined by three other nurses. Admissions were always collective efforts.
“Everybody ready?” Ginny, as assigned nurse, was automatically captain. “One, two, three, lift.” They transferred him smoothly onto the ICU bed, then quickly and efficiently set about getting the monitoring equipment applied and working.
“This is Mr. Donald Craig,” the floor nurse announced. Ginny started and looked more closely at the patient. An oxygen mask covered his face, but sure enough, it was Professor Craig, looking somewhat different from when she had seen him earlier in the day. Ginny grabbed a pen and started making notes.
“He presented in the Emergency Room about nine p.m. with sudden onset of numbness and paralysis in his legs. Sometime after dinner tonight, he noticed a tingling sensation in his feet, which worked its way up his legs. When he fell down on the way to the bathroom, he called 9-1-1. On admission, he was unable to feel or move his legs from the knees down. Chemistry and hematology within normal limits. Serology pending. Lumbar puncture showed elevated protein levels. Nerve conduction studies show damage to the myelin sheath. EMG shows motor muscles affected, sensory not. Tentative diagnosis of Guillain-Barré.”
Ginny nodded.
“About ten-thirty we noticed the paralysis had spread to his hips. By eleven, his arms were involved. By eleven-thirty, his chest.”
Ginny’s brow furrowed. “So fast?”
The floor nurse nodded. “We called his attending and he called Littleton.” They both glanced up as the ICU Intensivist arrived. The floor nurse continued with her report.
“He’s been awake, alert, and oriented the whole time. He never lost consciousness. He did not hit his head and he doesn’t have a bump. His medical history is positive for arthritis, high blood pressure controlled with diet and exercise, and a tonsillectomy at age five. He is on no medications. He is not allergic to anything. He has not been ill or around anyone who was ill in the last two weeks. His closest family is a nephew who lives in Memphis. We’ve called him about this transfer to the ICU and he and his wife are flying in.”
“Who’s his attending?”
“Armstrong, neurology, but he’s not on call tonight. Kennedy is. We put in a call to his office, but haven’t heard back so far. Anything else I can tell you?”
“No, thank you.”
“Okay. His stuff is in the bag in the corner. Nothing special; wallet in the office safe, watch and one ring still on him.”
“Thanks.”
Ginny turned to her patient, leaning over the bed.
“Professor Craig? Can you hear me?”
He nodded.
“It’s Ginny Forbes. I’m going to be your nurse tonight. Has the doctor explained what we plan to do?”
He nodded again.
“Once the endotracheal tube is in place, you won’t be able to talk, but I’m going to be right here the whole time. Do you have any questions?”
Professor Craig shook his head.
“The sedative will make you sleepy. You
just relax. We’re going to take good care of you.” She slipped the medication into the IV line and watched it take effect.
Dr. Littleton squeezed into the space at the head of the bed. “Are we ready?”
Ginny nodded, then waited as Littleton slid the tube into place and held it while Dee taped it down.
“ET tube’s in,” he said, listening to verify breath sounds.
Over the course of the next hour, Ginny and Margot helped Dr. Littleton insert a pressure line into a radial artery and a triple lumen catheter into the large subclavian vein running across the front of Professor Craig’s chest. The trio worked in smooth unison, anticipating each other’s needs.
Ginny liked her job. It made her feel useful, her skills a necessary part of something larger than herself, and it was teamwork in the truest sense of the word; physicians, nurses, respiratory therapists, pharmacists—all working together to accomplish something none could do alone. In here, in private and with the patients asleep, they used first names, each recognizing the other’s expertise and value.
“Coming through.” Bill Littleton disposed of his ‘sharps,’ placing them in the reinforced plastic box kept for that purpose. The physicians with line insertion privileges did their own counts and disposal. In this day and age, no one wanted to leave the possibility of being stuck by a dirty needle to chance.
He stripped off his gown, yawning. “I’m going down to radiology to make sure those lines are in place, then home to sleep.” He picked up his jacket. “I have to be back at eight.”
Ginny nodded. “We’ll try not to call you.”
“Thanks.”
Half an hour later Ginny had caught up on the admission tasks and was ready to start the charting.
“Whose signature is this?” Ginny pointed to the scrawl at the bottom of the Emergency Department admission sheet. Margot peered at it.
“Oh. They’ve got a new guy in the E.R., James Mackenzie.”
“Well he needs to learn how to write legibly. This is impossible to decipher.”
Margot grinned. “So what else is new?”
“Is he married?” Alice called the question from the other side of the nurse’s desk.
Margot answered her. “I don’t think so. At least, he wasn’t wearing a ring. What do you care? You’re already engaged.”
“It’s not too late to change my mind.”
The group laughed, no one taking her seriously. Alice had roped the entire nursing staff into her wedding party and was growing obsessive as the day approached. Ginny would be glad when she was safely away on her honeymoon.
“So you’ve seen him.” Lisa prompted.
Margot nodded. “I floated down there last week.”
“What’s he like?” Grace asked, joining the conversation.
“Dark blonde, broad shoulders, good hands.”
“And just what do you mean by that?” Grace teased. It was safe enough. The whole staff knew she and Margot had weathered nasty divorces and were both man-proof.
Margot looked up and smiled. “A light touch, deft. Good with sutures, especially on the kids.”
Ginny snorted. “But incapable of a legible signature.”
Everyone laughed.
“How old?”
Ginny glanced over at the only bleached blonde in the group. Lisa was wearing too much makeup and not enough uniform, as usual.
“Early thirties, I should guess. Maybe a bit more.”
“Where did he come from?”
“I don’t know. Shall I ask him for you?” Margot’s lips twitched.
“No, thank you.” Lisa smiled. “I can find out for myself.”
Ginny shook her head and went back to work. This sort of bantering could — and probably would — go on all night. She glanced at the clock. Two a.m. She could be caught up on everything by four, if she applied herself.
The crews worked twelve-hour shifts at Hillcrest, seven to seven each way. Ginny preferred night shift to its more hectic daytime version. She liked the dimmer lighting; the quiet, controlled voices; the soft pad of rubber-soled shoes on the tile floor.
They used mobile workstations set up just outside each of the rooms. From there, it was possible to hear the ventilator cycling, to look up and see the monitors glowing in the dark. The occasional alarm sent the chairs and tables rolling as a nurse rose to silence the alarm and deal with the problem. Everything calmly and efficiently handled. Everything under control.
* * *
In the deepest part of the night, Ginny approached her charge nurse. “Who was that I saw in Seven a few minutes ago?”
Margot looked up in surprise. “I didn’t see anyone. Family, maybe?”
Ginny shook her head. “They aren’t here yet. Besides, whoever it was had on a lab coat.”
“Oh, well. Must have been one of us, then. Is anything wrong?”
“Nope, other than I can’t keep my eyes open.” Ginny yawned widely.
Margot grinned at her. “Another admission would wake you up. Shall I arrange it?”
“Thank you, but no. Chemical stimulant is what’s needed.” She headed for the coffee pot.
They got another admission around five a.m. Not Ginny’s this time. Chest pain. Possible heart attack, routine orders.
Dawn had started to color the eastern sky when Ginny came hurrying out of Professor Craig’s room. She hunted up her charge nurse.
“Margot, I’ve got a problem in Seven. I can’t wake him.”
“Can’t wake him? What are you talking about?”
“Just what I said. The sedative wore off hours ago and he should be arousable, but he isn’t.”
“Neuro checks?”
“Fine at four a.m. Now his pupils are sluggish. The deep reflexes are still there, but all the higher order functions are missing.” Ginny turned to the unit coordinator. “Wendy, would you please page Dr. Kennedy for me?”
Ten minutes later Ginny hurried back to the nurse’s desk.
“Have we heard anything from Kennedy, yet?”
“No, and I’ve paged him twice.”
Ginny and Margot exchanged glances. It was not the first time something like this had happened. The politics of getting appropriate medical coverage for the night shift was an ongoing problem in any hospital.
“We’d better call Littleton,” Margot said.
Ginny nodded and dialed the number herself. “Bill? Sorry to get you out of bed. It’s Professor Craig.” She explained the situation to the sleepy voice on the other end of the line, then set the phone down, frowning. “He says go ahead and call Armstrong at home.”
Margot nodded. “Do you want to talk to him, or shall I?”
“I’ll do it.”
There was a delay getting through to the neurologist, but Ginny had him on the line at last, explaining her concerns.
“So where is Dr. Kennedy?”
“We don’t know. We’ve been paging him, but there’s no answer. Dr. Littleton instructed me to call you.” She didn’t apologize. This was all part of the job.
“He’s comatose?”
“Yes.”
The neurologist sighed. “All right. I’ll be there in an hour.”
The last couple of hours of a shift were always as busy as the first. Data had to be collected and sent on, counts tallied, patients and rooms prepped for the day, and every detail charted. Ginny hated to turn over responsibility to the next shift if there was any task unfinished, any problem unresolved. She especially hated to leave if the patient wasn’t doing well.
She frowned at her day shift counterpart and emphasized what was worrying her.
“So I called Littleton and told him about the neuro changes and he told me to call Armstrong. Armstrong said he’d be here around seven, but I haven’t seen him yet. There’s really nothing else wrong. It’s what you would expect to see in a newly intubated Guillain-Barré, except for the fact that he’s comatose.”
“Was he awake when he got here?”
“Oh, yes. Awake, alert,
cooperative. We sedated him, of course, for the intubation, but that was before midnight. It’s had plenty of time to wear off. It did, as a matter of fact, because I asked him around four o’clock whether he was hurting and he shook his head ‘no.’ So this is a new development.”
Ginny stood up and gathered her equipment. “I’ll be back this evening so you can tell me then what the neurologist had to say about it.”
“Will do. Have a good sleep.”
* * *
Chapter 3
Thursday / Friday
Eleven hours later Ginny pushed open the door to the ICU, pulled a pen from her pocket, grabbed a blank sheet of paper, slid into a chair in front of room Seven, and smiled at Gloria, who no longer looked as fresh as she had at dawn.
“Bad day?” she asked.
Gloria nodded. “It’s a good thing my other patient is stable.”
“I’m ready.”
“Armstrong got here just after you left and did the most thorough neurologic check I have ever seen. Ice water in the ear and everything. He came out frowning and ordered CTs, with and without contrast; MRI; EEG; skull series; drug screens; viral scans; tons of stuff. We repeated the lumbar puncture and this time it showed extremely high levels of protein. The EEG showed widespread structural damage and the Evoked Potentials showed brainstem involvement. So far, all the lab tests for the Epstein-Barr virus have come back negative. So it begins to look as if we can rule out Guillain-Barré. That raises the question of what else it could be.
“All the scans said the same thing. No excess pressure within the skull, no bleeding, and no swelling, so we didn’t do the craniotomy, but the techs said it didn’t look like normal brain tissue either. The EEG was the strangest of all. It showed almost no electrical activity. Not even what should have been there as a baseline, you know — the background noise of a comatose patient. So we took him off the ventilator to check for spontaneous respirations. There weren’t any, of course.
“None of us have ever seen anything like it. Armstrong has been a worse ass than usual. He’s been on the phone to people all over the U.S. about it. I gather he’s taking the whole thing personally. He’ll have to write it up, of course. Otherwise, someone might think he missed something. So I guess we’ll hear how it comes out in the end.”
The Arms of Death Page 2