The Killing Harvest

by Don Donaldson

  “Are you trying? Blink twice if you are.”

  His lids flicked twice.

  “Okay, you can rest now. But soon I’ll want you to try again.”

  Sarchi watched as Kate delivered .2 cc of the drug into the injection port of Drew’s IV. When Sarchi’s Mickey Mouse watch had counted off thirty seconds, she snugged Drew’s hand around her finger and asked him again to squeeze.

  Once more, she felt nothing. While Marge and Kate watched solemnly, she waited another thirty seconds and asked again.

  Drew’s poor muscles still could not mount a response.

  If the drug has an effect, it only lasts two or three minutes. So after Drew failed to show any improvement in three more tries, Kate gave him another dose, doubling the amount.

  This also had no effect.

  They repeated the procedure one more time as the test protocols recommended, emptying the vial. No one in the room was surprised when Drew remained as helpless as before.

  “Where does this leave us?” Marge said.

  “We’ve got a lot of tests going,” Sarchi replied. “The clue we’re looking for will likely be in those results.”

  “How long before everything is back?”

  “That’s a problem. Cultures can take a while, a day or two for bacteria, longer for viruses.”

  “We’re in a period now when data will be coming in slowly,” Kate said. “You might want to take advantage of this time by going home and getting some rest.”

  An expression of incredulity crossed Marge’s face. “Rest? How can I rest when my child is . . . like this?”

  “I understand,” Kate said, touching Marge’s shoulder. “But I’m sure a shower and a change of clothes would lift your spirits.”

  This seemed to make sense to Marge. “I need to tell my partner at the agency I won’t be in today. And I could get some of Drew’s books and read to him.”

  “There you go,” Kate said kindly.

  “I won’t be gone long.” Marge looked at Sarchi. “Should anything change before I’m back, you’ll call me right away?”

  “Count on it.”

  When Marge was gone, and Sarchi and Kate were out of Drew’s hearing, Sarchi said, “I love that woman, but having her as an audience while I flounder around playing doctor is wearing me out.”

  “You’re not playing at anything,” Kate said sharply. “All you’ve done for Drew has been correct. You’re not God, and you never will be.”

  Sarchi smiled wearily. “I don’t know about that. I could become a nephrologist.”

  “I’m glad you still have your sense of humor.”

  Sensing that Kate was leading up to something, Sarchi’s eyes narrowed with suspicion.

  “I guess you haven’t checked the results of Gilbert Klyce’s cultures this morning,” Kate said.

  “What’s he got?”

  “Four plus MRSA.”

  “Oh, shit.” Methicillin-resistant Staphylococcus aureus was among the worst bugs Gilbert could have acquired. “So now he goes on vancomycin.”

  “It’s all we can do,” Kate said.

  Vancomycin was an antibiotic sledgehammer. “I hope his kidneys are strong enough to handle it.”

  “You’ll write the orders?”

  “I’ll go up there next. Getting back to Drew . . . You think he might have Guillain-Barré?” Sarchi was referring to another autoimmune disease that, unlike myasthenia, causes degeneration of the fatty covering of nerve fibers.

  “The loss of deep tendon reflexes fits, but there was no protein increase in his spinal fluid.”

  “Isn’t the protein initially normal in some cases?”

  “That’s true,” Kate said, “but there’s also the fact that his condition came on so suddenly.”

  “Acute onset . . . That’s the harpoon in any diagnosis I can think of, except maybe a bleed. But there’s no evidence of that on the scans. What do you think?”

  “That I’ve gotten more kids to see this morning. We’ll talk about this later, when we’ve got more data.”

  Sarchi went to the nurses’ station to get Drew’s chart, but it wasn’t in the carousel. She asked the floor supervisor where it was.

  “Your friend Harry Bright has it. He’s in the chart room.”

  Harry Bright. Sarchi’s blood pressure rose to dangerous levels, and she stalked to the chart room, where she found Bright reading Drew’s growing hospital record.

  “What is it with you lower life-forms?” Sarchi said. “Do you have some kind of primitive sense organ that draws you to other people’s misfortunes?”

  Bright looked up. “Matter of fact, we do.” He reached for his zipper. “Want to see it?”

  “Sorry, I didn’t bring my magnifying glass.”

  Bright didn’t look like a smart-ass. With his well-trimmed mustache and goatee, sad eyes and thin lips, a sensitive expatriate Russian poet seemed a better fit . . . until you talked to him for a few minutes. Then it was smart-ass all the way. He was the local rep for North American Medical, an HMO that paid the bills for about twenty percent of all the hospital’s patients who weren’t on Tenn Care, the state program for indigents.

  Bright tapped Drew’s chart. “What do you think’s wrong with him?”

  “It’s too early to say.”

  “Hope you figure it out quick. You’re really running up a tab.”

  “That’s not my concern.”

  “See, that’s why people like me and my company exist. For too long, you doctors have thought you were the dog and the rest of us were the tail. Well, Doc, I’m here to tell you things have changed. And you’re just gonna have to get used to it.”

  “I never knew the other way. But I know this is wrong.”

  “If it was wrong, it wouldn’t exist.”

  “Change can work both ways,” Sarchi said. “Remember the Edsel.”

  “You just cling to that hope if it makes you feel better. Meanwhile, let’s talk about Michael Green. Isn’t he well enough to be moved out of the ICU?”

  Sarchi feigned a confused expression. “Tell me again where you obtained your MD.”

  “I’ll stake my five years of nursing experience at Mass General in Boston against your training any day of the week.”

  “That’s the problem.”

  “Then you won’t be moving Green?”

  “When we feel he’s ready. Could be today.”

  “There now, cooperation isn’t so hard.”

  “I need that chart.”

  Bright handed her Drew’s chart, and she took it to an empty chair. He watched over her shoulder while she entered the Tensilon results.

  “So it’s not myasthenia gravis,” he said before she’d written her conclusion.

  “Don’t you need to be somewhere?”

  “Actually, I do.” But he didn’t leave.

  “What’s the matter, forget the location of your next feeding station?”

  “I hear you’re quite a racquetball player.”

  “Who said so?”

  “You get around, you hear things.”

  The thought that Bright was inquiring about her was infuriating. “I’d prefer you not discuss me with people.”

  “The urge to gossip is such a fundamental human trait it ought to be in the constitution.”

  “I believe you were leaving.”

  “Play me.”

  “What?”

  “Racquetball. You think I’m such an asshole, you could put me in my place.”

  “I’ve got better things to do with my time.”

  “Yeah, that’s true . . . you might lose. And how would that look—a nurse beating a doctor.”

  Tired of this conversation, Sarchi got up and took Drew’s chart to the
nurses’ station.

  Bright followed. “Play me.”

  Ignoring him, Sarchi put the chart in the carousel and walked to the elevator, Bright close behind.

  When the elevator arrived, she was relieved that he didn’t get on with her. As the door closed, she heard him say, “Michael Green . . . don’t forget.”

  Going up to the neuro ward, Sarchi tried to tell herself Bright was merely a horsefly on the flank of the medical profession. But she knew better. Bright and his company, and the others like them, were greatly influencing the way medicine was practiced, substituting their judgment for the physician’s. And as much as she didn’t want to admit it, it could be a long time before things got better.

  In the neuro ward, Gilbert Klyce was still running a fever. Sarchi wrote the orders to start him on vancomycin and also ordered a blood culture to see if the Staph had invaded his bloodstream. She alerted the floor nurse to what she’d done and left for the asthma ward.

  Around thirty minutes later, her pager buzzed. When she looked at the number she groaned. Practically before the sound died in her throat, she had the neuro ward on the line, where a voice said, “Gilbert Klyce is not breathing.”

  7

  AS GILBERT WAS wheeled away to the ICU to be put on a ventilator, Sarchi suddenly felt like hitting something. It hadn’t been a reaction to the vancomycin that had made him go into respiratory arrest. More likely some kind of autonomic vagal reflex kicked off while his trachea was being suctioned. Would nothing ever go right again?

  She still had four hours to go on her thirty-six hour shift. Normally, by quitting time on such a haul, all she wanted was to sleep. But Harry Bright had planted a seed that took root. She reached for the phone, hoping Carl Lanza’s schedule was flexible.

  The call rang four times then rolled over to his lab.

  “Carl, this is Sarchi. I know it’s short notice, but would you be interested in a little racquetball today?”

  “Actually it’s the big racquetballs I like.”

  “Very funny. You must be having a better day than I am.”

  “So far it’s been one to hang on the wall. I got a phone call an hour ago inviting me to give a talk at the international brain conference in Lucerne this summer.”

  “That’s wonderful.” Carl was a molecular biologist who studied gene expression in nerve cells. His wife, Gail, was a resident in orthopedics at Campbell Clinic. Feeling sorry for Sarchi’s impoverished social life, they often invited her over to dinner.

  “Am I being insensitive to crow like this when you’re having a bad day?” Carl asked.

  “Just say you’re free at four forty-five to play, and I’ll overlook it.”

  “The way I feel, I’ll be tough to handle.”

  “We’ll see. Think we can get a court?”

  “The medical students are all getting antsy about their upcoming exams, so a court shouldn’t be a problem. I’ll check. If it is, I’ll call you. Otherwise, we’re on.”

  AFTER A FEW hours on a ventilator, Gilbert began to breathe on his own again—a human zucchini back on automatic pilot, hardly a reason to become giddy. And there was Drew, still undiagnosed, with her waiting for the results from a lot of cultures that couldn’t possibly point to a disease that fit the profile they’d developed.

  What was wrong with him?

  By four thirty, Sarchi’s desire to hit something was so strong it overwhelmed the guilt she felt at leaving the hospital before Drew was diagnosed.

  Fall and winter in Memphis are schizophrenic; gorgeous life-affirming days alternate with gloomy, cold, wet ones that arrive from the Arkansas rice fields across the Mississippi with a gale that turns umbrellas inside out. Such a wind had blown in the night before but had now departed, leaving the sky a pewter color that did nothing to buoy Sarchi’s spirits as she stepped outside the hospital.

  It took her a little over five minutes to walk the few blocks to the University of Tennessee fitness center. She was such a regular there that the guy sitting at the check-in waved her through without asking for her member’s card. Luckily, she had clean shorts, an athletic bra, and a fresh pullover in the locker with her racquet.

  Carl was warming up when she ducked through the small door off the hall and entered the court. He’d just slammed one off the front wall so hard it hit the rear wall near her head. He caught it on the rebound.

  “I should warn you,” he said. “I’m feeling merciless today.”

  “So I see.”

  Carl had clean-cut good looks but nasty hairy legs that were thick at the ankles. Gail always said that from the waist up he was Homo sapiens. Below, he was a troglodyte.

  “Everything get straightened out at the hospital?” he asked.

  “I sort of came here to forget all that. Do you mind?”

  “Not at all. I was just being polite when I asked anyway.” He grinned at his lie.

  “How’s Gail getting on with the orthopods?”

  “Every once in a while one gives her a break.”

  Sarchi groaned. “That’s really bad.”

  “It’s not my joke, it’s Gail’s. Blame her. I suppose you’d like to warm up before I teach you the game.” He tossed her the ball.

  It was good to be out of the hospital, and for a time Carl’s repartee and the physical involvement of stroking and following the ball provided a respite from those concerns. But it didn’t last.

  Usually, their games were close. Her workouts three days a week in the fitness center’s weight room had lent a surprising power to Sarchi’s swing. Carl, though, had more. But she was better at predicting where the ball could best be intercepted. Normally, she could resist the temptation to hit it at the peak of its first bounce and wait until she could stroke it low, sending it into the front wall so close to the floor that it was nearly impossible to return. But today, the faces of Gilbert Klyce, Drew Harrison, and Harry Bright continuously looped through her thoughts, destroying her concentration to the point that she invariably stroked the ball at the top of its bounce, caring more for the fury of her swing than its accuracy.

  Predictably, the first game went to Carl by a comfortable margin. She fared no better in the second.

  “If you’ll forgive the observation,” Carl said, “your game today is out to lunch.”

  Flushed and enjoying the feel of the ball against the strings of her racquet and the satisfying splat when she drove it into the front wall, Sarchi wiped the sweat from her brow with the back of her hand and dropped into a receiving stance. “You gonna talk or play, Lanza?”

  Carl proceeded to whip her a third time.

  “You can’t want any more of this,” he said.

  Suddenly, the anger boiling inside her was gone, replaced by numbing exhaustion. “You’re right. I’m through. You’re just a monster today.”

  “You didn’t exactly make it difficult.”

  “Guess I could have used a phone call like the one you got this morning. Say hi to Gail for me, and don’t tell her how badly I played.”

  Sarchi took a long shower, dressed, and headed for the parking garage across from the hospital, thinking of her warm bed and a night uninterrupted by her pager. At the entrance to the garage, she paused. Then, as much as she didn’t want to see the place again today, she crossed the street and entered the hospital.

  Marge was in Drew’s room reading to him. Sarchi slipped in unnoticed and stood by the doorway listening to the story, which was about a rabbit family with irresponsible kids who got into all kinds of trouble by not listening to safety rules from their parents. It was advice that would be of no use to a paralyzed boy, and the optimism in the choice of books pulled at Sarchi’s heart.

  Marge was a good woman, and she obviously loved Drew as much as if he’d been her biological son. Looking at them together, the old guilt lifted its head
and whispered in Sarchi’s ear. “It should have been you who took the boy when Carolyn and Bill died. You both have Seminoux blood. Whatever the cost, it should have been you.”

  Then the voice added a new twist: “If you had taken him, he might not be sick now.”

  At the end of the story, Marge let the little song engineered into the book play for a bit, then put the book down.

  “Are you going to stay the night?” Sarchi said, moving to Marge’s side.

  “Oh, hi. I didn’t hear you come in. There’s nothing at home for me.”

  Her answer felt like a rebuke. To walk away from Drew now seemed so wrong. But if she didn’t get some rest, she’d be worthless to Drew and the rest of her patients tomorrow. She was so tired, she’d have trouble spelling her name. Maybe if she hadn’t played racquetball, she’d have the stamina to remain.

  “I want to stay, too. I really do. But . . .”

  “You don’t owe me an apology,” Marge said, kindly. “We don’t need a symbolic gesture from you. We want you as sharp and alert as you can be. So get out of here.”

  “Call me at home if there’s the slightest change.”

  “Seems like I was saying the same thing to you a few hours ago. I’ll call. Now go.”

  Sarchi kissed Marge on the cheek, did the same to Drew, and set out once more for her car.

  Driving home, she dwelt on her inability to figure out what was wrong with Drew. She then recalled her conversation in the scan room with Koesler. He’d been standing right in front of her, and she didn’t press the issue about the MRI. She’d firmly believed it was in Drew’s best interests to get one that night, but she’d let Koesler walk away without taking a stand. Right now, she didn’t like herself very much.

  Sarchi lived barely two miles from the hospital in a newly remodeled forties-era bungalow on a street lined with huge oaks. The clincher in her decision to purchase it was its location across from an estate so heavily wooded, the turn of the century Victorian mansion in its bosom wasn’t visible even in winter.

  Turning the corner, she realized the Dumpster that had been a neighborhood eyesore for the last three months in the yard of the empty house next door was gone, replaced by fresh sod and a FOR SALE sign. But now the damned thing was in the yard on the other side of her house. No rest for the weary.