Angels on the Night Shift

by Robert D. Lesslie, M. D.

  “Let me tell you how this sort of thing works, Dr. Lesslie,” Walter began, assuming the tone of one of his MBA professors. “It’s very much like a case of embezzlement. The perpetrator has to fulfill three definite and specific criteria. First, they must have a need. This is almost always financial in nature. Secondly, they must have access—in this case, to the medication room and narcotics. And lastly, they must be able to rationalize their actions, overlooking the criminal nature of their activity and somehow justifying it. For some people, that’s the easy part.”

  He paused, looking at me again, seeming satisfied with his fund of knowledge.

  “Is it possible that the perpetrator, as you call them, might have a drug problem?” I asked him. “Maybe that’s the case rather than a financial need. After all, these are small quantities of drugs we’re missing, hardly a major deal on the streets of Rock Hill.”

  Out of the corner of my eye, I could see Virginia slowly nodding her head. But she remained silent.

  “No, that’s not the case here,” Stevens said emphatically. “Whoever is stealing drugs from the ER is doing so because of money. They are selling whatever they can get their hands on and will continue doing so until we catch them. And that’s what we’re going to do. In fact, we—”

  He stopped short, pursed his lips, and looked away from me.

  “You’re going to what?” I asked, curious where this last statement had been headed.

  Walter slapped the armrests of his chair, stood up, and with an air of finality said, “Virginia, I’ll be back with you in a couple of days. And we need to be sure this stays quiet. Not a word to any of your staff.”

  He glanced in my direction, and I thought there might be a hint of a warning in his eyes.

  “Dr. Lesslie, good to see you as always.” And with that, he turned and walked out of the office.

  Virginia looked up at me and shook her head.

  “Where do they find these people?” she asked in frustration. “You heard just a few minutes of it, but I’ve been in here for half an hour.”

  “What do you think he’s talking about?” I asked her. “Who has he narrowed this down to? He seems so certain, but nobody comes to my mind. I can’t imagine any of our people doing this. Yet…”

  “Yet, it’s happening,” she finished my thought. “But he hasn’t given me any specific names, just that he’s got a good idea of who’s doing this. He says he only needs a little more time and that he’s ‘gathering more information,’ whatever that means. Anyway, it will be interesting to see what he comes up with. Maybe he knows something that we don’t. And if he can help solve this, I will be glad for his assistance. We need to put a stop to it.”

  She was right about that. I stood up and walked to the door. Before opening it, I turned to her and said, “I might talk to Lori Davidson about this. She already knows about it, and she has a good read on people. Maybe she has an idea.”

  Virginia nodded her head and then pulled a pile of papers over in front of her. Without saying another word, she adjusted her glasses and went back to work.

  At the nurses’ station I was greeted with a “4-fer”—four patients for the price of one. The clipboard of room 5 held the charts of the four children I had seen heading into the ER. I guess they weren’t visiting after all, but were now my patients. I looked down at the complaint written on the top chart, and then quickly at the other three.

  Pinworms. Great.

  I picked up the charts and was about to head to room 5, when the EMS radio came to life.

  “Rock Hill ER, this is EMS 2.”

  Lori Davidson was standing beside Amy and she reached over and pushed the speakerphone button.

  “EMS 2, this is the ER. Go ahead.”

  There was some painfully loud crackling, and Amy leaned over to adjust the volume.

  “ER, we’re on the way in with a traumatic arrest—twenty-two-year-old woman,” the paramedic told us. It sounded like Denton Roberts, and he was out of breath or excited, or both.

  I stopped where I was, put the charts back down on the counter, and glanced up at the clock—9:15 a.m. It was early in the day for a traumatic arrest, I thought. Must be an auto accident.

  Lori was writing on a pad of paper beside the radio, shaking her head.

  “Did you say ‘twenty-two-year-old’?” she asked the paramedic.

  “Yes,” he responded. “Twenty-two, and pregnant. About thirty-eight to thirty-nine weeks.”

  Lori and I looked at each other. This last piece of information changed everything.

  I leaned closer to the receiver and said, “Tell us what you have.”

  “Doc, this is Denton Roberts,” he identified himself. “We’re out on Cherry Road, two or three minutes away. Open head injury with no responses at all. I don’t see any other obvious injuries. Blood pressure is 100 over 60 and her pulse is 110. Can’t tell anything about the baby—too much noise to hear fetal heart tones.”

  He stopped and said something to someone in the background.

  Then back to me he said, “She’s intubated and we’ve got two lines in. Loading up right now. Anything else?”

  I thought quickly. At this point, everything else needed to be done on our end.

  “No, Denton. Just get here as fast as you can. Major trauma on arrival.”

  “Got that, Doc. Major trauma.”

  There was more crackling and then the radio went silent.

  Lori was still looking at me, waiting for my directions.

  “Do you want me to call anyone?” Amy Connors asked. “This sounds awful.”

  “Check upstairs in labor and delivery,” I answered her. “See if one of the OBs is in the hospital. Maybe we’ll get lucky.”

  Then turning to Lori: “Come on, we need to get things set up.”

  We only had a few minutes, but in that short time we managed to open up an airway tray and a general surgical tray, and had one of our techs bring the newborn warmer into the room.

  “Plug that in over there,” I directed her, pointing to a spot up near the head of the stretcher.

  Lori had a concerned look on her face, and I thought I knew what she was thinking.

  “No, I’ve never done an emergency C-section,” I told her. “But I know what to do, and if there’s no OB in the hospital, we’ll get it done. Just don’t go anywhere.”

  She nodded her head and turned around to the counter, making sure everything was ready. I was glad she was with me.

  Thad Baxter stepped into trauma, and at the exact same instant I heard the automatic ambulance entrance doors open down the hallway.

  “What have you got?” Thad asked, stepping over next to me. He was one of our OBs and must have just come out of a delivery. He was wearing a surgical cap and scrubs, and his right shoe cover had spattered blotches of blood on it. Boy, was I happy to see him.

  “I came as fast as I could,” he added, quickly glancing around the room.

  I barely had enough time to tell him what little we knew, when the stretcher of EMS 2 was wheeled into the room. Denton Roberts was pushing the bed while at the same time bagging the young woman. His partner, Jamey, was walking beside the stretcher, trying to guide it with his body as he continued to do chest compressions.

  “What happened?” I exclaimed, grabbing the stretcher and pulling it beside our bed. Only moments ago this woman had had a pulse and blood pressure. Once again, everything had changed.

  Denton was flushed and obviously upset.

  “We pulled into the parking lot and up to the door, and before we could get her out of the ambulance she went flatline,” he explained hurriedly. “I mean…it just happened a couple of seconds ago.”

  We all worked together and got the young woman onto the trauma bed. Thad Baxter helped and then stepped back a little.

  “Robert, we need to get this baby, and as fast as we can!”

  “I think it’s about a hundred,” Lori said, taking her stethoscope from the woman’s pregnant belly. “Strong and
regular, though,” she added.

  The baby’s heart rate was a little slow, but it was there, and that was something to be thankful for. I knew Thad was right—we needed to act quickly.

  I began to examine her, making sure that the endotracheal tube was in the right position and that her breath sounds were normal. Then I checked her pupils. They were completely blown—as big as dimes, and unreactive to light. As I began to check the back of her head, Denton said, “There’s a fair amount of her brains on Cherry Road.”

  Thad Baxter was stunned by this statement and looked back over his shoulder at the paramedic. He had moved over to the counter and was putting on some surgical gloves. One fell to the floor.

  “Here,” Lori said, handing him another pair.

  The back of the woman’s head was crushed, and there were large pieces of skull missing.

  The obstetrician snapped his gloves in place, picked up a scalpel from the surgical tray, then turned to me and asked, “Does this woman have any chance?”

  I looked down at her and then up into his eyes.

  “No. None.”

  He stepped over to the side of the stretcher and completely exposed her abdomen. Denton’s partner didn’t miss a beat and kept doing his chest compressions.

  “I’m going to hand you a baby in about two seconds, Robert,” Thad told me. “So be ready.”

  Then without any hesitation he made an incision from just below her breastbone down to her pubis. There was very little bleeding, and the purplish mass of her uterus seemed to float up to us.

  Another quick incision, and there was an arm and then a face.

  Thad scooped the baby out of the uterus and handed a little boy to me. He was dusky, limp, and not making any effort to breathe.

  “Hand me some surgical pads and some…”

  Thad caught himself, and fell silent. This was no routine C-section, and he wouldn’t be doing anything further for this baby’s mother.

  Jamey looked over at me and I nodded. He stopped doing his CPR, took a deep breath, and leaned heavily against the side of the stretcher.

  “Let me know if I can help,” Thad said to me, stepping close and looking over my shoulder.

  “Lori, leave me some room with that umbilical cord in case we need to start a line,” I said.

  The nurse was getting ready to clamp the cord and then cut it. Sliding the clamp down another inch or so, she stopped and glanced up at me.

  “That’s fine,” I told her, toweling off the boy, trying to stimulate him. We had already sucked out his airway and this hadn’t elicited any reflex response. He was still dusky, and he had no muscle tone. But his heart rate was still around 100. There was still hope.

  Suddenly his mouth opened and his eyes scrunched tightly closed. His hands came up toward us and he took a breath. We waited for what seemed an eternity, none of us breathing. And then he started. At first, his cries were feeble, almost tentative. But then he got mad and started hollering. His color quickly improved and he started kicking his legs.

  “You go, boy!” Denton encouraged him from the foot of the stretcher. I looked up at Lori and saw tears running down her face.

  Thad put his hand on my shoulder and said, “Well, will you look at that.”

  While we celebrated this miracle, relieved and emotionally exhausted, his mother lay only a few feet away, dead.

  Denton told us what had happened out on Cherry Road. And it was only then that we learned the woman’s name was Nicki Tyler. She had been at the grocery store with a friend, when her water broke.

  Nicki had a four-year-old daughter, and she knew what to do.

  “Let me drive you to the hospital,” her friend had volunteered.

  But Nicki insisted she would be fine, and if her friend wanted to follow her, that would be great.

  At the scene of the accident, Nicki’s friend had told Denton what she had witnessed. She had been directly behind Nicki the whole time and had seen everything.

  “It was like slow motion,” she had said. “I knew what was going to happen, but I couldn’t do anything to stop it.”

  She told Denton that Nicki was a very careful driver and always wore her seatbelt.

  “Her belly must have been hurting after her water broke,” she had surmised. “Maybe she was having contractions, ’cause I saw her take off her belt when we stopped at one of the red lights. Then we drove on down Cherry Road and when we came to the next intersection, the light was red and I started slowing down. But Nicki didn’t. It was as if she didn’t see it or was looking somewhere else, but she just went straight through it. That’s when the pickup truck T-boned her from the passenger side and her door busted open and she went flying through the air. It was awful, just like I said, slow motion…and I couldn’t do anything to help her. She landed on the back of her head and bounced a couple of times, then just lay there in the middle of the road. I…I didn’t know what to do.”

  It made sense now. This explained the head injury and the lack of any other obvious trauma. Thankfully she wouldn’t have known anything once she hit the pavement.

  I was standing by the stretcher, looking down at Nicki’s face. Lori had put a fresh pillow under her head and covered her body with a clean sheet. She looked peaceful, almost as if she were sleeping.

  Now Lori was swaddling the baby in a warming blanket over his loud and persistent objections. He was going to be fine and in a few minutes would be taken up to pediatrics.

  “Her husband should be out front any time now,” Lori said quietly, not looking up at me.

  I knew I had to do this, but I had never been in this situation before. How was I going to tell him about his wife?

  I stepped over to the door, opened it, and looked back once more at Nicki Tyler and her son. This time Lori looked up at me and smiled. It was a mixture of sadness and encouragement, and it was what I needed. I stepped out into the hallway, closed the trauma room door behind me, and immediately froze.

  There in front of the nurses’ station was a young man, leaning over the counter a little and talking to Amy Connors. Standing by his right side was a little girl. One of her hands clutched her father’s pants leg, while the thumb of her other was in her mouth.

  With her large, brown, unblinking eyes, she was looking straight at me.

  9

  Hoodooed

  6:58 a.m. Liz Kennick was standing at the nurses’ station writing on a chart and shaking her head. She was upset about something.

  Angie Weathers was sitting at the desk beside Amy as I walked up. She caught my eye and shook her head mysteriously. What was going on?

  “Okay, time for you to go home,” I said to Liz, trying to be cheerful. “Anything to turn over?”

  She signed her name to the bottom of the chart and then threw her pen down on the counter.

  “This guy—” she said, spitting out the words and jabbing the paper in front of her with her index finger. “This guy did a number on me!”

  The clipboard was for room 2, and I looked across the nurses’ station to that cubicle. The curtain was drawn open and the room was empty.

  Amy looked up at me, then rolled her eyes just a bit. She was trying hard not to smile.

  “He did what?” I asked her, leaning closer to the counter and reading the record in front of her. The patient’s name was James Wiley III, and he was twenty-eight years old. “Chest pain, fever, and cancer,” was the listed complaint.

  “He worked me over, Robert,” Liz answered angrily. “And I don’t like it.”

  This sounded interesting, and I couldn’t resist. “Tell me about it,” I encouraged her.

  This time Amy put her hand to her mouth and swiveled around in her chair with her back to us.

  Liz apparently didn’t notice this, and she began to tell me the story of James Wiley III.

  “This guy came in a couple of hours ago, maybe four or four-thirty. We were still pretty busy and Angie brought him back from triage and put him in room 2. ‘Nothing urgent,’ she told
me, so I kept working with my other patients.”

  I glanced down at Angie. She raised her eyebrows and nodded her head in agreement.

  “I got to him about twenty minutes later,” Liz continued. “When I went in the room, he was sort of clutching his chest and rocking back and forth on the stretcher. It seemed like he was in a lot of pain. He got down and started pacing the floor and really had me worried. Then he proceeded to tell me about his medical history. A few years earlier, he had been diagnosed with some kind of lymphoma. He showed me a scar on his chest where he said the doctors at Johns Hopkins had done a biopsy to determine the extent of his disease.”

  She paused for a moment and her eyes narrowed. “I should have suspected something then!” she exclaimed. “I didn’t look closely at the scar—he just raised his shirt for a split second and pointed to it and then pulled his shirt back down. But now that I think about it, that wasn’t a very likely location for a biopsy. I should have known.

  “Anyway, he told me he had been in remission for a year or two and had done well up until three months ago. The lymphoma had come back and was in his chest, pressing on blood vessels and nerves and causing a lot of pain. That’s when he first asked me for some oxycodone.”

  “That should have been the tip-off,” Amy muttered.

  Liz shot her an icy glare and then looked back over at me.

  “This guy had a folder full of medical records,” she continued to explain. “And when I took a look at some of them, they seemed to support his story. All he needed was just enough pain medicine to make it back home to Tennessee, to his oncologist. It was just going to be a few days and…well…”

  “Let me guess,” I interjected. “He’s allergic to every drug known to man except oxycodone. Am I right?”