He stopped talking and his face got red again.
“What happened?” I asked him, confused. “Why did she—”
“Robert,” he interrupted me. “I looked down in that cart, and there sat Adelle, big as life. She was smiling and looking around, and… and…”
My mouth dropped open and I was speechless.
“I just stood there and stared at the two of them,” he told me, calmer now. “I couldn’t say anything, and Charlene just kept backing down that aisle, then turned a corner and disappeared. She never said a word.”
Hoodooed—all the way around.
10
Lost
It was several days after our meeting with Walter Stevens before I had a chance to talk with Lori Davidson. It was a little after seven in the morning, and I was washing my hands in the medicine room when she walked in.
“Lori, have you got a second?” I asked her, drying my hands on some paper towels.
“Sure. Just getting some Rocephin for the child in room 2,” she answered. She put down the chart in her hand, took a key chain out of her pocket, and unlocked one of the drug cabinets. We kept our injectable medicines, such as antibiotics and nausea drugs, locked up in a floor-to-ceiling cabinet. Beside that cabinet was the narcotic storage container. It was double-locked, requiring two different keys to open.
“You’re the one who found the missing Vistaril,” I began. “And I’m sure you know about the unaccounted-for narcotics.”
She stopped and looked at me, her key still in the cabinet lock.
“Yes, I do,” she answered, her voice serious and subdued. There was a frown on her face, something unusual for Lori.
“Does any of this make sense to you?” I asked her. “I mean, I don’t know who in this department would be messing with the narcotics. It would have to be someone with access to the keys, and even then… they’d have to be pretty brazen to be getting stuff out of the cabinet in plain sight, don’t you think?”
She sighed and shook her head. “I’ve been thinking a lot about this, Dr. Lesslie. And I’ve started watching different people, and wondering…I just can’t imagine any of our staff doing this.”
“You know about the Demerol vials,” I continued. “I’ve never seen anything like that. Walter Stevens showed me that box the other day, and I couldn’t believe it.”
“Walter Stevens,” Lori muttered, in a tone as close to disgust as I had ever heard from her. “He’s on some kind of a crusade, it seems. And if I hear about his bus one more time, I think I’ll explode.”
“His ‘bus’?” I asked her, confused. “What are you talking about?”
“I’ve been in a few meetings with him, and he always talks about ‘the bus.’ He compares the hospital to a big bus, and he talks about making sure the right people are on the bus and in the right seats. And if they don’t need to be on the bus, or shouldn’t be on it—well, he’s going to make sure they get off. I’m sure he just wants the hospital to be the best it can be, but sometimes he seems a little obsessive.”
It sounded like some kind of management style he had learned in business school, but I had never heard him mention it.
“He’s determined to solve this problem and have someone prosecuted,” Lori added. “I hope it’s not all about making himself look good, because somebody out there is in trouble and needs our help.”
I thought about this for a moment, realizing Lori’s perspective had been lost on me. Like Stevens, I wanted this figured out, and quickly. And I hadn’t considered this point of view, that whoever was doing this might have a real problem and need our assistance. Lori was right, but the first thing was to find out who this person was—maybe persons. Whoa—that was something else I hadn’t considered.
“And this idea of Mr. Stevens that someone is selling these drugs,” she continued, shaking her head. “That’s crazy. I think someone is stealing the stuff and using it themselves, as bad as that sounds.”
“I think you’re right,” I said. “I tried to tell Stevens that the small amount of missing drugs wouldn’t add up to very much on the street, certainly not enough to be worth the risk of losing your job. He just wouldn’t listen. But you know, before that meeting with Virginia and him, I was hoping this was all some mistake, some counting or documentation error. And then there was that box of Demerol. That’s no counting error.”
I tossed the paper towels in the trash can and was about to say something else, when Lori glanced at the door and quietly said, “I need to show you something.”
She took the key out of the antibiotic cabinet, sorted through the chain for another pair of keys, and opened the narcotics cabinet. There were several boxes of medication, just like the Demerol container, and she reached for one in the back of one of the shelves.
“I found this when I first came in,” she said, handing it to me. “Darren Adler worked last night, and he did the drug count with me. I didn’t say anything to him, because I don’t know who all knows about this. I was going to bring Ms. Granger in here just as soon as I took care of the child in room 2.”
I knew where to look this time, and I turned the box upside down. The plastic wrapper was still in place, but once again, there were several small holes in the bottom. I counted five, evenly spaced, just like before.
Shaking my head, I handed the Demerol back to Lori.
“I wonder if this could be dusted for prints,” I thought aloud.
“I was thinking the same thing,” she agreed. “But then I thought about how many people have handled this. There’s whoever delivered it to the hospital, and the people in the pharmacy—and every time we count the narcotics somebody picks it up. And now there’s you,” she added, smiling.
“Hmm…” I murmured, looking down at my hands. “Well, I guess that’s not going to help. But I agree, you need to let Virginia know. This is worse than I thought. Maybe the three of us can talk about it later.”
“What about Walter Stevens?” she asked, her frown returning. “Do you think he needs to know about this?”
“I wouldn’t tell him, Lori,” I said. “He’s got enough information to run with, it seems. But I’d let Virginia make that call.”
“You’re right,” she agreed, putting the Demerol back in the cabinet and double-locking the doors.
“Do you have any idea who might be doing this?” I pursued. “Any unusual behavior or strange activity? ’Cause I haven’t.”
“I haven’t either,” she spoke quietly, slowly shaking her head and studying the floor. Then she looked up at me and said, “But I’m paying more attention now. And if someone is using this stuff, it’s only a matter of time before they slip up, or do something stupid, or worse.”
Again she was right, And I was worried about the “or worse” part.
“I will be too,” I told her, stepping toward the doorway. “And if you see something, or find more punctured boxes of Demerol, let me know.”
I left her in the medicine room with the chart of room 2 and walked over to the nurses’ station, deep in thought and a little confused—and very troubled.
8:30 a.m. I didn’t know if Lori had had a chance to talk with Virginia, but I hadn’t. A few minutes after I walked out of the medicine room the floodgates had opened. There was a minor school bus accident out on highway 21, and EMS had brought in a dozen or so kids to be examined. Fortunately no one was really injured, but they all needed to be checked over.
And then we had a construction worker who fell off some scaffolding at his work site. He ended up being diagnosed with fractures of both heels. That wasn’t a life threatening injury, but it was a life-changing one. He would never walk the same and would probably always have pain in those feet. It happens so fast.
“Here, Amy,” I said, sliding the chart of this patient across the counter. “We need to get in touch with ortho and make sure they see him as soon as possible.”
“Sure,” she answered, picking up the chart and putting it on top of the pile beside her. “Just as
soon as I get some of these schoolkids straightened out.”
The ambulance doors burst open and a man who looked about thirty ran into the department.
“Help me!” he yelled. “Somebody help me!”
He was carrying a little girl in his arms, and as he looked around the ER for assistance, her arms and legs flopped lifelessly. She didn’t appear to be breathing.
He was panicking, twisting from side to side, taking a step in one direction and then another. I hurried over to him and took the child from his arms.
“Follow me,” I directed him, heading to the cardiac room. Jeff Ryan was a couple of steps ahead of me and I called to him, “We need an airway tray!” He didn’t need to respond, but I saw his head nod as he disappeared into the room.
“Amy, call radiology,” I ordered over my shoulder. “And get the lab down here. And respiratory therapy,” I added.
I took a look down at the little girl. She couldn’t have been older than three, and her color was terrible. She was a dark blue and hung like a wet towel in my arms. It was then I noticed the mucus coming out of her nose and a foamy substance coming from her mouth. And I was right—she wasn’t breathing.
“We’ll need suction,” I told Jeff as I carefully placed her on our stretcher.
“Right here,” he said, handing me the suction catheter, then turning to flip its switch on the wall behind him.
I cleared as much of the mucus from her nose and mouth as I could, and within another thirty seconds we had her airway secured with an endotracheal tube.
One of our respiratory therapists had just walked into the room and over to where I stood.
“Here, let me do that,” he said, taking the ambu bag and beginning to rhythmically inflate the girl’s chest.
“Thanks,” I told him, leaning down and placing my stethoscope on her chest, first on one side and then the other.
“That’s good,” I said. “She sounds wet, but we’re getting good breath sounds on both sides.”
Jeff had attached cardiac electrodes to her chest and now flipped on the monitor. At first there was just some chaotic activity, nothing that looked like any purposeful electrical impulses. But after a few seconds, we began to see some narrow, regular complexes—about thirty or forty a minute. That was slow and wouldn’t sustain her for very long. I hoped that providing oxygen to her lungs would fix that, and that her heart rate would quickly come up to where it should be—some place over 100.
The man who had brought the little girl had been standing quietly in a corner of the room. I assumed he was her father, and I turned to him and asked, “Is this your daughter?”
“Yes, it is,” he answered, barely audible. “Trish. Her name is Trish.” He was wringing his hands and I noticed how flushed he was. He was sweating, and his soiled T-shirt was plastered to his chest. I looked down and saw his blue jeans and grass-stained sneakers. He must have been working outside earlier this morning, maybe mowing grass.
“Can you tell us what happened?” I asked him.
Behind me, the radiology tech wheeled her portable machine into the room and beside the stretcher. She would be getting a chest X-ray to check on tube placement and for anything that might be going on in this little girl’s chest. The lab tech was drawing blood from her right elbow and Jeff was starting an IV in her left arm. It was controlled chaos, and there was a lot of noise. I stepped closer to the man so I could hear him.
He continued to wring his hands, and his eyes darted from place to place around the room, then focused back on his daughter.
He didn’t look up at me when I repeated, “Can you tell us what happened?”
“I was out in the yard, working…” he stammered. “I was just…I never thought it would…”
I leaned closer, trying to make out what he was saying.
“You were what?” I tried again.
“Dr. Lesslie,” Jeff called out to me. “Heart rate’s less than 30 and I don’t feel much of a pulse.”
I turned from the man and stepped back to the stretcher and the little girl. Her color might have been a little better, but she still wasn’t responding or making any effort to breathe. I looked over at the monitor. Jeff was right. Her heart rate was still dangerously slow. But why? With most kids, when you took care of their breathing, their heart rate would fix itself and improve. What was going on here?
“Look at her pupils,” Jeff said to me. He had raised both of her eyelids and was shining a flashlight into one and then the other. They were pinpoint and didn’t react to light. When the lids wouldn’t shut on their own, Jeff gently closed them.
“What do you make of that?” he asked me, searching my face for an answer. I wasn’t sure. Lack of oxygen usually makes a person’s pupils dilate, not constrict.
I was about to answer him when the X-ray tech came back into the room with the developed film and said, “Dr. Lesslie, you’ll want to look at this.”
She walked over to the view box, snapped the X-ray in place, then switched on the light.
As I quickly stepped across the room, I could tell from a distance that the endotracheal tube was in good position and where it should be. But as I got closer, I could see something was wrong—very wrong.
Her lungs were almost whited-out—full of fluid. It was the kind of chest X-ray you would expect to see in an elderly patient with end-stage heart failure. But her heart size was normal. What would—
I spun around and called out to Jeff, “Give her an amp of atropine! And then get ready for some more. She’s going to need a lot of it.”
Turning in the direction of the girl’s father, I walked over and got right in his face. “What were you trying to tell me?” I asked him, more forcefully now. I needed answers, and I needed them fast. “What were you doing out in your yard? And what was Trish doing?”
His eyes were glassy now, vacant. And he kept wringing his hands and sweating.
“We’ve got those army worms,” he said in a hoarse whisper. “They’ve killed most of the lawns in our neighborhood, and I was just trying to save ours. I didn’t think it would…” his voice trailed off and he just stared over at Trish.
“You didn’t think what?” I demanded, trying to get his attention. “Were you using some kind of insecticide? Some kind of poison?”
“Sevin,” he answered, almost mouthing the word. “The man at the hardware store told me to use Sevin dust. I was spreading it in the front yard and I…I wasn’t paying attention. There was a breeze blowing in my face, and no dust was getting on me. I just kept spreading it…and… and I didn’t know Trish had come out of the house and was walking behind me. I didn’t know…”
He stopped wringing his hands and tightly clutched both sides of his face. Then he started crying and rocking from side to side.
“She was lying on the grass,” he struggled between pain-filled gasps. “And there was dust all over her face and mouth and nose. And she was barely breathing. I grabbed her and jumped in the car and came straight here.”
He suddenly stopped, stood up straight, and started looking around the room.
“Where’s my wife?” he called out. “Where’s Fay?”
“Heart rate’s still around 40,” Jeff called out to me. “More atropine?”
I glanced at the monitor and then back to the man in front of me.
“Have a seat here,” I gently instructed him, guiding him to another stool in the far corner of the room. Then motioning to one of our techs, I said, “Stay here with him and try to keep him calm.”
Satisfied that he was being taken care of, I stepped back over to the side of the stretcher.
“Jeff, we need to get Amy to call the pharmacy for some 2-PAM. They’ll know what it is, and we’ll figure out a dose when we get it.”
Atropine was the first drug to be used for this poisoning, but 2-PAM was a more specific antidote. She might need a lot of it if she was going to make it out of the ER.
For the next hour and a half, we worked feverishly to save Trish. We
were battling a potent enemy, and it looked like we were losing. Sevin belongs to a group of chemicals that are very effective in killing harmful insects. But in heavy doses they are also harmful to humans, especially children. They cause nausea and vomiting, muscle spasms, increased secretions, and a slow heart rate. Seizures and death can occur, especially in the very young, like Trish. Fortunately, the treatment is centered around the use of a couple of readily available compounds.
After two or three adult-sized doses of atropine, her heart rate got as high as 96 and she had a detectable blood pressure. We used the 2-PAM and things began to stabilize a little. She even began to make some purposeful movements with her arms and hands.
Her father (we found out his name was John Sessions) continued to sit on his stool in the corner of the room, staring blankly at his daughter. He didn’t get up when his wife, Fay, came into cardiac.
She immediately ran over to the stretcher and tried to hug her daughter, screaming her name and resisting Jeff as he gently kept her from disrupting our efforts. She finally calmed down when she was able to stand by the head of the bed and stroke Trish’s hair.
“I’m here, baby,” she whispered over and over.
Occasionally she would turn around and look at her husband, searching for answers and some support—anything from him. There was never a response. He just sat there, staring at the stretcher, his hands tightly clasping his knees.
By eleven o’clock we had done all we could in the ER, and Trish was on her way up to the pediatric ICU. She was stable, as far as her heart rate and blood pressure were concerned, and she was starting to make some efforts at breathing. But she continued to be mostly unresponsive, showing only the occasional movement of her hands. She didn’t respond to pain and her pupils still didn’t react to light, though they were larger now. We would just have to wait and see. It was a matter of time, and it was out of our hands.
Angels on the Night Shift Page 11