She cleared her throat and looked over at me. Amy turned her head and also looked at me, her eyes searching mine, the smile now gone from her face.
“You two are spookin’ me,” she said. “Why so serious? Have I done somethin’ wrong? Or has somethin’ happened to Charlie or the…”
She grabbed the arms of her chair and was about to stand up when Virginia said, “No, no, Amy. Nothing like that. Charlie and your children are fine. This has nothing to do with them.”
Amy slowly sat back down in her chair, relieved, but still confused. “Then what is this about?” she asked.
The head nurse took a deep breath and began. “I’m sure you’ve heard that we’ve had some medications missing in the department. First some noncontrolled drugs, and now narcotics.”
Amy nodded her head and said, “Yeah, I’ve heard a little about that. A couple of the nurses were talkin’ about it the other day, but what does that have to do with me? I don’t have any idea about where that stuff might have gone or who might have gotten it. I don’t know how I can help you with it.”
Virginia picked up her glasses and started cleaning them with some Kleenex.
Amy looked over at me again. When I looked away, I saw her stiffen a little.
The head nurse put her glasses back on and looked at Amy. Before she could say anything Amy exclaimed, “Wait a minute! Do you think I know somethin’ about this? I just told you I barely heard about it the other day. Nobody has told me anything!”
“Amy, it’s not that,” Virginia explained quietly, trying to calm the young secretary. “I’m afraid it’s much worse.”
The secretary slumped in her chair and stared at her.
“Worse? What do you mean ‘worse’?” she asked, stunned.
Virginia told her about our conversation with Walter Stevens, and about his being convinced that not only did our secretary know about the missing drugs, but that she was the one stealing them. I was struck once again by the absurdity of this whole idea, and yet here we were, telling Amy and confronting her with what the administration was determined to do.
When Virginia finished, Amy stood up and headed for the door.
“Amy!” I said, turning quickly. “Where are you going?”
She stopped and spun around, fixing us with a look of anger and hurt.
“I’m going right to Mr. Chalmers and set things straight!” she told us defiantly. “This is the craziest thing I’ve ever heard, and I’m not goin’ to stand for it! Dr. Lesslie, Ms. Granger, you know I’m not involved with this! How could they even begin to think I would do somethin’ like this?”
She was silent, and looked first at Virginia and then at me. Suddenly her shoulders slumped and there was a look of confusion on her face, and then there was that same hurt.
“You guys don’t…” she muttered.
Virginia jumped up from her chair and hurried over to Amy. She put an arm around her and led her back to her seat.
“Of course we don’t think you have anything to do with this,” she told her. “This came out of the clear blue at us, and we haven’t had time to think about the best way to deal with it. But we wanted to talk with you and let you know what was happening.”
“We didn’t want you to be blindsided,” I said, turning in my chair so I was facing her directly. “We’re going to figure this out, and knock some sense into Walter Stevens if we can.”
“If Charlie finds out about this, he’ll be knockin’ more than the sense out of that little jerk,” she said, trying to force a smile.
“Anyway, Amy,” Virginia continued. “If you want to take the rest of the day off, I’ll understand. We’ll get someone to cover. I’m going to leave that up to you. But whatever you decide to do, I must ask you not to mention this to anyone, not even Charlie. We’re not supposed to be telling you this, but thought you needed to know.”
“I thought you didn’t hear that part,” I needled Virginia.
“Oh hush, Dr. Lesslie,” she said, not looking at me. “But Amy, we’ve given you a lot to handle, and if you need to—”
“I’ll be fine, Ms. Granger,” the secretary said, sitting up straighter in her chair and beginning to collect herself. “I need to work, and I’ll be alright.” Then with trust and pleading in her eyes, she looked at each of us in turn and said, “But I’m counting on you guys to help me.”
After she left the office, I said, “Virginia, are you sure we don’t need to go talk with Bill Chalmers right now? I think it might do some good.”
She thought for a moment, then answered me. “I think I’ve changed my mind, Dr. Lesslie. We should wait before we talk with Bill. Let’s just let this play out. We need to see what kind of evidence Walter has, if any. Personally, I think this is a bunch of hot air, and he doesn’t have anything. His preoccupation with Amy will blow over, and then we’ll still have to find out who is doing this. I know you’re impatient to get this done with, but if we give Walter a little rope, maybe he’ll take care of hanging himself.”
“I just don’t want to see Amy get hurt any more than she already is,” I told her, not yet convinced about her change of plan. I still thought Chalmers might be able to get Stevens under control and off Amy’s back. In the end though, I yielded to Virginia’s wisdom.
“I guess we’ll wait and see what happens tomorrow,” I acquiesced.
“Yep,” was all she said.
I got up and walked to the door. My hand was on the doorknob when Virginia spoke. “Dr. Lesslie, tell me, how is Darren Adler doing?”
Turning around, I noticed the look of concern on her face. Was something going on that I didn’t know about? I told her what Ted Nivens had shared with me, about his blowing up with the nurses in the CCU. But I couldn’t think of anything else.
“Sounds like they deserved it,” she responded, her face softening a little. “Is that it?”
I thought for another minute. “No, I think he’s doing fine. He’s always on time and he makes good decisions. He’s great out in triage.”
That was one of the toughest areas to work, and if you could handle triage effectively, you could handle anything in the department.
“Hmm…” she mused.
I knew where she was going and I was conflicted. I didn’t think there was any way Darren was stealing drugs. I had known him for too many years and would never suspect him of doing something like this. He was headstrong, and sometimes that got him in trouble. But this—this was something totally different. Yet there was no way in the world it was Amy Connors. So could it be Darren? Was there a side of him I just couldn’t see? No, it had to be someone else.
“I know what you’re thinking,” she said quietly. “And I can’t imagine that Darren is involved. I just wish he were a little more laid-back, at least for the time being.”
“If that’s a suggestion, Virginia, I’ll talk with him.”
“It’s a suggestion,” she said, picking up a stack of papers, signaling the end of this conversation.
The rest of the day was uneventful, other than the awkwardness of interacting with Amy. I had to admire the way she was able to put this aside and do her job. But I knew that just under the surface her emotions were boiling. She and I were a lot alike. And I would be looking forward to my confrontation with Walter Stevens. There wouldn’t be a lot of pleasantries exchanged between the two of us.
13
Dangerous Assumptions
6:58 a.m. On the way to the hospital the next morning, my mind was spinning with what might transpire between Amy and Walter Stevens. As I walked through the ambulance entrance, I was surprised to see she wasn’t sitting behind the counter of the nurses’ station. She should have been here by now. Instead, it was Susan Everett, the night-shift secretary.
I was about to ask her about Amy, when we heard loud screaming from down the hallway.
“Ortho,” Susan said calmly. “Dr. Kennick’s in there with some guy from Chester. Sammy Hodges, twenty-seven-year-old,” she commented, looking down at
a folder. “The ER doc sent him here ’cause he couldn’t get his shoulder back in place, or somethin’ like that.”
I turned and was headed toward the orthopedic room, when Susan called out, “Oh, and Amy will be a little late this morning. She’s having trouble with her truck.”
I was greeted by another loud cry of pain as I stepped through the doorway of ortho. There, in the far corner of the room, was the source of all of this commotion.
Sammy Hodges was lying on one of the stretchers. He looked over as I approached his bed, and his eyes became big as saucers.
“Arggh!” he bellowed, thrashing around but unable to escape Liz Kennick’s attempts at putting his shoulder back in place. She had Sammy’s left wrist firmly in her grasp and was applying traction to his left shoulder. One of our male techs stood on the other side of the stretcher, fiercely gripping the ends of a sheet that was passed under Sammy’s back, under his armpit, and back over his chest. The sheet was serving as a countertraction to what Liz was doing.
The first thing that struck me was the red faces of everyone in the room. Sammy’s face was red and contorted in obvious pain. The tech’s face was also red, and he was sweating. He was a big guy and was pulling with all his strength, making sure that the patient’s torso didn’t move an inch. And there was Liz, huffing and puffing and tugging for all she was worth. She looked up at me as I approached the bed.
“Robert, this is a tough one!” she gasped.
“What have you got?” I asked her, looking over at the X-ray view box. Its light was off and there were no films hanging on it.
“The ER doc over in Chester called me a little while ago. Mr. Hodges here apparently fell and injured his left shoulder sometime during the night. He’s not sure how it happened, but he went to the ER over there and they told him he had a dislocation. They tried for about an hour to get it back in place, but couldn’t. So they sent him over here to see one of the orthopedists. I thought I’d try to get it back in before bothering one of them.”
She leaned back a little more, putting greater pressure on Sammy’s shoulder.
“Arggh!” he yelled again, looking up at me for help.
“Have you given him anything for pain?” I asked, stepping around so I could examine Sammy’s shoulder.
“Yeah, we started an IV and he’s had 5 of morphine. Doesn’t seem to have touched him, though, and I’m probably going to need to give him some more.”
“He may need a good bit more than that,” I said, gently palpating his upper arm and shoulder. He was very muscular, making it more difficult to accurately feel his landmarks. It also made it more difficult to overcome any muscle spasm and return the head of the humerus to its socket.
“Are you sure he’s still out of joint?” I asked her, puzzled because I thought I could feel the head where it was supposed to be.
“Yes,” she answered without hesitation. “It’s an anterior dislocation and it’s still out. Textbook case, with a squaring off of the shoulder and everything. I just need to keep applying traction and it should pop back in place. Would you ask one of the nurses to come back here with more morphine?”
“Sure,” I answered, heading to the door. “Did they send some films with him?” I asked, looking around again for an X-ray folder.
“Yes,” she said. “I think they’re up at the nurses’ station. Maybe behind the counter.”
“Good—I’ll be right back.”
“Arggh!” Sammy screamed again, causing me to cringe a little as I walked up the hallway.
Virginia was standing at the nurses’ station, looking over Susan’s shoulder and pointing to something in the logbook. She looked up as I walked around the counter.
“What’s going on back there?” she asked. “Sounds like someone’s having his gallbladder removed without anesthesia.”
“It does, doesn’t it?” I agreed. I told her what was going on and that I was looking for Sammy Hodges’s X-rays.
“I think they’re over there,” Susan said, spinning around in her chair and pointing to the back counter. “Dr. Kennick put them down there when he came in.”
“Thanks,” I told her, walking over and picking up the folder.
Chester County Hospital, the jacket read. Under that was Sammy’s name, date of birth, and Left shoulder—2 views.
I stepped over to the view box, took the films out of the jacket, and snapped them into place. Virginia walked up beside me as I switched on the light.
“Oh no!” I exclaimed, not believing my eyes. I grabbed the X-rays, stepped around our head nurse, and took off for the ortho room.
“What’s wrong?” Virginia called after me. “What is it?”
“It’s not what she thinks it is!” I called back to her over my shoulder.
Racing to the room and over to the stretcher, I stopped right beside Liz and said, “Hold on, and don’t pull on his shoulder anymore!”
“I’ve almost got it,” she objected. “I felt something move a little just a second ago, and I think with—”
“Don’t pull on him anymore!”
Without waiting for her to respond, I reached down and took his hand in mine. “Here, let me hold this a minute,” I told him.
Liz backed away, puzzled, and looked up at me.
“Can I let go?”
It was the tech on the other side of the stretcher. He was exhausted and breathing hard.
“Yes,” I told him. “You can let go of that sheet.”
He thankfully complied and leaned back against the wall.
“Robert, what in the world—”
“Come over here with me,” I said to her, while gently placing Sammy’s arm across his chest. “Here,” I told him. “Keep your arm just like this. I think it will feel better.”
He had closed his eyes and was nodding his head in obvious relief.
I looked up at the tech and said, “Make sure he keeps his arm just like that, okay?”
“Sure thing, Doc,” he replied.
Liz followed me over to the view box on the wall just to the right of the doorway. I put Sammy’s films up and flipped the switch.
“What do you think about that?” I asked her, intentionally not pointing out the obvious pathology.
She studied the X-rays for a moment, her eyebrows scrunched in deliberate and focused concentration. Then suddenly her eyes opened wide and she mumbled, “Oh, Lord!”
She moved a little closer, carefully studying Sammy’s shoulder joint. He didn’t have a dislocation. In fact, he had never had a dislocation. It was something altogether different.
Slowly, almost painfully, Liz’s index finger approached the view box and came to rest over Sammy’s A-C joint. That was where the problem lay. The X-rays from Chester showed a complete A-C separation, not a dislocation. The ER doc in Chester had missed it, and Liz hadn’t looked at it.
“Robert, I…” she stammered.
I didn’t say anything, but waited for her to verbalize her thoughts.
“Have I hurt this man?” she whispered, shaking her head. “I’ve been pulling hard on that shoulder, and…If I’ve made it worse, I’ll…”
“I don’t think you hurt his A-C joint any more than the initial injury,” I told her. “Or any more than the ER doc down in Chester did. But you certainly caused him more pain than he should have had.”
“Good Lord,” she continued in a hushed voice. “I need to go tell him, and apologize. I should have looked at these films first, before doing anything.”
“You’re right about that,” I agreed, not willing to let her off the hook, but also not wanting to let her beat herself up too much. She needed to learn from this, and I thought she was getting the lesson.
We walked back over to our patient’s stretcher, and I explained to him what was wrong with his shoulder and that one of the orthopedists would be coming down to see him. Then Liz apologized, a couple of times.
“It’s okay, Miss,” he told her through the haze of the additional morphine we had given hi
m. “If you weren’t so purty, I might be upset.”
As we walked up the hall, Liz asked me, “Are you sure he’s going to be alright? I didn’t cause any permanent damage, did I?”
“No,” I answered truthfully. “He’s going to be fine. He’ll need surgery, but that was true from the moment he first injured himself. The important thing here, though, is that we learn something from it.”
“I know, I know,” she said. “Never make assumptions.”
“You’re absolutely right,” I agreed. “That’s one of the main things that get ER doctors—any doctors—in trouble. When we start assuming things, we’re usually headed down the wrong road.”
“I should have looked at those films for myself,” she responded, shaking her head again. “But that doc sounded so sure of the dislocation, and it seemed like he knew what he was talking about, and—”
“And you assumed,” I interrupted.
“Yes, I assumed,” she said in resignation.
We had reached the nurses’ station and I said, “Have you got a minute, or are you too tired?”
“I’m wide awake now,” she answered, taking a deep breath and looking up at me.
“Come over here then,” I told her. “I want to tell you something.”
We walked over to the back counter, pulled up two chairs, and sat down.
“I know you need to get out of here,” I began, glancing up at the clock on the wall. “But this is important, and it’s something to learn early on. I guess the best way to make this point is to give you an example of how things can go bad.”
“I think things went pretty bad back in ortho,” she interjected. “That’s an example right there.”
“It is an example,” I agreed. “But let me tell you how things can really get twisted, and people can get hurt. Sammy’s going to do fine, but that’s not always the case.”
Liz settled in her chair, folded her arms, and looked at me expectantly.
Angels on the Night Shift Page 13