Angels on the Night Shift

by Robert D. Lesslie, M. D.

  “I’ve lost my energy,” she told me, “and don’t seem to be able to do the things I’m used to doing. I tried to run about a week ago and almost collapsed.”

  “Just so you know, Doc,” her husband interjected. “This is a woman who runs half-marathons. So something must be going on.”

  I nodded my head, impressed by this piece of information, but a little surprised because of the now-frail appearance of the young woman sitting before me. Elliott was right—something must be going on.

  I continued questioning her. After my examination I told the couple we would be checking on some labs and getting a chest X-ray.

  “We’re going to try to get to the bottom of this today,” I told them, determined to do just that.

  “Thanks, Dr. Lesslie,” Elliott said, getting up and sitting by his wife on the stretcher.

  At the nurses’ station, I studied the record in front of me and the labs that Liz and Ted had done on her first two visits. Clara Adams had room 4 today, and I asked her to get a urine specimen and draw some blood from Kim.

  “They’re nice people, aren’t they?” she said, picking up some lab slips and making some notations on them.

  “Yeah, they are,” I agreed, not looking up from the clipboard. “We just need to figure out what’s going on with her.

  “Now this is odd,” I murmured, thumbing through the pages of the record.

  “What’s odd?” Lori Davidson asked, standing on the other side of the counter.

  “Just these labs on the woman in 4,” I answered. “Liz got a CBC two days ago, and her hemoglobin was 14. Last night, when Ted checked one, it was 12. That might just be lab variation, but if her hemoglobin is falling, I don’t have a clue why. We’ll see what today’s looks like.”

  Clara walked back over to where I stood, carrying several vials of blood and a cup of Kim’s urine.

  “Take a look at this,” she said, holding the cup where I could see it.

  The urine was dark, almost muddy.

  “Did you check it for blood?” I asked her.

  “Not yet,” she answered. “I thought you would want to see it first.”

  If that was blood in her urine, it opened up a lot of possibilities. But the fact that it was dark and murky made me wonder if she was breaking down muscle from all of her running. She might be in kidney failure and on the verge of getting into real trouble.

  “Nurse!”

  Elliott Carlton was standing in the opening of room 4 and calling for help.

  “Nurse, can somebody help us?”

  Lori immediately headed to their room and disappeared behind the curtain. I finished making some notes on Kim’s chart and then quickly followed her.

  Kim was sitting on the stretcher, wrapped in a blanket and shivering. But it was more than shivering—she was shaking, and her teeth were chattering. I had never seen anything quite like it, and the contrast between this and her condition just a few minutes ago was startling.

  “What’s the matter?” I heard Lori ask her.

  “I….I…can’t get warm,” Kim stuttered, her head shaking uncontrollably.

  Lori was reaching for another blanket, when Clara walked into the room. She stopped at the foot of the bed and stared wide-eyed at our patient.

  “I’ve seen this before,” Clara murmured.

  I barely heard what she said, and turned to face her.

  “What was that?” I asked, leaning close.

  “I’ve seen this before,” she repeated. “My aunt—”

  “What about your aunt?” I asked, concerned by her reaction.

  Clara didn’t answer me, but stepped closer to Kim. “Have you been traveling anywhere?” she asked. “Anywhere out of the country?”

  “We just spent our honeymoon in Costa Rica,” Elliott answered, stepping up beside the nurse. “It was four or five weeks ago. Why? We were told it was a safe place to travel. And we only drank bottled water.”

  “It should be a safe place,” I reassured him, trying to remember some of my travel medicine. “Where did you stay in Costa Rica? What part?”

  “We stayed in a place called Quepos, on the Pacific side, and spent a lot of time in the Manuel Antonio National Park. We did some ziplining and horseback riding. But we didn’t get sick while we were there.”

  Lori draped another blanket around Kim, and her husband jumped up on the stretcher and put his arm around his quivering wife.

  “I think that part of Costa Rica is fine,” I told him. “As long as you’re careful about the water.”

  Could she have some type of hepatitis or a parasitic infection?

  None of this was fitting anything I was familiar with. I turned to Clara and was about to ask her what she was thinking when she asked, “Did you leave the Quepos area? Travel up into the mountains?”

  Elliott thought for a moment and then looked up at her with a sudden realization. “We spent two days over near Limón, on the Caribbean side of the country. But we didn’t like it much, and we headed back to Quepos. Why? Is that a problem?”

  Clara looked up at me and said, “That’s it. Kim has malaria, and she’s starting to get really sick. Her urine—that’s ‘blackwater fever.’ ”

  “Malaria?” I exclaimed. “What makes you think she has malaria?”

  “What?” Elliott cried, grabbing his wife tightly with both arms. “Did you say malaria? And ‘blackwater fever’? What in the world is that?”

  “My aunt and uncle were missionaries in eastern Africa,” Clara explained. “When they got home, my aunt became very sick, and it took the doctors a while to figure it out. But in the end, she was shaking and looking just like Kim.”

  “In the end?” Elliott said, looking down at his wife with obvious fear in his voice.

  “Not the end,” Clara said quickly, correcting herself. “She did fine once they made the diagnosis. But it took them a while. Malaria is something that’s not very common in the U.S.”

  “That’s for sure,” I agreed. “I’ve never seen a case of it. But what makes you so certain?” I asked the nurse.

  “When Mr. Carlton mentioned Limón, I remember reading that there was a fair amount of malaria on the Caribbean side of Costa Rica. Once my aunt was so sick, I wanted to find out as much as I could about the disease and where you could get it. I don’t know why that stuck in my mind, but it did.”

  “But how do we find out for sure?” Elliott asked. “And if it is malaria, how do we treat it?”

  “We’ll find out,” I told him. “And we’ll treat it.”

  Then I turned to Lori and said, “Would you get in touch with the lab and tell them I need to speak with one of the pathologists? We’re going to be ordering some blood work that’s a little out of the ordinary.”

  Two hours later, we had our diagnosis. Kim did in fact have malaria, and the most serious strain. The hospital’s infectious-disease expert was admitting her, and he reassured all of us that she was going to be all right.

  “You’re going to be in the hospital for a while,” he told the couple. “But we’ve caught this in time, and you’re going to be okay.”

  “Thanks to Clara,” Elliott said, smiling at the young nurse.

  “Yes, thanks to Clara,” I echoed, truly thankful for her help.

  She was blushing a little as she left the room and walked over to the nurses’ station.

  A little after three, Darren Adler walked up the hallway, looking for Lori and for his evening assignment. Before he could find her, Virginia called him into her office and I joined them there.

  He was sitting in front of her desk, his hands on his knees, and he nodded as I took the chair beside him.

  “What’s going on?” he asked both of us. “Am I in some kind of trouble?” He chuckled a little as he said this, then added, “It’s not the CCU nurses again, is it?”

  I glanced over at Virginia. She wasn’t smiling.

  “Darren, we need to talk about a couple of things.”

  Her voice was serious, and her
steely glance didn’t waver from his face.

  He looked over at me, the smile now gone from his face, and his legs started bouncing nervously under the edge of the desk.

  “Sure, what is it?” he asked, turning back to Virginia.

  “We’ve had more morphine missing from the narcotics cabinet,” she stated bluntly while studying his eyes for a response.

  “More missing?” he said, with a surprised look on his face. “I thought that—”

  “It wasn’t Amy,” I interrupted him, knowing where he was going and getting a little angry about it. “It was never Amy.”

  Darren looked at me and then back at Virginia, with the beginning of understanding on his face.

  “You don’t think…Wait just a minute!” he sputtered angrily. “You don’t think I have anything to do with this, do you?”

  When neither of us said anything he stood up, almost knocking his chair over.

  “I’ll tell you right now—I don’t know anything about those drugs being stolen! Not the Vistaril, or the Demerol, or the morphine! I haven’t had anything to do with any of that!” He started angrily pacing the room.

  “How did you know about the Vistaril?”

  Darren stopped abruptly and turned to Virginia. “How did I…” he stammered, his voice trailing off.

  “Only a few of us knew about the Vistaril,” she said quietly.

  He shook his head, and then with a troubled look on his face said, “I don’t know how I knew about that. Maybe Lori said something. I can’t remember.”

  The two stared at each other, locked in a painful contest.

  “Look, if you think I’m the one doing this, then just say so,” he demanded. “But I’m telling you right now, I don’t have anything to do with it. And if you want a drug screen, let’s go! I don’t have anything to worry about.”

  My mind flashed back to what Walter Stevens had said all along, that the person stealing these drugs wasn’t using them himself, but selling them. If that was the case, any drug screen done would be negative.

  “We’re going to talk with the administration about that, Darren,” Virginia said calmly. “There’s a hospital policy concerning any drug testing, and we need to be careful to follow it.”

  “I don’t care about any policy!” he shouted. “I’m ready to be tested right now! This is crazy!”

  “We’re not going to do that right now,” she told him, her voice somehow still calm and professional.

  He looked over at me.

  “Dr. Lesslie?” His voice was pleading, exasperated.

  “Darren,” I said. “Your initials were the last ones on the narcotics log right before we found that the morphine was missing. How do you expect us to explain that?”

  He looked down, staring at the floor and shaking his head.

  “Listen,” I continued. “We want to help you with this, but—”

  “Help me?” he started to shout again. “Help me? You call this help? I’m telling you, I don’t know anything about this! But here’s how you can help me—I’m going to work my shift today, ’cause I’m not going to leave you shorthanded, Ms. Granger. But I’m going to take tomorrow off. I need to think about all of this. And if you want to send the police—well, I’ll be at home.”

  Without another word, he turned and walked out of the office, slamming the door behind him.

  Virginia and I sat in silence for a few minutes, each of us deep in our own thoughts. I was confused and troubled. Had I misjudged Darren all along? Or were we still missing something, and if so, what could it possibly be?

  It was Virginia who spoke first. “What was it that Shakespeare said? Something about protesting too much?”

  She was looking at me and slowly shaking her head. Suddenly she seemed very tired, and she took off her glasses and began rubbing her eyes.

  “What now?” I asked her.

  She stared down at her desk for another moment, then put her glasses back on.

  “I’m going to sit down in the morning with Bill Chalmers.” There was resolve in her voice, but also defeat. “It’s time to give this back to him and let him handle it. We tried.”

  I didn’t like that idea, considering how the administration had botched things with Amy Connors. But what else could we do?

  “You’re right, Ms. Granger. We tried.”

  I got up and left her alone with her thoughts.

  19

  No Explanation Necessary

  6:45 a.m. The sun was just beginning to come up as I pulled into the ER parking lot. The dawn of a new day should have cheered me, but my spirit was troubled and a cloud seemed to be hanging over Rock Hill General. There wasn’t going to be any good ending to this drug business, and I knew things would never be the same. Our close-knit family had suffered a significant blow, maybe even a fracture…maybe one that couldn’t be healed.

  Darren Adler had come up to me before I’d left last night and apologized for his outburst earlier. He had even been able to admit that the narcotics logbook looked suspicious. I was glad he had, yet I had the sense he could blow again at any moment.

  “You gotta trust me, Dr. Lesslie,” he had said. “You gotta know that I don’t have anything to do with this.”

  I didn’t know any such thing, but I wanted to trust him. I had mumbled something in reply and then left for home.

  And now I wondered what this day would bring.

  I got out of my car and was halfway to the ambulance entrance, when suddenly someone blew their horn at me. Startled, I wheeled around, and there was a brand-new silver truck pulling into a parking space not twenty feet from where I stood.

  It’s Amy Connors! And she’s coming back to work!

  I waved and took a few quick steps in that direction. Then I stopped. One of our OR techs got out of the truck, slammed the door behind her, and said, “Dr. Lesslie, you’d better watch where you’re going.”

  “You’re right, Donna, I’d better,” I said, trying to hide my disappointment.

  “Looks like it’s going to be a great day,” she added, smiling and hurrying toward the staff entrance.

  “Yeah,” I muttered, knowing she couldn’t hear me. “A great day.”

  The morning started smoothly enough, with only a handful of routine cases before nine o’clock. I was coming out of room 4 when Virginia walked over, glanced at the empty major trauma room, and motioned for me to follow her.

  She flipped on the lights and stepped over to the stretcher. Curious, I followed without saying anything. I wondered if she had talked with Bill Chalmers and something was getting ready to happen.

  Virginia looked down at the chart in my hand and said, “Tell me about that man.”

  Surprised, I glanced down at room 4’s clipboard. His name was Jim Barkley and he was seventy-eight years old. He had come in with cough and a fever of 102, and he had a history of a right-sided stroke that left him unable to use his arm or leg. He could talk, but it was difficult to understand everything he said.

  I gave her that information and said, “It looks like he has pneumonia. I’ll get some blood work and an X-ray, and then he’ll probably need to be admitted. Why?”

  “Was there somebody else in the room? Did he have a friend with him?” she asked.

  “Yes, there was another man there, and I guess he was his friend,” I answered. “He helped me communicate with him when Mr. Barkley would have trouble finding the right word or didn’t seem to understand what I was saying.”

  “That would be Frank Witherspoon,” she said, nodding her head as if that was something I was supposed to know.

  I waited for her to say something else, but she just looked at me for a moment and then walked over to one of the stools near the counter. She sat down and took a deep breath.

  “Have a seat,” she told me, rolling the other stool over in my direction.

  This was really strange. I had never seen Virginia like this before, and I didn’t know what to expect next.

  Following her instruction, I
grabbed the stool and sat down.

  “Dr. Lesslie,” she began. Her voice was somehow different, and it surprised me. She was speaking quietly, but with a definite seriousness, and there was something else there. It was a gentleness, something I couldn’t remember hearing before. “Do you believe in angels?”

  I sat there, looking at this ex-military nurse, with her starched and stiff white uniform and the pointed white cap on her head. This was a woman who intimidated most of the physicians on the medical staff and who never backed down from the biggest, most belligerent troublemaker in the ER. In fact, with her feet apart and her hands on her hips, she never failed to back down all of them.

  And here she was, sitting in front of me and asking me this question. I studied her face for a moment and knew that her question was serious. And I knew she really wanted to know what I thought.

  “I do, and I think if you work in the ER long enough, you have to.”

  “You know I’m not talking about wings and harps and halos and all of that,” she replied, smiling a little. “Although I’m not ruling it out entirely.”

  She chuckled a little, and I found myself relaxing, intrigued by this conversation. We had never talked like this before.

  “Do you remember the little Carpenter girl?” she asked me. “Emmy, I think her name was. The child with the leukemia?”

  It had only been a few months, and I clearly remembered the six-year-old.

  “Yes, I was here the last time she came in,” I answered. “You were here too, if I remember correctly. It was just two days before she died.”

  “And do you remember what she told us that morning?”

  I tried to focus, struggling to remember anything Emmy might have said, something that would have stuck in my mind. But I had been busy, in and out of the room, trying to get things lined up for her admission and talking with her specialists.

  “I don’t know,” I answered finally. “I don’t remember anything unusual.”

  “Well, I was in the room with her, and she was lying on the stretcher, as calm and peaceful as always. And then she asked me if I saw them.”

  Virginia paused and put her hand to her chin. Then she took another deep breath, sighed, and went on. “I asked her. ‘Who?’ and she pointed to the end of the stretcher and said, ‘Those beautiful ladies.’ ”