Code Blue

by Richard MD Mabry

  "I guess the first people we need to subpoena are the ones who might have had access to the prescription." Cathy flipped several pages and found the chart she'd made. "Here's the list."

  Will came around and read aloud over her shoulder."Milton and Gail Nix. The two pharmacists: Jacob Collins and Lloyd Allen. Anyone else?"

  "Not really. And I don't see Mr. Nix playing fast and loose with his own heart medicine."

  "We're working on the premise that it was done to hurt you. Who in this group doesn't like you?"

  "How about asking if there's anybody in town who does like me?" Cathy heard the self-pity in her voice and hated it."I thought Milton Nix wanted me to do well enough in my practice to pay offmy note at the bank." She gave a sarcastic laugh. "But now he's suing me."

  "Any problems with Gail Nix?"

  "Not that I know of."

  "Lloyd?"

  "No."

  "Jacob?"

  Cathy recalled her last conversation with the pharmacy owner. He'd seemed a bit too pleased when he had said, "I suspect it will be an important piece of evidence in the near future."

  The hairs on the back of her neck bristled. "Yes, I think Jacob has to be a suspect."

  9

  CATHY WATCHED JANE ESCORT THE MORNING'S LAST PATIENT TO THE front and begin the checkout process. Ten o'clock and she was through for the morning. At this rate, she wondered how much longer she could maintain her practice.

  She slumped down behind her desk and brushed her hair out of her eyes. Might as well tackle some more of the paper-work that never seemed to end. Cathy had just added her signature to the last insurance form when Jane tiptoed in with a bulging manila folder.

  "Here are the checks for you to sign." Jane's sad eyes conveyed a message that was confirmed when Cathy opened the folder.

  She thumbed through the checks: withholding tax, answering service, cell phone, office phone, supplies, rent, Jane's salary. The check on the bottom of the stack was the monthly salary Cathy had allotted herself—not much— just enough to cover her living expenses. Then she looked at the adding machine tape clipped to the front of the folder and compared it with her bank balance. She shoved the last check across the desk. "Here, rewrite this check for half that amount."

  Jane shook her head. "This is the second month in a row that you've reduced your salary check."

  "I knew going in that it would take some time to get the practice on a good financial footing. Eventually my practice will grow. Someday those insurance claim checks will start coming in. In the meantime, the boss is the last person to get paid. That's simply the way it is."

  Cathy picked up her pen and signed the top check in the stack. She looked up when she heard the office door open."Jane, do we have someone else coming in this morning?"

  "Not until after lunch. Let me check."

  Cathy couldn't quite hear the mumbled conversation in the waiting room. In a couple of minutes, just as she signed the last check, she heard Jane's voice again.

  "Come on in here and lie down. I'll get the doctor."

  Cathy was out of her chair in time to meet Jane in the hall. "What's going on?"

  "Mr. Phillips. Severe chest pain, difficulty breathing.Sweating and weak. Probably having that MI we predicted."

  "Let's see."

  Phillips lay on the examination table, his complexion as pale as the sheet beneath him. Large drops of sweat dotted his forehead. His coat lay rumpled on the floor. He'd loosened his tie and unbuttoned the top buttons of his shirt, but his chest heaved as he struggled for air.

  Cathy rolled the portable oxygen tank out of the corner, turned the valve to start the flow, and cinched the plastic mask over Phillips's face. "Jane, give him an aspirin to chew and swallow. Then call 911. We need them here—fast. After that, call the hospital and alert them that we're coming in."

  While Jane gave Phillips the aspirin, Cathy slipped a blood pressure cuffon his arm. His pressure was 116 over 70.Down from his previously high pressure, but not in shock— yet. Pulse 84 and a bit thready. Just what she'd expect with a myocardial infarction. She pulled the man's shirt open the rest of the way and applied her stethoscope to his bare chest.She frowned at what she heard: S3, a third heart sound. A classic sign of an early MI.

  "Mr. Phillips, I think you're having a heart attack." She applied the leads for an EKG as she talked. "I'll check an electrocardiogram to see how severe it is. We'll transfer you to the hospital as soon as the paramedics get here. Are you with me?"

  Phillips nodded weakly but did not speak. The muscles in his temple were knotted, and Cathy could hear his teeth grinding.

  Jane bustled in. "EMTs are on their way."

  "Give him a nitroglycerine to hold under his tongue."Cathy's eyes never left the EKG tracing. Rhythm stable.Slight ST segment elevation. A few isolated T waves flipped.Still early, probably no damage to the heart muscle yet—if she worked fast.

  She hurried to get an IV going before his pressure dropped more and all his veins collapsed. When she had it running, she said, "Mr. Phillips, I'm putting some medicine into your IV."

  "Whatever you say, Doc."

  "Jane, add a vial of atenolol into a small IV bag, and I'll piggy-back it onto this one."

  Phillips's color was better now. What else? Oxygen.Aspirin to slow down clot formation in his coronaries. Nitro for pain relief. Beta-blocker. The next step was an angiogram, but where was the ambulance?

  She fixed her eyes on the EKG. No change. Good.

  Sirens screamed in the parking lot, and in less than a minute, two paramedics wheeled a gurney into the treatment room. "What've we got, Doc?"

  Cathy recognized the lead EMT as one of the team that responded after her accident. "Acute MI, Mark. Let's get him to the hospital right away. I'll ride with him."

  Phillips plucked weakly at her sleeve. "Doc?" His voice was barely audible.

  "I'm right here, Mr. Phillips. I'll ride to the hospital with you and turn you over to the specialists there."

  "Whatever you say. But I want you around too." He swallowed hard. "And thanks."

  Cathy stuffed her white coat into the laundry hamper."Jane, I'm gone. I'll have my cell phone on if I'm needed."

  "How's Mr. Phillips?" Jane called from her desk.

  "He's doing well. I saw him this morning on rounds."

  Cathy reached into the workroom refrigerator and popped the top on a Diet Coke. After two deep swallows, she held it against her forehead and leaned against the wall.

  Jane appeared in the doorway, took one look at her boss, and opened the cabinet above the sink. She pulled down a bottle and held it out to Cathy. "Would you like some Tylenol?"

  Cathy shook her head. "Had some earlier. I'll be fine.Stop worrying about me."

  "Someone has to. Now tell me about our star patient."

  Cathy leaned back against the cabinet. "Dr. Rosenberg did a cardiac cath yesterday. Fifty percent blockage of the left anterior descending coronary artery. He did a balloon angioplasty and put in a stent. Phillips should go home soon."

  "Who'll do the follow-up care?"

  "Dr. Baker was the internist on call. He saw Mr. Phillips with me in the ER."

  Jane snorted. "So he's stealing your patient. You know you're qualified to take care of post-MI patients."

  Cathy shook her head. "It's been the practice here that myocardial infarctions are the province of the internists.Family practice docs diagnose them, give the patients acute care, and get them in the hands of the specialist. After Phillips is stable, Evan will send him back to me. Or not."She rolled her eyes. "Maybe I should settle for doing what all the other GPs before me have done." But she knew in her heart that she couldn't be satisfied with that. She'd worked too hard.

  In the parking lot, she climbed into the little Chevy and buckled her seat belt. As she backed out of her reserved slot, Cathy pictured her Toyota resting with dozens of other junked cars, consigned to the scrap heap after serving her so faithfully. As she wheeled out onto the road, she looke
d carefully in all directions. No black SUV in sight.

  Will was scheduled to come over tonight for another working dinner. Cathy smiled to herself as she remembered the sight of Will Kennedy, a bouquet in his hand, like a teenager calling on his first date. She might not have been prepared for him on that last visit, but this time she'd be ready. Cathy steered a course for the grocery store, her mind already turning over the choices of what she could prepare.

  She was in the frozen food aisle when she saw a familiar face. Might as well try to make nice. "Sherri. Hi. How are you?"

  Sherri Collins looked up from her shopping list. "Hello, Cathy. Or I guess I should say, Dr. Sewell."

  "Cathy's fine. How are things?"

  "Well—" The ring of her cell phone spared Sherri from what was obviously uncomfortable small talk. She gestured an apology to Cathy, answered the call, and moved away.

  Cathy hurried through the rest of her shopping, loaded her groceries, and drove off, still wondering if she'd made the right decision in returning to her hometown. She'd thought it might be a safe haven, a welcoming place, after her world had crashed around her. But it appeared that small towns had long memories, including at least one that made Cathy unwelcome. She forced the problem from her mind and concentrated on her driving.

  As she approached the next intersection, a black SUV shot out of a side street directly into her path. Cathy stood on the brake pedal. Her car immediately skidded to the right. A lesson from Driver's Ed flashed across her mind: steer into the skid. Still braking as hard as she could, she pulled the wheel to the right. She felt a massive bump and heard a loud bang. The car rocked once before coming to rest, the right front fender tilted like the bow of a sinking ship.

  Cathy closed her eyes and rested her head on the steering wheel. She felt the cold sweat that adrenaline brings. Her heart raced a mile a minute. Deep breathing didn't seem to help. How much of this could she take?

  When she heard an insistent tapping on her window, Cathy finally raised her head. A man stood outside her door, wearing a worried expression. She pressed the button to lower the driver's side window.

  "Ma'am, are you all right?"

  She made a tentative inventory of her body parts.Everything seemed to move. No blood anywhere. "I think so. Did you see what happened?"

  "Sure did. They pulled out right in front of you. Good thing you swerved." He peered over the hood. "I'll check and see, but it looks to me like you hit the curb hard enough to blow out a tire. Probably bent the wheel too."

  Cathy pulled her cell phone from her purse and thought of the calls she needed to make: insurance company, wrecker . . . It seemed like there was something else, but her addled brain refused to cooperate.

  Her insurance agent seemed shocked by yet another accident but remained professional enough to assure Cathy that this time she was covered. He asked for details, but she was able to beg offby promising to furnish a full report tomorrow.Right now she wanted to get home.

  The service manager at the dealership where she'd bought the car was sympathetic and helpful. He promised to dispatch a wrecker right away. If she'd ride back to the shop with the driver, he'd have a rental car waiting for her.

  "How long do you think it will take you to do the repair?" Cathy asked.

  "A day, two at the most. That is, if the frame isn't bent.Then it's a whole different ballgame."

  Two hours later, Cathy climbed the stairs to her garage apartment, weary and punch-drunk. She dropped her purse and briefcase on the sofa, pulled a soft drink from the refrigerator, and ran a hot bath. She was still soaking in the tub, half asleep, when she heard knocking at her door. She tried to block out the sound, but whoever it was seemed to have more resolve to knock than Cathy had to ignore the noise.

  "What now?" she muttered. She eased out of the tub, slipped into a terry-cloth robe, and padded to the door. "Who is it?"

  "Will."

  Oh, no! Not again. How could she possibly have let this happen? Will would think she was an absolute airhead. She'd fought against the stereotype of dumb blondes all her adult life. Now she seemed to have become a prototype.

  Cathy belted her robe tighter before she opened the door and gestured him in. "Will, I'm really, truly sorry. I was all set to cook for you, really I was, but then I had an accident on the way home. When I finally got here, I just collapsed."

  Will dropped his briefcase beside the door and took her by the shoulders. "Are you all right?"

  "Just sore and shaken up." Then it struck her. Her groceries were now sitting in the body shop of the Chevrolet dealership. "Give me a few minutes to get dressed, and I'll find something in the freezer that I can cook."

  "Never mind dinner," Will said. "Tell me what happened.Are you sure you're not hurt?"

  "Will, I'm fine. Really I am."

  "Then get dressed, and I'll take you out to eat. Someplace quiet, where you can tell me all about it. You need to relax."

  The prospect of having someone else cook sounded wonderful to Cathy. "Okay, but I owe you a dinner. I want you to include the cost of this meal with your expenses for my case."

  Will seemed to think that over. She noticed that he still had his hands on her shoulders. He'd made no move to release her, and she hadn't felt inclined to step away. Finally, he said, "I guess that depends on whether the dinner this evening is business or pleasure."

  "I thought it was business. What would make it pleasure?"

  "This."

  She watched him move closer to her, felt his lips on hers.His hands moved to encircle her in an embrace that made the years drop away.

  "Cathy, I want us to pick up where we left off," he said. "I've missed you. When I heard you were engaged, it was like someone I loved had died. And now that you're back here and you're free, I don't intend to let you get away from me."

  She looked up at him, into those blue eyes that had always seemed able to read her thoughts. Part of her—a big part of her—wanted to stay in those strong arms forever. But she had to be honest.

  "Will, I can't make a commitment. Right now my life is a shambles. I'm teetering on a knife-edge, doing my best to maintain my balance. I don't know who to trust. Not even—."

  No, she couldn't voice that fear, not to Will. Especially not to Will.

  She decided to take a different tack. "I've been through a lot since we broke up. I've put my trust in some men who've let me down." She saw him open his mouth, and she silenced him with a finger to his lips. "No, let me finish. I can't just follow my heart willy-nilly. I've got to convince my head.Can you be patient?"

  She watched the sparkle go out of his eyes, but his smile remained. "I'm willing to wait as long as it takes. But promise me you won't go running offthis time." He released her and stepped back. "Now put on something special and let's have a nice dinner." He grinned. "On me. I think this one comes under the heading of pleasure."

  Being with Will helped Cathy push her problems into the farthest corner of her mind. Over steak for him and fish for her, they talked and talked. Will brought her up to date on local gossip. Cathy was surprised how many of her high school classmates had chosen to stay in Dainger. She related stories from medical school, and Will countered with tales of law school. They lingered over coffee, but eventually—sooner than Cathy wished—they were back at her apartment.

  Will parked at the curb and turned to face her, his arm over the seat. "You don't know how much I enjoyed the evening."

  "And I had a great time being with you. It was wonderful to relax for a while. Thank you for dinner." Cathy reached for the door handle, but Will stopped her with an upraised hand.

  "It's early. Why don't I come in and we can spend an hour or so working on your malpractice case? I promise I'll be a perfect gentleman." He reached back and snagged a worn leather briefcase from the space behind him.

  Cathy hesitated. Could she keep this on a professional level? Did she want to? But they did need to start working on "the puzzle of the prescription," as she called it. "Sure.Co
me on up."

  In a few minutes Cathy joined Will at the kitchen table."I've got coffee going. It'll be ready in a minute."

  "Good. Here's where we are." Will spread a number of papers on the table. "Nix has hired Sam Lawton to represent him. I've notified your malpractice carrier that you've engaged me. I talked with the attorney they've assigned, gave him an idea of what we're doing, and he's fine so long as I keep him informed. The case has been set for trial in twelve weeks."

  She thought about that. "Can't we move it up? I don't want this hanging over me."

  "Believe me, twelve weeks is too quick to suit me. I suspect Lawton's pulled some strings to get the case scheduled this soon. I'd like to have more time. We have a lot of preparation ahead of us." He shoved a paper aside and pulled his legal pad toward him. "Now, I have to get ready to take these depositions we're scheduling. You're sure that someone tampered with that prescription?"

  "Absolutely." Cathy frowned. "But I can't prove that what's on that prescription in Jacob Collins's file isn't what I wrote. The only two people in that room were Milton Nix and me. It's his word against mine."

  Will scribbled a note. "I want to look at that prescription again now that we think we know how it was altered. I'll make sure that Jacob gets a subpoena duces tacem."

  "A what kind of subpoena?"

  "It means 'bring with.' He'll have to produce the original prescription, and we can have a closer look at it. There may be some way to prove it's a photocopy. How about the others on our list? What do they have that we need to see?"

  They spent some time discussing Milton Nix, Gail Nix, and Lloyd Allen before deciding to call it a night. Cathy had poured the last of the coffee into their cups when she heard a shuffling noise on the stairs outside. In a moment there was a timid tap on the door.

  "I wonder who that could be?"

  "One way to find out," Will said. "Shall I get it?"

  "No, I'll go." Cathy grinned. "I'm old-fashioned enough to be embarrassed by having a man in my apartment after dark. I may need to explain you away."