The Death Shift

by Peter Elkind

  But Medical Center Hospital would reveal to Genene Jones’s prospective employers not a hint of the sinister events that had surrounded her in the ICU. Anyone who called the hospital personnel office for a reference would be told only that Genene was eligible to reapply for employment. And she was free to brandish a letter on hospital district stationery from her former supervisor—offering not warning but warm endorsement. Like the other LVNs, Jones had in March been given a letter of recommendation, signed by Pat Belko and composed with help from Virginia Mousseau.

  TO WHOM IT MAY CONCERN:

  Due to the recommendation of a recent pediatric Intensive Care Site Team Visit, the Pedi ICU Unit is being converted to an all RN Staff composition at Medical Center Hospital.

  Ms. Genene Jones, LVN, has been employed in the Pedi ICU since 1978. This move in no way reflects on her performance in the unit. She has gained valuable knowledge and experience in pediatric intensive care nursing. During the time of employment this employee has been loyal, dependable, and trustworthy.

  Ms. Genene Jones, LVN, has been an asset to the Bexar County Hospital District, and I would recommend continued employment.

  But by the time she left Medical Center Hospital, Genene Jones had already found her next permanent job. She had accepted an offer from Kathleen Holland, the third-year pediatrics resident who had testified on her behalf before the Conn committee. Dr. Holland was getting ready to start her own practice in the Texas Hill Country, in the little town of Kerrville. She would open her clinic in August 1982, and Genene had agreed to work as her office nurse.

  With Genene Jones’s departure, the rash of mysterious emergencies that plagued the ICU suddenly stopped. Things returned to normal. The young woman anesthesiologist, with help from Dr. Robotham, took over as medical director; the rehabilitated Belko, despite the pediatricians’ continuing objections, remained in charge of the nurses. As the weeks slipped by, the residents and nurses spoke less often of the children who had died so horribly without explanation. They spoke less often, too, of the LVN whose hours on duty they had come to call the Death Shift. What had taken place was becoming history, in an inexorable process that those who ran the hospital and medical school were not about to interrupt. Their problem had been solved. There was no reason for anyone ever to know their terrible secret.

  And there it might all have ended—but for the nurse, Genene Jones.

  Several months after Genene Jones had departed Medical Center Hospital, a pediatrics resident named Marisol Montes discovered in the ICU’s break room a paperback novel with Jones’s name written inside. The book was titled The Sisterhood, and the back cover detailed its plot:

  Inside Boston Doctor’s Hospital, patients are dying. No one knows why. No one but…THE SISTERHOOD. Nurses bound together in mercy. Pledged to end human suffering. Sworn to absolute secrecy. But, within the Sisterhood, evil blooms. Under the white glare of the operating room, patients survive the surgeon’s knife. Then, in the dark hollow silence of the nighttime hospital, they die. Suddenly, inexplicably, horribly. No one knows why. No one but the Sisterhood.

  PART THREE

  The Clinic

  I would have given my life for hers—Goodbye Chelsea. Jones LVN.

  Note on Chelsea McClellan’s medical chart

  Twelve

  Genene Jones’s family never heard a clear explanation of why she was leaving Medical Center Hospital. She told her mother and sister she had quit because the doctors didn’t know what they were doing; she said the physicians were under investigation. Gladys Jones was relieved to learn of her daughter’s plans to move to Kerrville. In San Antonio, Genene was always badgering her, in the throes of one crisis after another. She’d lost her job; she was out of money; she needed Gladys to take care of the kids. Maybe in Kerrville Genene would learn to live on her own. She would have the opportunity for a fresh start.

  Genene’s resignation from Medical Center Hospital in March left her with five months before Dr. Holland was to open her clinic. For several weeks Genene took temporary assignments at local hospitals through a nursing agency called MedoX. In mid-June, she accepted a full-time job at Santa Rosa Medical Center in downtown San Antonio. She worked the familiar 3–11 P.M. shift in the surgical ICU. Santa Rosa administrators called Medical Center Hospital for information about Genene’s job performance, but a clerk in the county hospital’s personnel department said she could disclose only that Jones was eligible to reapply for employment. Genene would remain at Santa Rosa for a month—long enough for supervisors there to form their own impressions.

  On July 21, a Santa Rosa charge nurse wrote an incident report on Genene: “On this date at approximately 7:30 P.M. Ms. Jones came to me almost in tears that ‘they’ couldn’t find her child. (I don’t know who ‘they’ is, but just seconds before this she was on the telephone.) She told me that she had to go home—I asked her if her charts were up to date & time & she claimed ‘no—they were not’ but that she had to leave!” In checking on the two seriously ill patients Genene had been assigned, the charge nurse discovered that Jones had not even opened their medical charts. Genene had recorded one patient’s vital signs, though the patient claimed that no one had taken her vital signs during the shift. Added the nursing supervisor: “Since we came on shift Ms. Jones spent most of her time (1) smoking in the nutrition room (2) playing with the computer (3) on the phone & (4) visiting a patient in MICU & his family…Ms. Jones was not busy and should of had plenty of time to do her work before this last phone call.” By then, Genene had submitted a resignation letter, explaining that she had “fallen” on a better opportunity—“one in which I will be able to use the skills I am trained for.” She told her superiors she would work through July 26. Instead, Genene announced on July 22 that she would not work another day. She did not offer an explanation.

  After leaving Santa Rosa, Genene began looking for a place to live in Kerrville. When she had trouble finding a landlord willing to accept pets and young children—Edward was ten, Crystal five—Dr. Holland decided to buy a small house as an investment and rent it to her nurse. Genene and the doctor selected a $45,000 property: 1524 Nixon Lane, a modest three-bedroom brick house in an isolated subdivision among the hills seven miles outside town. Genene thought the place was perfect. In early August, she rented a U-Haul and moved in.

  To friends, Genene voiced great admiration—even deep affection—for her new employer. Kathy Holland wasn’t like the other residents. She was honest and caring, and unlike many of the young doctors, she didn’t seem to mind Genene’s constant questions; she respected her judgment. When Genene called to warn that something was going on with a child, Kathy Holland came running. “If Genene says something’s going to go wrong,” Holland told another resident, “then it usually does.” If Kerrville would be Genene’s salvation—an opportunity to escape from the distrust and persecution—Kathy Holland would be her savior.

  Holland was one of the few at Medical Center Hospital who considered the LVN a victim. She viewed Genene as a strong, talented woman who was being victimized by a male-dominated hierarchy for her candor—for having the guts to speak the truth, for refusing to play political games. In coming to know Genene Jones, her rocky life and willful ways, Kathy Holland could see much that reminded her of herself.

  Kathleen Mary Holland often expressed amazement that she had ever become a doctor. Early in life, her ambitions didn’t reach much higher than the basement of the Albany, New York, public library, where she labored as a clerk-typist. Born in 1946, Kathy was the only child of two factory workers, one Irish, one Polish. Her parents moved several times, but never outside the confines of their blue-collar neighborhood in north Albany.

  Life there was stormy. Both Kathy’s parents had drinking problems, which fueled frequent arguments. Kathy possessed a stubborn streak, which her overwhelmed mother tried vainly to exorcise by whacking her with a thick ruler. When her father died at fifty-nine of pneumonia in 1963, Kathy quit school in the middle of her juni
or year and took a job in a pizza parlor. Forced to return to school, she rebelled, behaving so badly that the principal wouldn’t let her back the next fall. She graduated instead from a predominantly black high school on Albany’s south side, then assumed her position as a clerk-typist. Until she met and married a librarian named Larry Doyle, she hadn’t considered going to college.

  Lacking ambition and self-esteem, Kathy had given herself to an aggressive intellectual, with ambition for both of them. Larry, twelve years her senior, pushed her. She started taking science courses at a nearby community college. When Larry found work in Tucson, Kathy enrolled at the University of Arizona as a biology major. After Doyle got a job at Cornell University in New York, Kathy completed her bachelor’s degree there, majoring in anatomy and physiology. Every step of the way, Larry Doyle drove his wife to perform. At his insistence, the couple lived for years without the distraction of a home phone. When Kathy scored a 97 on an exam, Larry asked why she’d missed a question. As Kathy neared completion of her undergraduate degree, Doyle drew on her affection for animals—she was perpetually taking in strays—to steer her toward a career as a veterinarian. When Cornell’s vet school rejected her two years running, she was crushed. She hired an attorney and appealed the second decision to a university panel. The appeal was denied. She and Larry then moved to San Antonio, where he took a position in the public library. She managed a Taco Bell fast-food restaurant, attended graduate school part time, and started thinking about studying human medicine.

  In July 1974, Kathy enrolled at the University of Texas Health Science Center, working toward both a medical degree and a Ph.D. in anatomy. Kathy had no passion for children; she had her tubes tied at age thirty. But during medical school rotations at Bexar County Hospital, she quickly decided to specialize in pediatrics. “It was just very comfortable,” she recalled. “Nobody seemed to be showing each other how much they knew. Nobody was putting on airs. Nobody was arrogant.” Another thing drew Kathy Holland to pediatrics: Sick children usually got well.

  Kathy and Larry and three cats had settled into a frame house on two acres in a rural area north of San Antonio. After earning her medical degree, Kathy remained in school an extra year to try to complete her doctorate. But she developed a conflict with the adviser on her research project and chose to abandon the Ph.D. The decision triggered an argument with Larry that convinced Kathy she could take no more of his demanding ways. Their uncontested divorce went through on July 27, 1979.

  By then, she had moved in with Charleigh Appling, a retired air force colonel who was a campus police officer at the medical school. The two made an odd match. Kathy was a sleepy-eyed woman with pale skin, a blank, moon-shaped face, and thin brown hair. She wore little makeup and dressed casually; her fondness for peasant blouses and faded blue jeans gave her the appearance of an ex-hippie. Charleigh Appling, like Larry Doyle, was Kathy’s senior by a dozen years; his shiny bald head made him look like her father. Charleigh had enlisted in the air force at nineteen, trained as a jet pilot, and flown spy planes over Vietnam. He quit the military in 1974 after earning his twenty-year pension. He rode a motorcycle to work at the medical school. He and Kathy had met one night when he escorted her out to her car in the parking lot.

  After rearranging her personal life, Holland began her three-year pediatric residency at Bexar County Hospital in July 1979, at age thirty-two. She quickly impressed her fellow residents as a diligent and capable doctor. But she did not mix easily with them. Older than most of her peers, she considered herself more mature and responsible. They thought her hardheaded, a bit aloof and intolerant. Holland was one of the few residents who did not sign the house-staff letter protesting Jim Robotham’s removal.

  But she did embrace J.R.’s aggressive treatment philosophy. Holland learned to look for the subtle signs that might signal a major problem—then move fast to intervene. She came to think of everything that might be going wrong with a child, no matter how remote the possibility. “I’m always looking for the hidden things,” said Holland. “That’s the challenge of medicine.” It was an approach well suited to an ICU, where children were quite ill and complications were quickly fatal. It was less appropriate in private pediatric practice, where almost all medical problems are minor. Nonetheless, it was private practice that Kathy Holland had decided to enter. Midway through her residency, Holland decided that after completing her training, she would open an office of her own in Kerrville.

  A community of 15,000 in the Texas Hill Country, Kerrville sat along the picturesque Guadalupe River, sixty miles northwest of San Antonio. The area was a haven for retirees attracted to its clean air and rugged landscape. Each winter it swelled with fugitives from the north, who were known to locals as “snowbirds.” The region had its share of trailer parks and struggling poor, but was better known for ranches and vacation homes owned by corporate executives and celebrities who loved to hunt game and play golf. Golfer Byron Nelson had a place in Kerrville; so did the chairmen of LTV and Frito-Lay. Country singer Janie Fricke was a frequent visitor. The town had been elevated to prominence by a Confederate Civil War captain named Charles A. Schreiner, a mercantile banker and rancher who amassed 600,000 acres of land by 1900. As the seat of Kerr County, Kerrville rose, squeaky clean and quiet, around a quaint courthouse square. So sleepy was the place that many year-round inhabitants dubbed it “Kerrpatch.” But then, no one moved to Kerrville expecting excitement.

  Kerrville drew Kathy Holland because it had a rapidly growing population of young families—and just one pediatrician. The doctors there, all of them men, encouraged her move to town. Kerrville also had the largest general hospital in the area: the 116-bed Sid Peterson Memorial. With its gaudy blue-green tile trim, the seven-story brick hospital dominated downtown Kerrville; there was no taller building in the county. Owned by a nonprofit foundation, Sid Peterson served patients from Hill Country towns a hundred miles to the north and west. Its equipment and staff could handle most illnesses and surgeries; patients who required more sophisticated facilities usually went to San Antonio. But because Kerrville had for years been a town of old people, Sid Peterson was weak in pediatrics. It had no pediatric or neonatal ICU, nor even a separate pediatric ward. It had never needed one. Weeks often went by without a single child in the hospital. As the head nurse of the hospital’s general ICU put it, “A pedi patient for us is forty-five years old.”

  Demographics notwithstanding, Kathy Holland was appalled. New pediatricians were taught that children needed specialized care and separate facilities—that they weren’t just little adults. Kerrville didn’t seem to recognize that. The hospital put sick children wherever there happened to be an empty bed. No one on the nursing staff specialized in pediatrics. And the hospital lacked much of the pediatric equipment that Holland had come to consider vital. Here, thought Kathy Holland, was her challenge: to bring modern pediatric medicine to Kerrville.

  Sid Peterson’s lack of experience treating children made Dr. Holland determined to find a nurse with good technical skills for her private practice. “The nurses at Sid Peterson really weren’t comfortable with starting pediatric IVs,” she said. “They really weren’t comfortable with drawing blood on kids younger than two…I wanted to take a nurse with me who had those skills, who had been through codes. I wanted someone who could start IVs for me, who could draw meds for me. I was really worried about going into a whole new community where they did not have pediatric nursing skills at a level that I knew it, and not having anyone to help me.”

  Holland’s first choice was registered nurse Pam Sturm, who worked in the pediatric ICU at Medical Center Hospital. “You can’t afford me,” Sturm told her; she was making $8.35 an hour. “What you need to look for is an LVN.” An LVN would make about $5 an hour. Kathy Holland spoke to a handful of other prospects. Then, in the summer of 1981, she said, she brought up the subject with Genene Jones.

  Genene said she turned down Dr. Holland’s job offer in late 1981 because she was intent on stayi
ng at Medical Center Hospital to clear her name. Several weeks later, she changed her mind when Holland came to the ICU with floor plans for her new clinic. “The rumors were flying, and it sounded real good,” recalled Genene. “It sounded peaceful and calm.” They agreed to begin in Kerrville in August 1982.

  Kathy Holland knew that there were suspicions about Genene Jones. One day in early 1982, Holland’s best friend among the residents, a doctor named Jolene Bean, sat down with her and suggested that perhaps she should change her mind about hiring Genene. Yes, Holland told her friend, she had heard the gossip that Genene might be doing something to the children, but she had worked with Genene Jones. She didn’t believe it. “Nothing I ever saw fit that pattern,” she said later. “You show me a puppy that comes up to me and licks my hand. Somebody comes up to me and says, ‘That puppy just tore up my leg,’ you gotta show me.”

  Holland talked to Pat Belko, who backed Genene, warning only that she was an assertive person—“You give her an inch, she’ll take a mile”—and that Holland would need to define clearly the limits of her responsibility. Wanting still more advice, Holland approached Dr. Victor German, the pediatrician who had served as deputy medical director in the ICU. “This is a new office and a new community that really needs pediatrics,” she told him. “I’m not asking you to disclose any absolute evidence. Just tell me: Is it a good decision to continue, or should I reconsider? Do you think there’s a possibility Genene could be doing something to hurt kids?” “No, I cannot imagine that,” German responded, according to Holland.