by Edie Claire
A fresh sense of dread washed over her. Why was it still so quiet? She stuffed the note in a pocket and walked inside. Stanley was in bed. He appeared to be asleep, but he made no sound. Mei Lin hastened to his side, her eyes searching frantically for signs of movement: a flaring of nostrils, the rise or fall of the blankets above his ribs—
She let out her breath with a gush. He was alive. His jaw was moving. He seemed as if he was trying to talk, but he was only dreaming again.
She opened the curtains to let in more light, then took a closer look at him. His color seemed all right, but he was feverish again, and his sleep was uneasy. His limbs began to twitch, and he made a dull moaning noise. Mei Lin looked at the bedside table. Her own note was there, crumpled into a ball. Last night’s medication was no longer present. But this morning’s dose remained untouched.
“I’m so sorry,” he mumbled suddenly, startling her. She thought for a moment that he had awakened, but he had not. His eyes were still closed. She watched as the wrinkles in his brow deepened. “I’m so sorry, Angela,” he mumbled. “I didn’t mean it. I didn’t… He was…” Stanley’s next words were indistinct. He broke out in a fresh sweat and his limbs began to thrash.
“Wake up, Stanley,” Mei Lin ordered, deciding that he’d had enough. Her fellow nurses had mixed feelings about awakening residents with nightmares, but she couldn’t stand to see anyone suffer from imagined horrors when their waking hours had enough real pain. She collected her rag and moistened it with water, then touched the cool cloth to his brow. “Wake up, now. Dr. Smith?”
His eyes flew open. For a second, they were filled with alarm. Then he blinked and focused on her face. “Mei Lin,” he said clearly. “What… what happened?”
The kernels of a theory began to form in her mind. Angela. Perhaps she was his Mariel? Whatever he had been apologizing for, the guilt of it affected him deeply. Could the burden be so heavy that it made him wish to die? “Nothing happened,” she said gently. “You’ve just been talking in your sleep again.”
Stanley closed his eyes and swore. He looked drained and wretched, but after a long moment he seemed to decide to pull himself together. He sat up higher on his pillows and stared at her accusingly. “By the way… you are an evil person, Nurse Sullivan.”
Mei Lin smiled. He was teasing her, which was an excellent sign. “Oh? How so?”
“Don’t play innocent with me. You are an extortionist!” Stanley insisted. He reached out for the crumpled note she had left and extended it with a frown. “Taking advantage of a sick man’s boredom. For shame! You knew damn well this would irritate the hell out of me!”
Mei Lin grinned shamelessly. “Did I?”
Clearly fighting a grin of his own, Stanley chucked the ball of paper into the fireplace. Given his condition, his aim was impressive. “I took the damn antibiotics. So you’d better hold up your end of the deal.”
Mei Lin feigned an innocent dullness. She was good at that. “Oh. But I thought I said specifically that your fever had to be down?”
Stanley glared. “It is down.”
“Hmmm,” Mei Lin mused, touching a fresh rag to his cheek. “I’m not so sure. Of course, it could just be because your morning dose is late…”
“Evil,” Stanley repeated. “Pure evil.” He was trying very hard to glare at her, but the spark of amusement in his eyes was hard to miss. He grabbed the pills that were laying out, tossed them in his mouth, and chased them down with a swallow of water. “Start talking,” he demanded harshly. “And I mean the whole, ugly story. Everything that happened with Mariel Gonzalez. Now.”
Mei Lin’s answering smile was hesitant. She felt a pleasant sense of triumph at having gotten two more doses of antibiotic into him. But in her ardor to make a bargain, she had neglected to consider the cost. Not only was Mariel Gonzalez the last thing she wanted to talk about, but once Stanley’s bizarre curiosity on the issue had been satisfied, she would lose her only remaining bit of leverage. What happened when tonight’s dose came due?
“And don’t leave anything out,” Stanley qualified.
Mei Lin drew in a breath and resigned herself. A bargain was a bargain.
She leaned back in her chair and started talking.
Chapter 15
Nine months ago, Dallas, Texas
Mei Lin punched a button on the desk phone at the nurses’ station, putting the caller on hold. Her heart beat fast. She rose and began walking down the A corridor of the Silverson Elder Care Center.
Julia, the licensed vocational nurse she sought, was one of the few others on this night shift that she knew. Mei Lin’s usual shift was three to eleven; she only worked nights when Tina Booras, the usual overnight charge nurse, was off. Tina’s frequent vacation, personal, and sick days were supposed to be covered by the part-time RNs who worked weekends — or so Mei Lin had been told at her interview. But in the three months she’d been working at Silverson, she’d been called in to sub for Tina twelve times. She suspected she could say no, but after the debacle with Jeremy, she needed the extra cash. Unfortunately, such shifts tended to be stressful because she was unfamiliar with the night staff. Turnover in Tina’s group was so high that her people barely knew each other.
She spotted the back end of the med cart disappearing into a room and hastened her steps. She was worried about Julia. The struggling single mother of four worked the same regular shift as Mei Lin, but the LVN could be found at the nursing home at any time, racking up extra hours. Julia was usually a fount of energy, but in the last week she had seemed increasingly pale and harried, and Mei Lin hated to bring her distressing news.
The thin, immature voice calling on the phone just now had sounded distraught, and the little girl had been sniffling and gulping so much that Mei Lin could barely understand her. What she eventually determined was that Julia’s children were home alone, two of them had gotten into a fight, somebody had gotten hurt, and no adult seemed to be around. They couldn’t reach their mother directly, since the staff at Silverson were required to keep their personal phones at the nurses’ desk, so the girl had nervously called her mother’s “emergency number.”
Mei Lin entered the room to find the LVN leaning over the bed nearest the door, gently awakening a resident. “Paulina,” Julia cooed. “Time for your meds, honey.”
“Excuse me. Julia?” Mei Lin interceded, stepping around the cart and into the room. “You have a call at the desk from your daughter. On line 2. She seems very upset, I’m afraid.”
“Which daughter?” Julia exclaimed, so loud that both residents in the room jolted awake. “MacKenzie? You mean she called the desk? Why would she do that? What’s going on?”
“I’m not sure,” Mei Lin replied calmly. “You go on and talk to her. I’ll take over here.”
The too-thin Julia stared at Mei Lin with disbelief for a moment. Then she handed over the glass of water and paper medicine cup she was holding and flew out of the room.
“I’m sorry, Mabel,” Mei Lin apologized to the woman in the far bed. “You go on back to sleep, now. And Paulina, you just need to take your medicine and then you can go back to sleep, too.”
Mei Lin froze, her eyes fixed on the tablet in the cup. What was this? She checked the medicine administration record. At this hour, Paulina was supposed to receive a single dose of pain reliever. But the small white tablet Julia had put in the paper cup was not the drug prescribed.
Mei Lin picked up the pill and examined it. It was circular and flat, with no manufacturer’s markings pressed into it. Paulina had been prescribed a narcotic to alleviate pain in her spine — a tablet with a specific shape and recognizable markings. “I’m sorry, Paulina. Can you hang on a minute?” Mei Lin asked. She unlocked the controlled substances compartment of the cart and checked its contents. Julia had only just started her rounds, and all the doses of narcotic that should still be on the cart were present and accounted for. Paulina’s dose had been removed, but it was not in the cup. Its empty wrapper lay on top of the
cart.
Mei Lin’s pulse quickened as she fit the pieces together. Even if the small white tablet Julia had been about to give Paulina had been accidentally placed in the wrong packaging, the LVN was experienced enough that she should have noticed the difference when she dispensed it. Far more likely was that the real pill had been switched with another — most likely a placebo — after the wrapper had been opened. Julia had stolen a narcotic!
A ripple of panicked horror shot through Mei Lin. Had Julia been planning to switch out other residents’ narcotics, as well? Each at the last minute, so that the cart itself would bear no evidence? Good God! Had Julia done this before? How many times? How many doses? How many residents had suffered?
Mei Lin turned to Paulina to apologize for the delay, but the frail woman had already fallen asleep again. Like many of the residents on A-unit, she suffered from dementia and paid little or no attention to the pills she was given. Some residents examined their own meds religiously… But Julia knew which residents did not.
Mei Lin dropped the placebo into her breast pocket, pushed the cart back out until the hall, and quietly closed the door. She stood in the hallway motionless. She knew that the opioid in question had a high street value. What she didn’t understand was how could Julia do it. The woman had her flaws, and she wasn’t terribly intelligent. But she had always seemed devoted to her job. She was one of the hardest-working LVNs Mei Lin had ever known, competent and caring with her residents. How could she secretly allow them to suffer?
Nurse! a man’s voice echoed in Mei Lin’s memory. My leg’s hurting awful this morning. Can’t you give me something for it?
Miss Mei Lin? Georgia had pleaded. The medicine isn’t working. I told the doctor it’s not! I hurt so much. Can’t you do something? Ask him again for me?
It must be getting worse, James had explained to her. Most of the time it’s fine, but every once in a while it aches like the devil…
Mrs. Santino had said nothing, but her daughter had said plenty. She didn’t have pain like this in the rehab hospital! What are you people doing to her? She should be feeling better, not worse!
“Oh, God, no,” Mei Lin muttered into the empty hallway. This had happened before, hadn’t it? Julia worked every shift at some point or other… she could easily pocket a pill here or there with no one being the wiser. She was one of the few LVNs that all the charge nurses trusted to dispense! Julia could have been stealing pills for months, years even. And to think that it had been happening on Mei Lin’s own watch!
Bile rose up in her throat, and the walls of the hallway began to teeter. Oh, why hadn’t she suspected anything? Why hadn’t she taken the residents’ complaints more seriously, seen the pattern? A crushing weight of guilt fell upon her, but she forced herself to fight it off. She could beat herself up later — right now she needed to act.
Part of Mei Lin wanted to confront Julia immediately, before a single other resident got cheated out of a dose of painkiller. But the scope of this crime went beyond one LVN and her charge nurse. Mei Lin would have to report the incident up the chain, so that the proper legal steps could be taken. The authorities would have to do a thorough investigation, review records, collect evidence…
“I’m going to kill that girl with my bare hands someday I swear to God!” Julia called out as she sailed back down the hall. “Those two fight like cats and dogs and she’s bigger than her brother and I just knew that something like this was going to happen! And who do you think’s going to get the blame if Ricky winds up having to go to the ER someday? Me! That’s who! I’ll be hauled in for child abuse, when it should be my damn niece who’s responsible. Outside with her boyfriend the whole time, do you believe it? And the baby asleep in her crib!”
“Do you need to leave?” Mei Lin asked, surprised to hear her voice sounding more composed than she felt.
“No,” Julia answered, barely looking at Mei Lin as she retook the cart. “My niece is on it now, and her boyfriend’s an EMT and he says nothing’s broken and they’re just going to ice it. The baby didn’t even wake up. And it’s better if I don’t go straight home anyway because if I got a hold of Rowena right now I’d likely break her bossy little bones myself!” She put her hands up and took a deep breath. “Don’t worry,” she assured Mei Lin, forestalling her next comment. “I’m all right. I’m calm. No problem.”
Mei Lin put a hand back on the cart handle. “Take ten minutes, Julia,” she insisted. “I can do the next couple rooms. Pour yourself a cup of decaf and relax.”
The LVN looked hesitant. She did not seem suspicious, but sitting and relaxing was a foreign concept to her. She was the type of energetic busy bee that seemed always to be in motion.
“Five minutes,” Mei Lin repeated, faking a smile. “That’s an order.”
Julia huffed out a breath and whirled away.
Mei Lin moved slowly. She dispensed meds to the next resident at a snail’s pace, performing the necessary checks three times over. She knew she was distracted, and she didn’t want to make a mistake. Her next step seemed clear. She should report the incident ASAP. The idea that the LVN might steal more pills, even as Mei Lin was on the phone, was gut-wrenching. But any harm from a missed dose tonight could be managed. It was more important that Julia not be tipped off until someone with more authority than Mei Lin could decide how best to proceed.
Her hands shook as she tore open packets and poured water. The course of action before her seemed logical and correct… but something about it still felt wrong. Technically, any suspicions of malfeasance on the part of her staff should be reported to the Director of Nursing. But Silverson’s DON was on leave to visit a new grandchild. And the acting DON was Tina Booras.
Deep in the swirling pit of acid that was her gut, Mei Lin was certain that telling Tina would be a mistake. She felt it deeply, knew it instinctively, even though she could not explain why.
What she had seen tonight with her own eyes implicated no one besides Julia. The LVN was known to have a stressed home life and myriad financial problems — her motivation for such a crime was obvious. But something dark and loathsome kept playing in the back of Mei Lin’s mind, and that something involved Tina Booras. Perhaps her own tortured conscience was merely lumping together her greatest moments of guilt, but she could not stop thinking about her last unpleasant experience with Tina… and the death of Mariel Gonzalez.
A few short weeks ago, Mariel had still been alive. The chatty ex-schoolteacher had a wide variety of health problems, but dementia wasn’t one of them, and her cheerful attitude had quickly made her one of Mei Lin’s favorite residents. Mariel had a large and caring extended family that frequently took her out of the home for day visits, but unfortunately, on one of those visits she took a fall and fractured several vertebrae. Not being a good surgical candidate, she was returned to the home from the hospital with a prescription for pain relief and strict orders for limited movement. For the first few days after her arrival, she appeared as upbeat as ever. But one afternoon, Mei Lin noticed a change. Though Mariel didn’t complain, she seemed uncomfortable and lacked her usual vivacity.
By evening it was clear that Mariel was worsening. Mei Lin kept a close watch on her and charted every complaint, but the woman’s symptoms were vague and none rose to the level of an emergency. Still, as the end of Mei Lin’s shift neared, her concern grew. Mariel had begun to sweat heavily, which she had never done before. Tears rolled down the old woman’s cheeks as she told Mei Lin that she didn’t want to be a bother, but that she felt awful and didn’t know what was wrong with her.
Mei Lin hadn’t known, either. She had gone home that night feeling unsettled, even after reporting her concerns to Tina Booras and confirming that the doctor would examine Mariel first thing in the morning. But when Mei Lin returned for her shift the next afternoon, she was told that Mariel had died. Passed away in her sleep, presumably from a stroke.
“I’m all right now, honest,” Julia chirped, interrupting Mei Lin’s reverie as s
he intercepted the nurse in the hallway. “I’m really sorry about all that. It won’t happen again, I promise.”
“I hope not,” Mei Lin replied, unable to avoid a double meaning. “I’m glad your kids are okay.”
“Thank you,” Julia said pleasantly, retaking the cart and turning it toward the next room. “I appreciate it.”
Mei Lin nodded. She walked back to the nurses’ desk, her limbs as heavy as lead. She was dropping into her chair when the realization hit. Anxiety. Restlessness. Inability to sleep. Excessive sweating… increased tear production. Not the usual set of symptoms that preceded a stroke. But classic for narcotic withdrawal!
She froze in horror. Mariel had been in withdrawal. How many doses of prescription opioid had she missed? It must have been several in a row to bring on such a “cold turkey” reaction. If Mariel did die of a stroke, it was no coincidence — not when withdrawal caused an increase in blood pressure!
Mei Lin spun around and punched at her keyboard. What other symptoms had Mariel shown that night, once Tina Booras had taken over? Did anyone notice her pressure spiking? Did Mariel have vomiting? Diarrhea?
She logged into Mariel’s patient record. She had checked for cause of death before, but this time she drilled down and pulled up the nursing notes from that night. Tina’s reports held nothing out of the ordinary. Nor, to her amazement, did her own. Mei Lin’s pulse pounded in her ears as she searched the now read-only document for words that were no longer there. The symptoms she had recorded… any mention of sweating or tearing… gone.
Gone!
Her stomach heaved. This was definitely bigger than Julia. Even if the LVN worked two shifts back to back, she couldn’t have stolen enough sequential doses of narcotic to put Mariel into full-blown withdrawal. Nor could she have altered Mei Lin’s nursing notes. The only people with sufficient clearance to edit her remarks were the other charge nurses and the DON — and they weren’t supposed to do it, either.