by Jaime Maddox
She grunted in response. “That’s an understatement. The last doctor who was here—I don’t know how to describe it, Dr. Thrasher. He was smart. Really smart. He could tell you amazing facts like why you shouldn’t give one drug with another because they utilized the same pathways of metabolism in the liver and could cause toxicity. And he’d name the liver enzymes that caused the reaction and the toxic metabolites that could build up. It was like chemistry class. He knew every muscle in the body. His patients didn’t have neck strain. They had trapezius strain. They didn’t have sprained ankles. They had lateral collateral ligament strains.”
When Erin paused for a breath, Ward tilted her head and studied her. “That sounds amazing. I bet you learned a lot working with him.”
“Yeah, but even though he was a wizard, his patients still died. And he didn’t seem to care very much.”
Ward was surprised. Hawk had seemed friendly enough. She’d met quite a few jerks during her career, and usually she could tell immediately. They didn’t bother with the friendly banter the way Hawk had, just ignored you from the start or said something condescending by way of greeting. “What do you mean by that?”
Erin shook her head and closed her eyes, seeming to gather her composure, and she shook her head, as if trying to free herself of a bad memory. Ward wasn’t sure Erin would say anything else, but after a moment, she did. “There was a little boy in a sledding accident. His only complaint was shoulder pain. But the doc made me put in an IV, and he ordered a CT of his abdomen, and sure enough, the kid’s spleen was ruptured. That was a brilliant catch. Amazing diagnostic skills. But before the surgeon could see him—he was in the OR with another case—the kid coded. We couldn’t bring him back. It was the most devastating code I’ve ever worked. We gave him blood, fluids, plasma, but nothing worked. And when it was over, Dr. Hawk just walked away. I mean he said the right things to the parents—he was sorry, and we tried everything, you know the deal—but he didn’t mean it. Five minutes later he was eating sushi in the lounge, with his feet kicked up while he watched CNN on the television.”
“Well—”
“And then last night, another awful case. It was a woman I know—I went to school with her daughter. She’s diabetic, with known kidney disease. Her daughter found her unconscious and called the ambulance. All she needed was a shot of sugar and she came around. So when she got here, she was laughing with the medics, trying to fix her daughter up on a date with one of them. And a half hour later, she was dead. I went in to check on her, and she was unresponsive. I called a code, but she was already flat-lined. We got nothing back, except when Dr. Hawk put in a pacemaker. We got heart activity on the monitor but no pulse. It was devastating, and again, he just shrugged as if to say, ‘Oh, well. You win some, you lose some.’”
“How old are you, Erin?”
“Twenty-four.”
“So you’ve been a nurse for two years?”
“Yeah. I volunteered on the ambulance for six years, though, so I’ve seen it all.”
“Well, then you must have some way of dealing with the emotional aspect of your job, right? Because if you live and die with every patient, you’ll burn out. And the people who need you won’t have a good nurse to take care of them. It doesn’t mean you shouldn’t feel compassion, or anger, or even sadness. You just have to learn how to feel without it pulling you under, or you’ll drown. I suspect that’s what Dr. Hawk does. And when you’ve been doing this for ten years, or fifteen years, you’ll still cry—at least, I hope you will. But it won’t be as often, and you’ll learn to hide your feelings from impressionable young nurses.”
A weak smile appeared in appreciation of Ward’s humor. “I hear what you’re saying, and I understand. But it’s different with Hawk. Take the MI. You were worried about her, I could tell. Hawk wouldn’t have been worried. He’d have been excited. He would have liked the challenge—but if she lived or died, he wouldn’t have really cared.”
Ward digested Erin’s words along with the last of her sandwich before speaking. “I don’t know him, and you could be right. But I suspect he’s just learned to hide his feelings so he can stay focused. In this job, if you lose your focus, people die. So, keep your focus, Erin.”
Erin looked at her and smiled, a real smile this time, and Ward thought perhaps she’d made a difference. She didn’t have a chance to wallow in it, though. The door opened and Jim poked his head in. “Doc, we need you.”
Erin turned to go, but he stopped her. “Finish your lunch. I’ve got you covered.”
Ward walked out into the ER to find that three new patients had arrived, and the afternoon passed quickly as she did what she was trained to do. That evening, after the sign-outs were given and clothes were changed, Ward was wandering slowly down the hall that led to the hospital’s side door and her house. The evening had been busy and she hadn’t had a chance to eat, and she was contemplating her options. A few taverns and restaurants were scattered around town, and she thought a burger might be a good way to end her day. No beer, though. She’d learned her lesson.
“Hey, Doc! Wait up!”
Ward turned to see Erin running to catch up with her, and then they walked side by side.
“I was wondering if you have a girlfriend,” Erin asked.
“Excuse me?” Ward turned to look at her.
Erin met her gaze. “A girlfriend. Do you have one?”
Ward hadn’t seen that one coming, and she couldn’t help chuckling at Erin’s brazen approach. “As a matter of fact, I do.”
“Well, do you wanna grab a burger anyway? Just as friends? Colleagues?”
Why not? Erin’s demeanor had improved tremendously after their lunchroom chat, and she’d enjoyed their banter as they worked together during the afternoon segment of her shift. After she got over her worries, Erin proved herself to be competent and charming as well. In the end, it had been a good day. Ward had nothing but an empty house awaiting her, and she’d been thinking about the burger anyway. “Why not?” she said.
Chapter Ten
Subarachnoid Hemorrhage
Shifting his stance, Edward discreetly dropped his right hand and adjusted himself. The sudden erection was painful in the confines of his form-fitting underwear and slacks, and his reaction was somewhat adolescent, but he truly couldn’t help himself. This was just too exciting.
The computer screen was like a silent movie, showing an animated feature as each picture changed slightly from the one before it. All of them combined to form the magnificent, excitingly erotic picture that had stimulated his manhood so completely. It might have been a difficult story for some to follow, but not for him. He was an expert at reading CT scans, and this one of the brain showed a layer of blood dissecting through the crevices of the most important of all the body’s organs.
It wasn’t a surprise, the blood. His patient, a thirty-five-year-old mother of three, had just dropped her children off at school when she felt an explosion in her head. It was so intense and sudden she didn’t even have time to pull the car to the side of the road before the first wave of vomiting hit. As a result, her car had plowed into another vehicle, and the other car’s driver had rapidly activated the emergency response system. If she’d hit a parked car, or been at home, the prompt care needed to save her life might have been delayed. It wasn’t, though, and so even though a significant amount of blood was visible on the CT scan, the woman was still awake and functioning. With a subarachnoid hemorrhage—the medical term for this woman’s condition—that fact was very important. She’d need emergency repair of the artery. A patient awake and talking at the time of the repair was likely to remain so afterward. Someone in a coma before the procedure might regain some function, but a full neurologic recovery was unlikely.
Her story was classic for a ruptured aneurysm, so perfect it could be written into a textbook or board question. Edward knew it and had anticipated the results of the CT scan, and so, just before following the patient to the radiology department, he’d slipped into the l
ocker room and retrieved a small vial from his effects. He pulled the contents of the vial into a small syringe, which he concealed in the pocket of his lab coat, and carefully wiped the bottle to remove fingerprints. Before his trip to the CT scanner, he slipped into the critical-care area and deposited it in the biohazard bag, where it would attract no attention.
Edward reached into his pocket and caressed the syringe, knowing what its contents would do to his patient. He’d stolen the clear liquid a week earlier, rerouting it into his pocket instead of the vein of a man suffering a heart attack. The powerful clot-buster would have helped open the blocked artery in that patient’s heart and might have saved his life if he’d been given it and not the saline solution Edward had left in its place. Instead, he’d suffered, sweating profusely as his choking heart tried to function without blood and oxygen. It had been a miserable forty minutes before the heart finally gave out, and no one could revive him. No amount of electricity could save a dead heart, and Edward had been thrilled that the man had died in his ER instead of in the ambulance on the way to see a cardiologist. He even kept a copy of the rhythm strip showing his fibrillating heart, just a quivering line really, the last vestiges of life, but one of the most exciting things he’d ever seen.
Now, he was about to have another thrill, a sort of two-for-one special. One drug—withheld from a patient who was clotting and given to another who was bleeding—could kill them both. A two-for-one special always delighted him, and this young woman was the perfect victim. Many people would cry for her, and he would be able to watch their mournful reactions when he gave them the news that she had died.
He reached for the phone and looked at the CT tech, who was busy copying the images to a disk. “What’s the extension for the ER?”
She told him, and he dialed it and spoke to the clerk when she picked up. “I need whatever hospital takes care of brain aneurysms. This patient needs a coiling. And send a helicopter. We can’t waste any time. She’s critical.”
“I just need a minute, Doc,” the tech informed Edward. “Then we can get her back to the ER.”
Edward smiled. “Thanks.” The tech was a cute young thing and had done everything to indicate her interest, but it was too soon. This was the twelfth of April, and a bad time with her could mean a miserable eighteen days in the ER here. He’d wait until the twenty-fifth or so, and then he’d have some fun with her. He’d have only five days of hell to pay afterward.
“I’ll talk to her,” he said, referring to his patient.
He opened the door and entered the scanning room, where his patient quietly lay on the CT table, awaiting further news about her awful headache.
“Hi,” he said, and she opened her eyes, winced from the bright lights, and immediately closed them. She was pale, and she looked to be in tremendous pain. Even though the nurse had removed her soiled clothing, Edward could still smell her vomit. It was sickening, and he had to force himself to stay close to her. He took her hand in his and, after checking to make sure the tech was still occupied, slipped the syringe from his pocket. He was able to conceal it in his closed fist, and after he quickly connected it to the IV port in the patient’s hand, it appeared that he was simply holding her hand to comfort her. Since she wouldn’t open her eyes, he leaned closer. “I have some bad news for you,” he said, and then in spite of the pain they flew open wide and she stared at him in horror.
He loved the fear there, and he wished he saw some sign as he depressed the plunger and injected the clot-buster. Maybe a scream of anguish as the bleeding worsened, or a seizure as it irritated the sensitive tissue of the brain—anything to indicate the medication was working. But he saw nothing.
“What is it?” she asked.
He leaned forward and whispered, so the microphone in the scanning room wouldn’t broadcast his words to the tech in her insulated booth. “You have a hemorrhage in your brain. You’re going to die.” He pulled back so she could see his face and smiled at her. As he watched, the light of comprehension faded and she simply closed her eyes. It was one of the most anticlimactic murders ever, and he couldn’t help feeling a little disappointed.
“We better get moving,” he said as the tech emerged with the disk containing the patient’s CT scan. She handed it to Edward, and he placed it in his pocket, next to the syringe. He had no worries about the syringe falling out when he removed the disk, because he knew the disk wasn’t going anywhere. The patient would be dead soon, so the helicopter ride would be canceled, and there would be no need to send images to another physician.
When they arrived back in the ER, Edward shook his patient gently but had no response. The bleeding was compressing the brain and function was diminishing by the second. Perfect! Her respirations had become irregular, in an effort to change the blood pH and lower pressure in the brain.
“She’s crashing. We need to intubate,” he informed the nurse, and the ER came to life as various hospital personnel came running to help.
Just as he secured the breathing tube, the clerk called out from across the room. “I have the doctor on the line.” Edward briefly glanced at the monitor. Her heart rate had slowed and her blood pressure dropped, both reflexes aimed at decreasing the pressure inside the skull. He shined his penlight into her eyes and saw no reaction.
His pace was brisk and bouncy as he crossed the department to reach the phone. “Dr. Hawk here,” he said. “I’m afraid I won’t be needing your services after all.”
When he was through, the unit clerk grabbed him by the arm. “The family is here. Her husband and a sister and a few others. They’re in the counseling room.”
Nodding, he turned and walked in that direction.
“I’m sorry—” He had to try very hard to suppress his smile when the woman’s sister wailed.
“No, no, please, no,” the husband begged him. Edward felt at that moment that he held the power of God in his hands.
*
“Is it possible to get it out without cuttin’ it, Doc? This is one of my favorite lures.”
Jess chuckled at the patient who had a fishing hook poking through his eyelid. Miraculously, it had missed the globe and his vision was intact. “Not without ruining your good looks. I’d have to make a pretty big cut to pull this out.”
He didn’t hesitate. “Do it. I can’t get any uglier.”
Laughing again, Jess opened a cabinet and removed the equipment she knew she’d be using a few more times on this first day of fishing in the mountains. With anglers everywhere, they couldn’t help hitting each other as they cast their lines into the lakes and streams of Northeastern Pennsylvania.
The procedure took just a few minutes, and Jess triumphantly handed him his prized lure after she’d rinsed it in the sink. He followed her to the nurses’ station for his paperwork.
It was an unusually quiet Saturday morning in the emergency department, and Jess wondered why. Sure, many of the county’s residents and visitors were fishing this morning, but where were the heart attacks and diabetic emergencies and car accidents? She feared this was the calm before the storm.
Sitting at her computer, Jess typed in her password and saw an alert flashing on her screen. Lab results were ready. That’s odd, she thought. No patients were in the ER and she hadn’t ordered any tests. Cultures of wounds and urine went into the general nurse mailbox, and someone in that role checked them daily, because the doctor schedule precluded them from responding to issues in a timely manner.
After handing her patient his instructions and wishing him a good day, Jess clicked on the lab icon. Her breath caught when she read her message. Lab results were back on her patient Ward Thrasher. More than a month had passed since she’d ordered the tox panel on Ward, and she’d been waiting. Jess knew it would take time for the results. The tox screen on spinal fluid was an unusual test and had to be sent to a lab with specialized equipment. Jess had checked for results just about every day and was expecting them, but still, she was shocked to see them. Or was it fear? What wou
ld she find?
She’d been trying hard to keep Ward from her mind. She’d been back in the mountains for six weeks, and they’d seen each other only three times. Jess still wasn’t sure what direction her life was going, or what part Ward would play in it, and all Ward did was confuse her, with her questions and loving looks and pleading eyes. She loved Ward, but she wasn’t sure she wanted a life with her. She didn’t know what she wanted.
She’d been on a date with an accountant, a nice man with two kids in college and a beautiful lake home in the mountains. They’d enjoyed relaxed conversation and good food, washed down by an excellent bottle of wine. Yet when the night was over, Jess felt a dread like she hadn’t had since her last date with a man—the fiasco with Emory didn’t count—almost twenty years earlier. No matter how nice he was, she felt no spark and had no desire to kiss him good night, and feared he might try to plant a big wet one right on her lips. So, when they pulled into her driveway, she fled the car as soon as it stopped and told him she’d call him. She wouldn’t. Once inside, she’d settled into a bath and thought about the county coroner, a very nice butch she’d met on several occasions in the ER.
Wendy, the coroner, had asked her out. It was common knowledge that Jess had lived with Ward, and common knowledge that Ward was gone, also common knowledge that Jess was dating again. Jess had told Wendy she’d think about it, and she had. Day and night. Wendy was adorable, with brown hair cut short and blue eyes that sparkled with mischief. She owned a funeral home, which she’d inherited from her father, and lived above it, just around the corner from the Victorian Jess was renting. In addition to seeing her on those unfortunate occasions when her services were needed in the ER, Jess had seen Wendy walking Cleopatra, her energetic little poodle. They chatted, and on mornings when Jess wasn’t scheduled in the ER, she’d started taking her morning coffee on the front-porch swing just so she could see Wendy and Cleo as they walked by. Almost always, Wendy lingered, and the day before, Jess had asked her in for breakfast. She’d accepted, and now they had a date scheduled for that very night.