Two weeks from Monday came and went. After making several more phone calls and threatening them with wrongful denial of a claim, I finally got approval. Then another two weeks went before we were able to admit Sarah to the hospital.
The week before my original admission deadline, Dr. Denby had seen Sarah in his office. It was unlikely that he would find a bone marrow donor, he'd said, because Sarah had no living relatives. Great. All that, and we couldn't do the transplant because we had nothing to do it with. But two weeks later, Dr. Denby called to say he’d found a compatible match on the national registry.
Dr. Denby was around seventy. He could have retired, but he loved what he did so he continued to practice. The first time I ever saw him, he was shuffling down the hall on rounds, greeting every nurse by name. There were stories among the nurses that dying patients would hang on through the night just to see him on his rounds, and that many had expired just following his rounds as though they had delayed death just to see him one last time.
Sarah’s first round of chemotherapy, to destroy the original defective cells, was scheduled by Dr. Denby to begin early on the first day of her admission. I planned to stop by on my rounds after office hours to talk to Sarah, and relate more about what to expect during the week.
Just after five o’clock on that day, I arrived in the medical records department of the hospital to dictate some of my more delinquent charts before completing my evening rounds, and seeing Sarah. The record room overflowed with stacks of manila folders lined up along the long walls with multi-colored ID numbers facing out like confetti. One day, hopefully soon, the hospital would catch up with technology. The charts needed to be put into an electronic medical record database in the worst kind of way. The only other person with me in the records department was a clerk behind her computer at the end of the cramped L-shaped room. She glanced up and offered a half-smile as I collected my pile of charts from the rack and found a carrel to start my dictation. Immediately, a metallic voice spoke overhead, startling me so that I stopped to listen to the announcement.
“Code Stat 3A, Code Stat 3A.”
That was the wing where Sarah was. My heart sped up. I hovered over my seat unsure whether to stay or go, waiting to hear who it was. I jumped anyway when my phone buzzed in my pocket. I shoved my charts off to the side as I rushed out, not bothering to call back. The floor secretary on 3A would see me soon enough.
Hurrying down the corridor, I reminded myself not to break into a run. I was mumbling to myself, trying to imagine what could have gone wrong so quickly, when I stepped through the doors of the elevator. Several heads turned to stare at me. One look at my distraught face, and lips moving inaudibly, probably convinced them that I was in need of medical, make that psychiatric, attention myself. I shut my mouth and stared straight ahead.
In Sarah’s room, there was a full team of nurses and anesthetists already in action. They handed control of the code over to me when I arrived. The nurse anesthetist turned to me as he finished placing an endotracheal tube down Sarah's throat, and began squeezing a large purple air bag rhythmically between chest compressions, to simulate breaths.
He said, “They called the code when the tech came in here and noticed Ms. Summers was not breathing. She was pulseless and apneic at that time, but we don't know how long she had been in that state since she was not on a cardiac monitor. Defibrillator pads showed asystole. We began CPR at once, but she’s still flatlined.”
I pulled on a pair of gloves as he spoke, and turned to look at the monitor where occasional irregular waves were seen. “Hold compressions.” The patient care tech, who had initially triggered the alarm, straightened and glanced at me with a look of relief for her moment’s respite. The waveforms disappeared, replaced by an ominous straight line. “Resume compressions.” The tech bent back to her work, counting under her breath, and pausing regularly to allow for a breath cycle.
I put my hand on Sarah's upper thigh palpating for her femoral pulse. Even though I knew that it was a false beat I felt, I was reassured by it. We were circulating oxygen, and that would sustain her brain and organs for the moment. “We have a pacemaker?”
“Yes ma’am.” A nurse standing by the code cart held up the defibrillator pads, and passed them across the bed to me.
I slid closer to the head of the bed and interrupted the tech and her compressions again to place the pads on Sarah’s chest. Another nurse quickly passed me the leads and we connected the transcutaneous pacemaker. If there was any electrical activity in her heart we would encourage it. “Okay. Clear.” I nodded to the nurse by the defibrillator. He clicked over to pace mode and pressed the button. I held my breath and watched the monitor. Five seconds, eight seconds, ten seconds. Still no waves. I let out my breath again. Damn. “Okay, resume compressions. Get me 1 of epi.” I glanced around the room, thankful to have such a well-trained code team present. Everyone knew their jobs, knew what was coming before I even said it, and moved swiftly without fumbling.
“Epinephrine is in,” said the nurse by the cart.
I nodded and repeated the pacer trial. Again we dosed the epinephrine. Then again, and again. My stomach clenched. Another nurse replaced the tech at her compressions. I stared at the monitor with every pause, willing Sarah’s heart to beat, to let the pacer spark a response. I wanted to kick the bed, to kickstart her heart back into action like a flooded engine. We cranked and pumped, cranked and pumped. Sarah! I wanted to scream at her. Sarah! Wake up!
The nurse anesthetist looked at me. “Dr. Lane?—It’s been thirty minutes.” Everyone paused with their eyes on me.
I swallowed. “One more time.”
He nodded faintly, and the motions resumed. A trifle less enthusiastically than before, I thought, but maybe I was imagining things. After all, they had to be tired, I was limp with fatigue. Again, the compressions paused. Again, I faced the monitor, the judge of all our efforts, as the final compression waveform traced its way across. I waited, and... nothing. I continued to stare at the traitorous monitor. The face of the grim reaper. And I did kick the bed. Hard. Startled, the others stopped and looked at me. “Okay.” I said in a strangled voice. “Call it.”
The tension drained from the room immediately, quickly replaced by a sense of failure. The team members were silent as they began removing the various leads and tubes attached to the dead body. I sank into the visitor’s chair and stared as people began to file from the room to return to whatever duties they had been attending to before being called here. Within two minutes, almost everyone was gone. The nurse anesthetist paused to give my shoulder a squeeze as he passed, then I was alone. I stood to pull the curtain around the bed, and took Sarah’s hand in mine.
I was alone in the tiny room. On the bed lay Sarah—alone, orphaned, and now gone. Her dusky, white face was distorted by the disconnected ventilator tube, which reared its knobby, white head from her slack mouth like some kind of movie alien. Its very presence a violence and a violation.
The room was hot and suffocating. More so now, because of the dull polyester curtain I had pulled closed around three sides of the bed, which now clung to the backs of my legs when I stood up. I felt trapped and edgy, verging on panic. I took a deep breath, trying to lift the pressure weighing on me. Stiffly, I released Sarah’s hand and started checking her body, lifting the sheets, looking for signs of allergic reaction: a puffiness of the legs or hives on the skin. I was looking for something other than the signs of malnutrition her body bore, something to explain why she was dead. There was nothing.
I sighed, and sat down on the edge of the bed, staring for a long moment at her lifeless face. I yanked out the alien tube and bent over her to whisper, “I’m so sorry, Sarah.” Then I turned and walked back out into the glaring light of the hallway, avoiding the glances from the nurses at the station, to put a final note in Sarah Summers’ chart. My hand trembled as I turned the pages, but no one paid any attention.
Dr. Peter Zacker appeared around a corner, still too far
away to see my distress. I gave him a grave nod and looked back at my chart, hoping he would see that I was busy, and not stop to chat. He was a member of my call rotation and we spoke frequently, but we were not close, and I was not feeling sociable, to say the least.
“Hi, Veronica. How’s it going?”
I looked up with another stiff smile, pretending as always that his high-pitched voice didn’t grate on my nerves. “Hi, Peter. I’m just reviewing the chart on my patient.”
“Was that the code I just heard up here?”
“Yeah, it was.” I flipped a page and tried to look occupied.
Sally, the nurse who had been in charge of Sarah Summers, chose that moment to appear. She cleared her throat to get my attention. “Dr. Lane, I can’t believe how she died. I’ve worked the cancer ward for eleven years, and I’ve never seen a patient go like that. One minute she was cheerful and talking, the next she was dead.” Sally stopped and looked at me clearly expecting an explanation.
“What time did she get her chemotherapy?” I frowned in thought.
“Two o’clock. The meds were delayed getting to the floor.”
I scratched my head. “That’s about enough time for an allergic reaction, not much else, but I didn’t notice any edema or urticaria. Did she have any other symptoms?”
Sally shook her head. “No. Nothing. She was smiling and talking at four-fifteen when I checked the room. I came back right after five and she was gone.” Before I could respond, a call bell rang and pulled Sally away to other duties.
Zacker remained, hovering by my elbow during the exchange. He raised an eyebrow. “What was her story?”
“We were going to do a bone marrow transplant for multiple sclerosis.” I answered.
“You’re kidding?!?” Zacker’s voice screeched in disbelief. “What in hell were you thinking? Bone marrow transplant? Why weren’t you using Rebif?”
I eyed him narrowly. Peter Zacker was a cookbook man. He carefully followed the path and pattern of those who had gone before. To him, practicing medicine was like following a recipe. It was satisfactory medicine, and I could trust my patients to his care when he was on call, but it lacked heart.
Modern medicine was built on the backs of great innovators. Zacker’s kind would still be bleeding the evil humors out of people if they were the only practitioners.
I blew my bangs off of my forehead in consternation, one of my only nervous habits. “I tried it. She failed everything, and this was her last shot. She knew the risks.”
I closed the chart with a snap and stood in preparation to leave. I really didn't feel up to a debate of philosophy. Zacker obligingly stepped back, but I noticed that he tipped up the chart and read the name plate as I started down the hallway to finish my rounds.
Chapter 3
At home, I slumped into the first chair I came to, accidentally dropping my keys on the floor. For a moment I stared at them lying on the faded braid rug, before leaning over to pick them up. My eyes roamed over my surroundings. Across from me was the den, where I could see the dust that had accumulated on the TV screen, and on my wedding picture that sat perched above it. It struck me, how out-of-date the old plaid couch looked. I had never noticed before. My mother had handed it down to me when Steve and I were married. Now that we’d split up, I needed to replace it.
Thoughts of Sarah stayed with me as I got up to go to bed, and I lay awake into the wee hours. When I finally found sleep, she followed me into my dreams. She went with Steve and me to the movies, shadowing us everywhere, walking on all fours because her legs wouldn’t carry her weight. She wore an old, pink, cotton dress of mine, and she was crawling down the road. Then it was me on all fours, alone. I crawled over hill after hill, lost. I awoke soaked through with sweat, panting. I groaned and rolled over. After tossing and tangling for what seemed like forever, I resigned myself to the inevitable and got up to shower and put on fresh pajamas.
Downstairs, I poured a glass of milk and sipped it at the kitchen table. Over the past few months, Sarah had begun to hover persistently in the periphery of my mind. Even before tonight I’d dreamt about her. The more her health slipped away, the more I focused on her, like a tongue playing with a sore tooth to remind itself that the pain was still there. I sighed, wishing I could shut the whole thing off. As I rose to take my glass to the sink, I thought maybe I should have tried Steve’s method, and had a little vodka instead.
I woke up at 6:00 AM, grateful for the two additional hours of sleep my little milk toddy, sans vodka, had gained me. I pulled on a pair of leggings that were lying by the bed, and a sports bra, and went into the guest bedroom. I climbed onto my new treadmill that sat behind a giant Schefflera plant. I zoned out to the music flowing through my earbuds and the pounding on the track, trying to put all of the events of yesterday out of my mind.
After twenty-five minutes, flushed and breathing hard, I stopped and grabbed the pink hand towel hanging over the handles. I headed to the shower as I mopped my face. The master bath is enormous. It has two sinks, and a huge Jacuzzi, and the toilet has its very own tiny room. Designed to be shared by two people, the room is now mine alone. Okay, I don't want to think about that, either.
I inspected my face in the mirror as I waited for hot water to reach the faucet in the shower. Two new strands of gray hair had appeared overnight, and I plucked them immediately. My eyes looked smudgy underneath. They had more than the usual shadows my olive complexion bestowed on me. I looked as bad as I felt, and I felt like I had a hangover.
After my shower, I dressed in a comfortable shirt, and a pair of gray pants that always seemed to flatter my butt. I put on extra under-eye concealer, and tried on a bright smile in the mirror. A glass of orange juice and a vitamin served as breakfast, and I was good to go. Outside, the air was still cool and pleasant with the mist rising from the ground, but the day promised to be the warmest of the spring. I inhaled the morning scents deeply before beginning the fifteen-minute drive to work in morning traffic.
Vickie heaved her awkward pregnant bulk out of her chair as I walked into the building, and followed me back to my office for our morning planning session.
“Good morning, Dr. Lane.”
Vickie kept patients and employees, including me, moving in a never-ending, always-efficient motion. I didn’t know what I was going to do when she left for maternity leave in another month. At least she’d promised to call in each day to help keep the staff on course. “Good morning, Vickie. How’s Samuel?”
“He’s fine. His ears cleared right up with the amoxicillin. He went back to day care today.”
“That’s good.” I nodded, but didn’t bother to smile. Vickie knows without asking what mood I’m in anyway; faking a smile doesn’t fool her for a minute. After our morning planning session, I began to sort through the first mail pile of the day. Many of the papers were lab results from the hospital. I examined those, initialed them, and sorted them into two piles: those to be filed, and those which needed action.
When I finally peeked down the hallway, there were already charts in the plastic racks on two of the doors. In the first room was a patient I was quite familiar with, and we chatted while I checked her blood pressure and refilled her medication.
Vickie called me before I reached the next room. I was diverted to a man who had been clutching his chest when he arrived in the lobby. The EKG showed a heart attack in progress, so we started emergency medication as we called for an ambulance to take him over to the hospital. He’d had a heart attack before, and should have known to call an ambulance directly to his house this morning when it started rather than waiting around for the office to open. I’d have to remind him of that before he left the hospital. I scribbled a quick set of orders that would get him admitted to the CCU, and called the Cardiology group to treat him when he arrived.
That got me thirty minutes behind. The next scheduled patient—the one I had put off to tend to the heart attack victim—complained that he had been on time, and that his time w
as as valuable as mine. I apologized, but said only that there had been an emergency. From there, the day got busier. The computer broke down and the last patient was not seen until seven o’clock.
At seven-thirty, I dropped into the chair in my office without even turning on the light. Sarah Summers’ chart sat smack in the middle of my desk. I tried to look at it, but caught myself twenty minutes later, mesmerized by the glittering of street-lit puddles on the asphalt. I couldn’t think about Sarah anymore—I couldn’t do anything anymore—I realized that for the first time in my life, I didn’t even want to see my patients. Krauss was right, I was burning myself out. I straightened my shoulders as I came upon the only possible solution, and grabbed the phone to call Peter Zacker.
“Hi Veronica, what can I do for you tonight?”
“I’ve decided to take a short leave of absence.”
“Because your patient didn’t survive? Are you out of your mind? It was a patient, sometimes you make the wrong call, and sometimes they die.” Peter’s high voice grated.
I grimaced, “Jeezum, Pete.” If only I could be so cavalier. “I just need some time away from the office.”
“Anything you say, Veronica.”
“Thanks, Pete. I’ll finish my rounds tonight, if you’ll take over in the morning.” I stared across the parking lot at the twinkling of lights on the hillsides.
“You know,” he drawled. “I’m thinking that you’ve been very unhappy since your husband left. Perhaps too unhappy to do your job well.”
“What? What is that supposed to mean exactly?” I asked, irritated.
“You may be right to take time off. You go right ahead and do that.” He didn’t seem to have enough air in his lungs to power his vocal cords—like he was being squeezed by a boa constrictor.
Treating Murder: Book One of the Veronica Lane, M.D. series (medical thriller) Page 2