Code Blue

by Janet Lane-Walters

  Susan curled on the couch and picked up the local newspaper. The headline produced a groan. "Local Doctor Shooting Victim." The story began in an equally aggravating way. "A second member of the staff at Bradley Memorial Hospital died violently yesterday. Dr. Joseph Barclay was possibly murdered at his hunting cabin upstate."

  Though the reporter went on to clarify that hunting accidents were listed as manslaughter, the intent seemed the same. In the second paragraph, Susan read about Joe Barclay's position in the community and his wife's illness. The third paragraph was full of speculations about the woman who had reported the death. The words brought an uncomfortable feeling. She hoped Leila would read the article and change her mind about the funeral.

  The story ended with a statement that disturbed Susan. "Though the police have stated that while the doctor's death was a tragic accident, there is a common denominator between his death and that of Barbara Denton -- the hospital."

  And with De Witt, Susan thought.

  She crushed the paper and jumped to her feet. She had to call Leila. Before she reached the kitchen, the doorbell rang. She opened the door. Adam and Robin burst inside.

  "Hi, Aunt Susan," they said in unison.

  Robin handed Susan a plastic container. "Your dinner. Dad said you're not to forget it this time."

  "Don't you ever get tired of working nearly every evening?" Adam asked.

  "Sometimes."

  Robin smoothed the paper. "Dad got upset, too. He said he wouldn't have handled the story this way. Did you know the doctor, too?"

  "Not very well."

  Adam pulled off his jacket. "A hunting accident isn't nearly as exciting as a murder. I'm starved. All Dad has are cereal, eggs and turkey. We have to go shopping. Do you have any of those chocolate chip cookies you always make?"

  "In the freezer. I'll zap a few in the microwave." Susan walked to the kitchen. Once the twins were settled at the table with milk and cookies, she refilled her coffee mug and joined them.

  "Do you think Dad will like the sweater and shirt we bought him?" Robin asked.

  "I still think we should have gotten Rob something different," Adam said.

  "Like that expensive golf club Mom suggested?" Robin asked.

  Adam looked at Susan. "She always wants us to treat him better than Dad. Except Dad's the one who buys things for us." He deepened his voice. "You should be grateful for the roof over your head and the food you eat."

  Robin made a face. "Is it wrong to love your dad more than your stepfather?"

  "Especially when he thinks you're a pain?" Adam added.

  Susan put her mug down. "You know it's not. Are you sure Rob doesn't like you?"

  "He's different when Mom's around." Adam reached for the last cookie on the plate. "These are great. Mom doesn't bake cookies."

  His wistful smile made Susan grin. "I'll give you the rest to take home."

  Adam eyed the bag. "Thanks. I wish we lived with Dad. Then we could come for cookies every day."

  Robin sat on the edge of the chair. "I have a better idea. Why don't you and Dad get married? Then we could come and live with you. I think Rob would be glad to get rid of us."

  "That would be great but we wouldn't want Aunt Susan to marry Dad just because she was sorry for us."

  Susan walked to the sink. The twins were as bad as their father about making plans for her future. "Your dad and I are friends." She handed Robin the bag of cookies. "I'll see you the next time you come to visit."

  "Will you spend Christmas with us?" Robin asked.

  "If I'm invited."

  "You will be. We'll tell him he has to," Adam said. "Thanks for the cookies."

  Susan closed the door behind them. She needed to talk to Patrick about the things the twins had said. Maybe concern for his children would divert him from wanting to arrange her life.

  As she walked upstairs to iron uniforms for the week, she grinned. Why did she feel the pair had just manipulated her?

  The smile faded. She had to call Leila and convince her to stay away from Joe Barclay's funeral. The phone rang. She dashed up the rest of the stairs and picked up the phone in the master bedroom.

  "Have you seen the newspapers?" Leila's voice rang shrill. "How do they get away with saying things like that?"

  "Calm down. Your name wasn't mentioned."

  "You know how everyone at the hospital will react when they read this."

  "With gossip and speculation about the identity of the woman." Susan let out a breath. "Now do you understand why you can't go to the funeral? One look at you and everyone will know you're the woman. Do you want people thinking you killed him?"

  For a long time, Leila didn't answer. Susan hoped her comment had reached her friend.

  "I have to go. I have to tell him goodbye."

  Susan slumped on the bed. "Think of your future. Joe's dead. Attending the funeral won't change that."

  "I'll think about what you've said. Talk to you tomorrow."

  The phone went dead. Susan opened the ironing board. Would Leila listen?

  * * *

  Gently, he placed the pine grave blanket over the place where Mommy slept. Should be roses, he thought, but the cold would kill them. For a long time, he stared at the grave. Mommy was alone, but Susan would join her soon. In his head, he heard Mammy's protests, but he refused to heed them. Susan had to be like Mommy.

  He had his plans. The seeds of the plan sown on the Overlook had sprung to life today. This morning, he had found the perfect place to lie in wait for her. How easy the matter had become once he had decided what to do.

  "You like Susan," he whispered. "You told me that. Won't it be nice when she's there to take care of you?"

  A smile turned the corners of his mouth upward. His laughter shattered the silence of the cemetery.

  * * *

  On Tuesday evening at six thirty, Susan entered the nurses' lounge and stopped just inside the door. Leila huddled in a chair at the round table and stared at the window. Susan caught her lower lip with her teeth. The depth of her friend's grief touched and made her feel helpless.

  "I tried to call you this morning." Susan crossed to the credenza.

  Leila turned. Unshed tears glistened in her dark eyes. Carefully applied makeup couldn't hide the shadows beneath her eyes. "You were right. I shouldn't have gone." She lit a cigarette.

  Susan's protest remained unspoken. She couldn't scold Leila today. "I wish I could help you."

  Leila shook her head. "I'm glad you didn't go. One word of sympathy and I would have fallen apart."

  "What happened?"

  "Nothing overt." Leila tapped her cigarette against the edge of a saucer. "Mary looked frightened. I didn't speak to her. She would have known."

  Susan nodded. "I'm glad you realized that."

  "De Witt stood behind her wheelchair looking like a palace guard. You should have seen the way he glared. Made me feel like a tax form being scrutinized by the IRS."

  Susan studied her hands. She didn't tell Leila that De Witt knew she'd been at the cabin. "Did you stay for the service?"

  Leila shook her head. "I had to leave before I broke down. I didn't even get to see him. The casket was closed. It took me twenty minutes after I left to calm down enough to drive home."

  "I know how hard it must have been." Susan touched Leila's hand. "Have you slept since he died?"

  "I've slept."

  Susan studied her friend's face. "I'm not sure I believe you."

  "Two sleepers and several gin and tonics give me three or four hours a night."

  "Leila! Do you realize how dangerous that is?" Susan's warning exploded in a shout.

  "I know, but I'm careful. I've moved to the family room to sleep. There are too many memories in the bedroom."

  Susan recalled her own long and lonely nights. "I slept in the guest room for months after Jim died."

  As soon as Leila's cigarette burned to the end, she lit another. She took a deep drag and placed the cigarette on the saucer
. Smoke curled toward the ceiling. "I think De Witt knows about Joe and me."

  "How?"

  Leila shook her head. "I have no idea. He glared and smirked at the same time."

  "Do you think he'll make trouble?"

  Leila shook her head. "I can make more for him."

  Susan leaned forward. "Maybe you should go to the police and tell them what you know."

  Leila shook her head. "Joe's dead. I have to protect his memory." She carried the saucer to the powder room. "Back to work. Thank heavens for routine. That's what keeps me going."

  Susan understood the sentiment. Routine had been her shield for a long time. "I'll call you in the morning. Maybe we'll go to lunch."

  "I'll be all right."

  The sharp edge in Leila's voice honed Susan's concern. "Take care of yourself, please."

  Leila touched Susan's arm. "I'll be fine. Just give me time."

  Though Leila's attempt to smile failed, the gesture warmed Susan. Her friend walked away. Rounded shoulders made her appear old.

  Trish stepped out of a patient's room. "What's with Leila? She looks like a puppet whose strings have been cut."

  "She has some personal problems."

  "Don't we all. Speaking of which..." Trish turned. "When you have a few minutes, could we...could you...oh, forget it."

  "Is something wrong?"

  Trish's bony shoulders hunched. "I thought I was ready to talk, but I'm not. Maybe some other time." She pivoted and entered the room she had just left.

  Susan frowned. After evening care, she would find an excuse to pull the other nurse aside for a talk. Did Trish's problems have anything to do with Barbara's death? Did the other nurse know something about the killer? After pushing her questions aside, Susan walked to her district and found Faye.

  "Why don't you start at one end and I'll begin at the other?" Faye asked. "There's no one requiring heavy care and if I have a problem, I'll call you. For pin care, it's peroxide and sterile swabs?"

  "That's right." Susan grabbed two draw sheets and walked into 501. The moment she entered, she knew there was a problem. The elderly woman in the first bed sat in an upright position and grasped the side rail. Pain contorted her features. Drops of perspiration dotted her forehead and ran down her cheeks.

  "Mrs. Greene, what's wrong?"

  "My chest. The pain." The elderly woman gasped for breath.

  Susan elevated the head of the bed. Four days before, Mrs. Greene had a hip pinning. Because of her obesity, she ambulated poorly. The day nurse also reported the patient's refusal to practice deep breathing exercises. As Susan began an assessment, she considered the possible complications.

  "I need to know about the pain. Does it hurt all the time?" Mrs. Greene shook her head. "Is the pain worse when you breathe in or out?"

  "In."

  "Does it move to your arm or chin?"

  "No."

  Susan pressed the bell of her stethoscope to Mrs. Greene's back and heard a crackling noise in the lower right lung. When Susan checked the elderly woman's legs, the right calf was red, swollen and hot.

  "What's wrong?" The patient convulsively grasped Susan's arm. "Am I going to be all right?"

  Susan wiped the woman's forehead. "I won't let anything happen to you. I'll have the house doctor come to check you. You'll soon be more comfortable." Before Susan left the room, she took a series of vital signs. She strode to the desk.

  Kit looked up. "There's a problem. I can tell by the look on your face. A bad one?"

  "It could be. Call the house doctor. Mrs. Greene in 501 has chest pain. Put in a call to her medical doctor."

  "Will do." Kit groaned. "De Witt's her doctor. He doesn't like the house staff to see his patients."

  "I don't care," Susan said. "We can't wait for his service to locate him. If he has a problem with my actions, refer him to me. Don't let him bully you."

  Susan dashed down the hall. When she located Faye, she called the practical into the hall. "I'll be with Mrs. Greene in 501."

  "Do you want me to come? Will there be a code?"

  Susan shook her head. "My guess is a pulmonary emboli. Once treatment is initiated, we may have to transfer her to ICU. She's anxious and tachycardic. Right now, she needs reassurance."

  "Go," said Faye. "I'll manage. If I need help, I'll grab one of the others."

  Susan hurried to 501. Mrs. Greene shifted her position in a restless dance. Her eyes were wide. Tears spilled down her cheeks. "I'm dying." She held out a tissue. "See. Blood."

  Small flecks of red dotted the tissue. Susan reached for the elderly woman's hand. "I know you're frightened but it's important for you to remain calm. Looks like blood, but it could be the cranberry juice you drank earlier." She pointed to the empty container on the bedside stand.

  Mrs. Greene slumped against the raised head of the bed. A shadow crossed the sheets.

  Susan turned. "Mrs. Greene, this is Dr. Mendoza. He'll check you and begin treatment. Your doctor's been called." She patted the patient's hand. "I'm going to tell the doctor what happened. If I forget anything, let me know."

  With a minimum of detail, Susan described Mrs. Greene's symptoms and what the assessment had revealed. A brief history of the patient's surgery and the course of her recovery followed.

  Dr. Mendoza examined Mrs. Greene and nodded. "Get the arterial blood gases, EKG, partial prothrombin time and prothrombin time, cardiac enzymes and portable chest X-ray. You should start the intravenous of 5 percent dextrose in water at thirty cc's an hour. Oxygen at five liters and give the sixth of morphine for pain."

  Susan noted the orders on a piece of paper. Before leaving the room, she read them back. At the desk, she handed the paper to Kit. "Make the ABG's, blood work, EKG and chest X-ray stat. Have you heard from De Witt?"

  "His service paged him. They're waiting for a call back." Kit reached for the phone. "I called her orthopod. He said to let De Witt handle the treatment."

  When Susan returned to the room with the morphine and the intravenous, the respiratory therapist was leaving. An oxygen cannula was in place. Mrs. Greene's color had improved. The lab technical drew blood. Susan gave the injection and started the IV. When the EKG technician arrived, Susan scooted to the desk. "Have you reached De Witt?"

  "Just talked to him. He'll be here in twenty minutes or so. I asked if he wanted to talk to you and he didn't. Here are the ABG results."

  Susan looked at the clock. Forty-five minutes had passed since she had discovered Mrs. Greene in distress. "Did you tell him what had been ordered?"

  "Didn't get that far. When he heard Mendoza was with the patient, he exploded." Kit grinned. "I won't repeat what he said. Looks like there'll be an interesting scene ahead."

  Susan inhaled. "If he creates a scene, notify the supervisor immediately." She strode away. Kit's eager anticipation of trouble made Susan want to slap the girl.

  Outside 501, Susan paused to take a series of calming breaths. She hoped De Witt would maintain a professional attitude in the patient's presence. Susan handed the blood gas results to Mendoza. He studied the paper and put it on the over-bed table.

  The X-ray technician guided the portable machine into the room. After positioning the patient, Susan retreated to the hall and joined Mendoza. "What does the strip show?" she asked. "From the gases, I'd say an emboli."

  "You are absolutely correct. Would you call the laboratory for the blood work results? I would like to see the baseline first, but I think you should give the patient ten thousand units of heparin by the push. Then order the lung scan."

  Susan nodded. "De Witt's on his way in. Would you like to hold the heparin until he arrives?"

  Mendoza shrugged. "He will complain if I do nothing or something. We will act for the patient. The tests will support my actions. The pulmonary emboli can be dangerous. The patient, she is lucky to have you for the nurse."

  "Thank you." Susan smiled. Compliments from Mendoza were rare. "What schedule do you want for the heparin boluses or do you wa
nt a continuous drip?"

  "De Witt will tell you when he arrives. I must take the chart and write the orders I have said."

  Susan rooted through the drawers in her med cart until she found a vial of heparin. After withdrawing the ordered dose, she checked the emergency tray for the antidote. She paused in the doorway of 501, and for a moment, observed Mrs. Greene. The elderly woman's respiration had slowed and her expression revealed her anxiety had decreased.

  The patient stared at the syringe in Susan's hand. "What's that?" Her voice tightened.

  "Did Dr. Mendoza explain your problem?" The elderly woman nodded. "This medicine will help your body dissolve the blood clots and prevent new ones from forming."

  "Won't I bleed too much?"

  "We'll check your blood levels frequently." Susan smiled. "I have an antidote that works in minutes." She wiped the injection port on the IV tubing and pinched off the clear plastic to prevent back flow. "Let me know if this burns and I'll stop the push."

  "If what burns, Mrs. Randall?"

  Susan turned her head and saw De Witt. "A loading dose of heparin." As she spoke, she slowly depressed the plunger. "Nearly an hour ago, Mrs. Greene complained of chest pain."

  "Who wrote the orders?" His words were clipped.

  "Dr. Mendoza."

  The blond doctor whirled and left the room. Susan completed the push and remained to make Mrs. Greene comfortable. Before she returned to the nurses' station, she straightened the bed of the second patient. When she stepped into the hall, the sound of two male voices raised in anger caused her to hurry to the desk.

  De Witt stood beside the doctors' desk. "Why did you initiate treatment? You should have known I'd come."

  "Did you not have the funeral for your uncle today?" Mendoza asked. "Mrs. Randall could not be sure how soon you could be reached. It has been one hour since she called for me."