by Judith Lucci
The lights were out in her office. Bridgett wasn't in, but she usually came in around nine after she dropped her little boy at school. I've got a lot for her to do today, Alex thought. I hope she comes in. She checked her voice mail and there was an urgent message from the night nursing supervisor asking her to come to the nursing office right away. Alex left her office immediately and met Bette Farve on the way.
"Morning, Bette. Where're you headed?"
Bette nodded stiffly at her and kept on walking.
Alex ran after her. "Bette, I had a message to report to the nursing office. What's happening?"
"More than you want to know about,” Bette snapped, her rigid face displayed her anger and irritability. “Fifty percent of the nursing staff has called in sick, and we need an emergency staffing plan. Thought you may want to be included."
"Fifty percent? What the hell! What's going on?" Alex asked, alarmed, as visions of food poisoning, the Ebola virus, and flesh eating bacteria ran through her mind. “Oh no, this couldn’t be more of the voodoo stuff, could it?”
"Beats me. I don't have a clue." Bette rolled her eyes.
Alex wondered why Bette was being so accommodating when she usually did her best to make Alex appear unprepared and incompetent. "We've never had an absentee rate like this. Are the absences confined to specific units?"
"As best I can tell, they're spread throughout the house. I don't know what's going on. Probably just a bunch of lazy asses looking for a day off." Bette was sarcastic. Somehow, that remark hadn’t sounded so bad when her grandfather had said it yesterday.
Alex bit back a bitter retort. “They are probably afraid they’ll ‘catch’ the voodoo curse. Have you talked to Don?”
"I left him a message. I'm going to meet with my assistant vice-presidents to review staff numbers. I guess these call-ins are related to yesterday?"
"Can I attend your meeting?" Alex expected Bette to say no.
"Yes, whatever plan we come up with will have to meet with your approval anyway, so we may as well get your advice early. Besides, I'm flying out of here tomorrow for New York. I have tickets to three plays and nothing's going to keep me from going."
Alex was amazed Bette was including her but suspected it was due to her upcoming vacation. "When do you meet?"
"Now," Bette said.
***
The vice-presidents for nursing were drinking coffee and talking among themselves when Bette and Alex arrived.
The news wasn't good. There were currently 273 inpatients in the hospital at CCMC, not counting the patients housed on the research units. Critical care, medicine, and oncology were full. This represented a decreased census rate of 50% since yesterday.
The vice-president for surgery reported that eighty percent of her staff had called in sick. Ten percent of the critical care and emergency room staff had called in, but sixty percent of staff scheduled in medicine and oncology had also called in. The vice-presidents had already instructed their secretaries and staffing coordinators to call the staff at home who were scheduled off and ask them to cover.
Alex said, "We need to close some units. Suggestions?"
Bette, her face as bright red as her dyed hair, shrieked at Alex. "You're crazy! We can't shut down units. Think about what that means to hospital revenues. We're having enough trouble keeping our market edge. I refuse to close units, and besides, Don would never allow it. God knows what Obamacare is going to do us and now you want to close beds."
"Bette, be reasonable. If there are no patients, there is no revenue. Besides, there's nothing else we can do. We can't run a six hundred-bed hospital on fifty percent staff. Logically, that would suggest that we needed one hundred percent of our scheduled staff. We're setting ourselves up for trouble. Be practical. Our staff would run themselves ragged, and they'd be exhausted after two days. Fatigue itself would cause mistakes and accidents, and our quality outcomes would decrease."
Bette was furious and invaded Alex’s personal space, her head inches from Alex’s face. "I’m not closing units. Do you understand? We'll check out agency staff to get us through this.” She moved away from Alex and glared at her VPs. “Anyone have any idea what is going on here?" She waited. “Come on, I know some of you know. Why are they calling in sick? This will count against them, their pay will be docked, and they will not be able to count it as a vacation day. Tell them that. I damn well guarantee it."
No one spoke. The tension in the room permeated the atmosphere. Bette was not defeated and said in a menacing voice, her nostrils flaring, "Some of you have good grapevine access... you must have some idea why we have this sudden rash of sick calls. Someone had better speak up. Diane, what do you know?"
Diane shook her head. "I have no idea, Bette. Had a three-day weekend and was out of town. I haven't even checked my units yet. Didn't even know about Mrs. Raccine until this morning when I came to work."
Diane Bradley, the assistant vice-president for critical care, stood up to Bette. Very little intimidated the veteran nurse. Diane continued speaking, "However, Alex is right. We need some contingency plans and we need to close units. I do suggest we develop several emergency staffing plans to get us through the next few days. Meanwhile, let's decide what to do today. We have patients in these units who have no nurse taking care of them. From what I can tell, the ICU and the emergency department are in pretty good shape. Medicine and surgery are a problem. I can lend some staff from critical care."
Alex smiled gratefully at Diane and could have kissed her. She was about to speak when her cell phone started to ring and the overhead hospital paging system began to STAT page her to administration.
"Got to go. Your suggestion is good, Diane." Turning to Bette, she said, "I'd like an opportunity to talk with you after you develop your plan. I'm free this afternoon. Good luck." Alex stood and smiled at the assistant VPs for nursing.
Bette hollered after her. "Just remember that I'm going away tomorrow. Any extra expenses here will be between you and Don," Bette warned on her way out.
"I'll take full responsibility," Alex said, and closed the door as she walked quickly toward the administrative suite.
On her way to administration, Alex ran into Elizabeth Tippet. "I've been paged to administration. How about you?"
"Same. Any idea what's happening?" Elizabeth said.
"Nope, but we'll know in a minute. How'd you sleep last night?"
"Not well at all. Had bad dreams all night. Do you have any more information about the voodoo? I can't believe we're in the twenty-first century, and people in this city believe in this crap. It's beyond me," Elizabeth sighed.
Alex nodded agreement and said, “Well, they do. Half of the staff called in today. Census is down over fifty percent from yesterday.”
“That’s great, that’s just great. Don will be even more freaked,” Elizabeth replied sarcastically as she shook her head.
As the two women entered the administration suite, they saw Don, John Ashley, and Robert Bonnet seated at the conference table where they talked quietly. John and Robert stood as Alex and Elizabeth walked in. Don kept his seat.
Alex asked quickly, "What's going on?"
Robert spoke directly to Alex, "Mrs. Raccine's in cardiac distress. I'm afraid she could go bad on us very quickly. I've called in the chief of cardiology and he's with her now. We’ll be transferring her to the CCU." Robert was concerned and looked sad.
"How's she mentally?" Elizabeth said.
"Unchanged. The nurses report that she's moving about and grimacing. Although she remains unconscious, it looks as though she may be remembering something."
Alex said, "Well, that could be good news provided that when she wakes up she doesn't have a heart attack."
"Our fears exactly," Dr. Ashley replied. "Meanwhile, three newspapers have called for a press release, and unfortunately, the Associated Press picked up the story, and it ran in every major newspaper this morning. The Washington Post, New York Times, Los Angeles Times, and Miami Herald
have correspondents who are eating breakfast in the hospital cafeteria."
"Did we offer them meal vouchers," Elizabeth glanced sideways at Don Montgomery. "We need to keep them as happy as possible and have another press conference. If these newspapers have sent representatives, you can bet all other major print media and news networks will send journalists, too."
Don's secretary, Latetia, appeared at the door. "Mr. Montgomery, we have People Magazine on the phone, and CNN just called and asked to speak with you. I told them you're in a meeting, so they said they'd be sending a correspondent and news team down. What are we supposed to say to these people? What are we supposed to do with them?" Latetia stood at the door, and refused to move until someone told her what to do.
After a brief silence, Elizabeth spoke up and said, "Tell anyone that calls that the hospital will be holding a press conference at five today. We'll take questions from reporters." She looked at Dr. Ashley and Don Montgomery. "We have to address their questions openly and honestly. Otherwise, we'll get more publicity that’s negative if it seems we are covering things up. We also need to get Governor Raccine to come. If he's supportive of us, it'll help us tremendously. Robert, you know the Governor. Will he participate?"
"I'll ask him. I'm sure he'll come if he can. If not, he'll send Andre Renou. I'll check it out and get back to you."
Elizabeth continued, "We have to draft something for the press and anticipate the questions they will ask us. Can we do that now?"
Alex intervened. "I'm in favor of what you're suggesting, but first, there's another problem that takes priority." Alex looked around the table as she spoke. "I've just returned from a meeting in nursing administration. Our sick calls are up fifty percent today. Only half of the scheduled nursing staff has reported to work."
Don jumped up from the table and screamed at her. "Fifty percent of the staff called in sick? Who the hell's taking care of the patients? We can't run a hospital on half-staff. We’ll be broke sooner than later. What a pile of shit all of this is! This is fricking insane!” Don's voice was loud, angry as he slumped in his chair.
Alex continued, talking over Don’s outrage. "The hardest hit areas are medicine and surgery. The ICU's are okay and so is the ED. So are the maternal-child areas. I asked Bette and her nursing managers to develop an emergency staffing plan and close several units to combine staff so we can offer safe care."
Don’s face was beet red as he jumped up from his chair, "No, no, no, hell no. We will not close beds or units," he retorted angrily. "It's unthinkable! What'll this look like to the public, to our competitors who are probably laughing their asses off at us already? I still think all of this is corporate espionage. We will NOT close beds, or the next thing you know, we'll have to close the damn hospital!"
Dr. Ashley said pleadingly, "Don, we have to close beds. We don't have any nursing staff to take care of these patients. Besides, it will save us money in the long run.”
Don thought for a moment and said, “If we close half of our beds, we won't have an image, because we won't have a hospital. It's preposterous. Do you realize how much money each closed bed costs the hospital? A hit like this will kill us. I feel like I'm being blackmailed. You’ll have to find another way,” Don said as he pounded his fist on the table.
Alex couldn't believe he was reacting this way. He was like a child in a rage. What an imbecile. "Don, we have to do this. We don't have a choice." She was beginning to think that Don and Bette were joined at the hip. "We have to combine resources. We have a lot of patients and need full staff for heaven’s sake. The ratios are low anyway, barely adequate in some areas and hardly meet national standards. That’s always been a huge risk for us. We need a plan designed to maximize resources as best we can and to keep as many beds open as possible. I'll ask Bette to call Louisiana State University and Loyola and offer overtime to all nursing students. Meanwhile, we'll call Tulane and see if they can help us out with morning care. We'll also check with the agencies for extra help. We'll never get these patients back in here for care if we don't handle this situation correctly. John, can you arrange to have our inpatient admissions redirected? We probably should consider directing the emergency department patients to other hospitals and distribute the ED staff to cover the house.”
John nodded in agreement. "Yes, Alex, of course. I think you're on target. I'll call a meeting of the medical staff this afternoon. We can also reschedule elective surgery for the next few days. If possible, I'd like to keep the emergency department open since we're the major trauma center in New Orleans."
John was surprisingly calm in assessing the situation and Alex was grateful for his ability to work under pressure. She nodded her support for keeping the ED open.
Don remained red-faced and sullen.
John glanced around the table and asked, "Anyone know why we've had all of these sick calls? Is it associated with yesterday?"
Alex said, "That question came up at the nursing meeting. No one had any explanation for the deluge of sick calls."
Robert looked up and shaking his head said quietly, "Yeah. I know why. It's very simple, if you think about it. It is about yesterday."
All of them stared at him, looking perplexed. "Speak, Bonnet," Montgomery roared.
"Voodoo legend says that if you accept the curse, that is, if you accept the voodoo, then you assume the curse. In this case, people who believe in voodoo would assume the curse by reporting to work. Even people who don’t believe in curses are scared. That's why the police can't find Bessie Comstock, the nursing assistant, and they won't find her anytime soon. She’s most likely left town, trying to escape what happened in Mrs. Raccine’s room. I had several physicians tell me this morning that they're admitting their patients to other hospitals. Simply put, the staff and the physicians are afraid to admit here and won’t because they will most likely lose patients."
“What did you say?” Don roared. “They are admitting to other hospitals? I want those damn, fucking doctor traitors taken off our medical staff list. They no longer have privileges here, Bonnet. You tell them that.”
No one responded to Don, so Robert continued, "Basically, I think we're lucky to have half of the staff here. I'm surprised that many reported."
Elizabeth looked at Robert. "Dr. Bonnet, how long do you expect this to continue? How long will people stay out of work?"
Don answered before Robert could speak. "They'll either get their asses back here tomorrow, or they're fucking fired!" In a fit of temper, Don left the room. The rest of the executive team looked at each other.
Elizabeth shrugged her shoulders and finally spoke, "I don't know if it's worse when he doesn't speak at all, or when he screams at us. Either way, he's pretty useless."
Dr. Ashley nodded his head in agreement. "You're right. He certainly isn't helping at all. Where does he think he's going to hire staff? If what Robert says is right, no one'll work here. Robert, how long before this blows over?"
"Don't know. It'll depend in part, on how well Mrs. Raccine recovers. The other part will depend on how well we handle the situation. Firing people won't help."
"Don't worry. I'll talk with Don a little later. Let's get to work. I’ve got to go. I've got patients to see." Dr. Ashley spoke authoritatively.
***
The executive team worked until almost noon on the press conference and staffing plan. Late in the morning, Alex toured the medicine and surgery units, and she found that things were going surprisingly well. Sixteen first-year nursing students from LSU were giving baths and making beds. Also, Delgado Community College had sent over ten nursing students. Alex was pleased at the cooperation between the local university, colleges, and hospital. The nursing vice-presidents reported that an additional twelve nursing students were coming in for the evening shift. Bette was nowhere to be found.
***
Alex grabbed a bite for lunch in the cafeteria and returned to her office a little after one. Bridgett was in but looked unwell.
"Bridge, h
ow you feeling?"
"Much better, thanks. How're things going," Bridgett had a strained look on her face and she was quiet, a total contrast to her normally vivacious self.
"Better than I would have anticipated early this morning,” Alex replied. “What's the rumor mill saying about the Raccine case and voodoo?"
"The usual, what you'd expect?" There was no eye contact and Bridget looked at her computer screen.
"Bridgett, what's going on? You know everything that goes on in this place. You’re my grapevine! What gives? You've been awfully quiet lately. Is anything happening with you I need to know about?" Alex gave her secretary a hard look.
Bridgett's voice was hesitant. "No. Not at all. Just didn't feel well yesterday. I knew you'd be out most of the day, so I left about two." Bridgett kept her eyes on her computer screen the entire time she was talking to Alex.
"Bridge, you're acting weird. Look at me."
Bridgett looked up from her computer. "Alex, I don't want to talk about the Raccine case or the staff shortages. In fact, I'm thinking about resigning. Darryl wants me to stay at home with the baby."
Alex stood there looking at Bridgett in amazement as she finally realized what was wrong. Bridgett was Cajun and was scared. Bridgett believed in voodoo and was afraid that, by reporting to work, she'd assume the curse.
“Okay, I get it. I understand what's happening here. Take some time off, all you need to, but don't resign. I need you too badly. Take the time you need, and we'll talk later."
"Thanks, Al. Thank you for understanding. I'll stay awhile today and finish up. Then I'll decide what to do." Bridgett looked relieved as she continued to type.
Alex went into her office. She decided to take a stress break and phoned Mitch. He was in, but his voice sounded strange, cold. He told her he was busy and couldn't talk, saying he had to get downtown. It was unusual and tense—the tersest conversation she had ever had with Mitch and Alex was baffled.
***
The ponytailed stranger, Monte Salvadal, stood across the street from the busy CCMC emergency department. Hordes of people entered and left through the glass doors. Business was looking good for CCMC—at least for now. He smiled.