“Now, at eighty-eight, and looking it, I can approach and talk with women I don’t know and they’re perfectly comfortable with me. It’s like I’m wearing a sign around my neck that says, not to worry...he’s safe, he couldn’t get it up if he tried.”
Warren laughed. “And that tickles you?”
“Nature has her way. Each time I lose one thing, she replaces it with something else. In my case, it’s mostly humor. You wanted to see me, Warren?”
“I’m sorry to have to bring this up, but Marion Krupp’s at it again.”
“It’s time to do something about her.”
“It’s funny, Jacob, but she used the same exact words about you.”
“Look, Warren, I know she’s obsessed with me, but I’m not the only one.”
Warren smiled. “Well, it will please you to hear that she thinks you’re special.”
“Of course. I remember a number of Krupps...prison guards at Auschwitz. I think she may have a special affection for Jews.”
“Don’t be paranoid. She can be obnoxious without being an anti-Semite.”
“You’re right, of course, but don’t accuse me of paranoia...with my history, I don’t think that’s possible.”
“It’s the Josh Friedman case. I know you two fought over end-of-life care, specifically morphine dosing, but now she’s suggesting you had something to do with his death.”
Jacob smiled, his ‘when-does-it-ever-end’ smile. “I figured that living long enough would put me beyond banal human pettiness. I guess you’re never too old to learn.”
“We’ve all eased the way for patients, Jacob...you and I agree that it’s part of our responsibility, but it is possible to go too far. You haven’t been shy about expressing your opinion. Everyone understands your position on the care of terminal patients.”
“Even if I were inclined to act aggressively, Josh Friedman was so close to the end that it wasn’t necessary. Look over his hospital chart. Josh died without my assistance.”
“I know, Jacob. Times don’t allow me to deal with these problems out of hand. I hope you understand.”
“I do, but not to worry. When I decide to do one of my patients in, nobody will suspect it or be able to prove it. My first and last loyalty is to my patients...nothing will subvert that.”
What a stiff-necked, stubborn old man, Warren thought. God bless him!
I smile at the name, Rory Calhoun. This can’t be the cowboy, the movie star Rory Calhoun. He died in 1999 from complications of diabetes. That Rory was a handsome heartthrob of the fifties. This one’s the scum of the earth.
I managed to read his chart. Rory, age seventy, was admitted for treatment of a non-healing foot ulcer. He has a thirty-year history of heroin addiction...thirty years...unbelievable. Then twenty years on Methadone maintenance. The drug addict somehow managed to work steadily and he actually remarried eight years ago.
I watch as he sleeps fitfully, thrashing his arms and legs around the bed and pulling against groaning leather bed restraints.
The sight of Rory draws me to his bedside. I raise his arms, one at a time. It sickens me to see the dark pigmented tracks, the dead labyrinth of veins, the portals for his ecstasy that cover his lower and upper arms.
Disgusting.
I look at the central line placed just below the clavicle, the only choice they had for IV fluids and antibiotics in a man who spent a lifetime destroying his own veins.
He opens his eyes. I quickly place my gloved hand over his mouth.
“I have something for you,” I say, holding up a 20 cc syringe filled with a clear fluid. “It’s something you’re going to enjoy...an old friend.”
I grasp the injection port on the IV line and inject 100mg of morphine.
There it is, thought Rory, the old familiar rush.
Rory smiles.
I smile back. This is such an appropriate ending for a wasted life.
Rory feels his dry lips.
His arms and legs are heavy.
He feels himself nodding off.
Where have you been all these years?
Enjoy the ride, I say, then walk to the sink and wash my hands of his contamination.
When Ginny Harrison entered Rory’s room twenty minutes later, she found him asleep. She took his blood pressure, 100/60—much lower than normal for this man, and measured his respirations, four per minute. His skin looked flushed and when she shined a light into his pupils were pinpoint.
Low blood pressure, flushing, reduced respiration, and pinpoint pupils screamed narcotic overdosage. She pushed the Code Blue button, and in seconds, the room filled with members of the resuscitation team.
Ginny stood wide-eyed clutching her stethoscope. “I think he OD’d...I think he shot up with heroin!” Jack Byrnes approached the bedside. “That would be some trick. He’s in restraints.”
One minute later, after Jack injected an ampule of Narcan, a specific narcotic antidote, Rory started moaning and pulling at his restraints. After another minute, he slumped back into a coma.
They moved Rory to the ICU.
Jack turned to the ward clerk. “Draw a toxicology panel. I want to repeat it every hour until we know that he’s safe. We could be dealing with anything, multiple drugs, contaminants and who knows what.”
Each time Jack administered the Narcan, Rory surfaced only to sink back into coma. At the end of the second hour, Rory’s nurse, Carla Watts, frowned. “His respirations are up to 40 per minute and he’s looking a little blue.”
“Get another set of blood gasses and give him more Narcan.”
Five minutes later, Jack looked at the arterial blood gasses results. Rory’s oxygen saturation had dropped markedly and the acid in his blood had increased as well.
“He’s going out.” Carla pulled the pillow from under Rory’s head and shoved a resuscitation board under his back.
“Push the button, Carla,” said Jack with a calm voice, “then break out the intubation tray.”
As the ICU resounded with the pulsating beat of the Code Blue alarm and the room filled with members of the team, Jack stood at the head of the bed with the stainless steel laryngoscope in his hand. Like a street thug with his switchblade knife, he jerked his wrist and the curved blade flipped out.
“Hurry up, Jack. He’s purple and his pulse is up to 180 beats per minute.”
Jack inserted the blade under Rory’s tongue, lifting the tissues and trying to visualize his vocal cords. The entire area filled with blood-tinged foam obscuring all landmarks.
“Get me the suction,” Jack yelled. “I can’t see a damn thing.”
Carla passed the clear plastic suction tube to Jack who began sucking away the foam. With fewer bubbles, Jack tried again to see the vocal cords when the area again filled with foam and bloody mucous. Pulmonary edema...his lungs filled with fluid. Jack suctioned again, and then turned toward Carla. “When I tell you to, push down on his thyroid cartilage, his Adam’s Apple. Hold it until I say stop.”
Jack strained for the v-shaped slit, the vocal cords, a drowning man reaching for a lifeline. He needed to pass this breathing tube through them, but again he saw nothing. “Push now, Carla!”
When she pushed down, the vocal cords, those beautiful vocal cords, descended into view. Jack pushed the tube through the cords, and then inflated the balloon cuff around the tube to fix it in place. He then listened to the chest as they inflated Rory’s lungs with a resuscitation bag.
“We’re in,” he said with relief. “Get a stat portable film and give him 40 mg of Lasix intravenously.”
Lasix, a powerful diuretic, would help remove the excess fluid in Rory’s lungs. The chest x-ray showed massive amounts of fluid, making his lungs look white on the films.
Jack had to repeat the Narcan twenty times in the next six hours with additional doses of Lasix until Rory’s condition stabilized.
That was one hell of a narcotic overdosage, Jack thought. What happened?
Chapter Twenty-Three
&nbs
p; While Mark Whitson, the chief of pathology, loved the medical aspects of his job, he hated the business part.
I must hire an administrative assistant, especially for the dirty work, he thought.
Mark turned to the small tray behind his desk containing his fly-fishing tools. He placed his newest idea, a small fly for Bass, in the vice, put it under the magnifying glass, and began his complex tying.
“It relaxes me,” Mark always said when caught in the act.
Few made the mistake of asking Mark about his hobby unless they had hours to spare.
Mark’s secretary interrupted his intense concentration. “Tommy’s here.”
“Show him in.”
Tommy Wells’s face remained impassive as he sat in Mark’s eight-by-ten office before a large oak desk covered with piles of charts and reports. On Mark’s light blue painted walls were diplomas and board certifications, plus perhaps a hundred specialty licensing documents for a whole range of diagnostic equipment and testing.
“I’m sorry to have to bring you in here again, Tommy, but I’m getting more complaints.”
“What the hell is it now?”
“That’s part of it, Tommy. Your short fuse.”
Thomas took a deep breath. “Who did I piss off now?”
“Jacob Weizman and his patient Gabriella Sago are two. They claim that you made inappropriate advances and when she rejected them, you deliberately hurt her.”
“What a load of crap that is. She had shitty veins. I can’t help it if I can’t get blood the first time, every time. As far as advances, have you seen her? She’s a gorgeous showgirl and I think it’s gotten to her head. Did I flirt with her…sure a little, but nothing out of line.”
“This whole thing comes close to assault. I really had to talk Jacob down.”
Whitson looked at the papers within the manila folder. “Look, Tommy, you’re an intelligent guy. You may mean well by involving yourself in ward activities, but the nurses especially don’t like it. Initially, they thought you were trying to be friendly and helpful, but many see you as interfering.”
“I’m sorry, Dr. Whitson, but for the moment, I spend most of my waking hours here. I have friends here. I meet women here. What’s wrong with that?”
“I don’t have the formula to make sure you don’t cross the boundaries of impropriety, but according to several nurses, you’ve done just that. In addition, this was the third time you’ve been warned away from the medication room. In this drug crazed culture, the nurses are paranoid about anyone pilfering medications.”
“I needed a few simple supplies. Now I’m stealing drugs? Where’s the proof? Show it to me.”
“Wait a second, Tommy. I’m not here to fire you. I hope that won’t become necessary. I’m trying to help. I owe it to your father. He was a dear friend.”
“Whatever I do…it turns out wrong. I hate being the lowest man on the totem pole, taking crap from everyone, but I understand that’s where I am for the moment. Once I complete my EMT training, I’m out of here.”
“Nobody’s asking you to take abuse from anyone. You come to me if that happens. Meanwhile, take the advice of someone who wants to see you succeed. Do your job. Be careful with your attempts at friendship with the staff. They may misinterpret it. And, Tommy…” he paused.
“What?”
“Keep the hell out of the medication room.”
Zoe sat with Margaret in the office after hours. “Look, Margaret, if the staff has some sort of problem with me, let them bring it to my attention rather than talking behind my back. I’m a reasonable person. We can work it out.”
“I’m sorry, Dr. Spelling, I don’t know what you’re talking about.”
“That’s another thing. I’ve asked you to call me Zoe when we’re out of the range of patients. Why do you insist on the formality?”
“I’m sorry Dr...I mean Zoe. It’s just a habit.”
“You have no problem calling Dr. Weizman ‘Jacob’.”
“Oh, but I did. It took nearly twenty years until I got that one right.”
“Maybe I’m too sensitive, pushing for the informality that only comes with time.”
“About the staff, they talk about everyone, but it’s totally benign. I haven’t heard a mean word from anyone about you. To Jacob and me, these people are family, but unlike a real family, we can get rid of the malicious gossipers.”
“I heard someone say that I didn’t know what I was doing...that pissed me off at first, then, in retrospect, it hurt my feelings.”
“I don’t know what you think you heard, Zoe, but the staff has taken to you. That’s a heck of an accomplishment when they naturally compare you with Jacob.”
“Nobody can compare with Jacob. If they try, I lose. He’s simply the best.” Zoe stood. “I’m sorry. I want people to like me. I don’t want Jacob to think he made a mistake when he allowed me to join his practice.”
“I think that you’d blush if you heard all the nice things that Jacob has said about you, Zoe. You’re doing fine. Relax. Lighten up.”
That evening, after dinner, Jacob and Lola sat at the kitchen table sipping their Decaf.
Jacob put down his cup. “This isn’t bad. Sorry we can’t have the real stuff.”
“If you want to be awake all night, I’ll brew you a cup of the real thing.”
“No thanks. My sleep is poor enough.”
“I saw Sarah Hughes in the office today.”
Jacob took another sip. “How did it go?”
“She’s angry and confused.”
“Just like us?”
Lola smiled. “No. She’s both those things and dysfunctional as well. I think I can help her, but it’s hard to get beyond the popular stereotypes of psychiatrists...they don’t exactly encourage confidence.”
“Look at the competition, Lola: Richard Gere in Final Analysis, Robin Williams in Good Will Hunting, and the psychiatrists’ favorite, Judd Hirsch in Ordinary People. Let’s not forget Dr. Melfi in The Sopranos, and our all time favorite, Cannibal Lector.”
Lola smiled. “I love the line from Professor Glen Gabbard. He’s the author of Psychiatry in Cinema who said: I’ve checked the American Psychiatry Association regulations, and I have to tell you, they have no rule against eating your patients.”
Jacob laughed. “I love it.”
“Psychotherapy is tough enough without preconceptions. Some of them may be appalling enough to keep patients away...that’s tragic. When you add the Scientology plot against psychiatry and especially psychiatric medication, and their use of celebrities, like Tom Cruise, you see the problem.”
“Want to hear my favorite psychiatry joke?”
“Okay, but I’ve probably heard all your jokes by now.”
“Well, at our ages, if I don’t remember telling it, you may not remember hearing it. Ronnie Shakes, the comedian, said: After twelve years of therapy, my psychiatrist said something that brought tears to my eyes. He said, ‘No hablo inglés.’”
Chapter Twenty-Four
By the next morning when Jack Byrnes entered ICU, Rory Calhoun was sitting up in his bed laughing as he watched television.
Jack grabbed his chart and made himself comfortable at the nurse’s station. Ross Cohen, one of Brier’s senior psychiatrists, and Rory’s shrink, pulled up a chair.
“What the hell happened last night, Jack?”
“Somehow, Rory got a massive overdose of a potent narcotic...heroin, I’d guess. If he wasn’t an addict with a high tolerance for drugs, and especially if he wasn’t on Methadone maintenance, he wouldn’t have made it.”
“How did he get it?”
“Don’t have a clue, but since he was in restraints, it came with someone’s help. Does he have any enemies?”
“Just himself.”
“Could he have arranged for someone to give it to him, and they screwed up?”
“I don’t see that,” said Ross. “On Methadone, he didn’t need anything to control withdrawal symptoms. Was he seeking a
high? You can never be sure with an addict.”
They walked over to the bedside. Rory stared at Ross. “Hey, Dr. Cohen, what in hell am I doing in this damned place?”
Ross turned and pointed to Jack. “This is Dr. Byrnes. He saved your sorry ass last night.”
“Thanks, Doc. That must a been one hell of a ride. I haven’t felt a high like that in years, maybe never have.”
“Do you remember what happened?”
Rory smiled. “Someone gave me the rush of my lifetime...who can I thank? That was some great shit.”
“That stuff would have killed a normal person, Rory,” said Ross. “Your tolerance after all the years of dope and the Methadone, saved your life.”
“You mean something good came from my bad habits?”
“Who gave it to you?” asked Jack.
“Haven’t the slightest...”
“Don’t hold back on me now, Rory,” said Ross Cohen. “We just want to know what happened.”
”Me too, Doc. All I saw was a dark shadow and a glint of a white coat. When I saw that needle entering my IV line, I thought I’d had it, then the all time high...shit, I really miss that.”
They found nothing new on examination, so Ross wrote transfer orders returning Rory to the ward.
“I think we have a reportable problem here, Jack.”
No Cure for Murder Page 10