Diagnosis Death pft-3

by Richard L Mabry

  Godwin sat silent for a moment. "I'll be looking into the circumstances of those deaths. Meanwhile, to prevent any such incidents at this hospital, I'm going to suggest that the chief of staff temporarily suspend your privileges in the ICU." He picked up his pen and pulled a stack of papers toward him. "That's all."

  17

  Will did what he'd learned to do best. He listened, filed away information, and waited for the speaker-in this case, Elena-to run down.

  "More shrimp fried rice?" Cathy asked.

  Elena shook her head. She chewed, swallowed, and said, "No, that's plenty." She turned to Will. "What can Godwin do? Can he suspend my ICU privileges?"

  "With the usual lawyer's disclaimer that I don't have all the facts, it seems that Godwin's within his rights to investigate a complaint against a physician. He should, and probably will, consult Marcus Bell. I don't know how those lines of authority are drawn now." He saw Elena's mouth open and stopped her with an upraised palm. "But I'm betting that he can't curtail your ICU privileges. First, I'm pretty sure the Credentials Committee would have to be involved, and any action would require a hearing. If I were representing you-and I'd be happy to do that if you like-I could make a pretty compelling case that Godwin is interfering with your right to practice."

  Elena shoved her plate aside and folded her napkin. "So, what should I do?"

  "I'd call Marcus Bell and give him a heads-up. It's better that he hear your side before Godwin gets hold of him." Will leaned back in his chair. "And I'd call him now. Don't embellish. Don't do too much explaining. Simply tell him what you told Godwin."

  Cathy pushed her chair back from the dining room table. "I agree with Will. You can call from our bedroom. Meanwhile, we're going to move to the living room, where it's more comfortable."

  Will helped get his wife settled into an armchair. "Shouldn't you go back to bed?"

  "Milton said I could be out of bed. I just can't exert myself." She wiggled in the chair. "Don't make me more of an invalid than I am." Another wiggle. She looked down at her bulging belly. "But I'm sure ready for our offspring to make an appearance. It's like carrying around a medicine ball inside me-a medicine ball that kicks."

  In a couple of minutes, Elena joined them. "You were right, Will. Marcus said not to worry. He thinks Godwin's flexing his administrative muscles."

  Will retrieved a legal pad from the end table beside him. "Why don't we get down to the business I wanted to discuss?"

  "I'm sorry," Elena said. "I got so involved in my problems I forgot that you asked me here."

  Will waved that away. "Five days ago, I engaged an investigator to look into your Tuesday night phone calls." He held up the legal pad. "He called me today and gave me a verbal report."

  "He actually traced those calls?"

  "Yes. He's identified your caller." Will consulted his notes. "The calls came from-"

  "Wait." A flush painted Elena's face crimson. "Slow down. I'm not sure I'm ready for this. How did he get this information?"

  "I asked my investigator not to be too specific when he reported. After all, I'm an officer of the court."

  "You mean he may have done something illegal?"

  "More likely he got someone to bend the rules a bit." Will waited to be sure there were no more questions. "I gave him your former home number in Dallas and your cell phone number. What I suspect he did was search the call logs of your carriers until he found the calls to those numbers at midnight on the dates in question. If they all came from the same number-and apparently they did-he had his answer."

  "The number, but what about who made the call?" Elena asked.

  "Once he had the number, it would be simple to identify who owned the phone. The only problem would be if the call were made from a so-called disposable cell phone. Fortunately, your caller wasn't that devious."

  "But every time my Caller ID showed the number as 'private,' or 'anonymous,' or something like that."

  Will smiled. "That means you, as the party on the other end, can't see it. But nothing is hidden from the phone companies."

  "The first calls were to my home phone. That's an unlisted number. Then, after I arrived here, she called my cell phone. How did she get those numbers?"

  "There are several ways, but I suggest you ask her that the next time she calls." He noticed that Elena's high color had faded a bit. "Are you ready to know the identity of your midnight caller?"

  Elena wondered why she was so hesitant to hear Will say the name. Maybe it was because to this point the midnight caller was only a disembodied voice, popping up once a week to torture Elena. But once Will gave the name, the voice would become a real person, someone she had to deal with. She wasn't sure she was ready for that. She knew it wasn't logical-but what was logical about the merry-go-round her life had become?

  The ring of her cell phone brought her up short. She looked at the display and started to ignore the call. Not now, David. But she pushed the button. "Hello, David."

  "Elena, I need your help. This is an emergency."

  She sat up straighter and pressed the phone to her ear so hard it hurt. "What?"

  "I'm doing an induction on Mrs. Gomez. She's the lady you referred, the one with preeclampsia."

  "I remember. What's the emergency?"

  "We started the Pitocin drip this afternoon. Things were slow at first, then she started making some progress. But now she's bleeding and having constant contractions. Fetal heart tones are rapid and getting fainter."

  Elena quickly connected the dots. Abruptio placenta. A premature separation of the placenta, the organ that nourishes the fetus, from the wall of the uterus. More common with preeclamptics. "Abruption?"

  "Grade three. I don't think we can deliver her fast enough to save her or the baby. I'm taking her for a stat C-section."

  "What do you need from me?"

  "I need an assistant. My partner's delivering breech twins, and has another woman in labor after that. The other OB in the area, Tom Denson, is tied up in Bridgeport."

  "I just talked with Marcus Bell. Call him."

  "I did. While I was on the phone with him, he got a second call-a patient with a perforated peptic ulcer. He's probably on his way to the OR by now."

  Elena was already on her feet. "Guess it's me, then. I'll be there in fifteen minutes."

  She saw the puzzled looks from Will and Cathy. Elena rattled off a brief explanation as she snatched up her purse and headed for the door.

  "Here," Will ripped the page off his pad and stuffed it into her purse. "You can read this later."

  The tension in the operating room was like an over-tight violin string.

  "How's the baby?" David worked to keep his voice steady.

  The pediatrician didn't look up from the fetal monitor. "Fetal heart tones weaker and slowing. We need to get that baby out of there."

  The anesthesiologist's voice was strained. "Her pressure's dropping, pulse up to one twenty. I'm running a unit of blood in each arm, full open."

  David held out his hand, and the nurse slapped a scalpel into his palm. He looked across the operating table. "Ready, Elena?"

  She nodded. He knew she was nervous. But he also knew she was well prepared. This wasn't her first C-section, nor was it his. But still, his pulse was racing, and he suspected the same held true for Elena.

  "Fast as you can, David," the pediatrician said. "This baby's in trouble."

  David did what he'd always done in emergency situations. He put his mind on automatic pilot and let muscle memory and hours upon hours of study translate to actions. Elena kept up with him, step-by-step, her hands working in unison with his.

  "Opening the uterus," David said. A gush of blood spilled out into the operative field.

  The anesthesiologist said, "I can't get the blood and fluids in fast enough to keep up."

  David willed himself to work steadily. In a moment, he held up the baby, clamped and cut the cord, and passed the infant into waiting arms. "Okay, let's get this bleeding under
control."

  David removed the placenta, but the bleeding continued unabated. "Are those coagulations studies back?"

  The reply came from the anesthesiologist. "Yep. No abnormalities. And I'm having a hard time keeping her stable. BP's at shock levels."

  "Emergency hysterectomy?" Elena asked.

  "Not if I can help it. This is a young woman. Maybe she and her husband want a brother or sister for this baby." He pointed with a hemostat. "Find the aorta and compress it."

  Elena reached gingerly into the abdominal cavity.

  David tapped the back of her hand with the instrument. "Don't be tentative. Find it by feeling for the pulsations, then use gentle pressure to shut off blood flow. Just be careful. We don't need a ruptured aorta to deal with."

  Seconds passed like hours until Elena said, "Got it."

  In a moment the bleeding slowed. David quickly identified and tied off first one uterine artery, then the other. Smaller vessels would nourish the organ, but ligating these arteries should stem the tide. "You can release your pressure now." He held his breath.

  Elena withdrew bloody, gloved hands from the wound and let them rest, clasped together, at her waist.

  Blood still oozed into the operative field, but it was nothing like the flood of five minutes before. David exhaled, then refilled his lungs. "That's better. Now let's clean up all the other bleeders and get this wound closed."

  Elena showered in the nurses' locker room and changed into street clothes. She borrowed a white coat from a hook on the wall and headed for the ICU. David was at the bedside of Maria Gomez. The breathing tube was still in her throat, and a ventilator puffed oxygen into it at a steady sixteen breaths per minute.

  "What do you think?" David asked.

  The anesthesiologist shook his head. "Her pressure got pretty low. I tried to keep her well-oxygenated, but with the blood loss and poor perfusion, there's no way to know how much brain damage there might be."

  "I'll keep the blood going until we get her back to more normal levels. Will you be around if I need you again tonight?"

  The anesthesiologist yawned. "Sure. You've got my cell phone number." He extended his hand to Elena. "I'm Charlie Tandy."

  "Nice to meet you. I didn't know I was signing on for this when I came to Summers County General."

  "We're large enough to have every specialty you might need, but small enough that the docs sometimes have to pitch in when it's crunch time." He grinned. "You did fine."

  Elena dropped into a chair at the doctor's charting station. In a moment, David joined her. He nodded toward the door leading to the waiting room. "Now I've got to go out there and tell Maria's husband that his baby girl is fine, but there's a chance his wife won't wake up from the operation."

  "You did everything you could," Elena said. "All you can do is play the cards you're dealt. And we don't know yet what the outcome will be." She ran her fingers through her still-wet hair. "You'll keep her here in the ICU, won't you?"

  "Yeah. One nice thing about this hospital-we have lots of ICU beds." He managed a wry grin. "Of course, this is going to drive Nathan Godwin up the wall. The payment we get for an uninsured OB isn't much, and there's no way it's going to cover time in the ICU."

  "So, what are you going to do?"

  "What's best for the patient, of course. Our esteemed administrator can go fly a kite." David flashed a grin. "But there's no need for you to worry. It's me he'll come after."

  "He's already after me," Elena said. She told him about her visit in the administrator's office earlier. "I've talked with Marcus Bell. He told me not to worry, but that's hard to do." She picked up a pencil from the desk and started tapping out a nervous rhythm on a metal chart cover. "Why is Nathan so uptight about insurance and payments?"

  "I can answer that," David said. "My associate told me the whole story when I first interviewed here. Marcus was doing a good job as chief of staff, but he wasn't riding herd on payments. You and I both know that most doctors aren't wired that way. So the hospital board hired Nathan. His contract specifies that Summers County General has to show a profit within two years, or he's gone. And the contract only has a few more months to run."

  "So the more nonpaying patients he can move out of here, the better his chances of keeping his job. Right?"

  David touched his nose. "Bingo. You got it."

  Elena finally told David goodnight, promising to call him tomorrow. She was driving out of the parking lot when her cell phone rang. Without taking time to see who was calling, she answered.

  "Elena, this is Marcus. Did I catch you at a bad time?"

  She wheeled into an empty parking space and killed the engine. "Not at all. Just tired. Are you through with your case?"

  "Uh-huh. Perforated peptic ulcer. Did it laparoscopically. Isn't modern technology wonderful?"

  "I don't think laparoscopic surgery would have worked for what we did. David did a stat C-section for a placental abruption."

  "Yeah, that's one reason I called. I wanted to thank you for stepping in. That's something the doctors here at Summers County General have to do-help out in a pinch."

  Elena pushed the lever to lean back in her seat. "Glad I could do it." She unfastened her seat belt. "You said one reason. Was there another?"

  "Um, yes. I didn't bring this up when we spoke earlier. It didn't seem like the right time. Would you like to have dinner with me some night this week?"

  "Marcus-"

  He hurried on. "As a friend. Remember, I know you're widowed, and as a widower I've been down that road. I just want to offer a listening ear. About anything."

  Now Elena knew what it felt like to be caught between the proverbial rock and hard place. Maybe it would be good to have someone else besides David to talk with about the struggles she'd had since Mark's death. On the other hand, Marcus might be called on soon to deal with a request to suspend some of her clinical privileges. Would a social relationship between them jeopardize their professional one?

  "I've had a really hard day, and it's hard for me to think," she said. "Can we talk about this later?"

  "Sure. Would you like me to call you, or shall I wait for you to call?"

  Elena yawned. "Call me tomorrow night. Is that okay?"

  She reached across to the passenger seat and dropped the phone into her purse. Oh, please let me make it home and into bed without any more interruptions. She navigated flawlessly through the dark streets, proud of how familiar she'd become with Dainger. Oh, don't mind the name. It's just named for some early settler. That might be true, she decided, but there was plenty of danger here as well. The threat to her career had followed her here. Someone was stalking her. And apparently her midnight caller hadn't given up after Elena relocated.

  She'd forgotten about her midnight caller. And this was Tuesday. She looked at the clock on the car's display. Two minutes to midnight.

  Elena saw a strip shopping center ahead. It was deserted at this hour, but the parking lot was well lit. It would be a good place to pull in. She wanted to focus her full attention on her caller tonight.

  She turned off the engine, checked to make sure her doors were locked, and reached into her purse. First she removed her cell phone and placed in on the dash in front of her. Then she rummaged until she found the slip of paper Will had given her. She unfolded it carefully, as though the information written on it might escape if mishandled. The light under which she was parked was bright. The words were clear, but the first time she read them Elena couldn't really process them. Surely not. There was no way.

  The phone rang. She looked once more at the name on the paper. Then she pushed the button to answer the call. Elena struggled to make her voice steady, her words neutral. "Hello, Karri. Why do you keep calling me?"

  There was a sharp gasp, then a click and silence.

  18

  Elena leaned across the table to be heard over the din of the hospital cafeteria. "I'm glad we could get together for lunch."

  David took a sip of iced tea
. "Sorry we had to eat here, but I have a lady in labor upstairs, so I need to be in the hospital."

  "How's Maria?"

  "Still in ICU. Showing a few signs of waking up. Breathing on her own now, so I've unhooked the respirator. Maria's still got a ways to go, but I think she's going to make it."

  Elena swallowed another bite of her BLT sandwich. "And the baby?"

  David beamed. "Beautiful baby girl. Everyone in the nursery's crazy about her."

  "Doctor Gardner. Who's your friend?"

  Elena's sandwich turned into a lump of lead in her stomach. "Hello, Eric."

  David stood and extended his hand. "David Merritt. I'm a new OB in town."

  "Eric Burson." Elena noticed Eric's hesitation before he returned the handshake. "I'm an EMT."

  "Nice to meet you. I look forward to seeing you around. Just not professionally."

  Eric scowled. "What's that supposed to mean? That you don't want me taking care of any of your patients?"

  David made a patting motion with his open palms. "Maybe I didn't say that well. I hope none of my patients have an emergency. But I do look forward to seeing you around the hospital. It's nice to meet you."

  The last words were said to Burson's retreating back.

  "Don't mind him," Elena said. "That's the way he's behaved since the first time I saw him." She went on to relate what she'd been told about Burson's wife and the effect her death had had on his view of doctors.

  "Whew. I wonder why he became an EMT. I'd think that being around doctors all the time would only keep him stirred up."

  "I guess we all wonder that. But everyone agrees he's good at what he does, so they put up with his attitude."

  "You don't suppose…"

  "What?" Elena asked.

  "If Burson's got something against doctors… Well, there's an old saying. 'Keep your friends close and your enemies closer.' You don't suppose he wants to be around doctors to look for a chance to get some sort of revenge, do you?"

  It sounded crazy when I first thought of it. Now I don't know. Elena looked at her watch. "I've got to get up to the ICU and see a patient."