Malice by design, p.8
Malice by Design, page 8
“Sounds good. I’ll meet you on the unit.”
Another harsh gust of wind slammed into her side, forcing her to lean into it to keep herself moving forward. Preoccupied in thought, she pressed on, admitting to herself that when Jack had first told her about Althea’s request for help she’d been skeptical about getting involved. But now, and for reasons she couldn’t quite get her head around, she was more than a little curious about what Dr. Austin’s research might reveal.
Chapter 19
Lisbet Collymore had been the nurse caring for Sam Shively since shift change at four p.m. From the moment she’d received the report from the day nurse, Sam had required her full attention. Lisbet had come to Oster five years earlier, had immediately been identified as a rising star, and had advanced quickly through the ranks to become an assistant nurse manager. On the tallish side with smooth facial skin and velvet brown eyes, she always maintained a calm demeanor and was a born problem-solver.
Sam had been battling leukemia for five years, having been in and out of remission four times. Having recently attained his fourteenth birthday and worn out from his long ordeal, he had become withdrawn and considerably less cooperative than most of the other leukemia patients. Lisbet had cared for him many times and was sure from an emotional standpoint he was nearing the end of his rope.
In spite of trying several different medications to sedate him, he continued to experience alternating periods of restless sleep and agitation coupled with disorientation. As was the case with the other children, his overall condition was made worse by continuing weight loss. Lisbet felt a welcome wave of relief when he finally dropped off into a more peaceful sleep. She had no illusions it would last very long, but she hoped she’d have enough time to complete her charting. It was eight p.m.
Her plan came to an abrupt end when the high-pitched shrill of the first alarm pierced the air. Her gaze flashed to the cardiac monitor. When she saw the flatline tracing, she raced to the bedside. Her mind flooded with possibilities as she went through her mental checklist, trying to figure out what was happening. Considering that less than a minute earlier his heart rate and blood pressure were completely normal, she prayed the problem was a technical one involving the alarm itself and not a sudden adverse medical event that had befallen her patient. But when her eyes fell on his ashen complexion and the bluish discoloration of his lips, she knew her prayers had gone unanswered and that Sam was in trouble.
Yanking his cover back, Lisbet exposed his chest and confirmed her worst fear—it wasn’t moving. In the flash of an eye, she slapped the code blue button and fitted an oxygen mask on his face. She rechecked the heart monitor and felt for a femoral pulse. There was none. He was in full cardiac arrest. Just as two nurses and a respiratory therapist charged into the room, Lisbet began chest compressions. Right behind them was Dr. Aiden Rogers, the ICU specialist on call.
“Somebody talk to me,” he ordered, taking up a position directly behind Sam. “C’mon people, I’m waiting.” Rogers had only been on staff for a little over a year. He tended to be disorganized and to forget his manners in emergency situations, but he remained supremely confident in his abilities. The more senior nurses advised the less seasoned ones to keep their suggestions to themselves when he was attending to a patient. Lisbet had one disagreement with him regarding a patient care issue that had ended with him telling her that, when he wanted her opinion, he’d be pleased to give it to her.
“His vital signs have been stable all night,” she reported, continuing to do chest compressions. “He just suddenly arrested.”
“Nothing happens suddenly. You weren’t paying attention. Has he received any medications in the last half an hour?”
“No.”
“You missed something,” Rogers stated, turning to the respiratory therapist. “Let’s get a tube in him and get a ventilator in here.” He then shifted his attention back to Lisbet. “Give him an amp of epi and draw up 150 milligrams of amiodarone and infuse it over ten minutes. Anything abnormal in his ten p.m. lab work?”
“Nothing that I remember, but I’ll recheck them—”
“C’mon, I need straight answers right now—not when you get around to it. This is a code blue, and he’s your only patient, Lisbet. You should have this information at your fingertips. We don’t have time for you to look up the answers to everything I ask you.”
“Dr. Rogers,” she began in an even tone. “There was nothing abnormal in his lab studies. He’s been restless but stable since the shift began. There were no changes in his condition that would explain a cardiac arrest.”
Rogers’s face tightened into a rigid stare. “The facts seem to tell a different story.”
“Tube’s in,” the respiratory therapist announced to the group, as she securely taped it to prevent it from slipping out of Sam’s windpipe. She then attached a breathing bag to the tube, and with each squeeze of her hand, she filled his lungs with an oxygen rich breath. Nothing the team tried worked. His heart remained in complete arrest.
“Keep the chest compressions going and give him another amp of epinephrine,” Rogers ordered.
Jenna Keith, the nurse manager, positioned herself beside Sam’s IV pump. The pharmacist handed her the two medications Rogers had ordered. She wasted no time injecting both of them into the line. “Meds are in,” she announced.
Rogers took a step back and scrutinized the monitor for a minute.
“Nothing,” he said. “Give him 40 units of vasopressin.”
“It’s getting a lot more difficult to ventilate him,” the respiratory therapist said, squeezing the bag harder with each breath to deliver the same amount of air. “His lungs are getting tight. They must be filling up with fluid.”
“I’m aware of that. Just keep bagging him, but hold the chest compressions,” he said, as he placed his stethoscope on Sam’s chest. “Let’s get another IV in him and call for a stat chest x-ray. I also want a complete new set of labs, including ABGs.” He pointed to the monitor. “Nothing. He’s still flatline.”
For the next fifteen minutes, the team did everything possible to jolt Sam’s heart back to life. But their efforts were completely in vain. Lisbet feared whatever thread of life he was clinging to was quickly unraveling.
It was at that moment that the respiratory therapist called out, “He’s back. We’ve got a rhythm.”
“His blood pressure’s coming up,” Jenna added, matching her colleague’s enthusiasm with a fist pump.
Everybody stopped what they were doing and kept their eyes glued to the monitors. Rogers folded his arms across his chest and said nothing. An infectious smile spread through the room as Sam’s cardiac function continued to improve.
After another ten minutes of observation, Rogers pulled off his gloves and tossed them to the floor.
“I thought for sure we’d lost him. Better lucky than good,” he said with a straight face as his eyes locked on Lisbet. Strolling to the other side of the room, he picked up one of the cardiac tracing strips and looked at it briefly. Even though she was speaking with one of the other nurses, he motioned to Lisbet. She groaned inwardly but cautioned herself to remain professional. She reluctantly crossed the room and joined him.
“The oxygen content of his blood was pretty low during most of the code,” he stated.
“I was just discussing that with Paula.”
“It’s impossible to know if he suffered any brain damage. I’m going to arrange for the neurologists to see him. I’ll put the order in the chart in a few minutes. Right now, I’m going to speak with the parents.” His tone of voice was even, and he seemed under control. Lisbet wondered if it were remotely possible he regretted his behavior. Whether he did or not was a moot point, because she doubted his ego would permit an apology. She shook her head and watched him exit the room. Too emotionally spent from the code blue to dwell on Dr. Rogers’s unprofessional behavior any longer, she made her way to the bedside. Sliding her stethoscope off her neck, she listened to Sam’s heart for a full minute. It was strong and regular.
Looking up, she checked the monitors. For the moment, everything looked good. She turned around, drew a cleansing breath, and scanned the room. The floor was littered with all manner of empty boxes and used medical supplies. Without giving it a second thought, she began picking them up and disposing of them in a large plastic bag. She’d been working for about five minutes when Jenna strolled over.
“I’m sorry about the way Rogers spoke to you. He can be a pompous jerk sometimes.”
“Sometimes? You’re very generous.” She grinned, demonstrating no outward signs he’d rattled her in the slightest.
“He’s still new and…well, the excitement of a code blue has a way of bringing out the worst in rookie physicians.”
“If it’s experience we’re talking about, I agree—the guy’s as green as Ireland. Maybe if he realized it, it would help him be more professional.” She paused and then in a single breath asked, “Do you think our new nurses would get the same pass the doctors do if they behaved in the same unprofessional manner Rogers does?” She held up her hand. “It was a rhetorical question, and I should probably be more charitable. Perhaps a conversation about Dr. Rogers’s behavior is best left for another time.”
“I’ll look forward to that chat,” Jenna said with a wink. “I’d better give Dr. Kavanaugh a call. If she finds out about this from somebody else, she’ll have my butt in her briefcase.”
After making sure Sam remained stable and finishing her code blue charting, Lisbet asked one of the other nurses to cover for her for a few minutes to give her the opportunity to speak with Sam’s parents. She had come to know them well, finding them more patient and understanding than many of the other parents.
She left the room and almost immediately saw them standing outside the parent lounge. They had their arms around each other and were both sobbing. Feeling the despair of the moment, Lisbet did everything in her power to hold herself together.
Sam’s future was in serious doubt. She knew that. Continuing toward Sam’s parents, she prayed she’d somehow find the words that might in some small way ease their suffering.
Chapter 20
After spending the entire afternoon completing a detailed review of Dr. Austin’s research, Jack and Madison exited the library and started back toward the guesthouse. As they strolled down a tree-lined walkway, a cloud-covered dusk was settling in over the campus. Before they had started their analysis of Austin’s work, they had agreed not to discuss their impressions of its quality and importance until they had finished the review.
“You go first,” Jack said.
“I’ve got mixed feelings. It’s certainly a very straightforward study, and I think it would stand up to scientific scrutiny with respect to the way it was done.” After pausing briefly to sidestep a small pile of wet leaves, she continued. “That being said, I can’t say her conclusions are convincing enough that I’d be comfortable advising the focus group to blindly accept Lennon’s contention that Dr. Austin’s research is the beacon lighting the way to curing leukemic malnutrition.” When Jack didn’t immediately respond, she asked, “What do you think?”
“For the most part I agree with you, but it’s hard to dismiss the fact that she did compile a list of leukemia patients who are now suffering from LM before anybody ever heard of the illness. I have a problem writing that off to pure coincidence. The question is, what’s the best way to share this with Althea without sounding like we’re dodging her question?”
“I don’t know, but you’re going to get your chance in about half a minute,” she said with a faint wag of her finger at the woman carrying an umbrella who was walking straight toward them. When Jack lifted his eyes, Althea was already waving at them.
“I assume you heard about Sam Shively?” she asked.
Madison nodded once in her direction. “We had a look at him this morning. He had a pretty stable night. Hopefully he didn’t suffer any neurologic damage.”
“We’re all praying for that,” she said. “I heard you were in the library. I was just on my way over there to track you down. How’s the review of Dr. Austin’s research going?”
“We finished up a few minutes ago,” Madison said.
“Don’t keep me in suspense. What do you think?”
“We’re in agreement that it was a nicely done study,” Jack answered.
“That’s nice to hear but are her conclusions well-founded enough to justify completely shifting gears and following Lennon’s pleas to devote all of our resources to looking for some mystery virus?”
“We’d say no,” Jack was quick to offer. “We’re unconvinced there’s enough substance to the work to justify Austin’s scientific conclusions, especially as they relate to leukemic malnutrition.”
“Is there anything further you need to do?”
Madison said, “We’d like to withhold any final conclusions until we’ve had a chance to speak with Dr. Austin directly. We feel her input would be helpful.”
Althea tapped her index finger against her cheek. “I think that’s a good suggestion. I just hope it won’t take too long to reach her. I’ve got Lennon circling like some famished bird of prey.”
“We have a question,” Madison began. “Since Dr. Austin’s research was never published, how did Lennon even know about it?”
“Dr. Austin was working with us on this project. Since we don’t keep things like that a secret, I can only speculate somebody in the lab must have mentioned it to her.”
“Any further word when Dr. Haas will be back?” Madison asked.
“The same question occurred to me, so I checked with his assistant.” She shook her head. “He hasn’t heard a word.”
“I wish I could schedule my vacations with no end date,” Jack said.
“Dr. Haas has made some incredible research contributions,” Althea stated. “Kendric Nash tends to indulge him, and to be honest with you, I kind of look the other way myself. He’s unquestionably one of Oster’s most outstanding assets.”
“Madison and I will contact you as soon as we speak with Dr. Austin.”
“I look forward to that. I’ll try to keep Lennon at bay until then, but I don’t think I’ll be able to keep my finger in the dike for too long. Now, if you’ll excuse me, I think I’ll go visit a few of the parents. I haven’t spent much time on the unit today, and after what happened last night, I’m sure there’s no shortage of anxious family members who could benefit from an encouraging word. Are you two headed back to the hospital?”
“Actually, Jack promised to take me into Defiance to do some Christmas shopping and grab an early dinner.” Having no recollection of any such promise, Jack looked at Madison askance.
“Enjoy yourselves. I’ll see you tomorrow morning,” Althea said as she walked away.
“I don’t recall making that promise,” Jack mentioned.
They started back toward the guesthouse.
“C’mon, you’ll enjoy yourself. You need to get your mind off medicine for a few hours.”
Jack was surprised Madison had suggested the trip into Defiance, but more than anything, he was beyond pleased she felt up to going.
Chapter 21
It was eight a.m., and Jack and Madison had just walked onto the LM unit when they noticed Althea approaching, accompanied by a woman. When they were a few steps closer, Madison recognized her immediately.
“I’m glad I ran into you,” Althea said. “There’s somebody I’d like to introduce you both to.” Before Althea could continue, Madison gave Dr. Gabriela Addesso, the director of the Ohio Department of Health and the principle adviser to Governor Sorenson on healthcare issues, a quick hug. Althea folded her arms in front of her and said with a grin, “I guess the introduction won’t be necessary after all. Obviously you two already know each other.”
“Madison and I serve on a couple of the state’s children’s advocacy committees together. And last year we worked together on a puzzling nest of infant meningitis cases in Southern Ohio.” Gabriela turned to Jack. “And how are you, Dr. Wyatt? The dean of the med school tells me you’ve been working your butt off.”
“Which is entirely your fault, Dr. Addesso, because you were the one mainly responsible for getting the funding we needed to open the Elusive Diagnoses Center at the university.”
Althea said, “The governor has personally expressed to me his grave concerns regarding leukemic malnutrition. He and I thought it would be a good idea moving forward to have Gabriela join us from time to time, not only to allow us to keep her briefed on our progress, but also to get her input.”
“As Althea just mentioned, the governor is deeply concerned about the crisis you’re facing here at Oster. He’s authorized me to assist you in every way I can. He’s also asked me to keep him in the loop, so you’ll probably be seeing me around from time to time. I’ll do my best to stay in the shadows, but if I become a bit of a pest, please forgive me.”
“I hate to break this little reunion up, but Gabriela has a meeting with the entire board in a few minutes, so I’m afraid we’ll have to get going.” Althea shifted her gaze to Jack and Madison. “Would you mind if I join you two on rounds after I escort Gabriela to the board room?”
“We’d welcome it,” Jack said.
“Have you rounded on Kip Dale yet?”
“No, but we were planning on seeing him in a little while,” Madison said.
“How about I join you in his room in about ten minutes? I’m sure his father will be there and I’d like to introduce you to him.”
“Ten minutes it is,” she said.
“I certainly appreciate both of you taking the time to meet with me,” Gabriela said, shaking each of their hands before strolling toward the exit with Althea.
“Are you surprised to see Gabriela here?” Madison asked.
“A little, maybe. What about you?”
