A RACE AGAINST DEATH: The 3rd Lenny Moss Mystery by Tim Sheard - $15.00
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READ THE FIRST CHAPTER
CHAPTER ONE
Nurse Gary Tuttle, seated at the foot of the bed, was writing his first note of the morning when he heard his patient mutter “I’m a dead man for sure.” Looking up, Gary saw a sour look on Rupert Darling’s face.
“It’s no fun, being sick is it?” said Gary, offering a sympathetic look.
“You can’t fool me,” Darling said. “I know these doctors like to experiment on you, and when you die they cut you open to see where they screwed up.” He scratched his chest with long boney fingers and looked with despair at the other patients in the Intensive Care Unit.
Gary knew Darling had put off coming to the hospital until he lost the feeling in his legs. Unable to walk, he finally called the paramedics, who wrapped him in a shabby blanket and brought him to James Madison University Hospital.
Tests revealed a progressive paralysis that might be permanent or might go away on its own, the course was wholly unpredictable. Darling took the uncertainty of the prognosis as proof that the doctors were idiots and that his life was in greater danger from them than from any disease.
While the patient muttered complaints, a housekeeper mopped the floor a few feet away, and the stinging odor of bleach tickled the young nurse’s nose. The soft sssh-ssssh of a ventilator filled the room with its gentle rhythm. Gary closed his eyes and tried to imagine how the blind navigated through the world by their other senses. He was a sandy-haired fellow just a few pounds over his ideal weight, dressed in a green scrub suit. Rimless glasses framed sleepy blue eyes and a gentle countenance.
“You are perhaps not getting enough sleep, Mr. Tuttle?” said a puzzled voice in the darkness.
Gary opened his eyes, saw Dr. Samir Singh, the ICU attending physician, watching him with a bemused look on his face while a gaggle of residents and medical students stood by. The nurse felt his face begin to color in embarrassment.
“I’m sorry, Dr. Singh, I was just . . . listening.”
“An excellent skill to develop,” said the physician, speaking with a polished British accent that reflected his London training. He stepped to the bedside. “Good morning, Mr. Darling. How are you today?”
“Lousy! I don’t want you draining all my blood and replacing it with some synthetic crap. I know how you doctors operate!”
Dr. Singh turned to his team. “Mr. Darling is under the misperception that the plasmapheresis treatment we are planning is an experimental procedure.” To Gary he said, “Tell me please, what is the level of the patient’s loss of sensation?”
“I, uh, haven’t checked that yet,” said Gary, realizing he hadn’t finished his neurological exam.
“It is very important to assess the level of the paralysis every four hours,” said Singh. “May I have a Q-tip, please?”
Gary pulled a Q-tip from a bedside cart and handed it to the physician. Singh broke off the end of the wooden stick, leaving a tip as sharp as a splinter.
“In the past we used a needle to test for the sensation of sharp,” he explained. “But with the advent of HIV, a needle used to prick the skin becomes a potential source of exposure for the physician.”
Beginning at the chest he alternately jabbed the patient with the sharp end and pressed gently with the cotton-padded tip. “Is that sharp or dull?” he asked. When the doctor reached the groin, Darling found it difficult to distinguish the sensations. At the thigh the patient, frustrated, gave up answering.
“Note that the paralysis is symmetrical and ascending. When it approaches the level of the cervical spine, there will be loss of enervation to the diaphragm. At that point we will have to─”
“Attention! Attention! Code Blue, Intensive Care Unit, third floor.”
The physician froze in place at the sound of the hospital operator in the loudspeaker overhead. Perplexed, he looked up and down the ICU, but saw nobody rushing to a bedside.
“The operator must mean the CCU,” said Dr. Singh. “Nobody is coding in our—”
Whoosh! The automatic doors to the unit opened as a stretcher came hurtling through.
“She’s brady’d down!” yelled a nurse who was pushing the stretcher. “I called a code from the phone in the elevator!” He squeezed an ambu bag connected to oxygen with one hand while guiding the stretcher with the other. A young African-American woman lay motionless on the stretcher while a woman in a white lab coat pressed vigorously on the patient’s chest.
With nurses and physicians rushing to assist, Dr. Singh said, “I was led to believe that this patient was going directly from the Emergency Room to the OR.”
The ER nurse grabbed a fistful of sheet. “They told me she was coming to the ICU to be tanked up first.”
After they moved the lifeless figure the bed, the charge nurse told Gary, “I wasn’t expecting this admission for a couple of hours. Can you handle a second patient?”
“Uh, I guess so,” he said, feeling a knot in his belly tighten at the thought of caring for a patient in cardiac arrest.
The charge nurse saw the worry on his face. “Relax. I wouldn’t give you a train wreck your second week of orientation. You’ll pick up Dillie’s pneumonia; she can take the admission.”
“Okay,” said Gary, feeling the knot begin to loosen.
Dr. Singh asked the Emergency Room nurse, “What medications have you given her?”
“One amp of atropine and one epi.”
“Stop CPR, feel for a pulse.”
The woman in the lab coat took her hands away from the patient’s chest and felt at the groin. In the space between the patient’s legs a pool of bright red blood glistened beneath the harsh fluorescent light.
“She’s got a pulse!” the woman announced. “It’s thready, but palpable.”
Singh turned to Dillie. “Run a liter of normal saline in under pressure.” While Dillie was preparing the intravenous fluids, Singh asked the woman in the lab coat, “Why hasn’t the OB team taken this patient to the OR, Doctor . . . ?”
“I’m a fourth year student,” she said. “Kate Palmer. The ER Attending told me that Doctor Odom was reluctant to accept the admission onto his service.”
“What do you mean ‘reluctant’? This is his patient, is it not? Dr. Odom performed the abortion on her four days ago. Is that not correct?”
“She was his patient last Saturday, yes, but I understand he told the ER that this patient should be on the Infectious Disease Service, so we paged ID. They haven’t answered yet.”
Perplexed, Singh said, “This patient’s infection is due to remnants of the fetus adhering to her uterine wall. Dr. Odom must take her to surgery and remove the source of the infection before ID can help her. It is her only chance of survival.”
Noting that the first unit of blood was nearly completed, he told the charge nurse, “Hang two more units of blood, please.”
“I’ll send the aide right away,” she said, hastily scribbling numbers and a name on a pair of blood bank requests.
“Tell them also to thaw two units of frozen plasma in the microwave right away.”
Dillie informed Dr. Singh that the patient’s temperature was one hundred and four degrees. She hurried to the supply closet for the hypothermia blanket.
Feeling his frustration mount, the attending physician turned to his medical resident. “Page Dr. Odom and tell him he must come and see the patient right away. Page him STAT. And page Infectious Disease as well.”
“Got it,” said the resident, hurrying to the phone to make the calls.
Dr. Singh studied the patient, worry dragging his handsome features down. He watched the young woman gasp for breath like a fish out of water. Despite the one hundred percent oxygen being forced into her lungs, she was experiencing severe air hunger―a grave sign.
The resident returned to the bedside. “OB said they’re doing an emergency C-section. They’ll be up as soon as they’re through.”
As Dillie pulled back the top sheet in order to put the cooling blanket in place, she saw a stream of bright red blood pour out of the patient’s vagina. “The blood is a river,” she said to Singh, her face grim.
“She has perforated her uterus. She must have the surgery right away.” Singh watched the blood pressure reading on the monitor slowly fall. He turned to the surgery resident.
“Have you ever done an exploratory laporotomy?”
The young resident, heavily muscled and darkly handsome, hesitated, knowing what was coming.
“I’ve assisted with one. I’ve never actually done one.”
“You may have to begin the procedure, it is the only way to control her bleeding.”
“You mean, open her abdomen? Here in the unit?”
“Yes,” said Singh, his face deadly serious. “She is losing blood faster than we can replace it. If you can clamp off the uterine artery it will give us time to stabilize her and transport her to the OR. Dr. Odom can complete the hysterectomy in a more controlled setting.”
He asked Dillie to bring a cut-down tray. As the pool of blood between the young woman’s legs grew, her blood pressure continued to fall.
Nurse Gary Tuttle, seated at the foot of the bed, was writing his first note of the morning when he heard his patient mutter “I’m a dead man for sure.” Looking up, Gary saw a sour look on Rupert Darling’s face.
“It’s no fun, being sick is it?” said Gary, offering a sympathetic look.
“You can’t fool me,” Darling said. “I know these doctors like to experiment on you, and when you die they cut you open to see where they screwed up.” He scratched his chest with long boney fingers and looked with despair at the other patients in the Intensive Care Unit.
Gary knew Darling had put off coming to the hospital until he lost the feeling in his legs. Unable to walk, he finally called the paramedics, who wrapped him in a shabby blanket and brought him to James Madison University Hospital.
Tests revealed a progressive paralysis that might be permanent or might go away on its own, the course was wholly unpredictable. Darling took the uncertainty of the prognosis as proof that the doctors were idiots and that his life was in greater danger from them than from any disease.
While the patient muttered complaints, a housekeeper mopped the floor a few feet away, and the stinging odor of bleach tickled the young nurse’s nose. The soft sssh-ssssh of a ventilator filled the room with its gentle rhythm. Gary closed his eyes and tried to imagine how the blind navigated through the world by their other senses. He was a sandy-haired fellow just a few pounds over his ideal weight, dressed in a green scrub suit. Rimless glasses framed sleepy blue eyes and a gentle countenance.
“You are perhaps not getting enough sleep, Mr. Tuttle?” said a puzzled voice in the darkness.
Gary opened his eyes, saw Dr. Samir Singh, the ICU attending physician, watching him with a bemused look on his face while a gaggle of residents and medical students stood by. The nurse felt his face begin to color in embarrassment.
“I’m sorry, Dr. Singh, I was just . . . listening.”
“An excellent skill to develop,” said the physician, speaking with a polished British accent that reflected his London training. He stepped to the bedside. “Good morning, Mr. Darling. How are you today?”
“Lousy! I don’t want you draining all my blood and replacing it with some synthetic crap. I know how you doctors operate!”
Dr. Singh turned to his team. “Mr. Darling is under the misperception that the plasmapheresis treatment we are planning is an experimental procedure.” To Gary he said, “Tell me please, what is the level of the patient’s loss of sensation?”
“I, uh, haven’t checked that yet,” said Gary, realizing he hadn’t finished his neurological exam.
“It is very important to assess the level of the paralysis every four hours,” said Singh. “May I have a Q-tip, please?”
Gary pulled a Q-tip from a bedside cart and handed it to the physician. Singh broke off the end of the wooden stick, leaving a tip as sharp as a splinter.
“In the past we used a needle to test for the sensation of sharp,” he explained. “But with the advent of HIV, a needle used to prick the skin becomes a potential source of exposure for the physician.”
Beginning at the chest he alternately jabbed the patient with the sharp end and pressed gently with the cotton-padded tip. “Is that sharp or dull?” he asked. When the doctor reached the groin, Darling found it difficult to distinguish the sensations. At the thigh the patient, frustrated, gave up answering.
“Note that the paralysis is symmetrical and ascending. When it approaches the level of the cervical spine, there will be loss of enervation to the diaphragm. At that point we will have to─”
“Attention! Attention! Code Blue, Intensive Care Unit, third floor.”
The physician froze in place at the sound of the hospital operator in the loudspeaker overhead. Perplexed, he looked up and down the ICU, but saw nobody rushing to a bedside.
“The operator must mean the CCU,” said Dr. Singh. “Nobody is coding in our—”
Whoosh! The automatic doors to the unit opened as a stretcher came hurtling through.
“She’s brady’d down!” yelled a nurse who was pushing the stretcher. “I called a code from the phone in the elevator!” He squeezed an ambu bag connected to oxygen with one hand while guiding the stretcher with the other. A young African-American woman lay motionless on the stretcher while a woman in a white lab coat pressed vigorously on the patient’s chest.
With nurses and physicians rushing to assist, Dr. Singh said, “I was led to believe that this patient was going directly from the Emergency Room to the OR.”
The ER nurse grabbed a fistful of sheet. “They told me she was coming to the ICU to be tanked up first.”
After they moved the lifeless figure the bed, the charge nurse told Gary, “I wasn’t expecting this admission for a couple of hours. Can you handle a second patient?”
“Uh, I guess so,” he said, feeling a knot in his belly tighten at the thought of caring for a patient in cardiac arrest.
The charge nurse saw the worry on his face. “Relax. I wouldn’t give you a train wreck your second week of orientation. You’ll pick up Dillie’s pneumonia; she can take the admission.”
“Okay,” said Gary, feeling the knot begin to loosen.
Dr. Singh asked the Emergency Room nurse, “What medications have you given her?”
“One amp of atropine and one epi.”
“Stop CPR, feel for a pulse.”
The woman in the lab coat took her hands away from the patient’s chest and felt at the groin. In the space between the patient’s legs a pool of bright red blood glistened beneath the harsh fluorescent light.
“She’s got a pulse!” the woman announced. “It’s thready, but palpable.”
Singh turned to Dillie. “Run a liter of normal saline in under pressure.” While Dillie was preparing the intravenous fluids, Singh asked the woman in the lab coat, “Why hasn’t the OB team taken this patient to the OR, Doctor . . . ?”
“I’m a fourth year student,” she said. “Kate Palmer. The ER Attending told me that Doctor Odom was reluctant to accept the admission onto his service.”
“What do you mean ‘reluctant’? This is his patient, is it not? Dr. Odom performed the abortion on her four days ago. Is that not correct?”
“She was his patient last Saturday, yes, but I understand he told the ER that this patient should be on the Infectious Disease Service, so we paged ID. They haven’t answered yet.”
Perplexed, Singh said, “This patient’s infection is due to remnants of the fetus adhering to her uterine wall. Dr. Odom must take her to surgery and remove the source of the infection before ID can help her. It is her only chance of survival.”
Noting that the first unit of blood was nearly completed, he told the charge nurse, “Hang two more units of blood, please.”
“I’ll send the aide right away,” she said, hastily scribbling numbers and a name on a pair of blood bank requests.
“Tell them also to thaw two units of frozen plasma in the microwave right away.”
Dillie informed Dr. Singh that the patient’s temperature was one hundred and four degrees. She hurried to the supply closet for the hypothermia blanket.
Feeling his frustration mount, the attending physician turned to his medical resident. “Page Dr. Odom and tell him he must come and see the patient right away. Page him STAT. And page Infectious Disease as well.”
“Got it,” said the resident, hurrying to the phone to make the calls.
Dr. Singh studied the patient, worry dragging his handsome features down. He watched the young woman gasp for breath like a fish out of water. Despite the one hundred percent oxygen being forced into her lungs, she was experiencing severe air hunger―a grave sign.
The resident returned to the bedside. “OB said they’re doing an emergency C-section. They’ll be up as soon as they’re through.”
As Dillie pulled back the top sheet in order to put the cooling blanket in place, she saw a stream of bright red blood pour out of the patient’s vagina. “The blood is a river,” she said to Singh, her face grim.
“She has perforated her uterus. She must have the surgery right away.” Singh watched the blood pressure reading on the monitor slowly fall. He turned to the surgery resident.
“Have you ever done an exploratory laporotomy?”
The young resident, heavily muscled and darkly handsome, hesitated, knowing what was coming.
“I’ve assisted with one. I’ve never actually done one.”
“You may have to begin the procedure, it is the only way to control her bleeding.”
“You mean, open her abdomen? Here in the unit?”
“Yes,” said Singh, his face deadly serious. “She is losing blood faster than we can replace it. If you can clamp off the uterine artery it will give us time to stabilize her and transport her to the OR. Dr. Odom can complete the hysterectomy in a more controlled setting.”
He asked Dillie to bring a cut-down tray. As the pool of blood between the young woman’s legs grew, her blood pressure continued to fall.