“Lenore! Call a code and bring me an ampule of fifty-percent glucose, a fifty cc syringe, and a fresh bottle of 135W.”
The LPN ran out of the room.
Meanwhile Carol managed to pull Cassi’s arms from between the rails. Next she tried to get a tongue depressor between Cassi’s clenched teeth but that was impossible. Instead she stopped the rapidly running IV, and concentrated on keeping Cassi from hitting her head against the top of the bed.
Lenore returned and Carol took the D5W and immediately changed the IV bottle. She put the old bottle aside, knowing the doctor would want to check the insulin level. Then she opened the IV all the way and transferred the fifty-percent glucose from the ampule to the large syringe. When she finished, she debated using it. Technically she was supposed to wait for a doctor to arrive, but Carol had spent enough time in crisis medicine to know that under the circumstances the glucose should be the first thing tried and that it certainly couldn’t hurt. She decided to give it. The amount of perspiration on Cassi’s body suggested a severe insulin reaction.
Carol stuck the needle into the IV and depressed the plunger. Even before she’d injected the last few cc’s, the result was dramatic. Cassi stopped convulsing and seemed to regain consciousness. Her lips opened and sounded as if she were trying to say something.
But the improvement didn’t last. Cassi sank back again into unconsciousness, and, although she did not convulse again, the isolated muscles continued to contract.
When the code team arrived, Carol reported what she had done. The senior resident examined Cassi and began issuing orders.
“I want you to draw blood for electrolytes, including calcium, arterial blood gases, and a blood sugar,” he said to the junior resident. “And I want you to run an EKG,” he said to the medical student. “And Miss Aronson, how about another ampule of fifty-percent glucose?”
While the team fell to work, Lenore picked up the bedside table, replacing the phone. With her foot she pushed the shards of glass from the broken pitcher into the corner. The drawer had come out of the table and Lenore replaced it. It was then she found several used vials of insulin. Shocked, she handed them to Carol, who in turn handed them to the resident.
“My God,” he said. “Was she supposed to give herself insulin blindfolded?”
“Of course not,” said Carol. “She had insulin in her IV and was being supplemented according to the amount of sugar in her urine.”
“So why did she give herself insulin?” asked the resident.
“I don’t know,” admitted Carol, “Maybe she was confused with all her sedatives and gave herself the medicine by rote. Hell, I don’t know.”
“Could she do that blindfolded?”
“Sure she could. Remember, she’s been injecting herself twice a day for twenty years. She couldn’t get the dose right, but she could certainly inject herself. Besides, there’s another possibility.”
“What’s that.”
“Maybe she did it on purpose. The day nurse said she was depressed, and her husband said she’d been acting strangely, I guess you know who her husband is.”
The resident nodded. He didn’t like to think of the case being a suicide gesture because he hated psych cases, especially at three o’clock in the morning.
Carol, who had been filling another syringe with glucose while talking, handed it over. The resident injected it immediately. As before, Cassi improved for a few minutes, then again lost consciousness.
“Who’s her doctor?” asked the resident, taking a third syringe of glucose from Carol.
“Dr. Obermeyer, Ophthalmology.”
“Somebody give him a call,” said the resident. “This isn’t a case for a house officer to fool around on.”
The phone rang and rang before Thomas groggily reached out and picked up the receiver. He had taken two Percodan before stretching out in his office, and he found it very hard to concentrate.
“You’re a hard one to wake up,” said the cheerful hospital operator. “You had a call from Dr. Obermeyer. He wanted to be put through immediately, but I told him you’d left specific orders. Do you want the number?”
“Yes!” said Thomas, fumbling on the desk for a pencil.