“I wonder why there are so many attendings in the house?” asked Andrea Bryant, the night supervisor. “It’s the first time I’ve seen Dr. Sherman here on a Saturday night since he was a resident.”
“Must be a lot of emergency cases in the OR,” said the other RN, Trudy Bodanowitz.
“That can’t be it,” said Andrea. “I spoke to the night supervisor there and she said that there were only two: an emergency cardiac case and a fractured hip.”
“Beats me,” said Trudy, looking at her watch. It was just after midnight.
“Do you want to take first break tonight?”
The girls were sitting at the central desk finishing the paperwork engendered by the arrest. Neither was assigned to specific patients but rather manned the central station and performed the necessary administrative functions.
“I’m not sure either of us is going to get a break,” said Andrea, looking around the large U-shaped desk. “This place is a mess. There’s nothing like having an arrest right after shift change to spoil routine.” The nurses’ station in the ICU rivaled the flight deck of a Boeing 747 for complicated electronic equipment. Facing the women were banks of TV screens giving constant readouts on all the patients in the unit. Most were set within certain limits so that alarms would go off if the values strayed too far from normal. While the women were speaking, one of the EKG tracings was changing. As crucial minutes passed, the previously regular tracing began to look more and more erratic. Finally, the alarm went off.
“Oh shit,” said Trudy as she looked up at the beeping oscilloscope screen. She stood up and gave the unit a slap with her hand, hoping that an electrical malfunction was the cause of the alarm. She saw the abnormal EKG pattern and switched to another lead, still hoping the problem was mechanical.
“Who is it?” asked Andrea, checking for any evidence of frantic activities on the part of the nursing staff.
“Harwick,” said Trudy.
Andrea’s gaze quickly switched over to the bed of Dr. Ballantine’s OR disaster. There was no nurse in attendance, which was not unusual. Mr. Harwick had been exceptionally stable over the last weeks.
“Call the surgical resident,” said Trudy. Mr. Harwick’s EKG was deteriorating even as Trudy watched. “Look at this, he’s going to arrest.”
She pointed to the screen where Mr. Harwick’s EKG was showing typical changes before it either stopped or degenerated to ventricular fibrillation.
“Should I call a code?” asked Andrea.
The two women looked at each other.
“Dr. Ballantine specifically said ‘no code,’” said Trudy.
“I know,” said Andrea.
“It always gives me an awful feeling,” said Trudy, looking back at the EKG.
“I wish they wouldn’t put us in this position. It’s not fair.”
While Trudy watched, the EKG line flattened out with just an occasional blip. Mr. Harwick had died.
“Call the resident,” said Trudy angrily. She walked around the end of the ICU desk and approached Mr. Harwick’s bed. The respirator was still inflating and deflating his lungs, giving him the appearance of life. “Certainly doesn’t make you excited about having surgery,” said Andrea, hanging up the phone.
“I wonder what went wrong. He was so stable,” said Trudy.
Trudy reached out and flipped off the respirator. The hissing sound stopped. Mr. Harwick’s chest fell and was still.
Andrea reached over and turned off the IV. “It’s probably just as well. Now the family can adjust and then go on with their lives.”
CHAPTER 5
* * *
TWO WEEKS HAD PASSED since Thomas learned of Cassi’s visit to his mother. While they had only fought briefly, the tension had been unbearable. Even Thomas had noted his increased dependency on Percodan, but he had to take something to allay his anxiety.
As he ran down the hall late for the monthly death conference, he felt his pulse race.
The meeting had already begun, and the chief surgical resident was presenting the first case, a trauma victim who had expired shortly after admission to the ER. The resident and intern had failed to notice warning signs that the sac covering the heart had been damaged and was filling with blood. Since no attending had been involved, the doctors happily raked the house staff over the coals.