Deadly Diversion: A Medical Thriller (14 page)

I flopped back in my chair. “Where? ICU?”

“And the E.R. and O.R. We’re going to start urine screens on all the nurses right away.”

“On the nurses who work on those units?”

“We’re testing every nurse at St. T’s.”

“Why?”

“Because we don’t know who took them or who they might have given them to,” she said, her voice carrying a note of exasperation. “Someone’s stealing our drugs. And we’re going to find out who. Starting today, every nurse who wants to keep her job is going to give us a specimen. Observed,” she added, standing.

“Observed? Someone’s going to watch them pee?”

“That’s the only way to be sure they haven’t tampered with it.”

“How could they tamper with their urine?”

“Wake up, Monika,” she said with a flap of her hand. “There’s all kinds of ways. Dilute it with water from the toilet bowl. Add soap. Or other substances. Substitute someone else’s urine.” She turned and her suit jacket fell open. A tiny coffee stain marred the perfection of her silk shirt where it bloused out over her waistband. “Someone will be up from the lab shortly. And,” she added, “this information should only be shared on a strictly need-to-know basis, Monika.”

“Don’t you think the people who are going to have someone watch them pee need to know?”

“Don’t be silly. That defeats the whole purpose. We’ve got to surprise them.”

“What about the docs? They have to pee, too?”

“Why?” she asked, her hand on the doorknob. “They don’t sign out drugs.”

BEFORE THE LAB tech arrived I took staff members aside and told them about the impending tests. I tried to make it sound routine, which some of the younger nurses believed, but the more experienced nurses knew otherwise. Jessie, as usual, took it in stride, and also reassured me that the narcotics had been counted that morning. All were correct. Tim, on the other hand, tightened his mouth when I told him about the urine test, mumbling about “invasion of privacy” as he walked away. This action by administration would just add to the union supporters’ grievances, especially since only the nurses were being tested.

Two lab techs—a man and a woman—came together. The man looked embarrassed but the woman just looked weary. I went first. The woman followed me into the restroom, tacked up an out-of-service sign on the door, and handed me a cup already labeled with my name, “Everhardt, M.” I propped the door open with my knee, pulled down my pants and peed. She glanced my way briefly. I sent Jessie in next. When one nurse came back, another went in. The woman had her tray of specimen cups full in less than ten minutes.

Tim had refused, Ruby told me.

I WAS STOWING THE MEDS from our pharmacy order when Serena came into the med room with an empty IV bag. She tossed it into the trash and leaned against the counter until I finished checking off the last of the order. I closed the cabinet and asked her what she wanted.

“Why are they doing all these drug tests? What’s going on?” She worried the cuticle on her thumb with a fingernail.

“Some narcotics are missing, and for some reason Judyth thinks nurses are taking them,” I explained. “We’re just so busy. Everybody’s grabbing what they need, and I’m sure people are just forgetting to check them out.”

A few months ago Serena had given a patient a medication when she shouldn’t have. She’d received a warning from administration, and she’d been extra careful with meds since then.

“What’s wrong? If you’re worried about the drug tests, don’t be. You don’t have to be tested. You don’t have access to narcotics.”

“It’s Judyth. She called me in and grilled me this morning.’ She rubbed her hands on her scrub-suit top and shoved her hands in her pockets.

“Grilled you? What about?”

“Everything!” she said, her eyes filling. “Had I made any more mistakes? Did I ever get into the narcotics’ cabinet? She said she’d received complaints about me. Did you do that, Monika"? Complain to her but not to me?”

“Of course not, Serena. That’s not my management style. 1 tell people right away when something’s wrong, you know that.” When she didn’t answer I added, “Don’t you?”

“I do, Monika. It’s just that with another patient of mine dying...” She played with a gold stud in her ear, tugging on her earlobe.

“I didn’t know you’d been taking care of him that morning.”

“I didn’t do anything to him! I didn’t! I just went in to see how he was. He asked me for some black coffee. I didn’t touch him!”

“Calm down, Serena, I didn’t say you did.”

“So, why did he die like that? Just stop breathing. I didn’t think that’s how it’d happen to him.”

“He was terminal, Serena. They can die in a number of ways. This was Huey’s.”

“I can’t have another patient of mine die and not know why!”

“Serena, a lot of your patients are going to die and you won’t always know why. It happens. It’s important to care, but you can’t get too involved. You have to keep a professional distance.” I put my arm around her thin shoulders. “I know it’s hard.”

She shook me off. “That’s not it. I thought Huey was kinda spooky with that arm and all. I just don’t want to be accused of doing anything wrong. I didn’t do anything, Monika, I didn’t. You have to believe me.” She bit her lip.

“Pull yourself together, Serena,” I said, my annoyance showing. “The post should explain things. In the meantime, you’ve got work to do.”

She turned away with a jerk of her head.

I CAUGHT MAX sorting through the piles on his desk. Stacks of papers, bulging file folders, books stuck full of post-it notes and an assortment of medical journals all competed for space on his oversize desk. The chest piece of a stethoscope peeked out of the pile, dangling precariously over the edge.

“I’m glad you stopped by,” he said, reaching his arm in between some folders and pulling out a slide. “Aha,” he said, carefully aligning the pile before it toppled over. “I knew it was in here someplace. Hazelman wanted it for grand rounds tomorrow,” he explained, smiling at me. He waved me toward the chair in front of his desk but it, too, was overflowing so I stayed where I was, closed the door behind me and leaned against it.

Max took off his thick-lensed glasses and wiped them on his lab coat. He looked up, his eyes unfocused. “What can you tell me about the patient, Castle?” he asked.

A knot of worry began in my stomach.

“You’ve done the post?” I asked him. At his nod, I took a breath and went on. “Cancer of the stomach. Alcoholic, we think. He had a respiratory arrest and died. Why? What did you find?”

He slipped his glasses back on, hooking wire temple pieces behind his ears. “Respiratory arrest. That’s a pretty unusual way for a cancer patient to die. His arteries were good, no CVA, like your other patient, or MI. In fact, his heart looked good.”

“Are you saying his death wasn’t related to the cancer at all?”

“Well, the cancer still doesn’t explain the respiratory arrest. Any indication that he was going bad?”

“I haven’t seen any change recently, nothing that would be a sign that he was about to die. Laura had him that morning and she thought he looked about the same.”

“You saw him when he coded?”

I nodded.

“And he wasn’t breathing? Not moving at all?”

“His eyes were open,” I said. “But his heart was still beating, according to the monitor.”

Max stood and came around to the front of his desk. He leaned back and crossed his arms, resting them on his paunch, lab coat spread open. “I got a call from the medical examiner about him.”

“Oh?”

“He’s going to rule the death ‘suspicious.’”

“Suspicious? Why? Just because we didn’t expect him to die this way doesn’t mean there’s anything suspicious.” When he looked as if he was about to disagree, I asked, “Is there?”

“There’s nothing in my report that indicates his death was anything other than natural, but I’m not the law. I’ve already talked to Lord. He’s puzzled by it, too, but no more concerned than I was. But once the ME gets ahold of something like this it’s out of our hands, Monika. Nothing you or I or anyone else here can do. The ME’s ruling has the force of law behind it. In fact, he is the law. And if I remember correctly you had some questions yourself. You asked me late Friday to check Castle’s blood for alcohol. You were wondering about something other than the cancer, weren’t you?”

“Well, that complicates things,” I said, ignoring his question. I told him about Huey wanting to talk to the detectives before he coded. “They acted like they thought that Laura might have had something to do with his death.”

“Let’s wait and see what they do. The police are as overworked as we are. Maybe this is one they’ll let go.”

“Well,” I said, “I don’t care if they do investigate. I’m sure a nurse didn’t do it. So they’re welcome to do all the investigating they want to do.”

“Respiratory arrests are awful, aren’t they?” He scratched his bald head and smoothed the surrounding white fringe of hair. “Death by asphyxiation.”

“What about his alcohol screen?” I asked.

“Negative. The ME is running a tox screen as well.”

“His narcotics levels will be pretty high. He had stomach cancer and pain control was a constant challenge.”

“I’m sure they’ll let us know the results.”

“That’s all we need,” I said as much to myself as to Max. “On top of the drug tests.”

“When I heard about those this morning, I knew you’d be upset.”

“Damn right, I am,” I said, my voice rising. “My nurses are already overworked and then administration has someone come in to watch them pee into a cup. It’s humiliating.”

He winced. “I can imagine it’d be terrible. But, Monika, we have to find out who’s taking the drugs before they harm a patient.”

“I suppose so,” I said, with no conviction in my voice.

“I know so. There’s no other way, short of catching someone in the act, to identify who’s doing it.”

“When will you have the results?” I asked.

“They should be back in a day or two,” he said, sitting back down in his chair.

“You don’t do them here?”

“We can’t handle that volume. But it shouldn’t take long. They contracted an outside agency for stat urines.” He glanced at a stack of reports awaiting his signature.

“Doesn’t that cost more?”

“Of course, but we can’t have people working here who might be on drugs. Anyway, these are just screening tests. If any come back positive, they run a confirmatory test. And, yes, that also costs more,” he added, anticipating my question.

“What’s the probability of a mistake in the testing process? Could anything go wrong with how they’re done?”

“Nothing’s one hundred percent, you know that. But we take a number of precautions to make sure the results are accurate.”

“What about when it’s going to the lab? How does it get there?”

“Monika, listen, we’re both busy here.” He tapped a plump finger on the papers behind him. “I wouldn’t worry about them.”

“Please, Max, just explain it. Please.”

He stared at me, his eyes magnified by the thick lenses. “All right,” he said. “We maintain strict chain of custody on all drug tests. In this case, only two techs collected the specimens and handled them. Then they hand-delivered them to the lab. Don’t worry. Nothing will go wrong. Satisfied?”

“Could it be labeled incorrectly? Or mixed up in the lab?”

“They do it every day. Why are you so worried? For goodness’ sakes, Monika, they know what they’re doing as well as you do.”

“Okay, okay.” I held up my hand as if it were a stop sign. “If they say there are drugs in a nurse’s urine, I’ll believe it.”

“If anything, it’s more apt to be a false negative.”

“So the person could be on drugs and not get caught?”

He nodded. “Or the test could accurately be negative, but the nurse could be stealing drugs for someone else. Or to sell.”

“No nurse would do that. And why does everyone think it has to be a nurse? If someone is stealing narcotics they’re a criminal, and a criminal could find ways to steal meds even if they aren’t the one who signs out drugs.” Max didn’t say anything so I went on. “What about a false positive? Does that ever happen?”

“It’s possible, but they usually set the cutoff high enough so that it doesn’t.”

“What would cause a false positive?”

“Lots of things. Medications—narcotics, certainly—but over- the-counter things, too. Antihistamines, cough syrup, some pain medications, those for sleep. Food even.”

“Food?”

“A few things, but don’t worry, Monika. That’s why they set the cutoff high. To rule out those things.”

“Let’s hope.”

BY THE TIME I SAW what was happening, I’d already stepped off the elevator at the lobby floor and joined the surge of people moving into the melee.

Tim and other nurses—most I recognized—had formed a sort of gauntlet through the lobby, shouting at employees as they left. Behind the chanting nurses stood several unsmiling men, bulky with muscles, their hands crossed in front of them.

“Hell, no, we won’t pee!” they screamed in unison. “NURSES WON’T DO IT TILL DOCTORS DO IT,” read a placard waved aloft by a short nurse.

Two elderly women came through the entrance doors but turned away, frightened, and hurried back out. One young couple trying to leave looked confused, were caught in the crush and yelled at. They escaped, running across the street to the parking garage.

The chanting continued as another elevator opened, discharging more tired employees. The press of the crowd pushed forward. Some employees assessed the scene in time to realize what was happening and slid into the line of protesters. Quite a few of them slipped on through to the back of the crowd and out of the building. I walked straight ahead, trying to tune out the shouts as I kept my face purposely blank, and kept moving. I passed Tim, his face screwed up in anger, one eye still puffy and streaked with yellow, as several uniformed security officers hurried in the door. I turned into the garage as two police cars squealed to the curb. I looked back and caught a glimpse of Judyth standing beside a post down the hall, her arms crossed over her chest and her mouth curled in satisfaction.