Mercy (34 page)

Michelle gave a little laugh. “Unfortunately, this is where a lot of my customers hang out.”

It was Julie’s turn to chuckle, though the rest of this conversation would have to wait until lunch. Amber emerged from Shirley Mitchell’s room with a concerned look on her face.

“Dr. Devereux, there’s a problem with Shirley’s central line. Could you take a look, please?”

“Yes, of course. I’ll be right there.”

Julie said a quick good-bye to Michelle and reconfirmed their plan to meet. Perhaps Lucy would be available and could join them. As if on cue, Julie’s phone rang. It was Lucy calling. Julie declined the call and sent it to voice mail. Then Jordan called, and Julie felt a little pang of concern. Why would both of them call in such short intervals? The answer would have to wait. Shirley needed immediate attention.

As Julie predicted, Shirley had not stabilized enough to be weaned off mechanical ventilation. It had been several days since Shirley’s return to the ICU, and her relatives could no longer maintain lengthy bedside vigils. Shirley was alone most of the time, breathing with help, and unaware in her blissful propofol slumber.

“She must have thrashed about and pulled out the line,” Amber said, concern in her voice. In time, the young nurse would realize these things happened. A patient pulling out their central line was not as rare as Kounis syndrome by any stretch, but it was not a common occurrence either, which was what had Amber on edge.

A trickle of blood oozed from a thin gap in the central line where it had detached from the skin. The catheter affixed to Shirley’s jugular vein had been sutured in place, so Shirley’s thrashing must have been considerable in order to dislodge it. It was standard procedure for Julie to put in a new central line. She did so without issue. The line had to be flushed, though, to make sure it was clear.

“Amber, please hand me a saline flush, will you?”

The saline flushes were commonly used items and kept in each ICU room for quick and convenient retrieval. Amber handed Julie a ten-milliliter syringe, though three milliliters of saline would be more than sufficient. Julie undid the wrapping and inspected the site for any redness, swelling, or signs of infection. She scrubbed the catheter hub with an alcohol swab for fifteen seconds, then removed the sterile cap. She inserted the open end of the syringe into a hub on the catheter, followed by a twist to lock it. Next, Julie opened the valve mechanism and slowly injected the proper amount of clear saline into the catheter.

“All set, Amber,” Julie said as she handed the syringe to the nurse for disposal. Julie left Amber to tend to other matters.

Five minutes later, Amber, sounding more anxious than before, called Julie back into the room.

“Dr. Devereux, Shirley Mitchell’s blood pressure just dropped.”

Julie rushed to Shirley’s bedside and immediately noticed a nosebleed so brisk it soaked though several applications of gauze. Alarm bells rattled in Julie’s head when she observed how all of Shirley’s IV sites were oozing. Red rivers snaked down Shirley’s bloated arms and marked her mottled neck. Closing the drape, Julie lifted Shirley’s hospital gown to examine the belly. Signs of bruising appeared as if by magic before her eyes, while pools of blood started to well up from between her thighs. Worry squeezed like a vise around Julie’s chest.

Oh, goodness, no …

“Amber, quick! Call for four more units of blood,” Julie said in a crisp and direct manner. “Draw a set of labs now. I think she is going into DIC.”

The proteins controlling Shirley’s blood clotting had become overactive. It was not unheard of for a patient with a necrotizing skin infection to suffer disseminated intravascular coagulation (DIC) and possibly die because of sepsis, but it was a highly unusual complication. Another nurse came running into the room with a liter of saline to hang as a bolus. Julie stayed calm. She had no intention of announcing Shirley’s time of death.

While Amber prepared to draw her labs, Shirley’s heart rate began to drop precipitously.

“Dr. Devereux, she’s bradying down.”

“Bradying” down was medical speak for a slowing heart rate. Shirley’s had plummeted into the twenties.

“Quick, an amp of epi and call a code blue,” Julie said with force.

Alarms sounded and much commotion followed. A swarm of people burst into the room and took their respective roles in an effort to pull Shirley out of her nosedive. But Shirley’s EKG went flatline, triggering more alarms, more noise, more commotion. Amber and a second nurse took turns performing CPR at a grueling rate of one hundred compressions per minute, while Tammy got the respiratory bag going.

A nurse called out, “Three minutes, another epi, Dr. Devereux?”

“Yes, please.”

Labs were quickly drawn, including a complete blood count, liver enzymes, chemistries, and a full coagulation panel. Two units of packed red blood cells arrived and the nurses hung the bags of medicine and hooked them to the infusion pump.

Come on now … come on …

Shirley continued to be asystole with no cardiac electric activity, no output or blood flow. Julie knew she was running out of time. A nurse delivered that third dose of epi.

“Any pulse?” Julie asked.

Compressions came to an abrupt stop as many hands felt Shirley for a pulse.

Nothing.

“Resume compressions,” Julie said.

No change. Still flatline.

“Is the family here?” Julie asked.

“No, nobody has arrived yet,” a nurse said.

“Okay. Okay, everyone. I’m calling it.”

The mood turned somber. Julie glanced at the clock on the wall.

“Time of death, ten fifteen
A.M
.,” she announced in a solemn voice.

Grim faces all around. Death was a regular visitor to the ICU, but never a welcome one. Julie left for the break room. She needed to clear her head, decompress, but she could not stop reviewing the case in her head.

Where did things go so horribly wrong?

CHAPTER 42

“I got fired,” Jordan said.

The wind was blowing hard, distorting Jordan’s phone call and making it difficult to hear. Julie thought she’d heard him right, but it still did not make any sense.

“You got what?”

“Fired,” Jordan repeated. “I’m out of White. Gone as of this morning.”

“Oh my goodness. I’m so sorry. Tell me everything.”

It’s my fault
was playing in the back of Julie’s mind.

She was seated at her desk, hours after Shirley died, and only now understood why a different diener, a man she had never met before, had come to collect the body. Julie would have to cancel her lunch plans with Michelle. She and Jordan needed to speak in person. Jordan told her the saga in brief.

“Routine search, my foot,” Julie said after Jordan finished his explanation. “William Colchester must have put someone up to it. He has connections at the prison. I’m sure of it.”

“Yeah, well, Dr. Abruzzo was going to take the fall for me. I couldn’t let that happen, so I had to confess to what I did.”

“I’ll get you your job back,” Julie said. “Don’t worry.”

Jordan breathed a loud sigh that rose above the howl of the wind and told Julie his worry was going to stick around for some time.

A nurse poked her head into Julie’s cramped office, a broom closet compared to where Dr. Coffey worked.

“I’ve got the lab on the phone. They’d like to speak with you. Said it’s urgent.”

“Jordan, I’ll call you in a minute. Hang tight, okay?”

Julie took the lab’s call at the nurses station.

“Hi, Dr. Devereux, this Dr. Becca Stinson down in pathology. The criticals for Shirley Mitchell are back. Sorry they took some time, but the tests needed to be repeated. They still don’t make much sense.”

Julie motioned for a nurse to hand her a pen and piece of paper.

“Give them to me over the phone. I’ll write them down.”

Julie jotted down each result as it was dictated to her. She blinked, because to say these did not make sense was more than an understatement.

Wbc: 13.6

Hct: 21.0

Platelet count: 274

Pt and inr: 14.0 and inr 1.0

Ptt >100

Fibrinogen 400

d-dimer: 3

Heparin anti xa level: >3.0 (nl between 0.3–0.7)

Julie’s mouth fell open and her body went numb.

“Read that last one again.”

“Heparin anti xa level greater than three point oh,” Becca said.

“Three point zero? Well, that’s a mistake,” Julie said. “Shirley Mitchell had a GI bleed. The last thing we would give her is an anticoagulant and blood thinner. Let me talk to Lucy.”

“I’m afraid Dr. Abruzzo—um—isn’t available,” Becca said.

Something cagey about Dr. Stinson’s answer unsettled Julie.

“Tell Lucy to call me as soon as she can.”

“Yes, Dr. Devereux.”

The results made no sense whatsoever for several reasons. Concern over Jordan’s unceremonious firing took a sudden backseat to this new and deeply troubling development.

A nurse rushed over to Julie while she was lost in thought.

“Dr. Devereux, we need you in room six. The patient’s oh two sat level is dropping.”

Julie tried to clear her thoughts so she could focus on this new crisis. She headed off to room six, but found it impossible to shake away her gnawing concern. Those lab tests were not just strange; they were downright sinister.

*   *   *

JULIE TRIAGED
the patient in room six for the better part of an hour. The end of the busy workday came, and not much had changed except for Julie’s lunch plans. Jordan was still an ex-employee of White, Shirley Mitchell was still dead, Lucy still MIA, and Julie still baffled by the test results. Julie was in her office, doing paperwork, preparing for the next round of battles with the insurance companies, when her desk phone rang.

“Dr. Devereux here,” Julie said.

“Dr. Devereux, this is Marilyn Bates, Mr. Janowski’s personal assistant. I’ve been asked to see if you could please come up to Mr. Janowski’s office right away. The matter is urgent.”

A pit opened in Julie’s stomach. “What is this about?”

“I’m afraid I don’t know. I only know that it’s extremely important.”

*   *   *

JULIE HAD
never been to Roman Janowski’s office before, but eventually she found it on the fifth floor of the Wilcox Building. A dour woman with curled gray hair sat at a desk near a set of shuttered double doors made of burnished wood. The nameplate on the woman’s desk read
MARILYN BATES
. She managed a look Julie felt was one part contempt, one part glee, and one part empathy.

“Roman is waiting for you inside.”

Perhaps Ms. Bates’s monotone was meant to be intimidating. Julie’s heart thundered as her stomach went through a series of somersaults. She had no clue what this meeting was about, but gut instinct told her it was not going to be anything good. The feeling was confirmed when Julie opened the door and saw Roman Janowski, Lucy Abruzzo, and Amber, the nurse who had cared for Shirley Mitchell, all seated at the large conference table in his spacious office, with grave looks on their faces. Three people dressed in business attire like Roman, two men and a woman, were also present.

“Please take a seat, Julie,” Roman said in a joyless voice.

Roman sat at the head of the table and pointed to an empty chair directly across from him. There was no handshake hello, no trace of the warmth he had shown at Sherri’s funeral. The CEO’s dead-eye stare chilled Julie’s blood.

“This meeting is being recorded,” Roman said. “I should advise you that you have the right to refuse to be on record, but just know we will consider your lack of cooperation justification to have you escorted from these premises and your employment suspended as a result.”

“Roman, what on earth is this about?”

There was a tremor in Julie’s voice, unusual given how many orders she had uttered in life-and-death situations that day.

“It’s about what happened to Shirley Mitchell,” Roman replied.

Julie’s eyes went wide and she directed her gaze toward Lucy, who was seated closest to her on the left side of the table. “Lucy, what is happening here?”

“Because you may not know everyone, I’m going to repeat introductions for the record,” Roman said. “Seated at the table are Dr. Lucy Abruzzo, White’s chief of pathological services; Amber Ellis, ICU nurse; Dr. Julie Devereux, pulmonary and critical care physician; Max Gilbride, director of patient safety; Val Mesnik, from human resources; and Bob Anderson, legal counsel for White.”

“Roman, please, I demand an explanation,” Julie said.

“I would like to lead this discussion, if you don’t mind, Dr. Devereux,” Janowski replied, his eyes boring into her. “Amber, would you please repeat what you told us right before Dr. Devereux arrived.”

Amber, who sat next to Lucy, shifted uncomfortably in her chair and refused to make eye contact with Julie.

“After Shirley came back from radiology, I heard her say ‘I want to die.’”

Bob Anderson said, “And at the time did you think Dr. Devereux heard these comments?”

Julie’s face flushed with anger. “I demand to know what this is all about,” she repeated.

Lucy shot Julie a stern look that said
keep calm, stay quiet, and be controlled,
all with a glance. Lucy had never admonished Julie before, and the experience was as unpleasant as it was unfamiliar.

“Yes, I’m sure Dr. Devereux heard those comments,” Amber said. “We looked at each other like, okay, that just happened. Let’s move on.”

“Move on, all right,” Roman grumbled as he slid a manila folder down the table. The folder scraped across the smooth surface and needed a push from Val to reach Julie, the intended target.

“What’s this?” Julie asked as she picked up the folder.

“Please have a look,” Roman said. “I would like you to confirm the contents. It’s articles, op-ed pieces and such, written by you that espouse your stance on death with dignity—patient self-determination, as you call it. Your views on mercy killing.”

“We’ve had these on file for some time.” Bob Anderson felt this was legally relevant to share, for reasons Julie could not fathom.