Code 15 (18 page)

Satisfied he had shattered her spleen and that she was at this very moment bleeding massively, he removed a clean white washcloth from his pocket and wiped down everything he had touched. He then flipped on the small courtesy light under the visor and leaned over toward Faith. He wasn’t surprised to see she was still breathing, but her effort was labored and shallow.

Gideon glanced down at his watch. He then waited for exactly three minutes before reaching over and placing his fingertips on her wrist. Her pulse was racing and threadlike, confirming his suspicion that she was already in shock from uncontrolled internal bleeding. Her face, usually animated and ruby, was drained of any color.

As if he had just finished a routine errand, Gideon got out of the car and left the parking lot the same way he’d come in. On his way home, his thoughts were of Faith. Although she was innocuous and unoriginal, she was a pleasant enough person. And while her death was unfortunate, it was essential.

Sitting in his den, Gideon waved a crystal snifter containing a fifty-year-old cognac under his nose.

He leaned back in his leather club chair and gazed across the room at the ornate antique grandfather clock that stood in the corner. The unbearable ringing in his ears had finally decreased to a tolerable level. When it had been exactly thirty minutes since he had left Faith to bleed to death, he opened the bottom drawer of his desk, pulled out a cell phone, and tapped in a number. It rang four times.

“Emergency room.”

Gideon cleared his throat. “I’m sorry to disturb you, but I was just leaving the hospital and noticed a woman getting into her car in the parking lot. It was a small red Toyota. The reason I’m calling is because she looked pretty wobbly. I probably should have stopped or called right away but . . . well, I had just come from seeing my wife and I was a little—”

“That’s okay,” Matt Petrakis, the unit secretary, said. “Where exactly was this again?”

“In that dirt parking lot across the street from the emergency room—down at the far end.”

“I’ll let security know. Thanks for calling.”

“You’re welcome,” Gideon said.

Having a pretty good idea of what was about to unfold in Dade Presbyterian’s ER, Gideon couldn’t help but grin. With nothing more to do, he stood up, turned out the lights, and went upstairs. He tiptoed across the bedroom’s pinewood floor, entered the bathroom, got undressed, and stepped into the shower. Closing his eyes, he pushed his face high into the pounding jets of hot water. Pleased with the way the evening had gone, his only regret was that he wouldn’t be there to see Morgan Connolly’s face when Faith Russo was rushed back into the emergency room.

If events continued to unfold as he’d planned, the good doctor would soon be facing the state medical board’s unrelenting scrutiny—a demeaning process that would, at a minimum, result in her professional humiliation. The irony was that the bitter fight she would undertake to save her reputation would be irrelevant. Where she was headed no medical license would be required.

With unshakable determination, Gideon was prepared to overwhelm Morgan Connolly with so much emotional trauma that when she finally did come face-to-face with her own death, she would welcome it with both arms open.

 

 

WHILE Gideon lay fast asleep ten miles away, Morgan was attending to an elderly gentleman with a sliver of glass in his eye. After paging the ophthalmologist on call, she slid the chart back into the rack, stood up, and stretched. Justine Cul len, the charge nurse, walked into the nursing station.

“You look like you’ve had enough for one shift,” she told Morgan.

“Actually, I think it’s quieting down. I was thinking of sneaking over to the on-call room for a few minutes.”

“Go ahead. I’ll call you if we need you.”

“Good, just try your best not to need me,” Morgan said, picking up her stethoscope and slinging it around her neck.

With a familiar grin on her face Justine said, “If the drunks and criminals leave us alone, we’ll leave you alone.”

“Deal,” she answered, smothering a mammoth yawn with her hand.

Morgan strolled out of the emergency room and went straight to the physician’s on-call room. After months of her pestering the administration, Bob Allenby finally caved in and allocated the money to refurbish the room. To the doctor’s delight, the desperately needed renovations included new carpeting, a re-styled bathroom, and a state-of-the-art computer station.

Morgan took a seat behind the flat-screen monitor. She had recently received news of her medical school reunion and she wanted to respond. But before she could bring up the e-mail, the phone rang.

“Morgan, it’s Justine. We need you in the trauma room right away.”

Assuming it was the first gunshot or stabbing victim of the night, Morgan came to her feet and reached for her coat.

“I was hoping to get through the night without anybody trying to kill anybody else,” she moaned.

“I’m afraid it’s worse than that,” Justine said in an uneasy voice. “You’d better get over here right now.”

“What do we have?” Morgan asked, craning her neck to see above the crowd of nurses and other ER personnel feverishly working on a young woman.

“We’re not exactly sure,” answered Justine as she cut the woman’s pant leg from ankle to thigh. “This one’s a little bizarre. Security found her in her car a few minutes ago. She still had her hospital identification band on.” Justine paused for a moment and looked up. “It’s Faith Russo. The woman we just discharged with the knee injury.”

Moving toward the bed, Morgan could feel her throat clamping down. “The one who fell off her bike?”

Justine nodded.

Morgan took a long look at the woman’s face. “This is impossible,” she muttered. “It was a minor fall.”

“That may be, but at the moment she has no pulse or blood pressure. Security called the paramedics. They began CPR as soon as they got to her.”

It was only her years of training and experience that allowed Morgan to dismiss the shock and bewilderment of the moment and get on with the business of saving Faith Russo’s life.

The assistant head nurse had already started an IV and was now placing a series of heart monitor leads on her chest. A respiratory therapist held a plastic mask that was attached to a black bag over her nose and mouth. With each squeeze of the bag, he forced one oxygen-enriched breath after another into Faith’s lungs.

Without looking up, Morgan yelled, “Forget masking her. Let’s get a tube in her right now—and keep up the chest compressions.” She turned back to the respiratory therapist. “We’ll need a ventilator set up right now. Get some help if you need to.”

“We have one ready to go,” she answered.

Morgan reached across Faith’s chest and stripped off her blanket. Her eyes froze in disbelief at her swollen abdomen. Morgan didn’t have to review a long list of diagnostic possibilities. She knew exactly what she was dealing with.

“This woman’s bleeding internally. Get the general surgery resident down here right now,” she said, spreading her hands out wide on Faith’s belly. “We need another IV. When it’s in, start another liter bolus of Ringer’s solution. As soon as you have it, give her two units of O-negative blood. I also need ultrasound in here stat.”

“I’ll get the blood,” came a voice from the back of the room.

Morgan examined Faith’s abdomen carefully. “There’s no entrance wound,” she announced. “There’s a small bruise right under the rib cage. This has to be blunt trauma,” she added, thinking to herself that the mark wasn’t there when she first examined Faith. She turned to Justine. “This woman probably needs to go to the operating room. Where the hell are the surgeons?”

“They’re on their way,” the unit secretary yelled from the doorway.

Justine said, “I think they’ll all be in the OR with that guy who got crunched on his motorcycle.”

Morgan grabbed a metal scope from the red crash cart. The cart was present in all critical care areas and was stocked with every conceivable device and medication that might be required for a code blue. She flipped the blade of the scope open, locking it into place. She then opened Faith’s mouth and slid the blade toward the back. The light on the end of the scope helped Morgan see her vocal cords.

Without moving her eyes, Morgan held her hand out. “Give me a seven tube.” As soon as she had it in her hand, she slid the tip of the clear plastic tube between Faith’s vocal cords and down into her windpipe. “We’re in,” she announced. “Start bagging her. How about that blood?”

“We’re hanging it now. We still can’t get a blood pressure,” Justine announced.

“Give her an amp of epinephrine and two of bicarb. And somebody mix up a dopamine drip,” Morgan ordered. She looked up at the monitor—still no vital signs.

Camille Olson, the chief resident in surgery, charged into the room. She was dressed in scrubs with a mask tied around her neck.

“Somebody talk to me,” she said, moving immediately to the head of the bed next to Morgan.

Justine answered, “This is a thirty-year-old woman who we saw about an hour ago. She had fallen from her bike. All she had was a mild knee sprain.”

Camille looked at Justine sideways. “How did we go from a mild knee sprain to an abdomen like this?”

Morgan hesitated. “Her abdomen was fine when I discharged her.”

Camille didn’t look up. Morgan knew she wouldn’t criticize the care the patient had received in front of the ER staff.

“Maybe she underestimated how hard she fell,” Camille offered, performing her own examination of Faith’s abdomen.

“When she left here she was fine,” Morgan insisted, as she continued to order medications and run the code blue.

“What do you think happened?”

“I have no idea. All I know is security found her in her car with no pulse or blood pressure and called the paramedics.” Morgan pointed at the cardiac monitor. “She came in flatline and that’s the way she’s stayed.”

Camille took a step back. “How long have you been coding her?”

“About fifteen minutes,” Justine answered.

“What about taking her to the OR?” Morgan asked.

Camille looked at her with surprise. “She has no vital signs. What am I going to do for her in the OR? It’ll be a warm autopsy.”

Morgan knew Camille was right but she was desperate.

Cass Drury, who had been the night ultrasound tech at Dade Presbyterian for years, pushed her portable ultrasound machine into the room.

“We want to see the abdomen,” Morgan said.

Cass selected one of the ultrasound probes and placed it just under Faith’s breastbone and began scanning her abdomen. After no more than a few seconds, she pointed to the monitor. “This looks bad. Her whole belly’s filled with blood.”

Camille said, “She must have a bad liver or spleen injury—maybe both.” She moved closer to Morgan. Speaking in just above a hush, she said, “I’m only the chief resident, Morgan. You’re the attending, so it’s your call, but I don’t think we have anything to offer her. We’re too late.”

“We can’t give up that easily,” Morgan insisted. “The woman’s barely in her thirties, for God’s sake.” She turned to the nurse who was doing the chest compressions. “Don’t stop the CPR.”

Camille stole a second glance at Justine, who urged her on by nodding a few times.

“Okay,” Camille said. “Let’s give this one more shot.”

Under Morgan’s and Camille’s direction, the entire team worked at a frenzied pace for the next twenty minutes doing everything possible to resuscitate Faith. But in spite of their Herculean effort, her heart never beat once. The blood loss had been too massive and the state of shock irreversible.

Finally, Camille stepped back from the table. She said nothing. Justine came around to the other side of the stretcher where Morgan was standing. She placed her hand on Morgan’s forearm and whispered, “She’s gone. It’s your call when we stop.”

When Morgan didn’t answer, Camille said, “We’ve been coding her for thirty-five minutes with absolutely no response. Her pupils are fixed and dilated. From a surgical standpoint there’s no reason to continue.”

With the futility of the situation finally obvious, Morgan scanned the defeated faces of the staff who had shared in the struggle to save Faith Russo’s life.

In a clear but shaky voice, Morgan said, “We’re finished here. Somebody please note the time.”

An eerie hush filled the room as everybody except Morgan and Justine filed out. Morgan walked over to the opposite side of the room and sat down. The stark realization of Faith Russo’s death took hold of her with a sickening sense of guilt and desperation. Her eyes never moved as she sat there without the first clue of how she could have missed such a devastating injury.

Picking up empty medication boxes from the floor, Justine stopped for a moment and looked over at Morgan. “Are you okay?”

“I . . . I don’t know. I’m the chief of the department. I’m the one everybody expects to set the standard for excellence in patient care.”

“Are you suggesting you did something wrong? It was a routine minor orthopedic injury. Her vital signs were fine. There was no reason to suspect she—”

“I should have ordered an abdominal ultrasound.”

“For a sprained knee? Be reasonable, Morgan. There’s not a physician in this department who would have done that.”

Morgan pressed her palms and fingers together. “She told me that the only thing that bothered her was her knee. I examined her abdomen anyway. It was fine.”

Justine cleared her throat. “The triage nurse said she mentioned that she did have a small amount of abdominal pain. She included it in her triage note.”

Morgan reached for the chart. “I saw the note. That’s why I specifically asked her about her abdomen.”