Deadly Diversion: A Medical Thriller

Cyanosis colored Huey’s arms and legs bluish-purple, and streaks of purple and blue mottled his chest. Even with the jelly pads, the paddles had left burn marks where I had shocked him.

The respiratory therapist came in to report on Huey’s blood gases that Time had drawn. She handed me the lab printout strip.

“His O2 is 37, CO2 65,” I read.

Incompatible with life.

“How long’s it been,” Lord asked, “since the alarm?”

I looked at the clock. “Thirty-three minutes.”

“Too late now,” Lord said. “Stop drugs.” He moved to the bedside. He checked Huey’s neck for a pulse, his ear next to Huey’s mouth. He shook his head and glanced again at the monitor now humming a straight line across the screen, whining our failure. “We’re calling the code,” he said.

“You’re calling the code,” I said, trying to keep my voice steady. I glanced at the clock behind me on the wall. “I have the time as 0749 hours,” I added, for the record.

“Yes, patient pronounced, 0749,” he said and walked out of the room.

Praise for Eleanor Sullivan’s Monika Everhardt mysteries:

 “The telling and characters are expertly handled, and the specialized background is rendered in warts- and-all detail.”

Ellery Queen Mystery Magazine

“… a medical mystery that rings with authenticity, and a spunky, likable, interesting nurse-protagonist… May we see much more of Monika Everhardt!”

Aaron Elkins
, Edgar award winner

“… for any reader who wants a wonderful new heroine and a suspenseful medical mystery.”

Nancy Pickard
, award winning author of
The Scent of Rain and Lightning

“Move over, Miss Pinkerton and Sarah Keate. Monika Everhardt is a great and authentic addition to the ranks of nurse sleuths in Eleanor Sullivan’s gripping mystery.”

Carolyn Hart
, author of the
Death on Demand
and
Henrie O
mysteries

“… grabbed me from the first pages… a thriller, a mystery and an insightful look into the sometimes shaky workings of a hospital, from administration to ER, written by someone who knows what she’s talking about. I hope she keeps it up.”

Lee Harris
, author of
Murder in Greenwich Village

"From the shadow of the St. Louis Arch to the ashes of the World Trade Center, Assumed Dead pulses with the authentic excitement of a busy ICU as head nurse Monika Everhardt uncovers the mysterious connection between a battered wife, an unidentified car crash victim and a long-missing man while laying to rest some ghosts of her own."

Marcia Talley
, Agatha and Anthony award-winning author of
The Last Refuge

DEADLY DIVERSION

Eleanor Sullivan

DEADLY DIVERSION, A Worldwide Mystery/October 2010

First published in hardcover edition in 2004 by Hilliard & Harris.

Copyright © 2004 by Eleanor Sullivan All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without permission in writing from the publisher. For information visit the author's website:

www.eleanorsullivan.com

This is a work of fiction. Names, characters, places and incidents are either the product of the author's imagination or are used fictitiously, and any resemblance to actual persons, living or dead, business establishments, events or locales is entirely coincidental.

More titles by Eleanor Sullivan:

Cover Her Body, A Singular Village Mystery (Bonus chapter at the end of this book,
click here
)

More Monika Everhardt mysteries

Twice Dead

Assumed Dead

Digital publishing services by Sellbox:
www.sellbox.com

BONUS MATERIAL

This edition includes a first chapter excerpt of the author's book,
Cover Her Body: A Singular Village Mystery
. It appears immediately following the end of
Deadly Diversion
.

Three may keep a secret, if two of them are dead.

-Benjamin Franklin

PROLOGUE

The loudspeaker woke him. It was happening again, another one was trying to die. They’d left the curtain open because it was nighttime and they thought all the patients were asleep. But not him. With the first sound, his training had kicked in, propelling him awake, alert.

After a few minutes he knew something was wrong. The nurse was competent, that he could tell from the swift, sure movements. But it was all going down too quickly. Much, much too quickly. Each task required specific steps in exactly the correct order. Otherwise, the mission could go wrong and someone could get hurt or die. He’d learned that long ago.

He knew who the patient was because the family had been in and out for the past few days and he had recognized them. But he’d kept quiet, concealing his presence.

Now he lay quietly and watched. He was good at that. And listened. He was good at that, too.

ONE

Wednesday, 08 August, 0645 Hours

“GUARDINO’S GONE,” Bart said, giving me a quick glance.

“Gone? Where?”

“Dead,” Bart replied, continuing to write in the chart in front of him.

I sat down hard, rattling the chair back. “What happened?”

Bart shrugged. An experienced critical care nurse, Bart had moved to St. Louis to study anesthesia in graduate school and had started work at St. Teresa’s Hospital six months ago. He’d wanted to work nights so he could go to school during the day. Few nurses wanted the night shift so I was glad to give it to him.

“Where’s his chart?”

“Why?” Bart asked, turning to face me.

“I want to know what happened.”

“As soon as I finish.” Bart shifted his attention back to the chart.

“Where’s the body?” I asked, looking around for a gurney from the morgue.

“I sent it on down,” he said, writing as he spoke. “I wanted to get it out of here before everyone arrived.”

“So what happened?”

“Here. See for yourself.” He closed up the chart and tossed it onto the counter in front of me. It landed with a clatter.

“The chart’s supposed to go with him,” I said, opening it up.

I had started out at St. Teresa’s straight out of nursing school more than twenty years earlier, working on medical-surgical floors until I’d been able to get my clinical legs under me, then I’d transferred to intensive care where the rush of adrenaline fed my need for excitement. Head nurse—now called patient care manager—for the past five years, I found the job becoming more and more difficult as managed care squeezed ever-increasing dollars out of our budget, and the nursing shortage meant each shift was a gamble.

“I’ll take it down when I leave.” Bart stretched his arms above his head, muscles rippling under his green scrub suit top. He closed the fat textbook that lay on the counter and stacked a yellow legal pad covered with notes on top of it.

“No surprise, I guess,” I said.

Mr. Guardino had come in three days before, unconscious from a stroke. Since he’d arrived his body had been shutting down, one organ system after another, in spite of our best efforts to keep him alive.

“My God!”

“What?” Bart asked, wadding up some scraps of paper. He tossed them toward the trash can under the counter. They fell short.

“You didn’t intubate him? Or shock him?”

“He was a B code, wasn’t he?” Bart asked, referring to the A, B, C system of coding we’d recently adopted to designate what should be done in case of a cardiac or respiratory arrest.

“No! The family was emphatic—full resuscitation. He was an A.”

An A code required that everything medically possible be done to resuscitate the patient. B codes, generally used for patients unlikely to survive, specified limited resuscitation efforts; and with a C code, previously designated as a “do not resuscitate” order, no resuscitation would be attempted.

“It wouldn’t have helped anyway,” Bart said. “He couldn’t have been revived, no matter what the code was.”

Determination of the appropriate code was based on the patient’s condition and likelihood of recovery as well as his or her previously stated wishes and the family’s desires at the time. It wasn’t a perfect system, by any means. Such life-and-death decisions are difficult even if they are discussed ahead of time, but under the stress of a critical illness families and staff alike find themselves torn between wanting to keep the person alive and accepting the futility of trying. And seldom do all those involved agree.

I wiped my hand across my face. “You didn’t know that. I’ve seen them come back from... Anyway, it was your job to know which code to use and to follow it.”

“Do you know how much care he required?” Bart asked, going on without waiting for my reply. “The constant juggling act it took to keep all those drips going? Keep his pressure up, they say, we’ve got to save what viable brain he has, they say, but not too high, they say, or he might stroke out.” He flung his arms outward and heaved a sigh.

“I know all that—”

“You don’t know the half of it, Monika. Do you know how many meds he was on? Antibiotics, muscle relaxants, a beta blocker—that was for the heart damage from the defibrillator they used in the E.R. to restart his heart—and more.” He rubbed the stubble on his chin. “And me here in charge alone on nights. It’s all we can do to keep up with the ones who are recovering, as understaffed as we are.” Bart stood and reached for his lab coat draped across the counter. “I did the best I could. No one can ask for more than that.” He swung the lab coat over his shoulder and started toward the door.

“I’ve got to write you up for this.” I reached for the incident report forms in the drawer.

He turned toward me, and I caught a flicker of anger. Just as quickly it was gone.

I stared at the form. Damn. This was the last thing I wanted to do—write up a competent nurse of whom I had far too few.

“Listen,” he said, coming back. “Are you really going to screw things up for me over some old man who was dying anyway?”

“Policy, Bart. And the law. It’s not your decision.” I looked back down at the form in front of me.

He dropped his book on the counter and leaned over me on the desk, fingers splayed. Wisps of blond hair curled on the backs of his hands. “I need this paycheck till I finish grad school,” he said, “and you’re not going to mess me up!”

Two nurses on the day shift came through the door.

“You keep quiet,” Bart said, then he picked up his book and papers and left the unit.

Ruby banged through the swinging doors carrying an insulated lunch bag. “What’s he in such a hurry for?” she asked, tossing a bulky red-white-and-blue cardigan over one chair and arranging herself in another. A ward clerk since before I had come to St. T’s, Ruby kept tabs on everything. And everyone. “Whose is that?” she asked, pointing to the chart in front of me.

“Guardino’s. He’s dead.” I took in a deep breath and let it out slowly, looking up at the ceiling.

“Hey, you ain’t that upset over him, are you?”

I shook my head as much to clear it as to tell her no.

“What’s it doing up here? And where’s the body?” Ruby asked, glancing toward Guardino’s room.

“Bart was going to take it down—”

“Here. Gimme,” Ruby said. “I’ll take it down to the morgue.”

I handed her the chart. “Just don’t go visiting all your friends on the way.”

“Hey, I ain’t got no friends in the morgue.” She chuckled. “No, sir, I don’t want nothing to do with the dead ones,” she added, clutching the chart to her chest. “I know some folks. That’s how I find out stuff. And you don’t seem to mind knowing what I find out, neither,” she added with a flip of her top-knot as she marched out the door.