Toxin (9 page)

“Calm down!” Tracy said. “She's undoubtedly just following orders. You don't think she makes up the rules, do you?”

Kim shook his head. The line inched ahead. At the moment there was only one clerk taking admissions. It was her job to fill out the check-in sheet with all the pertinent information, including insurance coverage if the patient was not a member of AmeriCare's health plan.

Becky's face suddenly contorted in pain. Pressing her hand into her abdomen, she whimpered.

“What's the matter?” Kim asked.

“What do you think?” Tracy said. “It's another cramp.”

Perspiration appeared on Becky's forehead and she became pale. She looked pleadingly at her mother.

“It'll pass like the others, dear,” Tracy said. Tracy stroked Becky's head and then used her hand to remove the moisture from Becky's face. “Do you want to sit down?”

Becky nodded.

“Keep our place!” Tracy said to Kim.

Kim watched Tracy lead Becky over to one of the molded-plastic chairs along the wall. Becky sat down.
Kim could tell that Tracy was talking with her because Becky was nodding her head. Becky's color returned. A few minutes later Tracy came back.

“How is she?” Kim asked.

“She feels better for the moment,” Tracy said. Tracy noted how little the line had advanced since they'd joined it. “Can't you think of an alternative to this?”

“It's Monday night,” Kim said. “A tough night anywhere.”

Tracy exhaled noisily. “I certainly miss Dr. Turner.”

Kim nodded. He rose up on his tiptoes to see if he could figure out why the queue wasn't moving, but he couldn't.

“This is ridiculous,” he exclaimed. “I'll be right back!”

With his mouth set in a grim line, Kim skirted the people in front of him to reach the counter. Immediately he could see why they had not moved forward. An inebriated man in a soiled and wrinkled business suit was struggling through the process of checking in. All his credit cards had fallen from his wallet. On the back of his head was an angry scalp laceration.

“Hello!” Kim called out, trying to get the receptionist's attention. She was an African-American woman in her mid-twenties. “I'm Dr. Reggis. I'm on staff in the department of cardiac surgery. I have my . . .”

“Excuse me,” the receptionist said, interrupting Kim. “I can only deal with one person at a time.”

“Listen!” Kim ordered. “I'm on the staff here . . .”

“It doesn't matter,” the woman interjected. “We're an equal-opportunity server. It's first-come first-served for all routine emergencies.”

“Routine emergencies?” Kim questioned. It was a ridiculous oxymoron. All at once the idea of trying to talk
to this clerk reminded him of the frustration of having to deal with medically untrained people when he called insurance companies or managed-care plans to get clearance for patients. That chore had become one of the truly exasperating problems of modern office practice.

“Please wait at the end of the line,” the receptionist said. “If you'll allow me to concentrate and get these people before you signed in, I'll be able to take your information sooner.” She then directed her full attention to the drunk. In the interim he'd managed to gather the contents of his wallet.

Kim started to protest, but it was all too obvious it was a waste of time to try to talk with this woman. It occurred to him that she might not even know what the term “on staff” meant. With growing frustration, humiliation, and irritation, Kim returned to Tracy.

“I don't know where they find these people,” Kim complained. “They're like automatons.”

“I'm impressed by how your exalted position in this hospital has greased the skids for us.”

“Your sarcasm doesn't help one iota,” Kim snapped. “It's all because of the merger. I'm not known down here. In fact, I can't remember ever coming to this ER.”

“If you'd taken Becky's complaints seriously over the weekend, we probably wouldn't have to be here now,” Tracy said.

“I took them seriously,” Kim said defensively.

“Oh, sure,” Tracy said. “By giving her some over-the-counter diarrhea medications. That's really an aggressive approach! But you know something? I'm not surprised you didn't do more. You've never taken seriously any symptoms Becky has ever had. Or mine either, for that matter.”

“That's not true,” Kim said hotly.

“Oh, yes, it is,” Tracy said. “Only someone married to a surgeon would know what I'm talking about. From your perspective, any symptom less than what would call for immediate open-heart surgery is a kind of malingering.”

“I resent that,” Kim said.

“Yeah, well, so do I,” Tracy said.

“All right, Miss Know-It-All,” Kim snapped. “What would you have had me do with Becky over the weekend?”

“Have her be seen by somebody,” Tracy said. “One of your many colleagues. You must have a thousand doctor friends. It wouldn't have been too much to ask.”

“Wait a second,” Kim said, struggling to control himself. “All Becky had was just simple diarrhea and some cramps, both of short duration. And it was the weekend. I wasn't going to bother someone with such symptoms.”

“Mommy!” Becky called. She'd come up behind Kim and Tracy. “I have to go to the bathroom!”

Tracy turned and, reminded of her daughter's discomfort, her anger immediately mellowed. She put her arm over Becky's shoulder. “I'm sorry, dear. Sure! We'll find you a bathroom.”

“Wait,” Kim said. “This could be helpful. We'll need a sample. I'll get a stool-sample container.”

“You must be joking,” Tracy said. “I'm sure she has to go now.”

“Hold on, Becky,” Kim said. “I'll be right back.”

Kim walked deliberately and quickly into the depths of the ER. Without Becky and Tracy, he wasn't challenged as he passed the nurses' desk. For the moment the mammoth Molly McFadden was nowhere to be seen.

The interior of the ER was a series of large rooms divided into separate cubicles by curtains that hung from
overhead tracks. In addition, there were individual trauma rooms replete with state-of-the-art equipment. There were also a handful of examination rooms used primarily for psychiatric cases.

Like the outer waiting area, the ER proper was packed and chaotic. Every trauma room was occupied and staff physicians, residents, nurses, and orderlies swirled between them in continuous motion.

As he walked, Kim searched for someone he recognized. Unfortunately he didn't see anyone he knew. He stopped an orderly.

“Excuse me,” Kim said. “I need a stool-sample container ASAP.”

The orderly gave Kim a rapid once-over with his eyes. “Who are you?”

“Dr. Reggis,” Kim said.

“You got an ID?”

Kim produced his hospital identification card.

“Okay,” the orderly said. “I'll be right back.”

Kim watched the man disappear through an unmarked door that apparently led to a storeroom.

“Coming through,” a voice called.

Kim turned around in time to see a portable X-ray unit bearing down on him. He stepped to the side as the heavy machine was trundled past by an X-ray technician. A moment later the orderly reappeared. He handed Kim two clear plastic bags with plastic containers inside.

“Thanks,” Kim said.

“Don't mention it,” the orderly said.

Kim hurried back the way he'd come. Tracy and Becky were still in line although they had moved up a few feet. Becky had her eyes shut tight. Tears streaked her face.

Kim handed one of the plastic bags to Tracy. “Cramps?” he questioned.

“Of course, you lunkhead,” Tracy said. Tracy grabbed Becky's hand and led her back to the restroom.

Kim held their place in line as it advanced by one more patient. Now there were two check-in clerks. Apparently the other had been off on break.

 

B
y nine-fifteen the ER waiting room was filled to overflowing. All the molded-plastic chairs were occupied. The rest of the people were leaning up against the walls or sprawled on the floor. There was little conversation. In one corner, a television hung suspended from the ceiling. It was tuned to CNN. A number of unhappy infants drowned out the newscaster. Outside it had started to rain; the smell of wet wool filled the air.

Kim, Tracy, and Becky had eventually found seats together and had not moved, except for Becky, who'd made several more trips to the restroom. Kim was holding the stool-sample container. Although there had been some spots of bright red blood originally, now the contents appeared a uniform light brown. Becky was miserable and mortified. Tracy was exasperated. Kim was still seething.

“I don't believe this,” Kim said suddenly. “I truly don't believe this. Every second I think we'll be called, but it doesn't happen.” He glanced at his watch. “We've been here an hour and a half.”

“Welcome to the real world,” Tracy said.

“This is what Kelly Anderson should have done her merger story about,” Kim said. “This is ridiculous. AmeriCare closed the ER at the Samaritan to cut costs and make everyone come here. It's all just to maximize profits.”

“And maximize inconvenience,” Tracy added.

“It's true,” Kim agreed. “AmeriCare definitely wants to discourage emergency-room usage.”

“I can't think of a better way,” Tracy said.

“I can't believe that not one of the staff people has recognized me,” Kim growled. “It's incredible. Hell, I'm probably the best-known cardiac surgeon in the department.”

“Isn't there something you can do?” Tracy pleaded. “Becky's miserable.”

Kim stood up. “All right,” he said. “I'll try.”

“But don't lose your temper,” Tracy admonished. “It might make everything worse.”

“How can it be worse?” Kim replied.

Kim walked out of the waiting room on his way to the nurses' desk. He'd gone only a few steps when the wailing of an ambulance siren reverberated through the main swinging doors to his left. A moment later a flashing red light was seen through the doors' glass panels. The siren died off and soon the doors burst open. Several bloodied people—apparently auto-accident victims—were rolled in and whisked into the ER proper.

Kim could not help but wonder if these new arrivals meant Becky would have to wait that much longer.

Kim approached the nurses' desk. Again he looked for Molly McFadden, but she was still out of sight. The people there were a clerk, who was on the phone transcribing laboratory values, and a solitary nurse doing paperwork while sipping coffee. Her name tag read:
MONICA HOSKINS
, ER Staff Nurse.

Forcing himself to be civil, Kim got her attention by gently tapping the countertop.

“Good evening,” he said when she looked up at him. “Perhaps you recognize me?”

Monica narrowed her eyes slightly as she gazed at Kim.

“No, I don't think I do,” she said. “Should I?”

“I'm on the surgical attending staff,” Kim said. “But right now I'm here with my daughter, and we've been waiting for over an hour and a half. Could you tell me when she'll be seen?”

“It's been a busy night, especially with auto accidents,” Monica explained. “What's the name?”

“Dr. Reggis,” Kim said. He squared his shoulders.

“No, the patient's name,” Monica said.

“Rebecca Reggis,” Kim said.

Monica picked up a stack of ER sign-in sheets. After wetting the tip of her index finger with her tongue she rapidly flipped through the papers.

“Okay,” she remarked as she withdrew one of them. “Here it is.” She read the chief complaint and then raised her face to Kim. She arched her eyebrows.

“Diarrhea, two days' duration,” she commented. “Not exactly a four-plus emergency.”

Kim lifted the stool-sample container to bring it into her line of sight. “She's been passing a little bit of blood this afternoon,” Kim said.

Monica leaned forward. “Doesn't look like blood.”

“It did earlier,” Kim said. “And it has her mother upset.”

“Well, we'll get to her as soon as we can,” Monica said noncommittedly. “That's about all I can say.” She replaced Becky's sign-in sheet to its former location in the stack.

“Listen,” Kim said in a deliberately controlled voice. “As a member of the staff, I expect some consideration, and after waiting this long already, I want her to be seen
shortly. I hope I'm making myself clear. She's in considerable discomfort.”

Monica treated Kim to a patently false smile. “As I said a moment ago, we'll get to her as soon as we can. We have limited resources. If you've been here for an hour and a half, I'm sure you've seen the auto accidents that have come in, and now the police have alerted us a shooting victim is on his way.”