Deadly Diversion: A Medical Thriller (20 page)

“I didn’t know.”

“In another e-mail this week—you really should check your messages, Monika—they said that from now on, personal e-mails are not allowed. Sort of the barn door thing, I think.” Peggy finished her pineapple, cottage cheese and lettuce salad and took a sip of water. “Tell me what happened to Laura. I’ve been worried sick about her ever since I heard she’d been arrested. They can’t possibly think that Laura killed someone.”

“Well, you’re the second person in half an hour who’s heard that rumor. I guess it’s all over the hospital. The truth is that the guy who arrested her is a new detective who wants to make a name, my friend who’s a cop says. And they released her this morning.”

“In the meantime, she’s still under suspicion, isn’t she?”

“As far as I know.”

“This is terrible, Monika. You don’t need this to worry about on top of everything else.”

“I know, Peggy, that’s why I’m trying to find out how the patient died. We’re all suspect until we know exactly what caused Huey’s death. I’m waiting to hear from Max if he received too much morphine. That’s the only thing I can think of that might possibly implicate Laura. Or any of us, for that matter.”

“It’s really unfair that that episode with the woman who bled to death is coming back to haunt her. She didn’t do anything wrong then, and you’ve told me many times since then that Laura is doing a good job. She wouldn’t have given a patient extra morphine. No nurse would. And since she’s still on probation you know she’d be extra careful.”

“Unless he’d already had a shot of morphine.”

She set her glass down with a bang. A little water sloshed out onto the table. “You know who they suspect took the missing drugs, don’t you?” She leaned back, her eyes squinted. “Moi,” she said, jabbing her chest with her thumb.

“But you’ve been.. .uh, recovered for a long time.”

“Recovering, Monika, never recovered. And, yes, it’s been four years, but they...” she nodded toward the administrative wing opposite the cafeteria “.. .never forget. It’s on my record permanently.”

“But your test was okay, wasn’t it?”

“Yes, of course.” She noticed the spilled water and began to mop it up with a paper napkin. “But that didn’t stop them. I had to give two more specimens, the last time they put blue dye in the toilet water so I couldn’t dilute the sample, I guess, and Judyth herself watched me.” She shuddered. “It’s so humiliating, Monika. Will it ever end? Will they ever stop seeing me as an addict?” she asked as if to herself. She turned back to me. “I heard about Lisa. Didn’t I tell you? You get a sixth sense about that when you’ve been through it.”

“You hear about any others?” I asked, wondering if word had leaked out about my test.

“Nope. They’re...” another nod toward administration “.. .being pretty close-mouthed about it. I only heard that Lisa was fired. I assumed they found opiates in her urine.”

“That would make her an addict, I guess.”

“No, it wouldn’t, Monika. It would mean that she had ingested the substance they’re testing for. The test simply indicates the presence of a drug. It says nothing about abuse or dependency. For all we would know, she could have used it one time.” She thought a moment. “Of course, in her case she exhibited addictive behaviors, too. That’s when addiction can be diagnosed.”

“Maybe she’ll stop now. Since she lost her job.”

Peggy shook her head. “That’s not how it works. Her main concern is finding more drugs. Addicts always find a way to get something. They might substitute and feed their addiction with whatever they can get their hands on, but if she doesn’t have something, she’ll go into withdrawal.” She swallowed hard. “And that’s not something I’d let my worst enemy go through.” She rolled the bottom of her glass around on the tray and watched the water as it swirled close to the edge and threatened to spill out again.

“She called me,” I said. “She wanted me to help her get her job back. That’s what Wanda and I were talking about.”

“What’d Wanda say?”

“That she couldn’t help. She said she’d be liable if anything happened, and Judyth wouldn’t let her anyway, I’m sure.”

“Maybe Lisa’s ready for the diversion program.”

“What’s that?

“It’s a program the state board and the nursing association put together. If a nurse enters the program and follows their recommendations and stays clean and sober for two years, she isn’t subject to disciplinary action against her license.”

“It worked for you.”

“No, they didn’t have the program then, although I could have used it. I was on probation for two years. I’m off it now, but that record will always be there. Always. If a nurse completes the diversion program, the record is wiped clean. That way the nurse is treated and the public is protected, too.”

“Is that safe? Couldn’t the nurse be using again?”

“Sure, but so could you.”

I started. It was the poppy seeds that had caused the elevated opiate levels in my urine, but I was being treated by those who were privy to the results as if I were guilty. Was this how Peggy felt on a daily basis?

“The difference is,” Peggy went on, “that the nurse in the program is being monitored, just like I was. There are unannounced urine analyses. There are regular reports from your supervisor. But if they do okay, there’s nothing on their record.”

I wanted to change the subject. I had heard more than I wanted to about drugs. Especially with the bag of dope in my pocket.

“You could talk to her,” Peggy said.

“Huh? Who?”

“Lisa. Tell her about the program. She called you and asked for help. You could suggest she call about it. Or you could call them and find out the best way to handle her.”

I put my hands up. “I don’t want to handle her in any way. It’s not my business and, I’m sorry, Peggy, I just can’t stir up any sympathy for her. She seems so...so manipulative.”

Peggy laughed. “Of course she is.”

“Well, why don’t you talk to her if you’re so hot to help her?” I said.

Loud laughter came from a corner of the cafeteria.

“What’s with him?” Peggy asked, nodding toward Bart who was entertaining a table of student nurses.

“He’s here doing clinicals for grad school,” I told her.

“The other night at the bar he looked depressed, now he’s bopping around like he’s juiced.”

“Too much coffee. From the espresso stand,” I added, referring to another of Judyth’s money-making ventures.

She squinted at him as if she were studying a rare specimen. “He looks bipolar to me.”

“Bipolar. Isn’t that what we used to call manic depression?” She nodded.

“I remember a patient I had in school. She was way over the top, not like Bart there.”

“There are degrees. Cyclothmic, it’s called. Shorter ups and downs, not as severe.”

“That sounds like most of us. And not too serious.”

“For these folks, it’s more than that. And worse could happen. Paranoia, delusion, suicide even.”

We watched Bart going from table to table, greeting people and smiling as if he were a politician campaigning for votes.

“Or maybe borderline personality disorder,” she mused, tapping her book with an index finger.

“What’s that?”

“Explosive, driven, impulsive.”

“He’s pretty intense, I’ll give you that. But a lot of students are. Working and going to school, both full-time. That would tax anyone’s mental health. I think you’re just seeing a psych diagnosis in everyone. You’ve been reading too much of that book,” I said, pointing to the textbook next to her plate.

Peggy flicked her hair behind her ear with a finger. “Those are bonafide diagnoses. In DSMIV.” The manual of psychiatric disorders.

“Yeah, a bunch of psychiatrists sit around thinking up an official diagnosis for every possible behavior so the insurance companies will pay. I heard a new one the other day—relational disorders. People who can’t get along with each other.” I wadded my napkin and stuck it under my plate. “I call that family.”

Peggy laughed.

Someone bumped me hard on the back and I jumped up as an elderly woman slipped behind me. Her gnarled hands clutched the air as she fell onto the floor, spreading bits of lettuce and watery tomatoes everywhere. Her tray had flipped upside down and was now mashed into a glob of spaghetti. A broken glass lay beyond it. I shoved my chair out of the way and knelt to see how she was. She didn’t move for a moment, her face frozen into a startled expression, then she started to whimper. Her companion, an elderly man held up by a walker, looked around as if he didn’t know where he was as a woman about my age bustled up and helped him to a chair.

I helped the woman on the floor up into a sitting position and checked her for any obvious signs of injury. When she said she was ready, I helped her stand. Splatters of spaghetti sauce and salad dressing dripped off her green polyester pants. Peggy brought me a stack of napkins and a cafeteria worker used a damp towel to help wipe the worst of the mess off the woman. I slid a chair under her and asked her how she felt.

“Shaky, but I think I’m okay.” She smiled tentatively.

“We need to get you to the emergency room and have you checked.”

“I don’t want to cause any trouble.”

“It’s no trouble. It’s what we do,” I said, watching Peggy negotiate a wheelchair through the crowded lunchroom. The cafeteria worker picked up pieces of broken glass as a man from housekeeping arrived with a mop and bucket. I left to deliver the woman to the emergency room.

RETURNING TO THE UNIT, I found Ruby and two staff huddled in a whispered conversation. “What are you telling them now?” I asked Ruby. “Don’t have enough work, any of you?” I said. The nurses scurried away, but Ruby held her ground. She jerked her head toward the conference room. “Just see for yourself,” she said, turning back to the desk.

I opened the door to the conference room to find Judyth and one of our young security guards rummaging through my locker.

“What do you think you’re doing?” I said. I realized I’d really raised my voice when I saw the guard’s startled face. “That’s my locker,” I stuttered.

Judyth had her hand inside my gym bag, which she had placed on top of the conference table along with an old spiral notebook I’d used for notes at a long-ago continuing ed program, a navy hooded sweatshirt and a half-empty water bottle.

I’d almost forgotten about my locker since I seldom used it anymore. I kept my purse locked up in my office.

“Hospital property,” she said.

“No, it’s not.” I reached for my bag, but Judyth moved it so that I couldn’t touch it. “It’s mine.”

Judyth nodded toward the guard. “Tell her.”

“No employee can assume an expectation of privacy in a place of business,” he intoned, pulling out a smashed donut from I don’t know how long ago. “If it’s on our property, we have a right to know what it is.” The guard dropped the donut in the trash can and dusted off his hands. “Everything here can be searched, and evidence can be confiscated.”

I fingered the package lodged in my lab coat pocket and felt sweat break out on my face. “So what are you?” I asked. “The police?” I asked, my voice came out in a croak.

“Security personnel are empowered by the city,” Judyth answered. “They’re the law in here.”

“What are you looking for?” I asked, trying to keep my voice steady.

“Evidence of criminal activity,” Judyth said, flipping through the pages of my notebook.

“In there?” I pointed to the notebook.

She tossed it on the table. “Drugs, Monika. Someone’s stealing drugs.” She checked her watch. “We’d better go, three more floors to do.” They left me there, my jaws clenched in anger.

With one swipe of my arm, I shoved notebook, gym bag and sweatshirt into the trash, trying to hold back tears of frustration before I had to face the distraught family waiting for me in their mother’s room.

“YOU WANTED TO KNOW about the tox screen on Castle,” Max said. “I heard from the medical examiner.”

“Please tell me he didn’t get too much morphine.”

“He had more than I’d expect,” he said and stared at me through thick lenses. “It was at the upper limits of the usual therapeutic levels.” He held up his hand as I started to interrupt. “But there’s an explanation. Remember I told you he had a fatty liver? An impaired liver isn’t able to process the morphine very well, so there’d be a buildup in his blood.”

“That doesn’t make sense. He kept asking us for more. No matter how much we gave him, he said he was in pain.”

“I suspect he was right.” He steepled his fingers under his chin. “The liver processes opiates, just like it does with anything toxic.”

“I know all that,” I insisted.

“Okay, so when the liver doesn’t work so well—such as in his case—drugs accumulate there but they’re not circulating enough to help his pain. Eventually, of course, it’d sedate him. If there were enough buildup, it’d depress his respirations, just like any other patient.”

I shook my head. “That’s not it. We tried Narcan during the code and it didn’t do anything. If he’d overdosed on a narcotic, the Narcan would have reversed the effects and we could have started him breathing again.” I slumped back in my seat. “So what happens now?”

“Normally, the ME would run more tests.”

“Normally?”

“But he says he can’t. The city’s budget is in crisis, tax revenues are way down, they’re overspent on the year already and it’s only August.”

“Where does that leave us? And Laura?”

“I really don’t know, Monika.”

“How about another drug? With his liver, couldn’t something else build up in his blood and cause a respiratory arrest?”

“I suppose.”

“Max, work with me here. I’m trying to come up with some theories about how he died.”

“I ran some routine tests. His potassium was elevated somewhat.”

“That would stop his heart, wouldn’t it?”

“He would have been in asystole if he’d had too much potassium. Do you remember what the monitor showed?”

“Not until the very end. V-tach, then he went into ventricular fibrillation.”

“It would have stopped his heart right away. It wasn’t enough to kill him, anyway.”

“So what else?”