Godplayer

Eleven

Cassandra woke up with a start, looking into the smiling face of a lab technician who was calling “Dr. Cassidy” for the third time.

“You do sleep soundly,” she said, seeing Cassi’s eyes finally open.

Cassi shook her head, wondering why she felt drugged. Then she remembered getting the second sleeping pill.

“I’ve got to draw some blood,” apologized the technician. “You’ve got a fasting blood sugar ordered.”

“Okay,” said Cassi equably. She let the technologist have her left arm, remembering that for the next couple of days she would not be administering her own insulin.

A few minutes later a nurse came in and deftly started an IV in Cassi’s left arm, hanging up a bottle of D5W with ten units of regular insulin. Then she gave Cassi her preop medication.

“That should hold you,” said the nurse. “Try to relax now. They should be coming for you presently.”

By the time Cassi was picked up and wheeled down to the elevator she felt a strange sense of detachment, as if the experience were happening to someone else. When she reached the OR holding area, she was only vaguely aware of the profusion of gurneys, nurses, and doctors. She didn’t even recognize Thomas until he bent over and kissed her, and then she told him that he looked silly in his operating paraphernalia. At least she thought she told him so.

“Everything is going to be fine,” said Thomas, squeezing her hand. “I’m glad you decided to go ahead with your surgery. It’s the best thing.”

Dr. Obermeyer materialized on Cassi’s left. “I want you to take good care of my wife!” she heard Thomas say. Then she must have fallen asleep. The next thing she was aware of was being pushed down the OR corridor into the operating room itself. She didn’t feel at all scared.

“I’m going to give you something to make you sleepy,” said the anesthesiologist.

“I am sleepy,” she murmured, watching the drops fall into the micropore chamber of the IV bottle hung over her head. In the next second, she was fast asleep.

The OR team moved swiftly. By 8:05 her eye muscles had been isolated and tapes had been passed around them. As soon as complete immobilization had been achieved, Dr. Obermeyer made stab wounds in the sclera and introduced his cutting and sucking instruments. Using a special microscope, he sighted through the cornea and pupil to the blood-stained vitreous. By 8:45 he began to see Cassi’s retina. By 9:15 he found the source of the recurrent bleeding. It was a single aberrant loop of new vessel coming from Cassi’s optic disc. With great care, Dr. Obermeyer coagulated and obliterated it. He felt very encouraged. Not only was the problem solved, there was no reason to expect it to recur. Cassi was a lucky woman.

• • •

Thomas had finished his only coronary bypass for the day. He’d canceled the next two. Happily the case had gone tolerably well although he again had trouble sewing the anastomoses. Unlike the previous day, though, he was able to finish, but the moment Larry Owen began to close, Thomas changed into his street clothes. Normally he waited until Larry brought the patient to the recovery room, but this morning he was too nervous to sit around with nothing to do. Instead he stopped down in the OR to see how things were going.

“Just fine,” shouted Larry over his shoulder. “We’re closing the skin now. The halothane’s been stopped.”

“Good. I’ve been called on an emergency.”

“Everything under control here.”

Thomas left the hospital, something he rarely did during a working day, and climbed into his Porsche. It thrilled him to hear the powerful engine as he turned on the ignition. After the frustration of the hospital, the car provided an enormous sense of freedom. Nothing on the road could touch him. Nothing!

Driving across Boston, Thomas left the car in a No Parking zone directly in front of a large pharmacy, confident his MD license plate would save him from a ticket. Entering the store, he went directly to the prescription counter.

The pharmacist, in his traditional high-necked tunic, emerged from behind the high counter.

“Can I help you?”

“Yes,” said Thomas. “I called earlier about some drugs.”

“Of course. I’ve got it right here,” said the pharmacist, holding up a small cardboard carton.

“Do you want me to write a script for it?” asked Thomas.

“Nah. Let me see your M.D. license. That’ll be adequate.”

Thomas flipped open his wallet and held it out for the pharmacist who just glanced at the license, then asked: “That’ll be all?”

Thomas nodded, putting his wallet away.

“We don’t have much call for that dosage,” said the pharmacist.

“I’ll bet,” said Thomas, taking the parcel.

Cassandra awoke from her anesthesia, unsure of what was dream and what was reality. She heard voices, but they seemed to be far away, and she couldn’t make out what they were saying. Finally she realized they were calling her name. She heard them tell her to wake up.

Cassi tried to open her eyes but found that she couldn’t. A sense of panic gripped her, and she attempted to sit up only to be immediately restrained.

“Easy now, everything is okay,” said a voice by her side.

But everything wasn’t okay. Cassi could not see. What had happened? Suddenly she remembered the anesthesia and the operation. “My God! I’m blind!” shouted Cassi, trying to touch her face. Someone grabbed her hands.

“Easy now. You have patches on your eyes.”

“Why patches?” Cassi yelled.

“Just to keep your eyes quiet,” said the voice calmly. “They’ll only be on for a day or so. Your operation went smoothly. Your doctor said you are a lucky woman. He coagulated a troublesome vessel, but he doesn’t want it to bleed again, so you must stay quiet.”

Cassi felt a little less anxious, but the darkness was frightening. “Let me see, just for a moment,” Cassi pleaded.

“I can’t do that. Doctor’s orders. We’re not supposed to touch your bandages. But I can shine a light directly at you. I’m sure you’ll see that. Okay?”

“Yes,” said Cassi, eager for any reassurance. Why hadn’t she been warned about this before the operation? She felt as if she had been cast adrift.

“I’m back,” said the voice. Cassi heard a click and saw the light immediately. What’s more, she perceived it equally with both eyes. “I can see it,” she said excitedly.

“Of course you can,” said the voice. “You’re doing fine. Do you have any pain?”

“No,” said Cassi. The light was switched off.

“Then just relax. We’ll be right here if you want us. Just call.”

As Cassie let herself relax, she listened to the various nurses as they moved about their patients. She realized she was in the recovery room and wondered if Thomas would come down to see her.

Thomas finished seeing his office patients early. By 2:10 he had just one appointment left at 2:30. While he waited he checked the OR to see which attending was on call that night for the thoracic service. Learning it was Dr. Burgess, Thomas gave him a call.

Thomas explained that he was planning to sleep in the hospital anyway to be near Cassi and suggested he take call as well. Dr. Burgess could pay back the favor when the Kingsleys were away.

Thomas hung up and, seeing he still had fifteen minutes to spare, decided to visit Cassi. She had just been brought up to her room, and Thomas could not tell if she was asleep or not. She was lying quietly, her face covered with bulky eye patches secured with heavy elasticized tape. An IV dripped slowly into her left arm.

Thomas went silently to the side of her bed.

“Cassi?” he whispered. “Are you awake?”

“I am,” said Cassi. “Is that you, Thomas?”

Thomas grasped Cassi’s arm. “How do you feel, honey?”

“Pretty well. Except for these patches. I wish Obermeyer had told me about them.”

“I talked with him,” said Thomas. “He called me right after the surgery. He said everything went better than he could have anticipated. Apparently only one vessel was involved. He took care of it, but it was a large one and that made him opt for the patches. He didn’t expect to use them either.”

“It doesn’t make this any easier,” said Cassi.

“I can imagine,” said Thomas sympathetically.

Thomas stayed for another ten minutes, then said he had to get back to the office. He gave her hand a squeeze and told her she should get as much sleep as possible.

To her surprise Cassi did doze and didn’t wake up until late in the afternoon.

“Cassi?” someone was saying.

Cassi jumped, startled by the unexpected voice so close to her.

“It’s me, Joan. I’m sorry if I woke you.”

“It’s all right, Joan. I just didn’t hear you come in.”

“I heard your operation went well,” said Joan, pulling up a chair.

“So I understand,” said Cassi. “And I’m going to feel a lot better when these patches come off.”

“Cassi,” said Joan. “I have some news. I’ve debated all afternoon whether I should tell you or not.”

“What is it?” asked Cassi anxiously. Her first thought was that one of her patients had killed themselves. Suicide was a constant worry on Clarkson Two.

“It’s bad news.”

“I guessed that from the tone of your voice.”

“Do you think you’re up to it? Or should I wait?”

“You have to tell me now. If you don’t I’ll just keep worrying.”

“Well, it’s about Robert Seibert.”

Joan paused. She could guess what effect the news was going to have on her friend.

“What about Robert?” demanded Cassi instantly. “Dammit, Joan, don’t keep me in suspense.” In the back of her mind she knew what Joan was going to say.

“Robert died last night,” said Joan, reaching out and grasping Cassi’s hand.

Cassi lay motionless. Minutes went by; five, ten. Joan wasn’t sure. The only sign of life from Cassi was her shallow breathing and the force with which she gripped Joan’s hand. It was as if Cassi were holding on for her own life. Joan didn’t know what to say. “Cassi, are you all right?” she finally whispered.

For Cassi the news seemed like the final blow. Sure, everyone worried when they went into the hospital, but with no more seriousness than one expected to win the lottery if he bought a ticket. There was a chance, but it was so infinitesimally small that it wasn’t worth thinking about.

“Cassi, are you all right?” Joan repeated.

Cassi sighed. “Tell me what happened.”

“They don’t know for sure,” said Joan, relieved to hear Cassi speak. “And I don’t know all the details. He apparently just died in his sleep. The nurses told me the autopsy showed that he had more severe heart disease than anyone suspected. I suppose he had a heart attack, but I don’t know for sure.”

“Oh God!” said Cassi, fighting tears.

“I’m sorry to bring you such sad news,” said Joan. “I just felt if it were the other way around I’d want to know.”

“He was such a wonderful man,” said Cassi. “And such a good friend.”

The news was so overwhelming that Cassi suddenly felt devoid of emotion.

“Can I get you anything?” asked Joan solicitously.

“No, thank you.”

There was a silence that made Joan feel acutely uncomfortable. “Are you sure you’re all right?” she asked.

“I’m fine, Joan.”

“Do you want to talk about how you feel?” asked Joan.

“Not now,” said Cassi. “I don’t feel anything right now.”

Joan could sense that Cassi had withdrawn. She questioned the advisability of having told Cassi, but what was done was done. She sat for a while holding Cassi’s hand. Then she left, turning at the door to wish her a good night.

On her way out, she stopped at the nurses’ station and spoke to the head nurse. She said she’d seen Cassi as a friend, not a consult, but she felt she should point out that Cassi was extremely depressed over the death of a friend. Maybe the nurses should keep an eye on her.

Cassi lay motionless for a long time. She’d not objected when Joan left, but now felt very much alone. Robert’s death had triggered all her old fears of abandonment. She kept remembering the nightmare she had as a child that her mother would send her back to the hospital in exchange for a healthy child.

In a panic Cassi groped for the call button. She hoped someone would come soon and help her.

“What is it, Dr. Cassidy?” asked a nurse coming into the room a few minutes later.

“I feel panicky,” said Cassi. “I can’t take the patches. I want them off.”

“As a doctor, you know we can’t do that. It’s against orders. I’ll tell you what I’ll do,” said the nurse. “I’ll go call your doctor. How does that sound?”

“I don’t care what you do,” said Cassi. “I don’t want eye patches.”

The nurse left and Cassi was again plunged into darkness. Time dragged. When she allowed herself to listen, she could hear reassuring sounds of people moving up and down the corridor.

Finally the nurse came back. “I talked with Dr. Obermeyer,” she said cheerfully. “He said to tell you he’d be stopping by shortly. He also told me that your operation went fantastically well but it is imperative that you rest. He ordered another sedative, so if you’ll just roll over, I’ll give it to you.”

“I don’t want another sedative! I want these patches off!”

“Come on now,” urged the nurse. She pulled back Cassi’s covers.

For a moment Cassi hovered between defiance and compliance. Then she reluctantly rolled over and got the shot.

“There,” said the nurse. “That should make you feel a little calmer.”

“What was it?” asked Cassi.

“That’s a question you’ll have to ask your doctor. Meanwhile, lie back and enjoy poor health. How about your television. Want it on?” Without waiting for an answer she turned on the set and went out.

Cassie found the voice of the newscaster reassuring. Soon the sedative began to have an effect and Cassi fell asleep. She woke briefly when Dr. Obermeyer stopped in to tell her in person how well her operation went. He said that he expected the vision in her left eye to be about normal when the patch came off, but that the next few days were critical and that she should try and be patient. He also told her that he’d left a standing order for sedatives and that she should ask for medication whenever she felt anxious.

Feeling better, Cassi drifted back to sleep. When she awoke some hours later, she could hear voices whispering in her room. Listening, she recognized one of them.

“Thomas?” she said.

“I’m here, dear.” He picked up her hand.

“I’m afraid,” she said, shocked to feel tears running out from under the bandages.

“Cassi, why are you crying?”

“I don’t know,” said Cassi, remembering that it was because Robert was dead. She started to tell Thomas but began to weep so hard she couldn’t talk.

“You have to get control of yourself. It’s important for your eye.”

“I feel so alone.”

“Nonsense. I’m here with you. You have a bevy of attentive nurses. You’re in the best hospital. Now just try to relax.”

“I can’t,” said Cassi.

“I think you need more sedatives,” said Thomas. Cassi could hear Thomas talk to the other person in the room.

“I don’t want another shot,” she said.

“But I’m the doctor and you’re the patient,” said Thomas.

Afterward Cassi was glad he’d insisted. She felt herself drift off into merciful sleep while Thomas was talking to her.

Thomas pressed the nurse’s call button. When the nurse arrived, he stood up from his perch on the bedside. “I want you to give her two sleeping pills this evening. She was wandering the halls last night after one dose, and we certainly don’t want her up tonight.”

The nurse left, and Thomas waited a little longer to make sure Cassi remained asleep. Within minutes her mouth fell open and she began a throaty, uncharacteristic snoring. Thomas walked to the door, hesitated, then returned to the bureau and opened the bottom drawer. As he’d expected, the SSD data had not been touched. Under the circumstances he didn’t want Cassi to be pulling it out as soon as her patches came off.

Quickly he picked up the computer printout and slipped it under his arm. With a final glance over at Cassi, Thomas left the room and walked down to the nurses’ station. He asked for the head nurse, Miss Bright.

“I’m afraid that my wife is not standing up too well to the stress,” said Thomas apologetically.

Miss Bright smiled at Dr. Kingsley. She knew him professionally very well. It was a surprise to hear him admit anyone might have a human weakness. For the first time she felt sorry for him. Obviously having his wife in the hospital was a strain on him, too.

“We’ll take good care of Cassi,” she said.

“I’m not her doctor and don’t want to interfere, but as I told the other nurse, I think for psychological reasons she should be kept under pretty heavy sedation.”

“I’ll see to it,” said Miss Bright. “And don’t you worry.”

Cassi could not remember having had dinner, although the nurse who brought in sleeping pills assured her that she had.

“I don’t remember it at all,” said Cassi.

“That’s not a very good recommendation for the hospital kitchen,” said the nurse. “Nor for me. I fed it to you.”

“What about my diabetes?” asked Cassi.

“You’ve been doing fine. We gave you a little extra insulin after your meal, but otherwise it’s all in here.” The nurse knocked the IV bottle with her knuckle so Cassi could hear. “And here’s your sleep meds.”

Cassi dutifully put out her right hand and felt two pills drop into her palm. She put them in her mouth. Then, reaching out again, she felt the glass of water.

“Do you think you need a sedative too?”

“I don’t think so,” said Cassi. “I feel like I’ve slept all day.”

“It’s good for you. Now your night table is right here.”

The nurse took the glass from Cassi, then guided her hand over the bedside rail so she could feel the water glass, pitcher, telephone, and call button.

“Is there anything else?” asked the nurse. “Do you have any pain?”

“No, thank you,” said Cassi. She was surprised she’d had so little discomfort from the operation.

“Do you want me to switch off the TV?”

“No,” said Cassi. She liked the sound.

“Okay, but here’s the switch.” The nurse guided Cassi’s hand to the button by the side of the bed. “Have a good night’s sleep, and if you want anything, give us a call.”

After the nurse left, Cassi did a little exploring of her own. Reaching out, she touched the side table. The nurse had pulled it away from the wall so it would be slightly more accessible. With some difficulty she pulled out the metal drawer and felt for her watch. Thomas had given it to her, and she wondered if she should have it put in the hospital safe. She didn’t find it immediately. Her hand touched her own vials of insulin and a handful of syringes. The watch was under the syringes. It was probably safe enough.

She pulled her hand back under the covers. As the medicine took hold she realized why people were tempted to misuse it. It made reality recede. The problems were there, but at a distance. She could think of Robert without feeling the pain of his loss. She remembered how peacefully he had been sleeping last night. She hoped his death had been as calm.

Cassi suddenly pulled herself back from the abyss of sleep. With a jolt she realized that she must have been one of the last people to see Robert alive. She wondered at what time he’d died. If only she’d been there maybe she could have done something. Thomas certainly might have saved him.

Cassi stared into the darkness of her eyelids. The memory of Thomas coming into Robert’s room replayed itself slowly in her mind. She remembered her shock at seeing him. Thomas had said that when he hadn’t found Cassi in her room, he’d assumed she was visiting Robert. That had satisfied her at the time, but now Cassi wondered why Thomas would have been visiting her in the middle of the night.

Cassi tried to imagine what the autopsy on Robert showed, wondering specifically if a definitive mechanism of death was found. She didn’t want to think about such things, but she found herself worrying if Robert had been cyanotic or if he’d convulsed at the time of his death. All at once Cassi began to fear that Robert might have been a candidate for his own study. He could have been case twenty. What if the last person to see Robert alive had been Thomas? What if Thomas had gone back to Robert’s room after he’d left her? What if Thomas’s sudden change of behavior was not as innocent as it appeared?

Cassi began to shake. She knew she was being paranoid, and knew how self-fulfilling delusions could be. She understood the stress she’d been under, and she’d had an enormous amount of drugs, including the sleep medication that she could already feel sapping her ability to think.

Yet her mind would not give up its horrifying thoughts. Involuntarily she found herself recognizing the fact that the first SSD case occurred at the same time as Thomas’s residency. Cassi wondered if any of the deaths coincided with the nights Thomas had spent in the hospital.

All at once she became aware of her utter dependency and vulnerability. She was alone in a private room with an IV running, blindfolded and sedated. There was no way for her even to know when someone came into the room. There was no way for her to defend herself.

Cassi wanted to scream for help, but she was paralyzed with fear. She drew herself up into a ball. Seconds passed, then minutes. Eventually Cassi remembered the call button. Ever so slowly she inched her hand in its direction, half expecting her fingers to encounter some unknown enemy. When she touched the plastic cylinder, she pressed the button, holding it down with her thumb.

No one came. It seemed as if she had been waiting for an eternity. She let the button out and pushed it again several more times, praying for the nurse to hurry. At any second she expected something terrible to happen. She didn’t know what, just something terrible.

“What is it?” asked the nurse curtly, pulling Cassi’s hand away from the call button. “You only have to ring once, and we’ll come as soon as we can. You have to remember there are a lot of patients on this floor and most are sicker than you are.”

“I want to change rooms,” said Cassi. “I want to go back to a semiprivate.”

“Cassi,” said the nurse with exasperation. “It’s late at night.”

“I don’t want to be alone!” shouted Cassi.

“All right, Cassi. Calm down. As soon as we finish our medication records, I’ll see what I can do.”

“I want to talk to my doctor,” said Cassi.

“Cassi, you do know what time it is, don’t you?”

“I don’t care. I want to talk with my doctor.”

“All right. I’ll put in a call if you promise to lie still.”

Cassie allowed the nurse to straighten her legs.

“There, that must feel better. Now you relax and I’ll call Dr. Obermeyer.”

By the time the nurse left, Cassi’s panic had lessened. She realized she was behaving irrationally. She was acting worse than her own patients. Thinking of Clarkson Two reminded her of Joan. She was the one person who would understand and wouldn’t be angry at being awakened. Groping with her hand, Cassi found the phone and lifted it onto her stomach. With the receiver propped up between her shoulder and the pillow, she got the hospital operator. After Cassi explained who she was, the operator put the call through to Dr. Widiker.

The phone rang for a while, and Cassi began to worry that Joan had a late date. She was about to hang up when Joan answered.

“Oh, thank God,” said Cassi. “I’m so glad you’re home.”

“Cassi, what’s the matter?”

“I’m terrified, Joan.”

“What are you terrified of?”

Cassi paused. With Joan on the line, she realized exactly how silly her fears were. Thomas was the most respected cardiac surgeon in the city.

“Has it something to do with Robert?” asked Joan.

“Partly,” Cassi admitted.

“Cassi, listen to me,” said Joan. “It’s natural you’re upset. Your best friend has just died and you’ve undergone surgery. Your eyes are bandaged. You mustn’t let your imagination run riot. Ask the nurse for a sleeping pill.”

“I’ve already had a lot of drugs,” said Cassi.

“Either you had too little or the wrong kind. Don’t try to be a hero. Do you want me to call Dr. Obermeyer?”

“No.”

“Is there anything I can do?”

“Do you know if Robert Seibert was cyanotic when he was found or if there was evidence he convulsed?”

“Cassi, I don’t know! And it’s not the sort of thing you should be torturing yourself over. He’s dead. That’s more than enough for you to deal with right now.”

“I guess you’re right,” said Cassi. “Just a minute, Joan. Someone’s here.”

“It’s Miss Randall,” said the nurse. “Dr. Obermeyer is trying to call you.”

Cassi thanked Joan and hung up. The receiver was barely back in the cradle when it rang again.

“Cassi,” said Dr. Obermeyer, “I got a call from the nursing office staff that you were upset. I don’t know how to convince you that everything is fine. Your surgery went extremely well. I’d expected to find the usual diabetic pathology but I didn’t. You should feel relieved.”

“I think it’s the patches over my eyes,” said Cassi apologetically. “I feel terrified of being alone. I’d like to be transferred into a room with another patient. Now.”

“I think that’s asking a bit much from the nursing staff, Cassi. Perhaps tomorrow we can think about transferring you. For now I’m more interested in getting you relaxed. I’ve advised the nurses to give you another sedative.”

“The nurse is here right now,” said Cassi.

“Good. Take the shot and go to sleep. I guess I should have expected this. Doctors and doctors’ wives always make the worse patients. And you, Cassi, are both!”

Cassi allowed herself to be given yet another shot. She felt Miss Randall give her a final pat on the shoulder. Cassi was alone again, but it didn’t matter. Drug-induced sleep descended like a silent avalanche.

Cassi awoke from a violent dream filled with wild noise and clashing colors. Despite the heavy sedation, a faint throbbing pain in her left eye reminded her immediately that she was in the hospital.

For a moment she lay perfectly still, her ears straining to pick up the slightest sound. Behind the bandages wild colors continued to dance before her eyes, presumably caused by the pressure of the bandages. Cassi heard nothing save for the distant, muffled sounds of the sleeping hospital. Then she thought she felt something. She waited and felt it again. It was the plastic tube of her IV line. Her pulse quickened. Was it her imagination?

“Who’s there?” called Cassi, suddenly finding the courage to speak.

There was no response.

Cassi lifted her right hand and swung it over the left side of the bed. No one was there. Reaching down, she felt the tape that secured the IV to her arm. Quickly she traced her finger up the plastic tube and pulled gently. The sensation was exactly the same twitch she’d felt. In the darkness someone had touched her IV line!

Trying to control her mounting fear, Cassi groped on the night table for the call button. It wasn’t there. She touched the pitcher, the phone, the water glass, but nothing else. She felt over a larger area, moving her hand faster, feeling her sense of isolation and vulnerability mounting. There was no call button. It was gone.

Cassandra found herself frozen by the power of her own imagination. Someone was in her room. She could sense a presence. Then she smelled something familiar. Yves St. Laurent cologne.

“Thomas?” called Cassi. Pushing herself up with her right elbow, she called again. “Thomas!”

There was no answer.

Cassi felt herself break out in a profuse sweat. In seconds her entire body was drenched. Her heart, which had already been beating quickly, began to pound. Cassi knew instantly what was happening. It had happened before, but never with such devastating swiftness. She was having an insulin reaction!

Desperately she grabbed for the patches, trying to get her fingers under the plastered-down edges of the adhesive. Her left hand, previously immobilized because of the IV, also tore at the bandages.

Cassi tried to call out, but her voice had no strength. The bed began to spin. She threw herself to the side, against the raised rail. Thrashing wildly, she again tried to find the call button. Instead she inadvertently tipped over the bedside table sending the phone, the pitcher of ice water, and the glass crashing to the floor. But Cassi didn’t hear. Her body was already locked into the grip of full-fledged grand mal seizure.

Carol Aronson, the night charge nurse on seventeen, was in the medication room drawing up an antibiotic when she heard the distant tinkle of breaking glass. She hesitated for a moment, then stuck her head into the chart area where she exchanged a questioning glance with Lenore, the LPN. Together the two women left the nurses’ station to investigate. Both had the uncomfortable feeling that someone had toppled out of bed. They’d advanced only a short way down the hall when they heard the clatter of Cassi’s side rails.

The women rushed into the room. Cassi was still convulsing wildly, her arms jammed through the rails, banging them back and forth.

Carol, who was aware Cassi was diabetic, knew immediately what was happening.

“Lenore! Call a code and bring me an ampule of fifty-percent glucose, a fifty cc syringe, and a fresh bottle of D5W.”

The LPN ran out of the room.

Meanwhile Carol managed to pull Cassi’s arms from between the rails. Next she tried to get a tongue depressor between Cassi’s clenched teeth but that was impossible. Instead she stopped the rapidly running IV, and concentrated on keeping Cassi from hitting her head against the top of the bed.

Lenore returned and Carol took the D5W and immediately changed the IV bottle. She put the old bottle aside, knowing the doctor would want to check the insulin level. Then she opened the IV all the way and transferred the fifty-percent glucose from the ampule to the large syringe. When she finished, she debated using it. Technically she was supposed to wait for a doctor to arrive, but Carol had spent enough time in crisis medicine to know that under the circumstances the glucose should be the first thing tried and that it certainly couldn’t hurt. She decided to give it. The amount of perspiration on Cassi’s body suggested a severe insulin reaction.

Carol stuck the needle into the IV and depressed the plunger. Even before she’d injected the last few cc’s, the result was dramatic. Cassi stopped convulsing and seemed to regain consciousness. Her lips opened and sounded as if she were trying to say something.

But the improvement didn’t last. Cassi sank back again into unconsciousness, and, although she did not convulse again, the isolated muscles continued to contract.

When the code team arrived, Carol reported what she had done. The senior resident examined Cassi and began issuing orders.

“I want you to draw blood for electrolytes, including calcium, arterial blood gases, and a blood sugar,” he said to the junior resident. “And I want you to run an EKG,” he said to the medical student. “And Miss Aronson, how about another ampule of fifty-percent glucose?”

While the team fell to work, Lenore picked up the bedside table, replacing the phone. With her foot she pushed the shards of glass from the broken pitcher into the corner. The drawer had come out of the table and Lenore replaced it. It was then she found several used vials of insulin. Shocked, she handed them to Carol, who in turn handed them to the resident.

“My God,” he said. “Was she supposed to give herself insulin blindfolded?”

“Of course not,” said Carol. “She had insulin in her IV and was being supplemented according to the amount of sugar in her urine.”

“So why did she give herself insulin?” asked the resident.

“I don’t know,” admitted Carol. “Maybe she was confused with all her sedatives and gave herself the medicine by rote. Hell, I don’t know.”

“Could she do that blindfolded?”

“Sure she could. Remember, she’s been injecting herself twice a day for twenty years. She couldn’t get the dose right, but she could certainly inject herself. Besides, there’s another possibility.”

“What’s that.”

“Maybe she did it on purpose. The day nurse said she was depressed, and her husband said she’d been acting strangely, I guess you know who her husband is.”

The resident nodded. He didn’t like to think of the case being a suicide gesture because he hated psych cases, especially at three o’clock in the morning.

Carol, who had been filling another syringe with glucose while talking, handed it over. The resident injected it immediately. As before, Cassi improved for a few minutes, then again lost consciousness.

“Who’s her doctor?” asked the resident, taking a third syringe of glucose from Carol.

“Dr. Obermeyer, Ophthalmology.”

“Somebody give him a call,” said the resident. “This isn’t a case for a house officer to fool around on.”

The phone rang and rang before Thomas groggily reached out and picked up the receiver. He had taken two Percodan before stretching out in his office, and he found it very hard to concentrate.

“You’re a hard one to wake up,” said the cheerful hospital operator. “You had a call from Dr. Obermeyer. He wanted to be put through immediately, but I told him you’d left specific orders. Do you want the number?”

“Yes!” said Thomas, fumbling on the desk for a pencil.

The operator gave Thomas the number. He started to dial and then stopped. Noticing the time, he was concerned. Obviously it was about Cassi. Going into the bathroom he splashed water on his face, trying to gather his wits.

He waited until some of the drug-induced fog receded before dialing.

“Thomas, we had a complication tonight,” said Dr. Obermeyer.

“A complication?” asked Thomas anxiously.

“Yes,” said Dr. Obermeyer. “Something we didn’t expect. Cassi gave herself an overdose of insulin.”

“Is she all right?” asked Thomas.

“Yes, she seems to be fine.”

Thomas was stunned.

“I know this must be a shock for you,” Dr. Obermeyer was saying, “But she is okay. Dr. McInery, her internist, is here and thanks to the quick thinking of the charge nurse, he says Cassi will be fine. We’ve moved her to the ICU for the time being just as a precaution.”

“Thank God,” said Thomas, his mind whirling. “I’ll be right over.”

As soon as he reached the hospital, Thomas rushed to Cassi’s bedside. She seemed to be resting peacefully. He noticed that the patch on her right eye was gone.

“She’s sleeping but she’s arousable,” said a voice at his side.

Thomas turned to face Dr. Obermeyer. “Do you want to talk with her?” he asked, reaching to shake Cassi’s shoulder.

Thomas caught his arm. “No thanks. Let her sleep.”

“I knew she was upset tonight,” said Dr. Obermeyer contritely. “I ordered extra sedatives. I never expected anything like this.”

“She was panicky when I saw her,” said Thomas. “A friend of hers died last night, and she’s been very upset. I hadn’t planned to tell her, but I learned one of the psych residents had the poor judgment to do so.”

“Do you think this was a suicide attempt?” asked Dr. Obermeyer.

“I don’t know,” said Thomas. “She could have just been confused. She is accustomed to giving herself insulin twice a day.”

“What do you think about a psychiatry consult?” asked Dr. Obermeyer.

“You’re the doctor. I can’t be very objective. But if I were you, I’d wait. Obviously she’s safe in here.”

“I took the patch off her right eye,” said Dr. Obermeyer. “I’m afraid the bandages may have been a large factor in her anxiety reaction. I’m happy to say her left eye is still clear. Considering the fact she just had a grand mal seizure, which is probably the severest test imaginable for my coagulation of that vessel, I don’t think we have to worry much about further bleeding.”

“What’s her blood sugar?” asked Thomas.

“Pretty normal right now, but they’re going to follow it closely. They think she gave herself a whopping dose of insulin.”

“Well, she’s been careless at times in the past,” said Thomas. “She’s always tried to minimize her illness. But this seems like more than carelessness. Still, it’s possible she just didn’t realize what she was doing.” Thomas thanked Obermeyer for his good work and walked slowly out of the ICU.

The nurses at the desk looked up as he went by. They had never seen Dr. Kingsley so depressed and anxious.