Night Shift

Chapter 9

Tuesday, December 7, 12:45 p.m.

As Jack expected, the Emergency Department waiting area was nearly full of patients. Lunchtime was a frequent time for people to decide to visit, although the vast majority hardly needed the attention of a trauma 1 facility. The problem was that they had no place else to go for basic healthcare needs and the hospital was required to see them by law. Many were there for particularly trivial reasons, like needing a prescription refilled or for a minor symptom that they had endured for days if not weeks. As a result, Jack was forced to wait in line to talk with a triage nurse. He could have forced the issue but decided against it, trying not to make waves. He’d even turned down David Andrews’s offer to intercede.

When he got to the counter, he flashed his medical examiner badge and told the nurse he was there on official business and needed to talk with the doctor in charge. The result was impressive. Within a minute or two, Jack was approached by a slight woman with steely eyes and dressed in personal protective gear over scrubs. He couldn’t see her expression because of her mask, but despite her size she exuded a competent, no-nonsense, in-charge persona.

“I’m Dr. Carol Sidoti,” she said with authority. “I’m the ED shift supervisor. What can I do for you?”

Just as he had done with the security head, Jack introduced himself and told the woman that he was doing a routine follow-up on the unfortunate death of Dr. Sue Passero that had been investigated by one of the OCME MLIs and whose death was under review. He said he’d already done the autopsy but needed to ask a few more questions by speaking with one of the members of the team who had tried to resuscitate the doctor.

“I was in charge of the resuscitation,” Carol said. “I’m happy to talk with you. Let’s go someplace a little more private. Follow me, please.”

Carol led Jack back into the depths of the ED to a square, counter-high command area surrounded by individual emergency bays, most of which were occupied by patients. Gesturing for him to enter one of the multiple entrance points of the central desk, she pushed a free chair toward him and took one herself. Within the area were more than a dozen doctors and nurses working at monitors. Others were coming and going. In the background various monitoring devices beeped constantly. It was a very busy scene.

“Sorry for the pandemonium,” Carol said.

“No problem,” Jack said, although the level of activity was distracting, especially when a monitor started sounding an alarm and no one seemed to care. He found it strange that Carol felt the location was “a little more private.” In Jack’s mind it was anything but.

“So...” Carol said. “What can I tell you?” In contrast to the security head, who had been mildly passive-aggressive initially, the ED shift supervisor presented herself as wanting to be demonstrably helpful.

“I’m interested in going over what our investigator reported to make sure we have all the details,” Jack said. “Our understanding is that the patient was initially discovered by a nursing supervisor, and he and another nurse administered CPR before getting the patient here.”

“That’s correct,” Carol said. “Our night nursing supervisor Ronald Cavanaugh was involved, which we thought was auspicious.”

“What do you mean, auspicious?”

“Ronnie is a competent nurse and conscientious nursing supervisor. To give you an idea, just about every time he’s on duty, he makes it a point to arrive at the hospital an hour or so early. One of the things he invariably does is come to the ED merely to check out what’s happening, particularly what kind of trauma cases are in process. He does it just to get a sense of what to expect during his shift. He’s that dedicated. He’s also clinically astute. As part of his responsibilities, he’s required to respond to every code in the hospital, which he does with true dedication. Consequently, he’s had a lot of experience, probably more than our cardiology residents, when you think about it. And he’s had a lot of success with resuscitations. There’s no doubt he’s saved more than his share of patients.”

“I get it,” Jack said. “What you meant by auspicious was that you thought the chances of a successful resuscitation were a bit higher since he was involved from the get-go.”

“Without a doubt,” Carol said. “Especially when he told us that his CPR efforts initially had a definite positive effect.”

“What was he referring to specifically? Or was it just an intuitive sense on his part?”

“He was being very specific. He claimed that after just a few breaths and a few minutes of chest compression the patient’s color improved dramatically.”

“I would say that was a good sign,” Jack admitted. “Tell me, did you see the patient when she first arrived here?”

“Of course. We had been alerted the code was coming in from the garage, and we were all set up and waiting in one of our trauma rooms.”

“How was the patient’s color when she arrived?”

“Not too bad, and it pinked up considerably once we got an endotracheal tube in and respired her with oxygen.”

“That makes sense. What was the presumed diagnosis at that point?”

“Heart attack for sure, especially after we got back the elevated troponin levels combined with the history of type 1 diabetes. Has it been confirmed?”

“It’s still pending,” he said. “Curiously enough, we didn’t see any evidence grossly, but histology has yet to be seen. We are also looking into a possible channelopathy.”

“Now that would be interesting,” Carol said. “That might explain why we weren’t able to get the heart to beat even with a pacemaker. It was frustrating, considering the patient was a respected hospital staff member who we all knew. I can assure you we pulled out all the stops.”

“I can imagine,” Jack said. He got to his feet. He felt a bit guilty taking the woman’s time as another monitor alarm had begun sounding. He wondered how people could work in such a pressure-filled environment day in and day out. “I want to thank you for your cooperation. It looks like you are busy, and I hate to take any more of your time.”

“We’re always busy,” Carol said. “Especially during this freaking pandemic. If you want any more details, I suggest you talk directly with Ronnie Cavanaugh. He’s a personable guy, and I’m sure he’d be happy to talk with you. He’s scheduled to be on tonight.”

“I just might do that,” Jack said. The problem was that the man worked the night shift and obviously slept during the day, meaning a face-to-face meeting would require his coming to the MMH one evening. How to arrange that without Laurie knowing he was out in the field investigating wouldn’t be easy.

“If you need anything else, you know where to find me,” Carol said. She also stood and gestured for Jack to precede her out of the desk area.