Night Shift

Chapter 34

Wednesday, December 8, 11:40 p.m.

I disagree,” Ronnie said, trying to control his impatience. He was talking with a charge nurse named Alan Spallek on a general medical floor. Alan was a heavyset man about Ronnie’s age who had also been in the navy but on a surface ship, not a submarine. As evidence of his service, he had a colorful tattoo of a mermaid on his right forearm. Thanks to his military training, he was a no-nonsense nurse who ran the floor like an overly strict chief petty officer. “This patient is not a medical examiner case, period,” Ronnie added for emphasis.

“But he fell and had a cerebral bleed,” Alan snapped. “That’s surely an ME case.”

Ronnie, who was sitting in front of one of the monitors at the central desk, pointed to the screen where he had the patient’s chart uploaded. “Alan, the man’s prothrombin time was six-point-six, which is way out of whack. The man fell because he had a bleed. That’s what makes the most sense, especially since you admitted he didn’t have a violent fall but rather merely slumped to the floor. He didn’t have the bleed because of a fall. I’m telling you, it is not a medical examiner case, period. If I called it in as such, the ME investigator would laugh at me and wouldn’t accept it. Take my word! I know what I’m talking about.”

“I don’t know how you can be so sure,” Alan growled. “But fine! It’s your call.”

“You bet it is,” Ronnie said. “Case closed.” He stood up and started off, heading for the next problem. As he walked, he took his pulse. It was almost a hundred beats a minute, reflective of the general anxiety he was experiencing, and which had slowly grown as the evening passed. He couldn’t stop worrying about Jack Stapleton suddenly waking up from his coma, realizing he was in the MMH, and starting to raise holy hell by carrying on about a serial killer. Even the term itself, serial killer, made Ronnie blister. He certainly didn’t think of himself as a killer, but rather a merciful savior. The killing was just the means to the compassionate and charitable end.

To add to Ronnie’s unease, a half an hour earlier he’d gotten a text message from the administrator on call, saying several police were on the way into the hospital to provide protection for Jack Stapleton and that Ronnie was to cooperate with them whatever their needs might be. When Ronnie asked why the man was being guarded, the administrator said he wasn’t told and didn’t ask. At first Ronnie was alarmed at the news, but his concern lasted only for a few minutes. In the past when there had been police, usually for guarding prisoners, he remembered they just parked themselves outside the individual’s location and that was it. The more Ronnie thought about the development, the more he realized the police would be no problem for what Ronnie had to do. They certainly weren’t going to keep him out of the SICU.

But everything added together made Ronnie feel he was like teetering on the edge of a precipice, mostly because for the moment his hands were tied. First, that had been because Jack was in the OR and then in the post-anesthesia unit, both of which were essentially out of bounds for Ronnie. Now, finally, Jack had been moved into the surgical intensive care unit, which was a relief because it was fully in Ronnie’s domain. To give himself a leg up, he’d used his control of intensive care bed allocations to be sure that Jack had been given one of the cubicles the farthest away from the SICU’s central desk. But still Ronnie had to bide his time, as he knew Jack would be getting a lot of one-on-one nursing attention until he was determined to be stable. At that point Ronnie was confident he would have relatively free rein to do what needed to be done.

The next problem turned out to have already solved itself by the time Ronnie arrived. He’d been called because a patient had taken a fall in one of the MRI rooms in the imaging center. But by the time Ronnie got there, a resident had shown up, examined the patient, determined he had not sustained any injury, and the patient had been taken back to his room. Ronnie made a mental note to check in on the individual when he made his general rounds after his dinner break.

With no other outstanding problems of the bewildering variety that Ronnie had to deal with hour-to-hour or even minute-to-minute, he was now free to make a preliminary check on how things were in the SICU in regard to Jack Stapleton. After a short elevator ride and then coming around a right-angle bend in the corridor, Ronnie’s anxiety ratcheted upward. His pulse, already high, inched up at the mere sight of the two uniformed policemen with all their law enforcement paraphernalia, including holstered pistols, sitting on hospital-supplied folding chairs on either side of the double swinging doors to the SICU. Despite knowing that the officers posed no threat to him, Ronnie felt a cold sweat break out on his forehead.

“Evening, Officers,” Ronnie said, being as nonchalant as he could manage as he passed.

“Evening, Doctor,” the two officers said in unison. Both were on the youthful and probably inexperienced side in Ronnie’s estimation, as evidenced by the newness of their equipment, and he sensed they were more nervous being in such an alien environment than he was at their presence.

Without hesitating or showing any identification, Ronnie pushed through the doors. He wasn’t challenged, which was a relief. “Some protection they provide,” Ronnie whispered snidely, since they didn’t even know he wasn’t a doctor.

Every night and sometimes on multiple occasions, Ronnie visited all the MMH intensive care units, as allocating intensive care beds was one of his main jobs, even though he’d complained on multiple occasions that the night bed manager should be the one doing it. The job fell to him because he was able to visit the units, whereas the bed manager wasn’t. If and when the census was high, it fell to Ronnie to decide which patients, if any, could be moved out to make room for a new, sicker patient. During the height of the pandemic the decision had often been difficult.

The SICU was comprised of sixteen cubicles, eight on each side, and currently was nearly full with only two cubicles vacant. Each patient had their own intensive care nurse, and each cubicle had its own panoply of medical technology with multiple flat-screen monitors displaying various vital signs. Clusters of intravenous bottles hung from poles, and the entire room was filled with a low-volume cacophony of various beeping with occasion brief alarms. In the middle was the central desk, serving as a kind of command post, complete with additional monitors that served as a backup for the monitors in each cubicle. At that moment a couple of staff doctors and a couple of residents were working at computer screens, oblivious to the various comings and goings of nurses obtaining supplies and medications. In command of it all, like a symphonic maestro, was a charge nurse named Patricia Hoagland, along with a clerk named Irene.

Ronnie paused just inside the swinging entrance doors and surveyed the scene. It comforted him that the atmosphere was relaxed, and despite his knowing that the situation could change in an instant, the current relative calmness helped take the edge off his high anxiety. Of the two doctors within the central desk, he was familiar with only one, Dr. Colleen Benn, who was one of the more senior intensive care doctors with whom he dealt frequently. The other woman Ronnie didn’t recognize, but it didn’t bother him in the slightest nor did the presence of the two residents.

Looking all the way down to the opposite end of the room, he could see the cubicle where he’d assigned Jack Stapleton. Every so often he could catch a glimpse of the nurse busily attending to him, meaning to Ronnie that Stapleton was still in the process of being stabilized after his arrival from the PACU. Ronnie was eager to walk down there to check out the man’s status, but he didn’t want to make it seem so obvious. Despite having already visited the unit an hour or so earlier to see which beds were available and check on the status of each patient, he made it a point to poke his head randomly into a few of the cubicles to catch the attention of the attending nurse. On each occasion, he simply asked if all was okay and either got a thumbs-up or a quick word of affirmation. He then approached the central desk and got Patricia’s attention. She was a particularly friendly, soft-voiced motherly figure, who liked everyone and whom everyone liked, yet despite this affable façade, she was highly organized and ran the unit competently. Ronnie had never had any trouble dealing with her, which he couldn’t say about some of the other intensive care unit charge nurses who took themselves way too seriously.

“How’s the shift going, Patti?” Ronnie asked, making casual conversation.

“So far, so good,” Patti said. “No complaints. Everybody stable. How about for you?”

“The usual number of nursing and nursing assistant no-shows,” Ronnie said. “But we had enough coverage in the pool. I suppose you noticed the armed police presence out in the hall.”

“I’m aware,” Patti said. “Dr. Benn told me. It will keep the riffraff out.” She laughed in her characteristic crystalline fashion.

“Talking about Dr. Benn,” Ronnie said, “who is the other doctor with her? I’ve never seen her before.”

Patti looked over at Laurie and Colleen. “She’s a medical examiner, or so I have been told.”

“Really?” Ronnie questioned. Now he was truly interested. “Why is a medical examiner here?”

“She’s a friend of Dr. Benn’s. She’s also the wife of the patient in cubicle eight.”

Ronnie’s anxiety ticked up a degree. This was something out of the ordinary, and under the circumstances he was not happy about it, considering what he had to do. “Hmmm,” Ronnie voiced, pretending to take the news in stride. “Interesting, but it seems highly irregular. Are you okay with it?”

“Oh, yeah,” Patti said. “Dr. Benn asked me, and since the woman is a doctor and dressed appropriately, I couldn’t see anything wrong with it, especially with Dr. Benn coming in and out. She said she was content to sit here within the central desk and wouldn’t interfere in any way. Are you okay with it?”

“I suppose so,” Ronnie said with a shrug after giving the situation a bit more thought. If the woman agreed to stay within the central desk area, it didn’t seem to him that it would make any difference. “It’s all right. I just would have preferred to have been given a heads-up. I am supposed to be in charge of this institution during my shift and to do that I need to know what’s going on.”

“Would you like to talk with Dr. Benn? I can ask her to come over. Or would you like to meet the woman?”

“No, no! It’s not necessary if you are okay with it,” Ronnie said. “This is your domain.”

“Fair enough,” Patti said. She then turned back to respond to the clerk who had shouted a question to her about a stat lab result.

After the short conversation with Patti, Ronnie did what he’d come to do, namely head down to cubicle eight to check out the newest arrival. Walking in, he looked up at the monitors. Blood pressure and pulse and oxygenation were all entirely normal. The nurse was Aliyah Jacobs, a woman whom Ronnie knew rather well as a particularly competent intensive care nurse and who never minded being moved around from unit to unit depending on need, which Ronnie appreciated and took advantage of frequently. One of the major aspects of his job was to make sure staffing was adequate for the night shift, which could be a challenge with people calling in sick, particularly in the ICUs.

“How’s your patient?” Ronnie asked. He noticed with satisfaction that both IVs were still running, particularly the large-bore catheter he’d put in down in the ED. He intended to use that IV line later.

“He’s rock-solid stable,” Aliyah said. “The hip incision site looks fine with minimal discharge, and the circulation of his foot is fine with the temporary plaster cast on his lower leg. More important, he’s also moving more, suggesting he’s going to come back and join us in the not-too-distant future.”

“Excellent,” Ronnie said, giving Aliyah a thumbs-up although he was not happy about the idea of Jack emerging from his coma. That threat alone argued for his acting sooner rather than later. Skirting the right side of the bed, Ronnie walked up to its head and looked down at Jack Stapleton. His cheek abrasion had been cleaned up, and he looked hardly worse for wear despite the violence of having been propelled airborne by a collision with the Cherokee at twentysomething miles per hour and slamming into the windshield before tumbling off and falling into the street. Ronnie couldn’t help but be impressed despite feeling irritated the man seemed to have nine lives. At the same time, nine lives or not, Ronnie was confident the potassium chloride was going to solve the problem in spades.

“We’re low on ortho beds,” Ronnie said. “So he’ll probably have to stay here even if he wakes up.”

“That’s fine,” Aliyah said. “Once it’s apparent he’s stable, I can help on a couple of the other patients who are more demanding. There’s a couple of sickies in here.”

Ronnie flashed Aliyah another thumbs-up, feeling even more appreciative of her work ethic, and then walked out of the cubicle. As he passed the central desk, he briefly locked eyes with the visitor. He nodded in acknowledgment, but Dr. Stapleton’s wife did not respond. He shrugged. He didn’t care one way or the other.

Leaving the SICU, he also nodded to the two police officers, both of whom nodded back. So much for their contribution, Ronnie thought with derision. Yet their presence did unnerve and bother him to a point, particularly since they were armed, in contrast to himself. Making a snap decision to bolster his nerves, he decided he could use the sense of security and the calmness his SIG Sauer P365 pistol could engender.

Since the hospital was currently problem free and because the pedestrian bridge over to the high-rise garage was only one floor down, he ducked into the stairwell and headed down. A few minutes later, when he arrived at the Cherokee, he slipped into the passenger seat. After giving the Cherokee’s dash a loving pat, he opened the glove compartment and pulled out his prized pistol. Although he knew it wasn’t necessary, he checked the magazine to make sure was full. It was. He then slipped the gun into the right deep pocket of his doctor’s coat before stepping back out of the SUV and locking it up.

As he recrossed the pedestrian bridge, he could feel the pistol gently thumping against his thigh. The weight of it calmed him dramatically by reminding him it was there, just as it had the night before on his visit to Cherine’s apartment. It didn’t matter that the chances of needing it were minuscule in either situation.

Once back in the hospital proper, he reflexively checked his phone to make sure he’d not gotten any calls or texts about hospital problems that required his immediate attention. Since he was still in the clear, he wanted to take advantage of the time to do what was certain to be one of the most important jobs of the evening, namely preparing the potassium chloride for the coup de grâce.

Using the elevator to get up to the sixth floor, he entered the nursing supervisor’s tiny office adjacent to the general medical unit. Locking the door to avoid any possibility of being interrupted, he used a key to open his private drawer in an old-fashioned, upright metal file cabinet. Inside was the entire pharmacopeia of medications that he had amassed over four years for the express purpose of supporting his crusade. The potassium chloride, or KCl, had come from the ED, as had the collection of syringes, although the syringes he could have gotten anywhere.

With appropriate aseptic care, even though he knew it really didn’t matter, Ronnie used multiple vials of concentrated, sterile KCl to nearly fill a 50ml syringe. As he held up the syringe and tapped the side to eliminate any air bubbles, he smiled, knowing he had probably enough concentrated potassium chloride to do in an elephant, much less a human.

Once Ronnie was finished, he replaced the plastic cap on the needle and then deposited the syringe in the depths of his left pocket. After relocking the file cabinet drawer, he left the office. As he walked, he could feel the pistol on the right side and the syringe on the left, and the sensations made him feel wonderfully calm and more in control than he’d felt all evening.