Disaster Status (2 page)

“But that’s unbelievable. That’s—”

“Exactly why I’m standing here,” the captain interrupted. “So without hospital ID or someone to corroborate, I can’t let you in.”

Her jaw tightened, and she glanced toward the ER doors. “One of your paramedics is back there somewhere; Chuck knows me. He’s married to my triage nurse. Find him and ask him.”

McKenna shook his head. “Can’t leave this spot.”

“Then call.” Erin pointed to the cell phone on his belt. “Better yet, ask for Dr. Leigh Stathos. Tell her I’m here. She’ll verify my identity. The number is—”

“I’ve got it,” he said, lifting his phone and watching her intently as he made an inquiry. He gave a short laugh. “Yes. A redhead in what looks like Army fatigues . . . Ah, let’s see . . . green eyes. And about—” his gaze moved discreetly over her—“maybe five foot nine?”

Erin narrowed her eyes. What was this, a lineup?

The captain lowered the phone. “Your name?”

“Erin Quinn,” she said, feeling like she should extend her hand or something. She resisted the impulse.

“Hmm. Yes,” he said into the phone. “I see. Okay, then.” He cleared his throat and disconnected the call.

She looked at him. “Did you get what you needed?”

“Well,” he said, reaching down to detach the rope from a sawhorse, “it seems you’re who you say you are. And that I shouldn’t expect a commendation for detaining you. Apparently it’s because of your request that I’m here. Not that I wanted to be. I still have men out on the plane crash, but . . .” He hesitated and then flashed the barest of smiles. Though fleeting, it transformed his face from Rushmore cold to almost human. “Go on inside, Erin Quinn. You’re late.” His expression returned to chiseled stone. “And for what it’s worth, I’m sorry. But that’s the way this has to work.”

“No problemo.” Erin hitched her tote bag over her shoulder and stepped through the barricade. Then she turned back. “What’s your first name, McKenna?”

“Scott.”

She extended her hand and was surprised by the warmth of his. “Well, then. Good job, Scott. But going by the book isn’t always the bottom line. Try to develop a little trust, will you? We’re all on the same team.”

Twenty minutes later, Erin finished checking on her staff and rejoined Leigh Stathos in the code room. They both looked up as the housekeeping tech arrived at the doorway.

“You wanted these?” Sarge asked.

“Yes. Great. Thank you.” Erin nodded at the tall, fortysomething man wearing tan scrubs, his brown hair pulled back into a short ponytail and arms full of plastic emesis basins. “Put those in the utility room, would you? And I think we could use some extra sheets and gowns too. If you don’t mind.”

His intense eyes met hers for an instant before glancing down. “Yes, ma’am, double time.”

Erin smiled at Sarge’s familiar and somber half salute, then watched him march away, his powerful frame moving in an awkward hitch to accommodate his artificial leg. She returned her attention to Leigh and the dark-eyed child on the gurney beside them. The ventilator, overriding her natural breathing, whooshed at regular intervals, filling the girl’s lungs. “She had two seizures but none before today?”

“Looks that way.” The ER physician, her long mahogany hair swept back loosely into a clip, reached down and lifted the sheet covering the child. “But see how her muscles are still twitchy? And her pupils are constricted. I’ll be honest: I don’t like this. The only thing I know for sure is that the X-ray shows an aspiration pneumonia. Probably choked while vomiting on the truck ride in. I’ve started antibiotics. Art’s coming in,” she added, referring to the on-call pediatrician. “And I paged the public health officer.”

“Good.” Erin’s brows scrunched. It was puzzling; an hour after arrival, Ana Galvez remained unresponsive, her skin glistening with perspiration. Though Leigh had inserted an endotracheal tube and the child was suctioned frequently, she was still producing large amounts of saliva. Her heart rate, barely 70, was surprisingly slow for her age. She’d had several episodes of diarrhea.
Poor kid. What happened to you?

Erin glanced toward the main room of the ER, grateful things appeared to be settling down out there. “I still don’t get this, though. Ana came from home? Not the ranch where everybody got sick?”

“Yes, but—” Leigh fiddled with the stethoscope draped across the shoulders of her steel gray scrub top—“she’d been there earlier. Felt sick after lunch and her father took her home.”

“So that goes right back to the food. But salmonella takes time. Still, the symptoms fit. Triage says most of the patients are complaining of headache, nausea, cramps, and diarrhea.” Erin checked the monitor: heart rate 58.
Why so slow?
“What did they eat?”

Leigh sighed. “Sack lunches. Every one different. That doesn’t fit at all. I wanted it to be huge tubs of chicken stew that everyone shared. That would make sense. But Sandy’s seen twenty-six patients in triage now, and the story from everybody sounds the same: picking strawberries since 6 a.m., lunch together around eleven, and—”

“I’m sorry to interrupt, but something’s . . . wrong.” Erin and Leigh turned at the sound of the triage nurse’s voice at the doorway.

Erin’s eyes widened. The triage nurse looked awful—pale, sweaty, teary-eyed. Sandy was holding her hand to her head, trembling.
What happened?

Before she could ask, Sandy’s eyelids fluttered and her knees gave way.

Chapter Two

Erin and Leigh each slid an arm around Sandy and eased her down into a chair.

“What’s wrong? Did something happen out—?” Erin lunged for an emesis basin as Sandy began to gag. Then noticed, with rising anxiety, the young woman’s constricted pupils. She slumped lower in the chair. Erin supported her weight, relieved to see that her breathing remained steady. “Hang in there; we’re going to get you lying down. Don’t worry.” She stared at Leigh, her mind whirling. Sandy and her husband had been trying to start a family, but this seemed far worse than early pregnancy symptoms.

“Let’s get some help.” Leigh turned and shouted through the doorway. She caught Sarge’s attention and waved. “Tell the staff we’ve got an employee down in here. Have someone bring a gurney!” She knelt beside Sandy’s chair, grasping her wrist. “Strong pulse but slow.”

In an instant, the doorway was filled with staff, one of the nurses taking over the care of the sick child, while Sarge and the relief charge nurse lifted Sandy onto a gurney and wheeled her away. Sandy’s paramedic husband, Chuck, dashed to her side and grabbed her hand.

Erin and Leigh followed—the doctor shouting orders for an IV and oxygen—but they were cut short by the arrival of two police officers. And Scott McKenna, holding a squawking emergency radio to his ear.

“What’s going on?” Erin asked, noting that the captain and police officers were now wearing protective gloves. And that there were more uniformed firefighters standing near the doors to the ambulance bay. A lot more. Sirens began wailing in the distance. Her heart quickened.

“Pesticides, they think.” Scott lowered his radio. “We just got the word a few minutes ago from the incident commander on scene. There’s a lot of confusion, but witnesses saw an ag plane spraying artichokes on the adjacent property earlier this morning. Some of the workers on-site remember a ‘fog’ that made their eyes burn. There’s enough wind to account for significant drift. The plane that crashed a few miles away was set up for aerial spraying—most likely this is all related. We’re trying to get hold of the artichoke rancher to confirm. We’ll know soon. ”

Erin’s stomach lurched. They were dealing with a toxic exposure? She ticked off the symptom acronym for pesticide poisoning, SLUD: Salivation, Lacrimation—excessive tears—Urination, Defecation. All bodily excretions increased in response to nervous system excitement from pesticides exposure via breathing, ingestion.
Or even through the skin.
Like Sandy, handling multiple patients’ saturated clothing. It fit
.

Erin’s gaze darted toward where Sandy was receiving an IV. Her husband, obviously worried, stroked her hair. Erin saw, too, that the ward clerk and a few of the registration staff had gathered near the nurses’ desk, their expressions anxious. In the distance Sarge emptied trash bins. Trash, patient clothing—all toxic sources now.
Everyone’s at risk.
“What poison?”

“Organophosphates.” Scott nodded. “At least that’s what the rancher at the crash site contracted for. There was a related structure fire, so they’re still sorting things out. And now with what’s going on here . . . Trust me, there’s going to be plenty of agencies investigating this incident.”

Leigh lifted her stethoscope from her neck, frowning. “I’m sure. But my biggest concern is getting these patients turned around as fast as I can. At least I have something to work with now.” She turned to Erin. “Have the ward clerk get poison control involved. Tell the pharmacy we’re going to need all of the atropine they have. And make sure we’ve got pralidoxime—2-PAM—in case we need it. And do whatever you need to do to get all those patients undressed and decontaminated.”

Within seconds, Erin alerted the operator and an overhead page blared throughout the hospital, announcing a hazardous material incident: “Code Orange ER. All departments be advised: we are now instituting Code Orange.”

Her mind raced to formulate a plan. She’d ask the relief charge nurse to cover triage; per policy, the supervisor would already be designating house staff to assist in the ER, and the hospital chief of staff would need to be apprised of the situation. She strode back to where Scott stood. “Is there an estimate on how many more victims there are?”

“Maybe ten so far. The strawberry rancher employs casual workers, mostly migrant, so there aren’t addresses. But the deputies are going house to house.” He lifted his radio. “County dispatch is handling things now, and any new victims should be transported to Monterey hospitals. They’ve been told to give you a break.”

“Good.” Erin thought aloud. “I’ll have engineering set up a temporary shower to get people washed down, and Sarge can put biohazard bins outside for clothing and waste, and—”

“Taken care of. All of it.” Scott interjected. “My hazmat team is two minutes out, and they’ll be setting up the county’s decontamination tent. I have six EMTs already outside, and city PD will stand by in case there’s any security breach. One of my volunteers is hosing the pavement right now.” He seemed to take in the confusion on Erin’s face. “Oh, maybe I should have explained. The chief has appointed me the incident commander on-site.”

“Which means?”

“You’re handling it in here; I’ve got it covered out there.” The smallest suggestion of a smile teased his lips. “Just like you reminded me, we’re on the same team.”

It was four hours before Erin came up for breath, and by then all of the ER staff wore scrubs borrowed from the OR, and most had snagged at least one bagel donated by the manager of Surf & Snack across the street. The connection between the downed plane and the accidental spraying of the strawberry ranch workers had been confirmed. Same plane, same pesticide.

They’d dealt with hordes of reporters and representatives of every conceivable agency—local, state, and even the federal government. Police, sheriff, fire department, the district attorney’s office, EPA, public health, FAA—an activist group expressing concern over the filming of possibly undocumented workers—and at least a dozen members of the Safe Sky Environmental Protection Group. At one point, the various agency representatives by far outnumbered the patients being treated.

But despite the red tape, every farm worker and family member—plus a few flustered interpreters and even the hospital chaplain—had filed behind privacy screens set up outside in the ambulance bay, shed their clothes, and showered in the county’s huge plastic decontamination tent. A contraption that looked strangely like one of those kids’ party bounce houses, but no one was having fun. And everyone seemed to be confused. Except for Captain Scott McKenna, who had calmly—stubbornly, if you asked Erin—taken charge of her ER by his book of rules. Which set her teeth on edge.

Though the department was still staffed to disaster response level, things were considerably calmer. Two additional farm workers, suffering intractable vomiting, awaited admission, but they were improving after IV fluids. Sandy stabilized after reversal of her symptoms with atropine sulfate. Both she and the still-unconscious Ana Galvez were being monitored in the intensive care unit.

The news reporters were dividing themselves among the disaster sites, but in Erin’s opinion, there were still far too many camped outside. She was holding on to a sliver of hope that things would wind down, and she’d be able to claim at least a few hours of her day off. Leigh had retreated to her office twenty minutes ago to work on medical records, and at present Erin had no patient responsibilities. She walked to the automatic doors of the ambulance bay, peered into the distance, and spotted the fire captain. He would likely know when the disaster response would officially end.

She’d gotten as far as the orange plastic cones and began to stoop under one of the yellow plastic Do Not Cross tapes when a familiar throaty voice called her name. She turned. “Nana?”

Her grandmother, tall and willowy and dressed in classic gabardine slacks and a shirt the same shade of blue as her eyes, smiled warmly from behind a sawhorse barricade. She brushed a wavy tendril of rust-colored hair back into her tidy upsweep, before waving heartily. “Apparently I’m not to be allowed in.” She raised her fist. “And I’m thinking of marching in protest!”

Seventy-seven-year-old Iris Mallory Quinn had done that more than once in her youth. And had a scrapbook of clippings to prove it. Erin walked over to her grandmother and hugged her over an awkward expanse of sawhorses. “No more agitators, please,” she teased, nodding toward the remaining pair of environmental protestors hoisting blue umbrellas and No Poison Rain signs. “We’ve had enough to deal with. Seriously, why are you here? You found my note?”

“Note? No, I haven’t been home yet. Actually, I saw you on TV,” Nana explained. She smiled at the confusion on Erin’s face. “The chamber of commerce said the community’s biggest need for volunteers is right here at the hospital. So I came to apply. Can you imagine, volunteering at the same hospital I worked for way back when?”

Volunteer . . . here?

Her grandmother continued. “When I saw the newscast, I hurried down to be sure you were okay.”

Erin saw the concern in her eyes, the same shadow of anxiety she’d bravely tried to hide all the long months her husband was dying. Erin made a mental note to do whatever she could to discourage her grandmother from accepting a volunteer position. She didn’t need to be around any more sickness and tragedy.

Nana sighed. “Anyway, I just wanted to say hello and give you a kiss, darling.” She looked past the barricades to where Scott McKenna stood guard. “Except I’m not allowed in. That man does everything by the book, believe me.”

“Hmm,” Erin said, hoping the terse firefighter had at least been polite with her grandmother. If he hadn’t, well . . . Erin patted her grandmother’s hand and nodded. “I’ll call you before I leave for home. It shouldn’t be long. But right now I need to talk with Captain McKenna.”

She watched until her grandmother made it safely back to her car, then walked toward Scott.

But before she could get to him, a reporter shoved a microphone in her face. “Amy Carson, Action News, here with . . .” The heavily made-up and rail-thin blonde squinted to read Erin’s makeshift name badge, a strip of adhesive tape scrawled with a magic marker. “Yes, we’re talking with Pacific Mercy Hospital employee Eric Quinn, RN. Will you answer a question for us, Eric?”

Eric?
Erin frowned, hoping it was her hasty penmanship and the shapeless OR scrubs that accounted for the gender mistake. “It’s Erin. And I don’t have anything to say.”

“Can you at least confirm that one of your staff, the wife of a local paramedic, was successfully treated for symptoms of this very toxic exposure?”

“No.” Erin took a step back from what appeared to be a camera lens the size of her head. Where on earth was the hospital’s public information officer?

“No? You’re saying the treatment wasn’t successful?” Amy Carson raised a well-sculpted brow and pressed eagerly forward. “There’s been a fatality?”

“Fatality . . . fatality?” A hungry roar erupted from the gathered news crew, and several reporters surged forward as if someone had thrown raw meat. A second and then third microphone were thrust at Erin’s face.

“Channel 7 news, Eric. What exactly is the hospital doing to ease panic among the patients? Is it true an OB patient called an ambulance to transport her newborn out of harm’s way?”

What?
“Please, I can’t comment.” Erin stepped backward again, stumbled over a traffic cone, and struggled to regain her balance. She caught a familiar scent of citrus mixed with smoke, seconds before a strong hand gripped her arm from behind.

+++

After Scott steadied the teetering charge nurse, he addressed the crowd, making certain his tone left no room for argument. “Everyone needs to get behind this barricade. Right. Now. Or be prepared to strip down and shower in that tent.”

“Shower?” The blonde reporter hugged her pink linen jacket protectively around herself and retreated behind the barricade. The others followed.

Good. He was tired, and his already-thin tolerance for the media was shot.

“That’s better,” he told them, nodding. “These rules are made for safety. And now, if you’ll be patient, I’m sure the hospital spokesperson will provide an update very soon.” He waited as they walked to the vans before glancing at Erin, more aware than he wanted to be of the warmth of her arm under his fingers. He let go. “You’re okay?”

“Yes, of course,” she answered. “Nice tactic, by the way, teasing them about having to shower in the decon tent.”

“Not teasing. True. They could have to shower. That’s policy. If they violate the barricade, there’s a risk of contamination. It’s a matter of public safety.” Scott stopped himself from offering her a copy of the Monterey County hazardous material protocols. He was sure she’d have a problem with that. “Anyway, I’ve given the same warning to everyone all day.”

“Including my grandmother?” Erin pointed back toward the parking lot. “She was here a few minutes ago, looking for me. Late seventies, fairly tall, wearing—”

“Blue. I remember her.” How could he forget?

“And you told her she’d have to strip down?” She crossed her arms, color rising on her cheeks.

Scott shook his head slowly, barely resisting a smile. He had no doubt she’d slug him if he smirked. “No. I told your grandmother I was here to protect her safety. That she should call you instead. I even offered her my phone. But I got the distinct impression she wasn’t satisfied with that. What’s that old saying about apples not falling far from the tree?”