No Cure for Murder (23 page)
The line remained silent for a moment. “It was just a thought since I suspected you were going to have a bad day.”
“I’m sorry.” Zoe softened her voice. “I’m going to make quick afternoon rounds. I should be home at six thirty.”
Zoe pushed the charts aside, grabbed her white coat, and started to leave.
When she reached the reception area, Margaret asked, “Did you do those dictations, Zoe?”
“I’m sorry, Margaret. Too much on my plate. I’ll get to them tomorrow.”
“Patients and referring docs are asking for those dictations, Zoe.”
“I said I’ll do them.”
Chapter Thirty-Nine
The ringing phone echoed through the house as Jacob returned from work.
I can’t get a break, he thought as he picked up the receiver.
“Jacob, it’s Phyllis Rodman.”
“What’s up? How was the trip?”
“I’m sorry to bother you but we just stepped through the front door of our home after our flight from Japan, when Harry had a few seconds of chest pain and couldn’t catch his breath.”
“Call the ambulance and have them take him to Brier. I’ll meet you there.”
“An ambulance. Is that necessary? Can’t we drive in?”
“Phyllis...” growled Jacob. “Just do as I say.”
At fifty-eight, Harry Rodman served as Chairman of the Board of Education although he planned to retire soon. Phyllis, two years his junior, taught fifth grade. With the encouragement of their two grown children, they had accepted a summer teaching position in Japan...their first trip to the orient, their first real adventure of a lifetime.
Jacob stood under the overhang at the ER entrance daydreaming in the magic of the heavy rain. He loved the look and the smell of a fresh rain...a lifetime of memories flooded in. The downpour reminded Jacob of gazing through the barred barrack windows at Auschwitz. The flooding water ran off the hard ground and into the ditches under the electrified fences. Pure water ran down the partially open window. He reached out allowing the fresh drops to pool in his palm, and then retracted his hand and sipping of a world beyond this nightmare.
His reverie ended with the screech of the ambulance on arrival.
The transport gurney’s shiny aluminum legs snapped in place as the EMTs slid Harry out of the ambulance and wheeled him into Treatment Room II. The oxygen tank rode next to him and connected to prongs that carried life into each nostril.
Harry grunted with each breath as he stared wide-eyed at Jacob.
When they transferred Harry to an ER bed, he grasped for Jacob’s coat and gasped. “Help me, Jacob. I can’t breathe. It kills me every time I take a deep breath...what’s wrong with me?”
Jacob pulled out his stethoscope and moved the flat side of its head over Harry’s chest and heart. “Where does it hurt?”
“Here,” he pointed to the front lower rib cage on his right.
Jacob placed the stethoscope to the exact point indicated. “Take a deep breath.”
Harry opened his mouth and started to inhale when he suddenly grimaced. “That kills me, Doc!”
At the deepest part of the breath, Jacob heard a loud rubbing sound and knew at once the diagnosis: Harry had thrown a clot from his lower extremities that moved into his lungs, a pulmonary embolus.
Harry tried another breath, but coughed uncontrollably as he brought up bright red blood.
“How long was that flight, Harry?”
“About twelve hours.”
“Did you get up during the flight?”
“Once, to pee. Those damn seats are too small for a normal person, no less someone of my size. I could barely move, doc. I felt like a canned sardine.”
“I’m going to run some tests, Harry, but the odds favor a clot to the lungs coming from your legs. We call that a pulmonary embolus.”
Harry tried to sit up, but Jacob placed his hand on Harry’s chest.
“How dangerous is that?”
“Small clots are bad enough. A large one can be life threatening. If the tests confirm my diagnosis, I’ll give you a clot dissolving medication and start you on blood thinners to prevent more clots.”
“Whatever you say, Doc.” He hesitated. “You’ll explain this to Phyllis...but please, Doc, don’t scare her.”
After the x-ray, lung scan, and a study of the deep veins in Harry’s legs, Jacob talked with Phyllis. He tried to maintain his optimism, but would not mislead her about the seriousness of Harry’s condition.
“This is a dangerous condition, Phyllis. I’m treating Harry aggressively and I’m asking our chief of cardiology, Sharon Brickman, to consult.”
“You’re scaring me, Jacob. Should I be scared?”
“Yes, at least for a while.” He placed his wrinkled, age-spotted hand on her shoulder. “The first few hours are the most dangerous.”
“I’m Dr. Brickman, and this is Ahmad Kadir,” said Sharon as they entered Harry Rodman’s room. “Dr. Kadir is a resident studying intensive care at UC San Francisco.”
Ahmad bowed slightly, and with his Palestinian accent said, “So nice to meet you.”
When Phyllis Rodman stared at Ahmad, her mind flashed on the images of suicide bombers she’d seen on TV. Embarrassed, she looked at the floor, saying nothing.
Harry grunted his greeting and extended a trembling hand.
Ahmad and Sharon examined Harry, and then put his x-ray up on the view box. “See this white area, Mrs. Rodman.” She pointed to the right side of the film. “That’s where the clot went into Mr. Rodman’s lung.”
Sharon sat in a chair opposite Phyllis. “Here’s where we are. If he shows any signs of more clots or if he becomes unstable, we may have to do a pulmonary arteriogram to visualize the clots in his lungs, and go into something much more aggressive and a lot more dangerous.”
They moved Harry to 614, one of the rooms in the step-down cardiac care unit where he’d be on the monitor while he received heparin, an anticoagulant. The laboratory would monitor how well his blood clotted.
Kate Planchette, Harry’s nurse, approached the bedside and turned to Phyllis. “You must be jet-lagged, Mrs. Rodman. That long trip, and now this. Why don’t you go home and rest. I’ll call you at once if anything develops.”
“Are you sure it’s all right? I’m dead on my feet.”
“It’s fine.”
Phyllis kissed Harry. “I’ll see you in the morning, sweetheart.”
Harry grunted something unintelligible, and then closed his eyes.
Luck is with me, I think, as I slip into Harry Rodman’s room.
Not so for you, Harry. This time, we’ll leave it to the fates.
Better make it quick.
Neither the beeping of the cardiac monitor nor the nurses coming and going disturb Harry’s sound sleep.
I reach into my white coat and remove the syringe containing 300,000 units of heparin and flush it into his IV line.
With this massive dose of anticoagulant, Harry won’t need to worry about a blood clot, now or ever and if I’m lucky again, Harry—you won’t have to worry about anything.
Kate had seen Tommy Wells going in and out of Harry’s room all evening to perform bedside clotting studies. He was due back in another thirty minutes when Kate entered the room. She pulled the sheet off Harry’s arm to measure his blood pressure, and then stared. His arm and entire chest wall were purple. Blood oozed from venipuncture sites, the IV site, his nose, and mouth, and when she pulled his lids open, Harry’s eyes bulged bright red.
My God, she thought. He’s bleeding out!
Kate pushed the call button and when the ward clerk answered, she said, “Get Dr. Weizman stat, and have the lab come up to draw a blood count and to do another clotting study.”
She tried to awaken Harry, but he failed to react. The right side of his mouth drooped and bloody saliva oozed out. When Tommy entered the room, Kate said, “Get a blood count stat and draw a clotting time.”
Tommy looked at Harry. “This guy looks like shit.”
“Tommy,” she shouted, “keep that language to yourself.”
“I’m sorry,” he said inserting a test tube of blood into the automated device.
They waited...stared at the machine awaiting the tell-tale beep that indicated a result. After 10 minutes the machine alarmed and flashed: Infinite. Harry Rodman’s protective clotting system lay in paralysis...he could bleed from anywhere.
Three minutes later, Zoe entered the room. “I was admitting another patient on the fifth floor. What’s happening?”
Tommy studied the clotting device. “His clotting time is infinite. I’ve been doing clotting times every hour or so and they were in therapeutic range.”
“What was his last clotting time?” asked Zoe.
“That’s it. He can’t clot at all.”
Zoe did a rough calculation then gave Harry a dose of protamine to counteract the heparin. “I hope it’s not too much or too little...each has its set of problems.”
After Kate administered the dose, Zoe completed her examination. “The drooping mouth and the flaccid muscles says that Mr. Rodman has had a stroke. We need an emergency brain CT scan.” Zoe paused. “I’d better call Jacob, and someone get me Mrs. Rodman’s number.”
“Should I call the chaplain?” asked Kate.
“Not a bad idea,” said Zoe, “except ask him to leave before Mrs. Rodman gets here. She’ll freak if she sees him.”
Chapter Forty
Jacob had a sixth sense for trouble and it was sounding strong as he walked toward Harry Rodman’s room that evening.
When Jacob arrived, Zoe saw his hair listing to one side and his bow tie askew.
He’s too old for this, Zoe thought. He should be in bed.
Jacob pulled back the sheet to expose Harry and saw the bloodstained bed, the bruising and bleeding, and yelled, “What the hell happened?”
“He has an infinite clotting time, Jacob,” said Sharon. “He’s bleeding from everywhere and clinically he bled into his brain too.”
“Oh, my God...how is he now?”
“Stroked out,” said Zoe. “How much heparin did you order, Jacob?”
“I gave him a standard loading dose of 50 units/kg of body weight then a maintenance dose of 20 units/kg/hour.”
“You adjusted that for his lean body mass?” asked Zoe.
“What are you talking about? I’ve been giving heparin for decades. Of course I adjusted the dose.”
Jacob stared at Zoe and Sharon, trying to read their minds. “His clotting time following the large loading dose was in the therapeutic range and so were the first few follow up readings. I don’t understand your questions and I resent your implications.”
“Take it easy, Jacob,” said Sharon. “We’re trying to find out what went wrong.”
Jacob stared at Zoe. “What are you doing here? I’m on call tonight.”
“I was here anyway, so I decided to come up.”
“Check my orders, Sharon, to your satisfaction...”
“That won’t be necessary, Jacob.”
“If the orders were appropriate,” said Jacob, “then I see only two other possibilities: a dosing error or another process leading to a clotting problem like DIC (disseminated intravascular coagulation). The heparin may have been the wrong concentration or they diluted it improperly. Off hand, I don’t see any reason for DIC.”
“I talked with Kate Planchette and reviewed the set up of the heparin infusion; it’s cookbook. Unless the heparin itself is mislabeled, I don’t see that kind of error.”
“Even if the Heparin infusion pump went bad and he got too much,” said Jacob, “that wouldn’t explain a massive overdosage.”
Sharon plunked herself down in the easy chair in Harry’s room and stared through the rain-streaked window. She turned to Jacob. “Maybe this isn’t an accident, Jacob. Bad things are happening to patients around Brier, especially your patients: Lidocaine overdose, heroin overdose, and excuse me Jacob, the question of morphine overdose...and now this. Could Brier Hospital have its own serial killer?”
“That’s absurd,” said Zoe. “There’s got to be some other explanation.”
“You’re not party to the detail of these cases, Zoe,” said Sharon, “but the more I think about it, the more obvious seems the explanation.”
On their way to view Harry’s CT scan, Zoe turned to Jacob. “I’m sorry. I wasn’t thinking straight. I was reaching for an explanation. I’d never...”
“Forget about it, Zoe. I know all too well the effects of stress and uncertainty on the human mind and its rationality.”
“But, you’ve done so much for me...how can I have thought...?”
“Forget it.”
The chief of radiology, Bernie Myers, stood before the high-resolution screen paging through slices of Harry Rodman’s brain. “He’s lucky, Jacob. It’s a small frontal lobe bleed.”
“The last thing I’d call this man,” said Jacob, “is lucky.”
“Well,” said Bernie, “I’ve seen a lot worse. If Harry has no further bleeding, he might just pull through.”
When they returned to Harry’s room, Phyllis Rodman sat next to her husband, holding his hand and crying. Her daughter Carol stood at her side stroking her mother’s hair.
Jacob entered the room. Phyllis rose and embraced him, tears running down her cheeks.