The Good Nurse: A True Story of Medicine, Madness, and Murder (16 page)

Charlie entered Han’s room; the woman was asleep. He took the direct route, injecting the digoxin dose as a piggyback into the IV line snaking between the hanging bag and her vein. Han was no longer supposed to receive dig; the IV bolus Charlie injected represented a dose eight times what Han had ever received.
¹³
Then he ditched the needle in the sharps bin and left the room. It was nearly dawn; the dose would take full effect only after his shift was over. The anticipation echoed across his day off, blurring thought. Charlie reported back for work on the evening of the sixteenth, early, to check. But Han was still there.

Charlie took the Cerner and went back through her chart. Han’s heart rate had plummeted, she’d been throwing up on the morning shift, and a blood screen found the dig in her system, which had spiked from her normal level of 0.63 up to 9.94. Han’s cardiologist immediately ordered an antidote, and Han settled down. Afterward she teetered through the day shift and into the night, not well, but surviving.

A
my called Charlie in, he was especially good at after-death care, helpful and quick. He had a serious routine, and he didn’t like to talk as he did it. He would wash the body, pull the IV needles from the veins, wrap the lines, unhook the catheters and feeding and vent tubes. Then he gathered the death kit and the shroud.
Shroud
: to Amy the word conveyed a holy thing, it was solemn and homespun and grave, but at Somerset the shrouds were thin sheets of cheap, clear plastic that ripped easily and were never large enough. They reminded her of generic Saran Wrap. Working alone, her dignified attempts always devolved into macabre slapstick. Wrapping a body required working multiple pieces of this plastic material under the dead weight of the corpse without ripping or wrinkle. It was like making a bed with someone lying in it. Amy’s pulling, lifting, and tugging generally
made a mess of the job. She’d tried fitting the four-foot squares so they overlapped, but there was always a gap in the middle that exposed the belly. Adjusting them this way and that she’d end up with the feet hanging out, then the head uncovered. Eventually she’d simply just wind rolls of tape around the crinkled gob, the way a child wraps a birthday present. Or, better yet, she’d call Charlie.

Charlie had it down. He squared the sheets neatly and with just the right overlap, angling and creasing and fixing the deceased into a professional polymer cocoon, head and feet and all. Charlie was good. She told him so. He told her it was easy. He’d had plenty of practice.

T
he Rev. Florian Gall had arrived by ambulance before being delivered to the Somerset Medical CCU, nearly nine months to the day after Charlie’s own arrival on the unit. His fever was three-digit and his lymph nodes swollen to stones, both symptoms of an overwhelming bacterial infection, probably pneumonia. His lungs, sodden as wet facecloths, labored to deliver minimal oxygen to his heart or brain. A machine would have to breathe for him. Gall’s chin was raised, his mouth opened, and a plastic tube was shoehorned into his windpipe, fitted into an accordianed length of plastic ductwork, and attached to a ventilator. Meanwhile, Gall’s overwhelmed kidneys began to fail. They would recover if he did; until then, a machine would filter his blood as well.
¹⁴

The reverend’s sister visited his bedside daily. Lucille Gall was a senior nurse at a nearby hospital, which allowed her to stay at his bedside late, a professional courtesy. The sister had opinions about her brother’s care. Charlie wasn’t always assigned to the reverend, but he always checked up on him, and he didn’t appreciate her proprietary attitude. She had argued with him, more than once, about which drugs he was giving her brother and why, acting as if she was in charge. She didn’t, for instance, think Tylenol was a good idea, considering the reverend’s failing liver. Her attitude bothered him, to the point that when he thought about Gall, the image in his mind was not him, but her. It was only when she left that Charlie could get down to business.

Gall’s real problem was his heart—atrial fibrillation, probably, meaning that one of his heart chambers was contracting too rapidly to effectively fill or pump. The cardiologist on call prescribed digoxin. It would slow the
atrium, and oxygenated blood would once again circulate through the reverend’s body. At least, that was the idea.

At that point, and for that whole first week, it was impossible to know whether the Reverend would live or die. His family consented to a Do Not Resuscitate order; if Gall’s body did quit on him, at least he would pass unto the Lord without the earthy indignity of dramatic and “extraordinary measures.” But then, gradually, the reverend started to improve. The DNR order was rescinded and his digoxin was discontinued. By the second week, Gall began to sit up and take his meals. As his pneumonia subsided and his heart rhythm stabilized, he would chat with his sister, who remained vigilant by his bedside. Grousing about the nurses who cared for him, unhappy to be hooked to tubes and drips and bleeping machines, the reverend was his old self again, cantankerous but familiar. He could eat and talk. Eventually, if he continued to improve, he would leave.

C
harlie would study the man at night, his bald head glowing in the light of the machines, his clerical vestments exchanged for a disposable frock. He looked nothing like the priests of Charlie’s youth, nothing like God’s man on earth—he looked sick, and very human. That was his prognosis. Charlie knew the charts, he’d pulled the little computer cart to the corner of the Cardiac Care Unit to pore through the drama of numbers.

Rev. Florian Gall coded at approximately 9:32 a.m. the morning of June 28. He went unexpectedly into cardiac arrest, and heroic measures were undertaken. They were unsuccessful. His time of death was noted in his chart: 10:10 a.m. Gall’s bloodwork showed that his digoxin levels were off the charts.

The Somerset Medical Center administration had a problem. It was not a natural death. And Gall wasn’t the first. They called him “Patient 4.”

The plan was to deal with it internally
¹⁵
and as quickly as possible. Pharmacy would examine the Pyxis around the dates of the digoxin deaths. Assistant Pharmacist Nancy Doherty was assigned to contact New Jersey Poison Control Center. The question was, how much dig would have been required for the numbers they saw in Gall’s blood work. The only part they needed help with was the math.

25

July 7, 2003

T
he hold music is lite jazz, upbeat and hopeful. The recorded voice said, “Thank you, a poison specialist will be with you shortly, please…”

Then: “New Jersey Poison Control Center, can I help you?”
¹

“Uh, yeah.” The caller identified herself as Nancy Doherty, calling from the pharmacy department of Somerset Medical Center. “It’s actually not something that’s happening now—we’re trying to investigate, um, a ‘didge’ toxicity that occurred in a patient and I don’t know if you have somebody that I could discuss it with…”

“Okay,” the operator said, figuring the date. “So this is a case that happened…”

“It happened… um… a couple… well, the person is actually…”

Dead.
But Nancy stopped herself.

“Six twenty-eight, it happened,” she said.

N
ew Jersey Poison Control pharmacist Dr. Bruce Ruck
²
called back to Somerset Medical Center ten minutes later. He was put on hold and listened to Vivaldi behind a professional female voice: “At Somerset Medical Center, patient safety comes first…”

“Nancy Doherty.” Nancy’s rounded Jersey vowels were a shock after the clipped broadcaster English:
Nyancy Dowyty.

“Nancy, hi, it’s Bruce Ruck.”
Broose
shared Doherty’s accent and much of her training. He knew that Nancy was only a messenger, tasked with handling a serious internal matter at Somerset.

“Yeah,” Nancy said. She exhaled into the phone. “It’s… getting real… complicated.”

Doherty was calling on the instruction of her bosses, to get help
figuring the probable drug dosages in two patients. She told Bruce that the first patient coded in their Cardiac Care Center three weeks ago, on June 16. A blood test revealed the patient had excessive levels of the heart drug digoxin. In small doses, “didge” helps stabilize heart rhythm. But Nancy was not calling about small doses.

“Then on the twenty-eighth, on the same unit, we had
another
dig toxicity….”

“Wait,” Ruck said. That couldn’t be right. Two patients, same drug, different nights? “And this was in the
same unit
?”

“Yeah.”

Ruck asked about the first patient, Mrs. Han—had she come into the hospital with dig toxicity?

No, Nancy said. “We called the lab. She had normal dig levels when she came in.”
³

“Oh my,” Bruce said. “Nancy, what hospital are you in again?”

“Somerset Medical Center,” Nancy said. “I feel like I’m a detective.”

“Well, it sounds scary to me!” Bruce said.

“Yeah,” Nancy said. She sounded relieved, hearing another pharmacist acknowledge that.

Nancy put Ruck on hold, so she could explain the rest from the privacy of her office. “Patient 4, the Reverend Gall—” Nancy read his dig numbers from the lab reports: 1.2. on the twentieth, 1.08 on the twenty-second, 1.59, 1.33,… and then, just after dawn on the twenty-eighth, it suddenly jumped to 9.61.

“So after the twenty-seventh, before he spiked—when did he get his next dig?”

“He never got another dig,” Nancy said. His digoxin levels spiked a full day
after
doctors took him off the drug.

“First thing I think of is lab error…”

“Well, they’re telling me they retested it.”

“Mmm,” Ruck said. “Then it couldn’t have gone up to nine-point something…”

Bruce wasn’t getting it. “He coded,” Nancy said. “He died, okay? All right?”

Ruck was struck silent. “Okay,” he said finally. “Let me slow myself down. I’m going to take a deep breath.”