Plague

Chapter 2 Day 1, 7:00 PM

Chapter 2
DAY 1
7:00 pm

As usual, the phone rang at the most inopportune moment possible. There was no such thing as rest for the weary, or, for that matter, for the blatantly overworked.
“Dr. Wright here and I’m off duty tonight so this had better be good!”
“Jacob, this is Tom Brighton. I’m on call for Neuroradiology tonight and something has come up that’s really strange. I’d really appreciate it if you came over to take a look at a CAT scan.”
“That’s wonderful, Tom, but as I said, I’m off tonight. Besides, Dr. Small isn’t fully retired yet. He’s on call tonight, so Neurology is covered. Talk to him.”
“Small is too old and too rigid for this, Jacob. I need you to see this. I promise it’s not a waste of time.”
“I’m really sorry, Tom, but I’ve got great plans to….”
“Look, Jacob, I’m calling in old debts. Do I have to remind you of the angiogram I came in at three in the morning to do for you on my night off?
“I’ve never been more serious, Jacob. When you see the scan, if you think I’m crazy, I’ll take you out for a steak dinner.
“Please, Jacob?”
“What’s the problem, Tom? You certainly don’t need me to interpret a scan for you,” Jacob said.
“Thanks, Jake; I’ll tell you the story when you get here.”
Tom hung up. Jacob looked at the phone for a moment, and then hung the receiver in its place. He sighed and grabbed a can of diet coke from the refrigerator in his practically miniscule kitchen and sat down on the rented couch; he looked out the window and down four stories, not really seeing the cars going by.
Jacob “Jake” Wright had just walked into his rented apartment and put his car keys in the bowl on table by the door when the phone rang. A neurologist, he had just finished doing a pro-bono cancer pain clinic. That was after spending his entire day doing hospital rounds and seeing patients in his office in the medical office building attached to the hospital. The clinic had been tough and he felt drained.
Jacob willingly worked with this difficult patient population, possibly as a way to deal with personal issues, not the least of which was self-imposed guilt that Jake would deny he had. He knew that because after his fiancée, Laura, died, he’d had that conversation a number of times with his friends and colleagues, and even a shrink. He had tried to help Laura, but he couldn’t. He had dealt with things that he wasn’t very conversant with- mysteries that he couldn’t fathom, no matter how hard he had tried.
Soon after Laura’s death Jacob had found himself living out in the middle of north-central California with a year’s locum tenens, or temporary contract which gave him a job at a new, high tech hospital for a year while they looked for a permanent neurologist.
This was fine with Jacob, as he no longer liked the idea of commitment. He went out of his way to avoid it in any form. He knew, with his heart, though possibly not his brain, that Laura’s death had hurt him more than he could describe. He’d changed then, in ways he knew he had yet to identify.
He sighed. He decided to eat dinner later, maybe pick something up on the way home.
He grabbed his keys, picked up the prescription medicine bottle in the bowel, started to put it in his pocket, stopped himself, glared at the bottle and threw it back in the bowel. In minutes he was on his way to the hospital.
The ride to the hospital seemed longer than the usual ten minutes. As he turned into the drive he did his second double-take that day as the modernistic steel and glass structure came into sight. Built by a group of rather wealthy physicians back when there were such people, the four story marvel was the epitome of beauty and grace in a building. It was also complete with every modern and up-to-date piece of equipment that could be purchased in all fields of medicine, and then some.
Jacob pulled his Porsche into the physician’s parking lot, careful not to scratch his pride and joy. He had bought it to be ‘one of the guys’, a fact that he recognized with feelings close to dismay. He had tried hard to fit in with the other physicians. They had lots of girl-friends, so he tried to do the same. This was difficult for him, as he had been engaged for most of the time he was in medical training. He had been faithful to the very end. Until Laura had been killed.
Jacob’s pager beeped just before he shut off his car. He turned the key before he grabbed it off of his belt. A message to call the third floor.
At least it wasn’t a STAT, or emergency call.
Jacob walked quickly through the hospital entrance. He crossed the marble floors, past the doorway to the stairs which led down to Dr. Brighton, and walked up to the elevators. He punched up and waited, only seconds, for a door to open. He rode it up uninterrupted to the third floor, got off and went to the Nursing Station. Only one nurse was at the station. He didn’t recognize her, and briefly wondered if she was one of the interminable part-time or agency nurses the hospital had to use because of the Nursing shortage.
He approached her and said, “Hi, I’m Dr. Wright. Did you page me?”
The nurse looked up from the chart she was writing in and hardly glanced at Jacob. She was sitting at the desk at the nursing station and Jacob realized that she wasn’t about to stand up. She wore a white uniform that had several areas of variegated colors on the front, as if she was wearing her breakfast, lunch and, perhaps, diner. She was heavy set with what seemed to be a perpetual scowl on her face.
“Yeah, Mrs. Jerome in 323 keeps calling me. She wants more dope.”
For a moment, at least, Jacob was speechless. Finally, he stopped goggling at the nurse and said, “Excuse me. She wants what?”
“Dope. Pain medication. You know, she keeps complaining of severe pain.
“She got her last pain meds six to eight hours ago. That should have held her.”
Now, the nurse did look at Jacob. “I don’t know, Dr. Wright, but maybe she’s getting addicted the pain medications.”
“Nurse,” Jacob asked, doing his best to speak quietly. “What is your name? I don’t see you wearing a badge.”
“Oh, sorry about that,” she simpered, “I’m from the agency. I just forgot my badge. My name is Judy Foxel.”
“Well, Ms. Foxel,” Jacob said, looking her in the eyes, his eyes focused and unblinking. “Do you have any idea what Mrs. Jerome’s diagnosis is? You know, why she might need pain medication?”
“No, I missed report. I got here late. All I know is she’s a pain in my ass. She keeps ringing for me, but I just have too many patients to keep going in to see her.
“Now you’re here, maybe you can get her to lay off the buzzer.”
Jacob remained silent for a few moments, than asked, “Ms. Foxel, please give me Mrs. Jerome’s chart.”
After Jacob had the chart in his hands, he quickly opened it to his initial consultation, then to the last page of the dictation, where he listed her diagnoses.
“Ms. Foxel, may I assume that while you are a terrible nurse, you can read?”
Jacob watched her face tighten up, her eyes buried beneath fleshy, overly made up lids, grew big.
“What did you say to me, doctor?” she asked, her voice pinched.
“I said that you are a moron, and you won’t be finishing your shift at this hospital. Nor will you ever be back here.
“Is that plain enough?”
“How dare you, doctor! I’m going to speak to the nursing supervisor. I’ll see that you’ll be disciplined for speaking to me in such a fashion!”
“I don’t think so,” Jacob said, the anger in his voice making the nurse seated in front of him seem to shrink back in her chair.
“Mrs. Jerome has metastatic breast cancer, Ms. Foxel. She has bony metastases that are very painful. She is getting chemotherapy and radiation therapy.
“What’s more, Ms. Foxel is the fact that she is terminal.
“She’s going to die, sooner, rather than later, and you’re sitting here telling me that I might have addicted her to pain medication? Even worse, you’ve withheld her pain medication for at least 6 hours.”
Jacob took a moment and leafed through the chart to the medication notes.
He raised his eyes and looked down at the nurse. The anger was no longer simmering. He was visibly angry now.
“No, I see that you’ve withheld her medications for seven and half hours!
“That’s it, Ms. Foxel; get the hell out of this hospital. Now!”
“You can’t tell me to leave, doctor,” the nurse said, her voice low and almost tentative.
“Watch me. You let a terminal cancer patient go without her pain medications and then you bitch about her wanting too many medications. I am going to write a letter to the nursing board and see if I can’t help you to lose your license. Do you understand me?”
Nurse Foxel barely nodded.
Barely reining himself in, Jacob raised his voice. “Get me a syringe with Dilaudid, 4 milligrams, and I mean now!”
The nurse got up from her seat and practically ran into the medication room. She soon returned and gave Jacob a syringe with a brownish liquid in it.
“No way, Ms. Foxel. I want to see you draw up the medication. Go get the bottle and another syringe. No, never mind. I’ll go with you and do it myself.”
Jacob verbally hustled the woman along in front of him. When they got into the medication room, the nurse asked, “What should I do with the syringe I just gave you?”
“Frankly, Nurse, I could care less. Here,” Jacob said, uncapping the syringe, “Let me help you.”
He shot the liquid into the sink.
“There, you just saw me discard whatever it was in that syringe. Document it.
“Now, give me another clean syringe and the bottle of Dilaudid.”
Jacob quickly swabbed the top of the multiuse vial with an alcohol pad and then drew up the medication he wanted. He gave the bottle of narcotic back to the nurse and watched her lock it away.
“After you,” he said, pointing towards the door. He followed her out of the medication room and back to the Nursing Station.
“Now,” Jacob told her, “Get your things. You are leaving as of now.”
“I will not,” she said.
“Oh yes, you will,” Jacob said.
He placed the tray on which he had carried the Dilaudid on the desk and picked up the phone. He dialed the operator and said, “This is Dr. Wright. Please have the Nursing Supervisor call me at this extension. Yes thank you, I’ll be waiting right here.”
After placing the phone down, he looked at the nurse. “I told you to get your things. Now do it!”
Defiantly, she said, “I want to speak to the Nursing Supervisor!”
“I don’t have a problem with that,” Jacob said, “She’ll just tell you to get the hell out of this hospital. Just like I did.”
The phone rang, and Jacob picked it up. He listened for a moment and then said, “Yes, this is Dr. Wright. I need you to replace Nurse Foxel here on three. I just threw her out of the hospital. Yes, she is right here. Of course, I’ll tell you what happened.”
When Jacob had finished talking, he gave the phone back to Nurse Foxel.
“I don’t expect to see you here when I get back,” he told her. He picked up the small metal tray with the syringe and went down the hall to room 323.
The door to the room was shut, so Jacob knocked before he opened it. Inside the dimly lit room were two patients. Mrs. Sharon Jerome was lying in the bed by the window. She wore a bandana on her head to cover the baldness that was secondary to her chemotherapy. Sharon was cachectic, as she had no appetite secondary to her pain and her cancer treatment. Her thin body habitus was extreme. Her face had lost most of its beauty: Jacob could remember her from six months earlier when she had first become his patient. Now she lay on her side, quietly crying. Jacob could see tears falling down her face onto her pillow. She had both hands fisted, her teeth clenched from her pain.
Jacob saw that her IV bag was almost empty. He said nothing until he stood by her bedside. He reached down and touched her shoulder. Her body startled, as if she had been shocked by electricity.
“Hey, Sharon, it’s me. Open your eyes, will you?”
It appeared to Jacob that his patient needed all of her remaining strength to lift her eyelids. She quickly wiped the tears from her reddened, bloodshot eyes and said, “Hi, Dr. Wright, did that horrible nurse call you to tell her how bad I am?”
Jacob sat down on her bed and looked her up and down, slowly, so she could see him. Then he said, “I’ve heard that you had a bad day. I’m so very sorry, Sharon. I can promise you it won’t happen again. I’ve gotten rid of the nurse that refused your requests for pain medication. Now, looking at you, I have got to tell you, you look terrible!”
Sharon immediately giggled and said, “You have no idea how terrible I feel. I can’t remember the last time I was in so much pain. I’ll bet you’re right, I probably look like shit.”
“No, actually you look worse than that; but after what you’ve been through today, I can understand why.”
Her eyes teared up and Jacob watched, hoping she wouldn’t begin to cry again.
“Hey, look, I brought you some Dilaudid. I’m going to give it to you through your IV. You’ve been on strong opiates for months so while you might feel a little groggy, you’ll definitely feel a lot less pain. OK?”
“OK? Damn straight it’s OK, Dr. Wright. Thank you!”
Jacob stood up and reached for the intravenous tubing.
“Wait a minute, Dr. Wright. Did I do something wrong? Was I a bad patient?”
“Not at all, Sharon. Why would you think such a thing?”
“Well, that’s how that nurse made me feel. And, I don’t know, my husband Steven hasn’t been around too much. I think I make him feel bad.”
She laughed, a short, loud burst of self derision, and said, “Hell, I bet I don’t do much for me either!”
“Now, cut this crap out,” Jacob told her. “If you want to feel sorry for yourself, I’ll give you a minute to do it, and then we go back to working toward getting you to feel better.”
“Dr. Wright, you know I’m not going to get better. I know you do.”
Jacob slowly injected the Dilaudid through his patient’s medication port. He put the empty syringe on the night table and sat down next to Sharon Jerome.
“Hey,” he said, “You are one of the strongest people I’ve ever met. We both know that you may not be able to beat the cancer, but we can help you feel more comfortable. You have a lot to deal with. You don’t have to suffer too.”
“Right,” Sharon said, her voice beginning to get slurred, “That’s what you told me. I remember.
“Dr. Wright, will you do something for me?”
“Sure, Sharon. What would you like?”
“I’ve been in such pain all day, I’ve feel like I’ve been run over by an eighteen wheeler.”
She lifted her face to him and finished, “Would you, you know, sort of just hold me until I fall asleep? I can tell by the whooshing in my head and my pain is getting better. I’m going to fall asleep really soon.”
Her voice slurred a bit more as she finished, “So, would you? Please?”
“It would be my privilege, Sharon,” Jacob said. He helped her lie flat on the bed and then wrapped his arms around her shoulders and neck, nestling her head on his shoulder, as he bent over the bed, still sitting in his chair. He could hear her breathing begin to soften and become more even.
His eyes began to tear, as he reminded himself that this person, his patient, wasn’t going to live much longer. It didn’t matter how smart he was or how good her other doctors were. She was terminal.
Jacob heard her say, “Thank you,” her voice a whisper. He laid her back on the bed and carefully covered her with her bed sheets.
As he got up to leave, the other patient in the room said, “Dr. Wright?”
“Yes,” he said, his voice low, “What can I do for you?”
“Well, my doctor wanted me to see you. See, I’ve got cancer too. He said you could help me keep my pain under control. I didn’t want to see you.”
Jacob’s lips came up in a small smile. “That’s no problem. There are a lot of doctors you can see. I won’t take it as a bad review.”
“Well, I’ve watched Sharon suffer all day. Even I couldn’t stand it! If I ever see that smart ass nurse again, I’m gonna crown her with my bed pan!”
“Don’t worry,” Jacob said, “You won’t see her again in this hospital.”
“Good, glad to hear it. But you don’t understand.”
“What’s that?” Jacob asked her, paying more attention to her. She looked to be in her sixties. She still had her hair dyed “old lady blue”. She was a bit heavy set, but the look on her face was definitely fixed. This was not a lady, Jacob knew, who would take any crap from anyone.
“Well, I’m gonna come see you, right after I get out of here. I saw how you helped Sharon.
“You’re good people, Dr. Wright. I think you care about your patients, so I want to be one. One of your patients.”
Jacob thought he could see her face flush with blood. He thought it would take a lot to make her blush.
“Well, hell, you know what I mean. My name is Sonya Greenman.”
“Mrs. Greenman,” Jacob told her, “It will be my pleasure to see you.”
“Thanks. Really. If you can keep me from suffering like Sharon, I will defiantly need your help. I’ve got pancreatic cancer, see. They tell me they can’t do anything about it.
“One of my friends died from the same thing. She hurt like hell. I don’t want to die like she did. I’d rather be shot.”
“Well, we’ll have to see that you don’t suffer, agreed?” Jacob said.
“Absolutely. I’ll see you soon, Dr. Wright.
“I’ll look forward to it, Mrs. Greenman.
“You can call me Sonya.”
“Fine. Sonya, I’ll tell my nurse to expect your call. Good night.”
Jacob looked back at Sharon Jerome. She was sleeping peacefully.
With a nod to Sharon Greenman, Jacob left the room and went back to the Nurse’s Station.
He was pleased to see no sign of Nurse Foxel. He wrote a note in Sharon’s chart and ordered the use of a PCA pump, for patient controlled analgesia. Jacob felt that Sharon needed to be able to help herself. Jacob wrote all of the orders necessary, including an order to renew Sharon’s IV, then he called central supply to tell them to have the pump up on the third floor within the hour, flagged his orders and explained them carefully to the charge nurse, who was responsible for taking off the physicians’ orders.
Jacob noticed that her voice was a bit strained
“What’s the matter, Ingrid?” Jacob asked her.
Ingrid looked at him for a moment and then asked, “Did you really get rid of Judy Foxel?”
“Yep. I did indeed. I’m surprised you couldn’t hear the ruckus from where you’re sitting.”
“Well, the other nurses will be your friends for life. That woman was a walking advertisement for retroactive euthanasia. I mean no one she took care of felt better!”
“I hear you. I can assure you that she’s gone for good.”
“Thanks, Dr. Wright. She was a terrible nurse.”
“No problem, Ingrid. She messed with my patient. No one messes with my patients.”
Ingrid giggled.
“I don’t think anyone will mess with anyone of your patients again. At least, no nurse around here would think of it!”
“Good,” Jacob said, and then in his best Godfather imitation, which he knew was terrible, he added, “The next person who messes with my patients will sleep with the fishes.”
“I’ll tell all the other nurses. I don’t think you’ll have to worry about that.”
Jacob smiled and said, “I’m glad to hear it.”
His pager beeped again. He recognized the number- it was Tom Brighton, probably wondering where he was.
“Ingrid, I have to go. You have a good night, OK?”
”OK, Doc, thanks.”
“You’re welcome. I’ll try to come back later. Make sure the new nurse takes good care of Sharon.
“Don’t worry, I’m sure they will.
“Good,” Jacob said. “See you later.”