The Daily Novel

Chapter Thirteen

Lauren heard the page from the nurses’ station just as she finished hooking a new vial of morphine to Mr. Oliphant’s self-dosage machine. She patted the man’s arm. “See you later.”

He managed a weak smile. “Okay, Lauren.”

She hurried to the nurses station. Olga Herrera handed her the telephone. “Lauren Miles,” she said.

“Lauren, this is Vera in the ER. We need you and Donald Arrington down here stat.”

“What’s up?”

“Pickup truck broadsided a school bus. Four dead at the scene, and seven kids on the way. The E.M.T.s say at least two of them are in critical condition.”

“Be right there,” Lauren said. She gave the telephone back to Olga. “Let the other nurses know Donald and I are going to the ER. They’ll have to cover for us.”

“Will do,” the girl said, noting the urgency in Lauren’s tone.

Lauren paged Donald. When he did not appear immediately, she ran down the hall, peering into each room until she found him. He was checking Mr. Oliphant’s morphine bottle. The patient snored raggedly. “I just changed it Donald,” she said.

Donald jumped and placed his right palm over his chest. “Damn! You scared blazes out of me, Lauren.”

“Sorry. Come on . . . they need us downstairs.”

She filled Donald in on the accident as the elevator descended. When the doors slid open, they stepped into bedlam. The moans and cries of children filled the ER.

Lauren saw that the three ER suites were filled with frenzied activity as doctors and nurses battled desperately to attend the most critically injured. Four other children
tossed fitfully on gurneys lining the hallway.

Donald and Lauren donned gowns, masks, plastic booties to reduce the risk of static electricity, and pulled rubber gloves over their hands, snapping them in place. Lauren headed for the room that appeared to be the most understaffed. “See what you can do for the kids on the gurneys, Donald.”

A girl of seven or eight, her mop of blonde curls caked with blood, looked up at Lauren fearfully. The doctor palpated the child’s abdomen. She winced in pain and cried out. “We’ve got a ruptured spleen here, people,” the doctor said.

Only then did Lauren realize the doctor behind the mask was Ben Tolson.

Suddenly the child convulsed, then became rigid. Her color faded to a pasty white, and her eyelids flickered.  Lauren checked the monitor. “Blood pressure eighty-six over fifty and falling,” she announced.

“Call the lab and tell them we need three units of O negative, stat, and draw ten millimeters for type and cross-match of another three units, ASAP. And get an IV of D5W started. She’s bleeding out.”

Lauren rushed to the red telephone on the wall, gave the request to the lab, then hurried back to draw blood from the child. The girl’s veins were tiny, but Lauren performed the venipuncture expertly. She drew the blood sample, then detached the plastic syringe from the needle and connected a bag of 5% dextrose and sterile water to the needle. “Rate of drip?” she questioned.

“Wide open,” Tolson said. “We have to keep her fluid volume up until the blood gets here.” Tolson intubated the girl, establishing an airway.

Lauren rolled the plastic regulator downward with her thumb. The D5W flowed into the child’s vein. Checking the chart, Lauren labeled the warm tube of blood with the girl’s name and passed the sample to a lab technician standing just outside the room. “Type and cross for three units, ASAP . . . and tell them to hurry with the O neg.” The technician nodded and ran for the elevator.

Tolson tapped another nurse on the shoulder. “Carol, check the status of the OR.”

The nurse headed for the telephone, spoke for a moment, then listened. She held her hand over the mouthpiece. “Dr. Tolson, the OR is swamped . . . the other two kids are already in there. Brain hemorrhage and severed femoral artery.”

“Damn! Okay, we’ll do it here. Lauren, get her prepped, please, and lay out a surgical tray.”

“Yes, Doctor,” Lauren said obediently, wondering when Tolson had recognized her.

To the anesthesiologist standing nearby, Tolson said, “Put her under, Bill.”

Lauren prepped the child’s abdomen with alcohol and an iodine solution and tore the wrapping from a sterile surgical tray. She arranged the instruments in the order they would be used. A blood bank technician ran in carrying three bags of O negative.

Carol replaced the bag of dextrose with the first unit of blood and opened the shunt. “That’s too slow,” Tolson barked. “Use a pressure cuff.”

The nurse hurriedly slipped the bag of blood into a gray mesh blood cuff and pumped the pressure up until it flowed at a steady stream.

“BP fifty over thirty,” Lauren said, aware that the girl maintained a tenuous grip on life.

“Lauren, come over here and assist me,” Tolson ordered. “I have to open her up now or we’ll lose her.”

Lauren stepped around the table, careful not to trip over any of the electrical cords that operated the monitoring devices, and stood at Tolson’s side.

“Bill?” Tolson asked.

“She’s under, Ben . . . go for it,” the anesthesiologist answered. He monitored the level of anesthetic flowing into the child to maintain unconsciousness.

“Scalpel!” Tolson said.

Lauren slapped the instrument, handle first, blade facing outward, into Tolson’s gloved hand. The razor-sharp instrument parted the child’s pale skin as easily as a bullet parts air. Blood fountained up from the girl’s belly in a brackish dark geyser. “Suction! I can’t see anything,” Tolson snapped.

Carol suctioned away the stream of blood. The slurping sound always gave Lauren chills.

“Retractors,” Tolson said.

Lauren handed him the instruments one at a time. With them, Tolson spread the flesh, fat, and muscle to either side of the incision, providing a large operating field. “More suction,” he said. Then, glancing up at the empty blood bag, “Carol, hook up another unit of blood . . . Lauren can suction.”

Carol handed the suction tube to Lauren and went about exchanging the empty bag for a full one.

Tolson probed the wound with his fingers, exploring. “It’s the spleen, all right. Hemostat,” he barked four times in rapid succession.

Lauren slapped the scissors-like clamps into Tolson’s waiting palm each time the word left his lips, while maintaining suction. Tolson clicked the hemostats in place to shut down the blood flow from the veins and arteries leading into the damaged organ.

Lauren patted Tolson’s perspiring forehead with a gauze pad.

The anesthesiologist snapped a warning. “Heartbeat is irregular, Ben, and respiration labored. She’s going.”

“Carol, tube her!” Tolson shouted, indicating he wanted the nurse to manually pump air into the child’s lungs. To Lauren he said, “Scalpel.”

She placed the blade in his hand. He peered into the gaping wound. Lauren heard him mutter to himself. “Hang on, baby. Hang on.”

With precise strokes, Tolson excised the spleen and dropped the ruined organ into a waiting metal pan. He called for more hemostats, clamping off the bleeders as he found them. “Suture set,” he demanded.

Lauren opened the kit containing pre-threaded, curved suture needles and placed it in front of Tolson. Slowly, meticulously, he tied off and sutured each point of bleeding.

Lauren saw the pink flush return to the girl’s cheeks.

“Pressure 70 over 50 and rising. Respiration normal,” the anesthesiologist sighed with relief.

Tolson took a deep breath. “Get that third unit of blood going while I close, then send her up for a CAT scan. I don’t want to take any chances with her scalp laceration. She could have a concussion or subdural hematoma, though her pupils are responsive and undilated.”

The child began to stir soon after Tolson closed the incision and the flow of anesthetic ceased. She looked up at the trio surrounding her with astonishingly big blue eyes. A tiny smile turned up the corners of her mouth. Tolson tweaked her nose gently. “You’re going to be fine, sugar.”

As the child was wheeled out of the room, Ben Tolson expressed his appreciation. “Thank you all for a job well done. You we’re great. Now . . . let’s see what we can do for those other four kids in the hall.”

As they filed out of the room, no one saw him squeeze Lauren’s hand. Her heart fluttered in her chest.

Fortunately, the remaining children had sustained only minor cuts and bruises, with the exception of a red-haired, freckle-faced boy whose ulna was fractured. All were treated and released. Lauren made a quick call to the OR to check on the two critically injured children. The child with the severed femoral artery was in stable condition. The one with the brain hemorrhage remained critical.

After a quick salad and a diet cola, Lauren returned to her floor, still in awe of Ben Tolson’s dedication, determination, and compassion during the surgery. She felt she had seen a side of him it would have taken months to discover through casual dating. Her trepidation about their pending date rapidly dissolved.

She checked in at the nurses station. Olga Herrera stood updating charts. “You guys handle the floor all right while Donald and I were gone?”

“Sure. Mr. Oliphant was the only problem . . . the pain again.”

Something nagged at Lauren. Having tended many cancer patients over the years, she knew even in their final days the effects of morphine comforted them, kept them from being driven insane with pain as the cancer ate through them.

“Where’s Mr. Oliphant’s chart?”

“Right here,” Olga said, sliding it across the countertop.

Already reading the chart, Lauren said, “If anything comes up, I’ll be in the lounge for awhile.”

She found the lounge deserted, thankfully. She wanted to examine the chart, hoping to discover nothing out of the ordinary, but fearing she would. After ten minutes she realized she would need additional information. Retracing her steps to the nurses’ station, she pulled the nursing schedules for the previous week from the file cabinet and took them back to the lounge. In another fifteen minutes she managed to correlate the schedules with the notations of excessive pain noted in Mr. Oliphant’s chart.

Only three nurses had been on duty simultaneously during the shifts when the man’s pain worsened: Olga Herrera, Donald Arrington, and herself.

Olga was new, having worked only two months at St. Matthews. Young and energetic, she did not fit the profile one would expect from someone hooked on morphine. On the other hand, Donald’s tenure with the hospital for eight years spoke well of him. He also demonstrated no signs of addiction to any drug. Then, as though a curtain were lifted from her senses, Lauren knew the answer.

She heard the door squeak open behind her and twisted in her chair. Donald. He saw the chart and time sheets spread out on the table. His initial smile slipped into a frown.

Lauren felt a deep sadness for the action she knew she must take. Donald was a friend, and an excellent nurse, but the truth must come out. “For Bob, Donald?” she sighed.

“What?” he asked, feigning ignorance.

“Your boyfriend. You’ve been stealing morphine from Mr. Oliphant’s administration bottles for Bob, haven’t you?”

“I don’t know what you’re—”

“Donald, don’t lie to me. I care about you. If I called the Medical Director and asked him to have Mr. Oliphant’s morphine tested, they would find it has been diluted with sterile water . . . wouldn’t they?”

Donald pulled out a chair and sat across from Lauren. Large tears rolled down his cheeks. “Bob is still having so much pain from his back surgery, and his doctor refused to prescribe continued painkillers . . . I can’t bear to see him in such misery.”

“He isn’t in pain, Donald. You know that. He’s become addicted to the morphine,” Lauren said softly.

Donald’s perfect face contorted with emotion. “I . . . I know. But I still had to help him. I love him, Lauren.”

“Doesn’t the pain you caused Mr. Oliphant bother you? That poor man . . . .”

“Yes, it bothers me! I’m a nurse, Lauren. I’ve spent my whole career trying to make patients more comfortable, to help them recover or to die with dignity. But Bob . . . .”

“How did you do it?” Lauren interrupted.

Donald swallowed hard. Sniffed. “Whenever another nurse hooked up a fresh vial, I’d wait until Mr. Oliphant fell asleep. Then I would remove the bottle, draw off half the morphine in a syringe, and replace it with sterile water from another syringe.”

“No wonder he hurt so badly. He was getting only half the dosage he needed.”

“What are you going to do, Lauren?” Donald, asked, regaining his composure.

“You know what I should do. I should report this to the Medical Director. You would be terminated and possibly prosecuted. You could lose your nursing license.”

Donald nodded resignedly.

“But you are a good nurse. If you’ll promise to get Bob into rehab, and take a leave of absence from the hospital until he’s over his addiction, I’ll keep this between the two of us. If you really love Bob, you’ll do this for him. If he loves you, he’ll let you.”

Donald stood, leaned forward, and kissed Lauren’s forehead. “Thank you. I would have bet you would just report me and get it over with. No-nonsense Lauren . . . cold and predictably proper.”

Her eyes met his. “A week ago you would have won that bet. Take care. And, Donald . . . give me the morphine.”

He withdrew the syringe from his jacket pocket and handed it to her. When he left, she spurted the painkiller down the sink and disposed of the syringe in the sharps disposal.

Lauren gathered up her evidence and returned it to the file. Then she went to Mr. Oliphant’s room and “accidentally” knocked over the bottle of diluted morphine. It shattered on the tile floor. She replaced it with a fresh bottle and wrote up a report concerning the breakage and loss of the narcotic.

A very long day came to an end.