Cell (17 page)

EMERGENCY DEPARTMENT

L.A. UNIVERSITY MEDICAL CENTER

WESTWOOD, LOS ANGELES, CALIFORNIA

THURSDAY, JULY 3, 2014, 1:14
P.M.

G
eorge walked back into the emergency room. He wanted to find Kelley and check Laney's condition. The ER was really busy, not quite as bad as it had been early that morning, but with the heat wave still going strong it was busier than usual for the time of day. Kelley and all the other ER doctors were just trying to keep their heads above water. It took George a few minutes to locate her and ask if the OB consult had seen Laney. He had expected to have been paged if the consult had shown up, but it hadn't happened.

“They are still busy upstairs, so not yet, but the resident slotted to do the consult called about fifteen minutes ago and said that she would be down within the hour. They're wrapping up a couple of final deliveries.”

“Did you tell Laney . . . about the ultrasound result?” George asked.

“My senior resident did. I just couldn't handle it. But he did a good job, and it was a good learning experience for me. She took it better than I feared.”

“I hope you don't feel that I copped out.”

“Not at all. I understand. Actually at one point I thought about going into radiology to avoid such situations. We're doctors, but we're human, too. But in the end, the drama of ER medicine was too much to pass up. I felt that after all those years of schooling I wasn't about to shortchange myself.” She stopped and glanced up at George. He had stiffened up on that last comment. “I'm sorry. I didn't mean it like that.”

George put up his hands. “Don't apologize. I'm not offended.” But in truth he was, a little. He took a step away but then turned back, remembering something else. “One more thing. Do you know offhand which of the ER residents was in charge of DeAngelis's case?”

“I don't know, but I can find out.”

“Please do. I want to ask about the self-inflicted wounds.”

“I'll find out the name for you.”

“Thanks. Hope you guys catch up before the evening commute.”

Kelley nodded before heading back into the fray.

George returned to the imaging room and went over the latest films with Carlos. About forty minutes later Kelley walked in with a tall, African American woman. George got to his feet as Kelley introduced her as Dr. Christine Williams, one of the senior OB residents.

George said he wanted to make sure she knew the results of the ultrasound before she saw the patient and offered to go over it with her if she wanted.

“Actually I already saw the ultrasound report,” Christine said. “How did you get it in the record so quickly?”

“I put a rush on it so that it would be there for you. We knew how important it was going to be in determining how the case should be handled. I assume you will be trying to convince her to abort?”

“I can already give you some feedback on the patient,” Kelley offered. “After my senior resident gave Laney the results of the ultrasound, Laney said she would still not abort, no matter what.”

They were silent for a moment.

“Well, let me examine the patient and talk to her,” Christine finally said. “With her cardiac status and the fact that the fetus is not viable, it would be tragic to let her try to deliver.”

George felt terrible about the case. Once again a study he was involved with had changed someone's life, and not necessarily for the better, although in this case the imaging might save the patient's life. And to think that he believed radiology was going to be a shield from such things.

“Thanks for offering to go over the ultrasound with me,” Christine said. “But it's not necessary. Instead I'd like to see the patient.”

“If it is all right with you, I'd like to come,” George said. “Laney and I go back a ways. Maybe I can offer her a bit of support. She doesn't have any friends that I know of.”

“Be my guest,” Christine said graciously.

They made their way down the long hallway. As they walked, Kelley caught George's eye and gave him a thumbs-up sign in recognition that he was doing something a bit more than the usual radiologist might.

The door to Laney's room was closed. “We've let her sleep,” Kelley explained. “She was exhausted.” Kelley knocked on the door gently so as not to frighten the young woman. When she didn't hear any response, she knocked harder and called out Laney's name. Still there was no sound from within. A shadow of concern crossed Kelley's face. She opened the door and all three doctors stepped into the windowless room. The lights had been dimmed.

Laney appeared to be asleep. Kelley called out to her again as she approached the side of the bed. George and Christine went to the opposite side. Kelley gave Laney's arm a gentle shake. “Laney?” There was no response. She tried again. “Laney? Are you all right?” Still no response.

Concern ratcheted up in the room.

“Laney?” George yelled as he reached to check her pulse. He couldn't find one. “There's no pulse!”

Kelley quickly opened each of Laney's eyes between her thumb and index finger and shined in a penlight. The pupils were dilated and nonreactive. “She's not breathing!” Kelley cried.

“My God,” George blurted as he yanked the pillow from beneath Laney's head. He leaped up onto the bed to begin CPR, noticing Laney was loosely holding her phone in her right hand. Christine grabbed an ambu bag from the top of an oxygen cylinder while Kelley used the intercom to call a code.

Within two minutes an entire resuscitative team headed by a senior resident swept into the room and went to work on the patient. Having gotten wind of what was going on, even Carlos appeared just as it was announced that Laney had flatlined, meaning there was no cardiac activity whatsoever. A moment later someone called out that Laney's temperature had fallen below ninety degrees Fahrenheit. Regardless of the negative signs, they feverishly continued their attempt to resuscitate her.

With nothing to do, George turned on Laney's phone. He pressed the iDoc app icon just as he had with Kasey's. He saw that, as with Kasey's, the iDoc app had been shut down and wiped clean more than an hour previously. Knowing what he did, he guessed it meant that Laney had not had a heartbeat for all that time.

“I think she's been dead an hour,” George announced. He held up the phone. “According to iDoc, anyway.”

“An hour!” The leader of the resuscitation team motioned to the man doing the chest compressions to stop. “Now we know why we haven't been able to get any cardiac activity. An hour? Christ! This patient is long dead! That's it. Let's pack it up, guys! Even if we managed to get a heartbeat, the brain would be gone.”

The team began gathering up their gear. George, Kelley, Carlos, and Christine appeared transfixed by the situation.

On his way out of the room, the head of the resuscitation team approached George, who he knew was a senior resident. “Dead an hour? That doesn't look good for our ER. How long was the patient left alone?”

“Almost two hours,” Kelley said, answering for George. “I'm the junior resident assigned to the patient.”

“What is this, your third day?” the team leader questioned. He let out a long, slow whistle. “They'll have fun with this one at the morbidity and mortality conference. Let's hope the media doesn't find out about it. But I suppose we shouldn't be surprised. It is July!” He snickered as he herded his team out the door.

It was a devastating parting shot to the first-year resident. Everybody in the room knew what he meant by “July.”

For a moment George couldn't speak. Laney's death had brought back the horror he had felt waking up next to Kasey's corpse. She, too, had been dead long enough to be cold. Again the question came back: Why was death stalking him? Or was it rather that he was somehow the culprit, bringing death to everyone around him, starting with his own mother?

“Oh, my God!” Kelley said, forcing back tears. “What a disaster. I feel so bad. I should have checked on her.”

One of the ER nurses put her arm around Kelley's shoulders. “It wasn't your fault. Don't listen to that resident. Nurses and orderlies should have checked on her, too. If it was anybody's fault, it was everybody's.”

“What that resident said was completely uncalled-for and mean,” Carlos said, waiting for George as the most senior resident to speak.

“If it was anybody's fault, it was ours,” Christine said. “OB shouldn't have made her wait. Sometimes the system just doesn't work. We should probably have one resident in charge of ER consults rather than just relying on who happens to be free.”

George remained silent, staring at Laney's lifeless face. He wandered out of the room, ignoring the others. He couldn't shake the sense that something was wrong in his world. Very wrong.

EMERGENCY DEPARTMENT

L.A. UNIVERSITY MEDICAL CENTER

WESTWOOD, LOS ANGELES, CALIFORNIA

THURSDAY, JULY 3, 2014, 3:31
P.M.

C
arlos brought up a chest X-ray on the monitor and gave the pertinent history of the patient to George, sitting next to him. Carlos was still chafing at George for not standing up for Kelley. Like everybody else, Carlos knew that Laney's death was a system error, meaning there were a number of people who could be faulted. The senior medical resident's picking on a first-year resident amounted to bullying.

“What's your take on this film?” Carlos asked, his voice reflecting his disappointment at George's reaction to the incident. “Do you think there's a secondary finding?” The X-ray had been taken to evaluate probable rib fractures, but Carlos had spotted a possible secondary finding. He wasn't sure whether or not there was hilar lymphadenopathy, or swollen lymph nodes, at the portion of the lung that carried all the blood vessels to and from the lung as well as the bronchial tubes. Carlos knew that lymphadenopathy was a finding common with a number of infectious diseases but could also signify lung cancer. Although detecting it obviously carried a great significance, it wasn't a black-and-white call.

George was staring blankly at the monitor and didn't respond.

“Are you okay?” Carlos asked. His disgruntlement was changing to concern.

George broke from his trance. “Sorry. I'm a little preoccupied, I guess.” He stood up. “Excuse me. We'll finish up with this current batch of films later.”

George left the imaging room, aware that Carlos was most likely mystified by his behavior and wondering when George was going to snap out of his reaction to Laney Chesney's death. He imagined that Carlos would have believed that George, as a fourth-year resident, should be inured to such incidents.

George was on a mission. He knew he was supposed to be at the radiology conference at four, which didn't leave much time, but he decided he needed to talk to Kelley Babcock. As bad as he felt about Laney, he was sure she felt worse. He found her sitting alone in the doctors' lounge, hunched over a cup of coffee.

“Kelley?”

She looked up. George could see her eyes were red.

“You mind?” He nodded to the empty chair next to her.

“I don't own it.”

Not the most welcoming of invitations to join someone, but he took it anyway.

“Dr. Warren Knox,” Kelley said unbidden.

“Pardon?”

“You asked me who the ER resident in charge of the DeAngelis case was. It was Dr. Knox. But he has the day off.”

“Thanks. I'll talk to him the next time he's on duty. But that's not why I'm here.” He cleared his throat and began. “I recently had two people on whom I'd done MRIs pass away.” He paused, thinking of the best way to phrase what he wanted to say. “I take it personally when a patient dies, too. Maybe I should have learned better how to compartmentalize, put it in a box—I mean, it's not like I don't put it in a box. I do. But I only pretend the box is shut tight, and things leak out.”

Kelley looked up at him, curious.

“I guess what I'm trying to say is that I'm sorry. I was upset and . . . I should have stood up for you with that medical resident. He was definitely out of line when—”

“Thanks. But it's not just me or my guilt I'm upset about. I mean, I should have gone back to check on her, I accept that lapse. But it is also something else. It's just . . . the unfairness of who gets dealt a bad hand. Why have I been so lucky? She was so young.” Kelley stirred her coffee absently. “When my father died I thought my life was over. I was home alone with him. . . .” She paused. “I was just a dumb thirteen-year-old teenager, and there I was with my father having a heart attack right in front of me. She shook her head at the memory. “I wanted so badly to be able to help.” She looked up at George. “It's probably why I went into medicine, and emergency medicine in particular. But now that I'm here, my great fear is about somebody coming in that ER door needing and expecting Superwoman and getting a very ordinary, scared little girl from Kansas who can make mistakes.”

George watched Kelley as she went back to stirring her coffee. He thought she was possibly more beautiful on the inside than on the outside. Now, that was something.

“I don't know what you think about my opinion,” George said. “But I am one hundred percent sure you are going to be a super ER doctor. I mean it.”

“Thank you. That's a real compliment coming from someone in his fourth year.”

“Despite what that medical resident said, don't beat yourself up about Laney Chesney. Like the nurse said, we all have to take some blame. Hell, even me. I told her to get some sleep, and I'm the one who wanted the OB consult to come see me before going to her. That was an added delay.”

“You're just trying to make me feel better.”

George sat quietly a moment, then looked up. “You're right. But I'm beginning to think it wouldn't have mattered even if she had been checked on by you or anyone else.”

Kelley looked at him, puzzled.

George looked around to make sure no one was listening in. Suddenly, in response to her honesty, he had the urge to be totally open with her. “I know this is going to sound a bit off the wall, but people are dropping like flies around me. I mean, I'm seriously beginning to think I'm the Grim Reaper.”

“What do you mean?”

“They're all very sick to begin with, don't get me wrong. But they're still dying before they should be.”

“I'm not following you.”

George counted on his fingers, “Kasey Lynch, Greg Tarkington, Claire Wong, Sal DeAngelis, and now Laney Chesney. Five people. My fiancée, my next-door neighbor, and three patients. My fiancée was three months ago, then the other four in the past three days.” He absentmindedly took Sal's cell phone from his jacket pocket and set it on the table.

“Fiancée?” Kelley appeared dumbfounded. “Your fiancée died?”

“Unfortunately, yes. But I don't mean to drop that on you.” He looked her in the eye. “As bad as that was, and believe me it was bad, it's like these deaths are accelerating.” He paused, worried that he was coming off as a crazy. “I feel as if death has been following me around, and I should be doing something about it.”

“What can you possibly do?”

He shrugged. “It's just a feeling I have.” He suddenly felt embarrassed, wondering what could have made him open up with someone he hardly knew but would like to get to know. “Sorry. Forget I said all that. The point I'm trying to make is that I might have had more to do with Laney's death than anyone.”

Kelley looked at George skeptically. “Are you being serious?”

“I don't know, to tell the truth. Anyway, don't be too hard on yourself about Laney. I don't think it was your fault in the slightest.”

Kelley looked at the smashed-up phone that he was twirling absently on the table. “Cracked your screen, I see. Did the same with mine, but not nearly that bad.”

George looked down. “No, this isn't mine.” Earlier, with the help of a charging wire, he'd managed to get the screen to come on.

“I see it has the iDoc app.”

“Yeah, it does. Well, it did, anyway.”

“You seemed to know a lot about iDoc when we talked earlier.”

“I've been learning quite a bit. A crash course, you could say. For better or worse it's going to play a big part of medical care in the near future. Medicine as we know it is going to change dramatically.”

“Really?” Kelley said. She straightened up in her chair. “I'd love to hear more about it.”

George gave her a five-minute summary of what he knew about iDoc. She seemed intrigued. Her eyes never left his face.

Just then the door to the lounge opened and a nurse stuck her head in. “Doctor Babcock, your presence is required in the emergency room.”