Chaos at Crescent City Medical Center (13 page)

"I'll ask him.   I'm sure
he'll come if he can
.  If not, he'll send
Andre Renou.  I'll check it out and get back to you
."

Elizabeth continued, "We have to
draft something for the press
and anticipate the questions the press will ask us.  Can we do that now?"

Alex intervened.  "I'm in favor of what you're suggesting, but first, there's another problem that takes priority."   Alex looked around the table as she spoke.  "I've just returned from a meeting in nursing administration.  Our sick calls are up fifty percent today.  Only half of the scheduled nursing staff
ha
ve
reported to work."

Don
jumped up from the table and screamed at her
. "Fifty percent of the staff called in sick?  Who the hell's taking care of the patients?  We can't
run a hospital on
half-staff
. We’ll be broke sooner than later.  What a pile of shit all of this is
!
  This is fricking insane!
”
Don's voice was loud, angry.

Alex continued,
talking over Don’s outrage.
"The hardest hit areas are medicine and surgery.  The ICU's are okay
and so is the ED
.  So are the maternal-child
areas.  I asked Bette and her nursing
managers
to develop an emergency staffing plan and close several units to
combine staff so we can offer safe care."

Don
’s
face was beet red a
s he
jumped up
from his chair,
"No, no, no, h
ell no.
We will
not
close
beds or units," he retorted angrily
.  "It's unthinkable
!
  What'll this look like to the public
, to our competitors who are probably laughing their asses off at us
already?
I still think all of this is corporate espionage.  We will NOT close beds or t
he next thing you know, we'll have to close the damn hospital
!
"

Dr. Ashley said
pleadingly
, "Don, we have to close beds.  We don't have any nursing staff to take care of these patients.
  Besides, it will save us money in the long run.”
 

Don thought for a moment and said,
“
If we close half of our beds, we won't have an image, because we won't have a hospital.  It's preposterous.  Do you realize how much money each closed bed costs
the hospital?  A hit like this will kill us
.  I feel like I'm being blackmai
led. You have to find something better to do
,
” Don
said as he
pounded his fist on the table.

Alex couldn't believe he was reacting this way.
He was like a child in a rage.  What an imbecile.
  "Don, we have to do this.  We don't have a choice."  She was beginning to think that Don and Bette were joined at the hip.  "We have to combine resources.  We have a lot of patients and need full staff for
heaven’s
sake.  The ratios are low anyway, barely adequate in some areas
and hardly meet national standards.  That’s always been a
huge
risk for us.   We need a plan
designed to ma
ximize resources as best we can
and to keep as many beds open as possible.  I'll ask Bette to ca
ll Louisiana State University and Loyola
and offer overtime to all nursing students.
  Meanwhile, we'll call
Tulane and see if they can help us out with morning care.  We'll also check with the agencies for extra help.  We'll never get these patients back in here for care if we don't handle this situation correctly.  John, can you arrange to have our inpatient admissions redirected?  We probably should consider directing the emergency department patients to oth
er hospitals and distribute the ED
staff to cover the house.
”

John nodded in agreement.
"Yes
, Alex
, of course.  I think you're on target.  I'll call a meeting of the medical staff this afternoon.  We can also reschedule elective surgery for the next few days.  If possible, I'd like to keep the emergency department open since we're the major trauma center in New Orleans." 

John was surprisingly calm in assessing the situation and Alex was grateful for his ability to work under pressure.  She nodded her support for keeping the ED open.

Do
n remained red-faced and sullen
. 

John glanced around the table and asked
, "Anyone know why we've
had
all of these sick calls? 
Is it
associated with
yesterday?
"

Alex said, "That question came up at the nursing
meeting.  No one had any explanation
for the deluge of sick calls."

Robert looked
up
and shaking his head
said quietly, "
Yeah.
I know why.  It's very simple, if you think about it.
  It is about yesterday.
"

All of them star
e
d at him, looking perplexed.  "Speak, Bonnet," Montgomery roared.

"Voodoo legend says that if you accept the curse, that is, if you accept the voodoo, then you assume the curse.  In this case, people who believe in voodoo would assume the curse by reporting to work. 
Even people who don’t believe
in curses
are scared. 
That's why the police can't find Bessie Comstock
, the nursing assistant,
and they won't find her anytime soon.
She’s most likely left town, trying to escape what happened in Mrs. Raccine’s room.
I had several physicians tell me this morning that they're admitting their patients to other hospitals.  Simply put, the staff and the physicians are afraid
to admit here and won’t because they will most likely lose patients
."

“What did you say?” Don roared.  “
They are admitting
to other hospitals?
  I want those damn
, fucking doctor
traitors taken off our medical staff
list
.  They no longer have privileges here, Bonnet.  You tell them that.”

No one responded to Don,
so Robert continued, "Basically, I think we're lucky to have half of the staff here.  I'm surprised that many reported."

Elizabeth looked at Robert.  "Dr. Bonnet, how long do you expect this to continue?  How long will people stay out of work?"

Don answered before Robert could speak.  "They'll either get their asses back here tomorrow, or they're
fucking
fired
!
" 
In a fit of temper,
Don left the room
.
  The rest of the executive team looked at each other. 

Elizabeth
shrugged her shoulders and
finally spoke, "I don't know if it's worse when he doesn't speak at all, or when he screams at u
s.  Either way, he's pretty useless
."

Dr. Ashley nodded his head in agreement.  "You're right.  He certainly isn't helping at all.  Where does he think he's going to hire staff?  If what Robert says is right, no one'll work here.  Robert, how long before this
blows over?"

"Don't know.  It'll depend in part on how well Mrs. Raccine recovers.  The other part will depend on how well we handle the situation.  Firing people won't help."

"Don't worry.  I'll talk with Don a little later.  Let's get to work. 
I’ve got to go. 
I've got patients to see."  Dr. Ashley spoke authoritatively.

***

The executive team worked until almost noon on the press conference and staffing plan.  Shortly before then, Alex toured
the medicine and surgery units and found that things
were going surprisingly well. 
Sixteen fi
rst-year nursing students from LSU
were
giving baths and making beds.  Also, Delgado Community College had sent over ten nursing students.  Alex was pleased at the cooperation between the local university, colleges, and hospital.  The nursing vice-presidents reported that an additional twelve nursing stud
ents were coming in for the evening
shift.  Bette was nowhere to be found.

* * *

Alex grabbed a bite for lunch in the cafeteria and returned to her office a lit
tle after one.  Bridgett was in but looked unwell.

"Bridge, how you feeling?"

"Much
better
, thanks
.  How're things going," Bridgett
had a strained look on her face and she was quiet
, a total contra
s
t to her normally vivacious self
.

"Better
than I would have anticipated early this morning
,” Alex replied.
 
“
What's the rumor
mill saying
about the Raccine case and voodoo?"

"The usual, what you'd expect."
There was no eye contact and Bridget looked at her computer screen.

"Bridgett, what's going on?  You know everything that goes on in this place.
You are my grapevine!
What gives? You've been awfully quiet lately
.  Is
anything happening with you I need to know about?"  Alex gave her secretary a hard look.

Bridgett's voice was hesitant.  "No.  Not at all.  Just didn't feel well yesterday.  I knew you'd be out most of the day, so I left about
two.
"  Bridgett had kept her eyes on her computer screen the entire time she was talking to Alex.

"Bridge, you're acting weird.  Look at me." 

Bridgett looked up from her computer.  "Alex, I don't want to talk about the Raccine case or the staff shortages.  As a matter of fact, I'm thinking about resigning.  Darryl wants me to
stay at home with the baby."

Alex
stood, looking at her in amazement as she
finally
realized what was wrong.  Bridget
t was Cajun and was scared.  Bridgett
believed in voodoo and was afraid that
,
by reporting to work, she'd assume the curse.

“OK, I get it. 
I understand wh
at's happening here.  Take some time off, all
you need to, but don't resign.  I need you too badly.  Take the time you need, and we'll talk later."

"Thanks, Al.  Thank you for understanding.  I'll stay
awhile
today and finish up.  Then I'll decide what to do."  Bridgett
looked relieved as she continued to type
.

Alex went into her office
, decided to take a stress break
and phoned Mitch.  He was in, but his voice soun
ded strange, cold.  He told her he was busy and
couldn't talk, saying he had to get downtown.  It was
an unusual and tense
--
the
tersest
conversation
she had
ever had
with Mitch
and
Alex was baffled
.
 

xxx

The ponytailed stranger,
Monte Salvadal
,
stood across the street from the
busy CCMC emergency department.
Hordes of people entered and left through the glass doors.
  Business was looking good for CCMC—at
least for now.  H
e smiled to himself.
 

After several minutes Salvadal became
impatient. 
The evil one hated to
hire people, preferring to do
all
his own work.  At least that way all would go smoothly.  He saw
Frederico
smoking a
cigar across
the street
.
  The gangster waved his hat in greeting, but the evil man ignored him.  He detested the stocky man and his gangster tactics.
 
He just wa
nted to get the fuck out of New Orleans
.  He hated this town.

Sandy Pilschner, RN Nurse
Manager
of the CCMC Emergency
Department
was
working on a staffing plan
in he
r office
.  Her boss, Diane Bradley, was meeting with her to determine if the emergency department could send several nurses to Surgery to help out over the next few days. 

Sandy said gratefully, "Thank goodness it isn't the weekend
!
W
ith the shootings in this town, we'
re always running.  We'd
be up the creek if it were Friday.  We had six shootings last Saturday night."

Before Diane could reply, both nurses heard several strange crackling sounds coming from the patient care area of the emergency department.  They also heard loud voices. 

"Sounds like an equipment malfunction.  I'll go check it."  Diane immediately left
,
and with a sense of foreboding, Sandy
quickly
followed.

As Sandy and Diane entered the open area of the emergency department, two reception clerks were screaming.  They could hear gunfire in the patient reception area.  Before anyone could act, a
masked gunman, carrying a machine gun
, entered the open area of the emergency department and bega
n shooting.  An ER
physician
immediately lunged towards him but was shot.  Blood spurted
everywhere.  The physician, Dr.
Ron Davis, fell to the floor, with half of his head missing. 

The gunman swung around
, still firing
. 
Bullet
s dismantle
d the patient care area and
oxygen and carbo
n dioxide tanks
released gas
that
caused
a cloud of gas vapor
in the area.

"Down on the floor, all of you," the gunman screamed.  Before the staff could hit the floor, a second gunman appeared.  He began pulling open patient privacy curtains
and shooting up the patient care areas.  He laughed at the terrified patients.
Glass cylinde
rs and IV bottles exploded with
the gunshots.
A burning smell permeated the ED area from two computer work stations that had been destroyed by gunfire.
A large shard of glass hit the second
gunman in the forehead, and caused
a burst of blood from a superficial head wound.  The shooter went wild, screaming, "I've been hit, I've been hit.  I'm bleeding.  Where's the son-of-a-bitch who shot me
!
"  The gunman, blood pouring from his head wound, turned his gun on the staff members, crouching and crying on the floor.   Another burst of weapon fire hit an emergency department staff nurse from behind as she lay crouched behind a supply cart. 
She slumped forward.

Diane heard the telltale be
ep of a cardiac monitor in bed four
,
that symbolized
the beginning of a heart attack.  She stood helpless for what seemed like hours as the monitor screen displayed a dangerously rapid heart rate.  Finally, the line of the monitor was flat, signifying a cardiac arrest.  Diane, without thinking,
intuitively moved toward
the patient and cut on the cardiac defibrillator. 

The first gunman screamed at Sandy.  "Get me the drugs
!
G
et me the drugs
, bitch
!
  Now
!
  Now, dammit
!
  Move
!
" 

S
andy got up and began m
oving towards the narcotics cabinet
but realized that she had no key to the locked bin.  She immediately began throwing vials of saline, sterile water, needles, and plastic bags of intravenous fluids at the gunman. 

The gunman looked at the vials and screamed at Sandy, "Don't give me this shit.  Open that goddamn cart
and cabinet and give me the drugs, now
.  A nurse
, crouched behind a bed,
slid
Sandy
her
set of narcotic keys.  As Sandy picked them up, the gunman moved closer to her.  Sandy could literally smell sweat, body odor and gunpowder as he leaned over her shoulder
and looked
at the locked narcotics bin.  He was within a foot of Diane.  The second gunman had momentarily stopped shooting and, temporarily unable to see, was frantically wiping blood out of his eyes.

As Sandy struggled to unlock the narcotics bin, Diane turned the cardi
ac defibrillator up to 360 joules
and moved closer to the gunman.  The shooter, intent on getting the drugs, didn't notice her.  Within a second, Diane
touched him with
the paddles sending the electricity surging
through his body.  The gunman turned toward Diane,
and dropped
the automatic weapon on the floor as the electricity surged through his body.  He tried to reach out to
grab
her
,
but his arms flailed
,
and he fell.  Diane again struck him with the paddles
,
a
nd the man immediately had a grand mal
seizure. He fell to the floor;
his body writhing with volts of current, his limbs and torso in spasm.
Foam covered his face.
Finally he lay still, except for a few involuntary jerking movements. 

The second gunman,
momentarily able to see, realized
his partner was down, ran to him,
and bent
over him for a moment.  Then he made a piercing animal-like noise
,
and turned his weapon on Diane, emptying several rounds into her body.  Diane fell forward onto the dead gunman's body.

The second gunman ran from the emergency department,
and collided
with a third man with a ponytail.  "Out, out, let's go.
Get the fuck out of here.
Johnnie's dead.
”
  The gunman and the man with the ponytail ran out of the
side emergency department door. The gunman shed his mask, ran
towards St
. Charles
Street,
and disappeared
into hundreds of costumed
revelers
. 

***

At three-thirty
,
Alex was completing her review of the
hospital
emergency staffing plan and preparing to go to administration to finalize
the plans for the five o'clock press conference when
Bridgett
screamed and
burst into
her
office
. 

"Alex, Alex, security just called.  There's been a shooting in the emergency department.  Come quick."

Alex and Bridgett ran to the stairs
and took the
three flights to the ground floor.  By the time they reached the emergency department,
they could hear telepage announcing a code red and a code blue in the ED.  Alex’s heart stood still
,
and she could barely
breathe
.  She was paralyzed with fear.  H
ospital security was clearing out patients
, families
and bystanders.  All available physicians were called to the emergency department.  A code orange was announced.  Alex's stomach reeled at Code Orange, the disaster code. 
She was struck by the memory of the
only other code orange she'd been a part of
.  It
had occurred shortly after her graduation from nursing school when she was a staff nurse at the Washington Hospital Center.  She'd been part of the rescue team that had pulled dozens of bodies out of the Potomac River after an airplane had
crashed shortly after takeoff from Re
a
gan National. Oh, please G
od, don't let this be as bad as that, she prayed.  

Bridgett and Alex ran past security into
the patient care area of the emergency department.  Alex gripped the door frame to keep from fainting and Bridgett doubled over, vomiting.  Blood was everywhere. 
The floors were sticky from spi
lled intravenous fluids. A
metallic
smell of blood,
gunpowder,
smoke
and sweat
permeated the area.
  The nois
e, while quiet, was
chill
ing
as
patients and staff cried softly to themselves.  Several staff members
remained in
shock
and crouched in corners of the patient care area
.  All seemed paralyzed in place
and everything seemed to be
moving
in slow
motion
.  Dr. Davis's
body was prostrate on the floor;
his face revealing the horror of his death.  A make-shift medical team was bending over the body of a nurse.  Alex couldn't tell who it was, so she moved to the side to see. 

"Oh no.  Oh no," Alex cried when she recognized Diane.  Her knees buckled.  She looked around for Bridgett, then saw her being lead off by a paramedic.  Alex vaguely noticed a fine spray of black powder all over the Emergency Depar
tment's brightly polished floor, sticking quickly to the spilled glucose fluids.

"Is she alive?  Is Diane alive?"  No one was paying any attention to
Alex
.  The medical team
were
busy
intubating Diane and several nurses were starting IV fluids.  She heard a physician she didn't recognize ca
ll for
10 units of
O negative
packed cells.  Other members were stanching the flow of blood from Diane's abdomen. 

"G
et her up to the OR STAT
!
  Maybe we'll be able to save her if the internal damage isn't too bad," the same physician was saying to the team.  "Take her out through the back.  This place is going to be crawling with cops and press any minute.  Dr. Bonnet's waiting in the OR.   If she's got any chance at all, it's with Bonnet." 

Diane was placed on a stretcher and rushed from the emergency department.  Then Alex noticed the body of the dead gunman and the slumped body of another emergency department nurse she didn't know.

Within moments, the entire emergency department was covered with New Orleans police. The crime
team retrieved the machine gun
and began dusting it for fingerprints.  Other policemen
were rolling the entire area in yellow crime tape,
taking photographs, videotaping the scene, and removing emergency department staff from the patient care area. 

The noise level in the emergency department became loud
er, almost deafening
and the smell of sweat, vomit, and gunpowder become intolerable
.
  There was a low hum of agonized human sound
s
coupled with static voices of police radios.  People were yelling at each other for help, and the trauma team w
ere
crashing intravenous bottles together and racing for equipment, in an attempt to treat other injured people. 

Alex noticed Don who appeared to be in a trance
.
His face was vacant and his eyes were unseeing.
She grabbed his arm. "Let's go to Sandy's office and pull ourselves together." 

Don willingly
, like a child,
allowed Alex to lead him out of the emergency department area.  Within seconds they were joined by Elizabeth and Dr. Ashley.

Alex realized that even Dr. Ashley was too traumatized to speak.  Elizabeth found her
voice and spoke first.  "What the hell is happening
?"   Before anyone could answer, Sandy Pilschner appeared.

Alex hugged her
and said, "Sandy, tell us what happened?"

Sandy's eyes looked wild, her pupils dilated
.  She braced herself
; she was visibl
y
shaking
. "I'll try.
I don’t know.
It happened so fast.   Diane and I were in here reviewing staffing.  We heard a crackling sound, some pops and then loud noise.  We ran to the patient care area just as a man with a gun was entering the room.  He made us lie down on the floor.  I don't know, I think they were after drugs."

Dr. Ashley said gently, "What about Dr. Davis?" 

Sandy continued her story,
"Ron
charged the gunman and
tried to t
ake the gun away
, but
the gunman
shot him. Then another
man with a gun
came in.  He started shooting up the place.  A piece of glass cut his face, and he was so mad he started shooting at us on the floor
,
and I think he hit Sheila. Then he asked me for drugs and he moved close to watch me open the narcotics cabinet. 
Then
Diane moved over and shocked him with the defibrillator.  He came at her, but missed and she shocked him again. 
I think h
e's dead
.  Then
his friend shot her.  Is Diane okay?   I'm so worried about her.
There was a lot of blood.
"   Sandy started crying uncontrollably, the
n stopped, her eyes again attempting to focus
.