Disaster Status (11 page)

Chapter Twelve

Iris smoothed the front of her crisp pink volunteer apron and smiled at Erin’s expression when she caught sight of her grandmother in the hospital chapel. Iris had been the first to arrive at the Friday morning Faith QD gathering and had kept her plan a surprise, partly because it was her first official day and she wasn’t yet sure of her duties, but mostly because she wasn’t sure how her overprotective granddaughter would react. Erin told her more than once that these meetings, meant to “jump-start our shifts with an infusion of faith,” often became emotional for staff who dealt daily with tragedy and death. Prayers were offered, encouragement given, but happy endings could never be guaranteed. It was the nature of their work. And Erin’s plan, apparently, was that Iris’s work never involved anything weightier than a giant cluster of Get Well balloons.

Erin gave Iris a hug as a few other employees filed in and walked toward the front of the chapel. “Nana, this is so great.”

Iris returned her hug and stepped back. “The flyer outside said all staff welcome, so . . .”

“So then—” Erin’s smile broadened as she gestured for the other employees to gather in a circle, then grasped her hand—“let’s get started.”

Iris glanced around the circle as the staff gathered hands: Arlene, the clerk Iris recognized from ER registration; a heavyset blonde wearing the navy scrubs assigned to ICU; a nurse in teddy bear print scrubs; and—holding Iris’s other hand—a young brunette with vivid blue eyes wearing a paper hair cap used in central service. She whispered to Iris, “I’m Brooklynn. Glad you’re joining us.”

Iris’s heart tugged. She’d almost forgotten what it felt like to be part of a team.

Erin squeezed Iris’s hand and looked at each face in the circle. “Any special prayers or concerns today?”

The blonde in navy nodded. “Our six-year-old from the pesticide incident. Ana’s still on a ventilator, and her family keeps waiting for her to open her eyes, but it hasn’t happened. I don’t speak Spanish, but I see it in their faces. I watch her mother kiss her fingers. . . . I feel how much they’re hurting. That poor family can use as many prayers as possible.”

“And I’m still asking for prayers for ten-year-old upstairs. Cody’s always so brave.” The nurse dressed in teddy bears shook her head, her eyes suddenly shiny with tears. “He even tries to comfort me when I have to stick him for IVs. His antibiotics are nearly complete, and then he’ll have the MRI. I can’t bear the thought he’ll have his leg amputated. My son’s his age. It seems so unfair, and . . .”

Arlene slid an arm around the nurse’s shoulders.

“Yes,” Erin said gently, “sometimes it feels absolutely that way.” She glanced at the others, and when no one had anything else to add, she bowed her head and the others followed suit. “Father, thank you for being here today. For entrusting us to do the work you would have us do and, in doing so, to know the joy that comes with giving. And when days are tough and we too are wounded, to know by faith that you intend healing for us as well. We ask special care for those patients we’ve mentioned today, that they, their families, and their caregivers feel your comforting presence and trust that you have a loving plan. . . .”

Iris prayed silently for an unconscious girl and a brave little boy she’d never met. And then added a prayer of gratitude for her granddaughter’s gift to these courageous and caring people. Faith QD: faith every day. She’d learned long ago that’s what it took.

+++

Leigh gulped coffee from a paper container as she walked toward ER, her third caffeine boost before 7 a.m. But even if she injected it directly into her veins, she doubted it would help. She’d been awakened by a call from her sister after midnight and spent more than an hour talking her down from her latest troubles. When Leigh finally got back to sleep, she’d dreamed Nick was on her doorstep dressed in his uniform and Kevlar vest . . . cradling a tiny baby in his arms.

Leigh groaned against the coffee’s plastic lid. Three days since he called saying the National Guard might send him to Pacific Point—
and that he wants to see me
—and no further word since. It didn’t look like they’d need the Guard, but the silence was like waiting for the other shoe to drop. No, it was like expecting a steel-toe Army boot to stomp on the remains of her heart.
Stay away, Nick.

She passed by the closed doors to the chapel, knowing that Erin was there leading her Faith QD. A good idea, she supposed, but prayer was a thing of the past for Leigh.
Like my husband, my baby, my home
. In the last year her life had turned into what could pass for a bad country song—betrayal, loss, and unbearable confusion and grief. One punch after another since she discovered her husband’s affair. She went from shell shock to anger to a sadness so deep she could barely drag herself out of bed. And then she’d miscarried, and the cycle started anew.

There finally came a point when she was certain even God was tired of listening to her misery. She reminded herself she was a doctor and there was work to do, lives to save; it was time to move on. She told herself to be grateful she wasn’t pregnant. She stopped praying for miracles and started thinking about escape, first by leaving San Francisco and now by . . . Her throat squeezed unexpectedly, her stomach sinking.
I told him I want a divorce. I finally said it.
She was sure God would disapprove. It was good she wasn’t talking to him anymore.

She took a long swallow of her coffee as she hurried on. No doubt Erin was asking God to “guide their day.” She’d said that was the general idea.
God in the ER?
Leigh smiled ruefully. They were short staffed on a Friday, and this doctor was running on fumes. At the very least, they could use some mercy.

But it didn’t happen. And in less than thirty minutes, adrenaline filled the gap where Leigh’s caffeine fell short. Their first patient of the morning arrived swirling the drain.

“Talk to me,” she told the husky and perspiring paramedic, her gaze never leaving the African American woman lying dentureless and somnolent on the ambulance stretcher. The woman’s eyes remained fixed in an upward gaze, and an oral airway protruded from her lips beneath an inflated non-rebreather oxygen mask. Her respirations were deep and snoring, her breath sour.

“Charlene Bailey. Sixty-two-year-old type 2 diabetic, awakened at 6 a.m. by the worst headache of her life,” the medic reported as his partners transferred the patient from their stretcher to the ER gurney. “Agitation, vomiting, history of hypertension. Those are her meds.” He wiped his sweaty forehead with his hand and pointed to his notes. “We just got 240 over 110 as we pulled in.”

“Blood sugar?” Leigh asked as Judy switched the oxygen from the portable tank to the wall source and checked the IV line. Erin attached the cardiac monitor leads and then the BP cuff and pulse ox finger probe.

“Glucose 140,” the medic said.

“Still verbalizing?” Leigh asked, checking the cardiac monitor.
Rate a little slow at 58.

“She was.” The paramedic glanced toward the doorway. “Her family should be here any minute. Husband said she was holding her head, pacing around and ‘talking kind of crazy.’ He called their son at work to come over and help him figure out what to do. The son took one look and called 911. But she was incoherent by the time we got there and on the ride in she deteriorated to this. I gave her a Glasgow Coma Scale of 8. Maybe down to a 7 now—that posturing just started.” He indicated the woman’s right arm, bending at the elbow and curling stiffly inward. Her fist twisted against her chest in response to Erin’s needle stick on the opposite arm.

Leigh looked at the woman’s legs, extended and stiff.
Decorticate movements . . . increasing pressure on the brain.
Ominous signs.

“Pressure’s 248 over 112, heart rate 56, respirations 24, oxygen saturation 99 percent on high flow.” Judy pressed a handheld thermometer to the patient’s ear canal. “Temp 99.2.”

“I’ve got blood for all the labs,” Erin said, collecting the last in a rainbow of capped tubes. “And the stroke team’s on its way.”

“Good.” Leigh pulled off her lab coat, draped it over an IV pole, and moved to the head of the bed as she spotted a respiratory therapist arriving with the ventilator. “Let’s get this woman intubated so we can protect her airway.” She nodded at Erin. “We’ll titrate nitroprusside for that blood pressure. I want something we can pull back on if she deteriorates and gets hypotensive.” She sighed, catching a glimpse of a handsome, bearded African American man, his face etched with worry, pacing outside the room. “Slip in a Foley catheter when I’m done. Go ahead and get the Nipride on board. I want Mrs. Bailey on her way to the CT scanner stat; we need to know if this is a bleed. Time is brain, folks.”

Leigh stepped aside as the respiratory therapist fitted an Ambu mask over the patient’s face. He squeezed the attached football-size bag, hyper-oxygenating the woman’s lungs in preparation for placement of the breathing tube.

Leigh turned at the sound of soft crying outside the code room and saw that more family had joined Mr. Bailey. A tearful young woman and a good-looking man wearing police blues. He was holding an infant. She struggled against the memory of her fitful dream.
Nick. Our baby.

The paramedic spoke beside her. “That’s Mrs. Bailey’s son, the one who called us. He works nights for Pacific Point PD. And he’s very worried about his mother’s condition.”

Leigh reached toward the tray Erin had prepared for her: stainless steel laryngoscope, a range of cuffed endotracheal tubes with a flexible metal wire guide, anesthetic lubricant, syringe for inflating the tube’s cuff, and a CO
2
detector. Erin would stand by with suction, and with any luck Leigh would get the breathing tube properly placed—just distal to the white-edged vocal cords—on the first try. They’d tape it in place and get a quick portable chest X-ray to be certain of its position. Then Mrs. Bailey could go on to the CT scanner, with a nurse accompanying her.

Leigh glanced at her charge nurse. “Erin, I want you to go with Mrs. Bailey to the scanner.”

“Sure.”

“Thank you.” Leigh positioned her patient’s head into sniffing position. She lifted the laryngoscope and checked its light source, while trying not to hear the sound of the baby crying in the outer hallway. Erin would pray for this woman. She probably was right this moment. And that was good because Charlene Bailey’s son had reason to be very, very worried. His mother’s prognosis was grim.

Leigh stroked a gloved fingertip across her patient’s cheek.
Stay with me, Charlene. I’m trying to save your life.

+++

Iris stopped the library cart in the pediatrics department hallway, feeling a goose-bumpy wave of déjà vu. She’d walked this same corridor fifty years ago as a student nurse in a starched uniform and white stockings, with shiny bandage scissors, long hair swept high off her shoulders, cap pinned securely in place, and a sparkly new engagement ring on her finger. Iris’s eyes misted unexpectedly.
Doug, I’m here again.
She sighed. Erin was wrong. It felt wonderful to be working in a hospital and completely different from the long, painful vigil she’d kept at her husband’s bedside.
Because I’m beginning something, not waiting for an ending.

Iris battled a twinge of guilt. She’d let her granddaughter assume she’d be working in the Little Mercies Gift Shop, away from direct patient contact. Erin was worried that being close to pain and tragedy would be too hard on Iris. She hadn’t said so in words, but Iris saw it in her eyes. As usual, her granddaughter was fighting to protect her.
My little Wonder Woman.
But what Erin didn’t know wouldn’t hurt her. Or Iris. There was no risk in being here. Bottom line, she needed this.
And maybe somebody here needs me.

Iris took hold of the handle and pushed the book-laden cart along the corridor, then stopped and backed up as a young voice called from the patient room nearest to the housekeeping closet. A blond boy, maybe nine or ten years old. With his leg on a pillow . . .
The boy we prayed for this morning?

“Oh, great! Cool! I thought I was going to have to wait until this afternoon,” the boy gushed, his infectious grin punctuated by a single dimple. He shoved himself upright in bed, wincing briefly as his bandaged right leg shifted with the movement. “I finished my homework, and there’s nothing on TV except—” his nose wrinkled—“some girl thing about painting your toes. You’re saving my life!”

Saving his life.
Iris laughed and felt a second rush of goose bumps. “Good deal, then. It so happens there’s nothing in this world I’d rather do.” She pushed the cart into the room, then stepped close and extended her hand to the tousle-headed boy. “I’m Iris.”

His blue eyes twinkled as he grasped her hand, small fingers warm against hers. “I’m Cody.”

Chapter Thirteen

Erin stood in the quiet room holding a box of Kleenex—and her breath—as Leigh spoke with the Bailey family. Heart cramping, she watched their faces as their confusion turned to palpable despair over the doctor’s words.

Charlene’s husband obviously struggled to find words as long hours of hope began to dissolve into the unthinkable. “You’re saying there’s nothing that can be done?” he finally asked, voice barely above a whisper.

There was soft whimper, and Erin wasn’t sure if it was the baby or his mother. Her fingers tightened on the tissue box.

“The hemorrhage is large and has spread deep into your wife’s brain tissues.” Leigh exhaled slowly. “I’m afraid surgery isn’t an option.”

“Then we have to wait for the blood to absorb?” the son asked. “Or . . . ?”

Erin’s throat constricted at the sudden helplessness of this man so obviously used to taking control, making things right.
Lord, help them.

“The bleeding has caused damage to the portions of your mother’s brain that are responsible for vital life functions.” Leigh’s voice was gentle. “Including heart activity, breathing—”

The daughter-in-law gasped and clutched her infant close. “Mama’s not breathing?”

There were voices in the outer hallway.
Please let that be their pastor.

Leigh took a step toward them, bridging her palms together. “I’ve inserted a tube into her airway, and she’s on a ventilator that’s breathing for her. We’ve started potent medications to try to control her blood pressure. As soon as possible, she’ll be moved to the intensive care unit and be examined by the neurology specialists, but I’m afraid—”

Mrs. Bailey’s daughter-in-law cried out and lowered herself into a chair. “She can’t die. Oh, please, Jesus, don’t let her die!” She began to tremble uncontrollably.

In an instant, her husband lifted the baby from her arms, handed him to Leigh, then knelt beside the chair. He pulled his wife close, rocking her gently, as his own eyes brimmed with tears.

Mr. Bailey stood protectively over his family, a low, guttural sob escaping his lips as tears began streaming down his cheeks.

An hour later, Erin sat at the table outside the ER, grateful for a few minutes’ respite. She broke her PowerBar in half and held the larger piece out to Leigh, waiting as her friend finished a row of knitting. The doctor looked tired and troubled. Erin sensed it went beyond the stress of delivering tragic news to the Bailey family.

Leigh drew in a deep breath of ocean air, then glanced across the table at Erin. She set her knitting down and took the piece of PowerBar. “Thanks for dragging me out here. I needed some sun on my face. Nothing worse than walking into the quiet room carrying boxes of Kleenex. The families know it’s bad as soon as they see us coming.”

Erin nodded, wincing at the memory. Mr. Bailey’s sob, that heartsick look in Leigh’s eyes as she held the baby. “Thank goodness their pastor arrived and that they have so much support from their family and church.”

“It’s going to be awful for them over the next several days. If she makes it that long.”

“I don’t want to imagine trying to handle something like that with my grandmother. At least with my grandfather there was time to be with him and say good-bye. But something like this, so horrific and coming without warning . . .” Erin shook her head. “Charlene’s son said she and his dad booked a Mexico cruise for their fortieth anniversary next month. They’d been taking tango lessons.”

Leigh took a sip of her coffee and was quiet for several seconds. “I saw Iris this morning. She looked cute in that pink smock, and she was all smiles. I’m glad you didn’t talk her out of volunteering here.”

Erin snorted. “Like I could. But I’m glad she’ll be staying put in the gift shop. I still don’t want Nana exposed to all of this tragedy and chaos.”

“You mean the kind of chaos that could end up sending us to stress debriefing?” Leigh checked her watch. “You’re still planning to talk with more of the staff today?”

“Yes, I think I’m almost finished. It took a few days to go through the list, but I’m glad social services agreed to this initial peer contact. I think it’s really important to find out if they’ve been troubled by any symptoms of stress since this pesticide scare started. There’s a nurse in the ICU who’s had the CISM training as well, so she’ll be doing the same thing. The social worker had some good pamphlets, listing symptoms and things to do to help. You know, like journaling, exercising, eating well, avoiding alcohol. And I’m reminding them about the employee assistance program in the event they feel the need for professional counseling.” She frowned. “I sent information over to the fire station for Chuck, though his captain made it clear he’s not a fan of counseling.”

“Scott? Oh, that’s right. You told me you were going to talk with him. When you called me that night . . . at the stables.”

Erin paused, watching Leigh. There it was again—that troubled look in her eyes. It likely had something to do with her separation from her husband. Or new problems with her half sister in San Francisco. But Erin wouldn’t pry. Leigh kept things pretty private. “Yes, we met for coffee. And sort of walked on the beach.” Why on earth had she added that?

Leigh’s PowerBar stopped halfway to her lips. “Oh?”

Erin raised her palms. “So he could play Smokey the Bear and douse a campfire. That’s all. Really . . . don’t do this to me.”

Leigh was maddeningly silent, but a smile played at the corners of her lips.

“Besides, my current opinion of men in general makes real bears—maybe even Sasquatch—look like a far better choice.” Erin’s hand clenched before she could stop it, anger prickling. “My last boyfriend stole money from charity donations I’d collected and tried to use my grandmother’s credit card number for online horse betting.”

Leigh’s eyes widened.

“I’m serious. I can really pick ’em.” She shrugged. “But somehow it made the fact he was also cheating on me seem easier to accept.”

Leigh picked up her Golden Gate cup and turned away for moment, glancing toward the corner of the building where Sarge smoked a cigarette. He was working a few extra hours to cover for a fellow housekeeper.

“Well, if it makes any difference,” she said, turning back, “I never heard about Scott being anything but a decent guy. Maybe too decent. He wasn’t at all like the other men the nurse in San Francisco normally dated. To tell you the truth, I never understood the attraction between those two.”

Erin looked down at her coffee and tried to sound indifferent. “It wasn’t something serious, then?”

“I only heard things on the periphery; I try to avoid getting involved in personal issues. But she complained that he was too involved with his career, that he was spending more and more time doing things like Ocean Rescue and didn’t make enough time for her. She said he’d become moody and hard to be around. I didn’t hear how it all ended and frankly didn’t want to.”

“Hmm.” Erin chewed at her lower lip, remembering the pain and anger on Scott’s face when he’d told her about the car crash that killed his sister and her husband and injured their son so badly.

“But on the other hand, you seem like the kind of woman Scott—”

“Hold it right there.” Erin lifted her palms like she was stopping oncoming traffic. “I agreed to meet Captain McKenna. Once. At a bait shop. Where we managed to disagree on almost everything from that point on. Flavors of coffee, exercise regimens, Wonder Woman—”

“Wonder Woman?”

Erin rolled her eyes. “Long story. Just trust me. But the worst of it was that we’d met to agree on a plan to help the citizens of Pacific Point and especially the members of our individual teams, his firefighters and my ER staff. And we didn’t. Scott’s wary about counseling in general.”

“He thinks it doesn’t help?”

“He thinks it could make things worse, maybe even drive some people over the edge emotionally.”
Like when Cody’s father aimed their speeding car at a power pole.
“I don’t think he’d interfere with Sandy’s husband’s participating in a hospital debriefing—if it comes to that. But Scott wouldn’t be comfortable with offering counseling resources to his crew. You can bet your horse on that.”

“Hey, leave Frisco out of this. He’s all I’ve got.” Leigh’s expression faded into that troubled look again as she tucked her knitting into its tote. “Let’s get back in there and wrap things up so you can do your interviews.”

As Erin stood, she saw Sarge snuff out his cigarette and head toward the ER doors. He raised his hand in greeting and she waved back, feeling a stab of guilt. She’d almost forgotten to include the housekeeping tech on her list of employees to talk with. He’d been there the day of the disaster, quietly helpful as always. He deserved as much consideration as anyone else. It wasn’t only doctors, nurses, and rescue personnel who could be affected by disaster situations. Everyone was at risk for critical stress.

+++

Scott glanced at the metal-framed wall clock, then back at the stack of paperwork on his desk—fire inspection reports and daily logs for review, budget requests to consider. He muttered under his breath as he saw the neat stack of CISM pamphlets Erin had delivered via the chief
.
She wasn’t going to give up. He jabbed his pencil against the base of his desk lamp, remembering Erin’s determination that night at the beach. Her protective insistence on providing closure for staff involved in the pesticide incident. And her compassion when he’d told her about Colleen and Cody.

Scott jabbed the pencil again, scowling as the tip snapped off and rolled beneath a framed family photo. The snapshot was taken in front of the giant octopus exhibit at Monterey Bay Aquarium: Scott’s grinning grandfather in a volunteer’s jacket, his mother holding a wriggling baby Cody, his stepfather, and Scott and Colleen mugging for the camera. Colleen’s husband absent as usual. A lump rose in Scott’s throat as he looked at his sister’s teasing smile, her single dimple exactly like Cody’s. Colleen Heather McKenna, two years his junior. Funny, smart, beautiful inside and out, and so brave. Scott swore aloud. Then his anger turned without mercy to guilt. Why hadn’t he returned his sister’s call that night? If he’d had a chance to talk her out of getting in that car with her husband, then . . .

He stared at the stack of pamphlets, which he felt certain included counseling resources. He’d meant what he said about the risks. Even if counseling was highly beneficial the majority of the time, emotions couldn’t be predicted.
“Sometimes you stir up the embers and everybody gets burned.”
He knew that only too well now. And yet . . .

Scott exhaled softly, recalling the tenderness in Erin’s voice when she talked about her grandmother, the feel of her hand on his arm after he told her about the car accident, how she’d stood there silently beside him, and then how that strange sense of peace washed over him. That warm eddy after so much soul-wearying cold.

He reached for a pamphlet. He would read it, but he wasn’t promising any more than that.