Sleight of Hand (38 page)

Cassie shook her head to clear it.  "Antwan Washington," she corrected the clerk.  "I'll be right there.  Thanks."

"Sure thing, Dr. Hart."  The clerk headed back to her station near the phones.  Cassie rubbed her eyes and looked around.  There were no windows in the ICU, it could be noon for all she knew.  She finally spotted the clock above the door.  It was ten after two, she'd slept almost three hours.  She felt like she needed about forty more.

Standing and stretching the kinks out of her neck, she looked at the monitor readings more closely.  If anything they were improved.  

"I'll be right back," Cassie whispered to Muriel and squeezed her shoulder.  

The PICU was down the hall.  She went in through the sliding doors and approached the desk clerk.  "Someone called me about Antwan Washington?"

The clerk shrugged.  No one else was around except for two nurses back in the medication room.  

Cassie walked over to Antwan's cubicle.  Tammy Washington was asleep, her head and arms slumped across her son's body.  Cassie looked down for a moment, smiling at the domestic tranquility of the scene, despite the medical equipment looming all around the mother and child.  

Then she noticed two large eyes staring at her.  Antwan Washington was awake.  Cassie took the chair on the other side of the bed, lowering herself to his height.

"Hi, I'm Cassie," she said.  The little boy said nothing, merely stared.  "You're Antwan, right?"  He nodded, still silent.  "How old are you, Antwan?"  

He looked at her suspiciously, obviously he had learned not to trust anyone in this place where they were just as likely to poke you with a needle as give you a hug.

Cassie just smiled and waited.  Slowly, he withdrew a hand from under his mother's head and held up three fingers.  Cassie nodded.  "Three?  You're a big boy."  She spotted a stack of books on the counter.  "Would you like to read a bedtime story?"  He nodded.

She went through the books.  They were all brightly colored with thick cardboard pages little fingers could turn easily.  She had no idea which one to choose, so she picked out the most worn, thinking that it must be a favorite.

"
Goodnight Moon,"
she read the title to Antwan.  "Is that okay?"  

He nodded eagerly and guided her hand to position the book where he could reach it.  He obviously had the book memorized because as Cassie read it, he turned the pages at the right places.  Until about two thirds into the story, when she noticed his breathing was slower and his head had slumped over.  She quietly finished the book, then kissed his forehead gently before replacing the book and leaving.

One success, at least.  She stopped by the nurses' station and took Antwan's chart into the dictation area to review.  She wanted to see what the neurologists thought his ultimate outcome would be.

Antwan's chart had grown as thick as a bible, filled with the cryptic scribbles of house staff and consultants.  Apparently the meningitis had caused a small stroke that affected the muscles on his left side.  Cassie deciphered the cramped scrawls with an ease that came with practice, but was frustrated to find no definite prognosis given.  The neurologists were taking a "wait and see" attitude.  At least they'd already ordered some physical therapy and a child life consult.

The lines of black ink began to blur and Cassie yawned.  Just a few more pages and she'd go back to Muriel.

"Dr. Hart, wake up!"  A rough pair of hands shook her.  "We need you!"

"What?"  Cassie jerked awake.  She'd fallen asleep in the dictation area of the PICU, Antwan Washington's chart her pillow.  "What?"

A nurse was shaking her.  "It's Antwan Washington.  He started to seize about five minutes ago.  The fellow and Dr. Sterling are down in the ER with a patient that's crashing.  Could you help?"

Cassie jumped to her feet and raced to Antwan's cubicle in the back hallway.  The nurses had the crash cart in the room and had already placed an oxygen mask on the little boy as his body jerked mightily in all directions.  Tammy Washington stood in one corner, tears streaming from her face. 

"Help him, Dr. Hart, please help my boy," she cried.

Cassie grabbed a stethoscope from one of the nurses.  "Get me one point five of Ativan," she ordered as she bent forward to listen.  He was barely moving air, the seizure was preventing the oxygen from entering his lungs.  Cassie looked up at the monitor.  Antwan's oxygen level was falling.

"Ativan in."

She grabbed the anesthesia bag from the head of the bed.  "Hyperventilate him.  Let's set up for intubation.  Give me a two blade and a number five tube."  The seizures continued unabated despite the medication.  "Another one point five of Ativan," Cassie ordered.

"But it's only been two minutes."

"Give it.  I'm going to tube him anyway."  

The nurse quickly gave the second dose.  The seizure activity slowed somewhat, but so did Antwan's breathing and his heart rate.  Cassie moved to the head of the bed and quickly intubated him.  Once the tube was in place, his oxygen level and color improved dramatically.

"Damn it, why is his heart rate so low?  Atropine point three and a fluid bolus."

The nurse gave the medication just as Carl Sterling arrived.

"What happened?"

"Generalized seizure, responded after a second dose of Ativan.  Tubed for apnea, but he's bradycardic and hypotensive," the nurse reported.  

"What meds is he on?" Cassie asked, checking the pupillary reflexes and trying to think of anything that could be triggering this constellation of symptoms.

"Only vancomycin and phenobarbital," the nurse answered her as Sterling moved to the bed and yanked the ophthalmoscope from Cassie's hand.

"What are you doing here?" he demanded.

Cassie ignored him and turned to the nurse. "Are his levels okay?"

"Yes, I checked them myself," Sterling replied.  He listened to the breath sounds and looked up.  "You can leave now, Dr. Hart.  I have everything under control."

"Not with his pressure so low.  Give him one and a half cc's of epinephrine," Cassie ordered.  If they couldn't get his blood pressure higher, his body wouldn't get the oxygen it needed.  "And set up for an epi drip."  The nurses scrambled to get the medications from the crash cart.

"I'm in charge here," Sterling snapped.  

The nurses froze at the crash cart looking from one physician to the other.  The alarm blared as Antwan's blood pressure fell further.  Sterling's eyes cut over to the monitor display.  

"Do it," he finally conceded.  "And hang the drip."

"What's this?" One of the nurses stooped over then rose with an empty syringe of lidocaine in her hand.  

"Who gave him lidocaine?" Sterling demanded, his glare settling on Cassie.

"The crash cart was already here when I arrived," Cassie said.  A lidocaine overdose could cause seizures, a slow heart rate and low blood pressure.  There was no specific treatment.  It would wear off in a few hours if you could keep the patient alive for that long.  "What is that?  A hundred milligram vial?"

The nurses became even more hyperkinetic as they scrambled to discover where the lidocaine had come from.  Antwan's heart rate and blood pressure improved with the epinephrine.

"Dr. Sterling, that lidocaine didn't come from our crash cart," a nurse spoke up. She held up two amps of the medication.  "We have both of ours and the lot number is different."

"So, where the hell did that lidocaine come from?" Sterling demanded.  The nurses all jumped at his tone and epithet.  He quickly took control of the situation.  "He's stable now, I want everyone out of here except Linda and his mother."

Cassie turned to Tammy Washington.  "Do you remember anyone being in here?"

She shook  her head.  "I just woke up 'cause he was thrashing around.  I called the nurse right away.   Is he going to be all right?  What happened?"

"He's going to be fine.  We're still looking into what exactly caused this seizure."      

"I said, everyone out, now.  I'd like a note of what happened before I arrived, Dr. Hart."  Sterling's tone was frosty, and Cassie was too tired to argue further.  She went over to where she'd left Antwan's chart at the dictation station.

If only she hadn't fallen asleep, she might have seen something.  Or someone.  She felt certain that Virginia Ulrich was behind this latest incident.  Antwan's cubicle was in the side hallway, close in proximity to the nurses' station, but not in a direct line of sight.  It would be frightfully easy for anyone with knowledge of the PICU to walk in unseen.

And Virginia certainly was familiar with the PICU.

Cassie finished dictating her part of Antwan's resuscitation.  She called down to the Pediatric unit, but the nurses said that they hadn't seen Virginia Ulrich at all that night.  

Sterling entered the dictation area.  "The police are on their way."

"Good.  How's Antwan?"

"Stable," he said in a grudging tone.

Cassie stood.  

"Where are you going?" Sterling asked sharply.

"To see Antwan and talk to his mother.  I'm sure she's frightened by all this."

"You can't do that."  

"Why not?"  Cassie looked around the nurses' station, realized that everyone was staring at her.  And their looks were distinctly unfriendly.  

"The charge nurse tracked down the lot number of the lidocaine vial," Sterling said.  "It came from an ER crash cart." 

CHAPTER 30

"Surely you don't think I had anything to do with this!" Cassie tried to keep her voice low, but failed.

Sterling glared at her.  Cassie looked at him in disbelief, then pushed past him.  She'd left Muriel alone–she had to get back to her.

Two police officers and a hospital security guard blocked her way as she left the PICU and turned toward the SICU.

"Out of my way!" she flared, her patience exhausted.  

"Dr. Hart, will you please come with us?" one of the uniformed officers said as his partner moved to her other side.

"I need to get to the Surgical ICU."  She'd promised Drake she would protect his mother, that everything would be all right.  She needed to see Muriel, make certain that she was safe.  

"We would prefer if you had no contact with any patients until this is cleared up," the hospital security guard told her.

"I need to see a patient there," she tried to explain.  She couldn't keep the shrillness of her fear out of her voice.

"I don't think that's a good idea, right now," the police officer said, taking her arm.  "Why don't you come with us?  We just want to talk to you."

She twisted away from his hand and tried to push past them to the SICU.  

"Please, I just need a minute."  She was almost in tears.  Why couldn't they understand?  

Both police officers took her arms, holding her in place.  A small crowd had gathered, night shift workers from the ICU's as well as family members.  Cassie looked up to see Jacob and Nellie Steadman emerge from the elevator.  The security guard guided them to one side, as if they were in danger from her.

"Come along now, Dr. Hart.  Let's go someplace quiet where you can calm down."

"Nellie," Cassie called out.  "Stay with Muriel.  Don't leave her alone."

Muriel's sister looked at Cassie with a mixture of horror and disbelief.  "Please," she pleaded as the officers lead her past the Steadmans into the elevator.

The four of them rode down in silence.  She looked up at the police officers and thought about how she looked in their eyes–a disheveled, tear-stained maniac, probably.  If they thought that she'd deliberately poisoned Antwan Washington, she didn't blame them for wanting to get her away from there as fast as possible.  

In their minds she was a monster.  How could she ever convince them that it was Virginia Ulrich who was the real monster?

"Where are we going?" she asked as the elevator doors opened on the first floor.

"That's up to you, doctor.  We can take you down to the station and the detectives will talk to you there in private.  If you refuse to go, then we'll have to make other arrangements."

Cassie didn't like the sound of that.  Other arrangements probably meant getting a warrant for her arrest, having the hospital security expel her from the premises, and more publicity.

"I'll go to the station," she said quietly.  "You need to call Detective Drake.  He knows everything about this case."

"Detective Drake isn't on duty."  

They walked her through the front lobby to where their cruiser sat in the circle at the doors.   She was surprised that several reporters were waiting.  The flash of their cameras blinded her as the policemen helped her into their car.  

Cassie turned to look out the back window.  She couldn't help but wonder if she'd ever be allowed to return to Three Rivers again.

They placed Cassie in a room no larger than a linen closet, bare except for two scarred plastic chairs and a table.  The table was bolted to the floor and had rings secured to its top, presumably for handcuffs.  She had a lot of time to think about it and imagine herself wearing those handcuffs as she waited for the detectives.  Her only companion and distraction in the room was a whistling steam radiator that would occasionally rattle and shake, forcing a disproportionately tiny amount of warm air into the already stuffy room.

If she'd just stayed calm up in the PICU, she was certain she could have explained everything.  Well, maybe.  So now she was doing her best to be a model prisoner, not insisting on a telephone or a lawyer.  After all, she had not done anything wrong, so she'd nothing to worry about, right?  

Cassie paced back and forth, measuring the narrow confines of the room with her steps.  The police had repeatedly told her that she was free to go at any time, a ploy to avoid any semblance of coercion.  Only question was: where else could she go?

Finally she stopped moving and sat down on one of the two plastic chairs.

This was it.  Time to give up.  She'd been through a lot of fights in her life, but she'd met her match in Virginia Ulrich.  She was more certain than ever that Virginia had killed her first two children and was trying to kill Charlie and Antwan.  But how to prove it?  Cassie couldn't even prove her own innocence right now.