The Moon by Night (38 page)

“Dr. Duvall?”

“Hm? Oh yes, Dr. Varick?” She had been washing her hands at the carbolic acid stand outside of Henry Norton's cubicle and staring into space. She
was
tired.

The intern, Stephen Varick, was the complete opposite of the other male student, Dr. Gilder, but the two had been at Columbia College together and had made best friends. Dr. Varick was barely twenty-one but already had thinning brown hair, weak eyes, stooped shoulders, and an earnest demeanor. He was brilliant, however, and for someone who looked as if he might have frail nerves, he was fearless when it came to surgery. Oddly, his friend Duncan Gilder was the devil-may-care dashing young-blood-about-town, but actually Duncan had less self-confidence in his chosen field than did Stephen Varick.

Now Dr. Varick said softly, for they were close to the curtained door of Henry Norton's cubicle, “Dr. Duvall, I really think you'd better come see to Mrs. Green. I think she's in deep pain, but she won't say anything one way or another.”

Cheney nodded. “All right, but you must understand, Dr. Varick, that if Mr. Green comes back, you'll have to keep him away if I'm in with her.”

He nodded. As slight as he was, he could exert more authority than bronzed and athletic Duncan Gilder ever could. Ira Green listened to Dr. Varick, while he just brushed by Dr. Gilder. Dr. Varick stayed at the nurses' station to update some files and also to keep a watch for Ira Green while Cheney went to see about Rebecca Green.

“Hello, Mrs. Green,” she said softly as she came in. The girl was lying in bed, every muscle rigid, nostrils distended, eyes tightly shut, tears rolling down her cheeks. Cheney picked up the girl's hand. It was feverishly hot and sweaty. Sighing, Cheney began taking her pulse. She looked up from her watch and saw Mrs. Green's dull gaze fixed on her. “Dr. Varick told me that you are in pain, and I think he's right. Can you describe to me how you feel?”

Numbly the girl shook her head and closed her eyes again. Her face was deathly white, her lips colorless. Her pulse was fast and irregular. Her wrist felt like a knobby little stick. Cheney was sorry for her. When she had first been diagnosed with breast cancer two months previously, she had been a big healthy-looking girl with a sweet shy smile and bouncing glossy brown curls. Now she looked like a dying old woman.

“I know you're worried about me being here in case Mr. Green comes back, Mrs. Green,” Cheney said in the most kindly manner she could muster. “But please don't be concerned about him just now. All of us here just want to make you as comfortable as we can, and Dr. Varick rightly wanted me to examine you because I am the on-duty physician at the moment. Dr. Buchanan had surgery scheduled in Queens this afternoon. He'll return later this evening, but he left me in charge. So please tell me how you feel, Mrs. Green.”

The sharp bones of her jaw tensed, ground again. Her eyes remained squeezed tightly shut with distress. “I hurt all over, Doctor. All over. I haven't hurt like this ever. I can't hardly…hardly…bear it…anymore.”

Cheney nodded and squeezed her hand lightly. “I understand. I'm going to give you an injection, Mrs. Green, of a powerful drug that should ease all of your pain.”

“Please…please help me. It's all I can do…not to scream.”

“I'll be right back,” Cheney promised. “Just hold on. I'll be right back.”

She hurried to scrub hard and fast, then rushed up to the nurses' station. Dr. Varick saw her face and jumped up with alarm. “She…is she—”

“She's not dead,” Cheney said grimly. “But take it from me, Dr. Varick, that woman is in enough pain to kill two grown men.”

“Oh, I…I'm so sorry, Dr. Duvall, I didn't…” he stammered.

“Come with me. I'm going to need some help,” Cheney said brusquely. He followed her as she went down the stairs to the laboratory. “And don't feel guilty, Dr. Varick, this kind of thing takes experience. I'm just glad that you called me in. That was the right thing to do.”

“I didn't know what to do. I didn't know that was the right thing,” he argued. “How am I ever going to learn?”

“You're learning now,” Cheney answered. “And I hope your mathematical skills are better than mine. I'm going to give her an injection of morphine, but the textbook is no good in her case. She has such a high tolerance of laudanum, and the pain has obviously escalated, so we need to calculate the titration for the optimum dosage for her.”

“That I can do,” he said firmly. They went to the lab table. Dr. Varick opened Mrs. Green's file and began jotting down her weight, the quantities of the liquid pain-killer she had been taking, the frequency of dosage.

Cheney hurried to light a lamp and went into the storage area to find the morphine. After squinting up and down one section of the shelving, she whirled and went back to the lab table. “I can't find the floor and ceiling in there,” she grumbled. “I keep my medical bag stored underneath here, and I always keep morphine sulfate. Here it is. Now what's the titration ratio?”

Dr. Varick worked quickly while Cheney cleaned three syringes and the needles with carbolic acid.

“I think an initial dosage of one and one-quarter fluidram,” he mumbled, scribbling calculations. “If that doesn't achieve the desired therapeutic effect, another one and one-quarter fifteen minutes later. Maximum safe dosage, three fluidrams total.”

“Good,” Cheney said, carefully inserting the first syringe into the bottle and pulling the plunger to fill it. “It would have taken me half the day to figure it.”

“I doubt that,” the young man said, pushing his thick glasses up on his nose in a habitual gesture. “Dr. Duvall, she's dying, isn't she?”

Cheney held the syringe up to the light, checked the hatch marks on the barrel, and pushed the plunger just a fraction until a tiny amount of liquid shot out of the hollow needle so that any air bubbles would be compressed out of the barrel. “Yes, she is,” she answered evenly. “So the best we can do is try to keep her as pain free as possible.”

He nodded thoughtfully, then asked, “Dr. Duvall? May I ask a question?”

“Of course.”

“If she's dying anyway, why hasn't Dr. Buchanan given her morphine injections previously? I mean, I understand the dangers of addiction, but what does it matter if a patient is terminal?”

Cheney smiled. “Because Dr. Buchanan is very reluctant to give up on any patient, and I happen to share his philosophy. When you have a patient like Mrs. Green, who has all the advantages of youth and strength and a healthy history, it's not a perfect certainty that she won't go into a remission. Many patients do. To have a deep physical dependence upon morphine often stifles this mysterious self-healing. Good doctors like to give the patients who have some chance the most advantageous course of care to encourage self-healing. It's hard to find the right balance and decide whether to subject them to what may be a higher level of pain in order to encourage the body's natural healing processes or to just let them be completely but artificially free from pain. My personal rule is that morphine injections are only to be used in the last resort.”

“So this is the last resort for Mrs. Green?” Dr. Varick asked soberly.

“I believe so,” Cheney answered. “And it's my responsibility, since I am the doctor in residence right now. All right, I've got these syringes ready.” Cheney replaced them in a wooden box with a removable linen lining that was specially fitted to hold three prefilled syringes. She motioned for the intern to follow her back up to the ward. “You do understand why I've filled three syringes instead of one, don't you?”

“Actually, that was my next question.”

“Because even though I'm calm, and I'm glad to see that you are too, Doctor, this sort of situation can be very taxing. It's too easy to make a mistake. This way I don't have to inject some of the morphine and then stop at just the right moment. It's so much easier if you know that you are to inject the entire contents of the syringe.”

Dr. Varick nodded. “That makes perfect sense. I won't forget.”

“No, you won't. You're going to make a very good physician,” Cheney said. “I'd like you to come with me, Dr. Varick. Mrs. Green is going to have to be carefully monitored as we give her the morphine, so I'd prefer that you be there in case I'm called away.”

They went into Mrs. Green's cubicle. She was in the same position, unmoving, tears still rolling down her hollow cheeks. “I'm going to give you an injection now, Mrs. Green. Just try to relax, if you can. The shot may sting a little.”

“Doubt…I'll…notice,” she said with grim humor. Her eyes never opened.

Cheney gave her the injection in a withered upper arm. Before she had emptied the plunger, Mrs. Green's face began to relax.

“Thank God,” she mumbled indistinctly.

Cheney and Dr. Varick stood on either side of the bed watching her intently. Slowly her tense muscles began to relax; her hands unclenched, her jaw sagged a little, her brow, which until recently had been fine and unlined in the full bloom of youth, at last fully smoothed out the lines of pain.

The two doctors watched in silence for one minute. Two minutes…three minutes…

Her respirations grew slower and slower, with the resting time between inhalations and exhalations lengthening more and more.

“Dr. Duvall,” Dr. Varick whispered uncertainly.

“I know,” she said shortly. Leaning over, she touched the girl's shoulder and spoke clearly but in a low tone, “Mrs. Green? Mrs. Green, open your eyes.” She shook her just a little, then said more loudly, “Mrs. Green, open your eyes.”

She looked up at Dr. Varick. “Go get Timothy and bring a stretcher. We're going to have to move her into Surgery 1. Find Nurse Kalm. Tell her to run.”

Without another word he turned and ran out of the cubicle. Cheney leaned over and put her ear right next to Mrs. Green's open mouth. Grabbing her stethoscope out of her pocket, she fit the earpieces, then hastily tossed the covers off the patient and pressed the stethoscope against her upper midsection.

Kitty Kalm came racing through the curtains, her eyes wide. But her voice was calm. “What do I do?”

“She's got bowel sounds, so she may vomit,” Cheney said, pocketing her stethoscope again. “Let's turn her on her side in the coma position.” Together they pushed Rebecca up on her right side, her legs slightly bent, one in front of the other, right arm underneath her head, propping it up, left arm underneath her chin.

After stuffing pillows and rolled-up bedcovers behind her to wedge her, Cheney said, “I'm going to go to the office and get my husband. When Dr. Varick and Timothy come back, get her onto the stretcher in this position. Be sure and watch if she vomits!”

“Yes, ma'am.”

Cheney ran to the office and was shouting even as she burst through the front door. “Shiloh! I need you. Hurry!”

He bounded down the stairs three at a time, and together they ran back to the hospital.

“I gave Rebecca Green a morphine injection, and she overdosed,” Cheney explained as they ran. “She was stuporous after four minutes. I want to move her into Surgery 1 so we won't disturb the other patients while we work on her.”

“Is her husband here?”

“No. He left yesterday,” Cheney answered with a hint of sadness. “Dev said he ran out after he told him that she was going into a steep decline. He didn't come back last night or today.”

They went to her room, and Timothy, Kitty, and Dr. Varick were just finishing getting her situated on the stretcher. Immediately Shiloh took charge. “Okay, I'll take her head, Timothy, you and Dr. Varick take the feet. Kitty, walk alongside and watch carefully. She'll likely start vomiting any minute, and you've got to keep her airway clear. Okay? Everybody ready? Let's move out.”

They picked her up and Cheney said, “I'll be there in a minute. Go ahead and start working on her, Shiloh.”

“Okay, Doc.”

Cheney grabbed her medical bag, scrambled around until she found a clean syringe, pulled out one bottle, threw it back inside, fumbled out another one, threw it back in—She stopped, lifted her head, closed her eyes, took a deep breath, and whispered, “Help me, Lord.”

Calmly now she opened her eyes and found the bottle of atropine. Her eyes searched a far distance while her lips moved slightly as she calculated a dosage. With certainty she prepared the syringe and held it as she grabbed her bag and hurried to the surgery.

Mrs. Green was lying on the surgery bed in the coma position. Shiloh was bent over her, cleaning her mouth. “Respiration down to four per minute, Doc, and her pulse is forty-two irregular. Skin's cold and clammy. Vomiting, involuntary aspiration prevented.”

“I've got one-fourth fluidram of atropine, Shiloh,” Cheney said, but it was a question.

He shook his head as he continued cleaning Mrs. Green's slack mouth. “Give her a half, Doc. She's got nothing left to lose.”

Wordlessly Cheney prepared another syringe. “Note her chart, please, Dr. Varick.” Cheney gave her the shot.

“Have you got it, Shiloh?” she asked.

“Yeah, she's all right for now, Doc.”

“Then lay her back so I can get some good vital signs, and let's try to wake her up,” Cheney said.

“I'm gonna need to do the triple airway maneuver,” Shiloh said evenly. “Her tongue's completely slack.”

Cheney sighed but said firmly, “Okay. Kitty, I'm going to need hot bricks for her feet, two hot water bottles, and some heated blankets. Start heating two, then bring one when it's heated. We'll rotate them, you understand?”

Kitty ordered Timothy, “Come with me.” They left.

“Dr. Varick,” Cheney said, “bring that surgical supply table over here, please. Find the aspirator, get some clean rags ready, and pour up a basin of carbolic acid.”