Michael Palmer - Flashback

"Is it… all right if I listen in? " the nurse asked, pausing between words to clear a huskiness from her voice. "Fine with me, if Dr. Norman doesn't mind."

Norman hesitated and then shook his head. "We haven't met, " Zack went on. "My name's Iverson, Zack Iverson. I'm the new neurosurgeon on the block."

"I'm Doreen Lavalley, " she said. "Annie was my patient up on four. I feel sick about what happened. We had her tucked in with the side rails up. She soiled herself. I think she was trying to get to the bathroom when she fell. We were all in with a post-op patient who had started hemorrhaging, and our routine bed check was delayed almost an hour, and … and we're just She bit at her lower lip and d away. "Go on, " Zack said as they walked from the cubicle to the nurses' station. For a moment, it seemed as if the young woman was going to cry. Then a flash of anger mixed with the anguish in her eyes. "Dammit, " she said, "I knew something like this was going to happen."

"What do you mean?"

She glanced over at Donald Norman and then turned again to Zack. "We're short, " she blurted. "That's what I mean. We're short a nurse on every shift on every tloor except the unit here. It's been that way for more than a year. First they got rid of the union with all those promises of increased pay and benefits and staffing, Then, just slowly enough so that none of us could organize to complain, they began to cut back on nursing. I knew something like this was going to happen. I just knew it … Her fists were clenched in frustration. "Who's they'? " Zack asked.

"The hospital, that's who… the administration… Mr. Iver-" She stopped in midword and looked sheepishly at Zack. "Oh, great… Way to go, Doreen… Brother?" Zack nodded. "Sorry, " she said. "Don't be.

Don, you're the chief of staff. Are the physicians aware that this has been going on?"

Norman's face was pinched and flushed. However, his indignation was directed not at the situation, but at the nurse. "If Miss Lavalley has complaints about this hospital or the way it is run, " he said, his back almost turned to her, "there are channels established for her to voice those concerns. She's worked here for enough years to know that-and also to know that airing her own distorted point of view in the middle of the intensive care unit is not one of those channels. Now, Doctor, if you'd care to share your thoughts on Mrs. Doucette with me, I can get on with the business of trying to save her life."

The woman tensed at Norman's rebuke, but said nothing. Zack wrestled against the urge to defend her, and won a narrow victory.

The issue at hand was getting Annie Doucette diagnosed, treated, and stabilized. The nurse's charges, disturbing though they were, could wait. He thought about calling Suzanne in, but quickly tabled the notion. Annie's monitor pattern was regular, at least for the moment, and Donald Norman, as thin-skinned as he was thick-wasted, seemed hardly the sort to welcome any encroachment on his authority. "So?

" Norman asked impatiently, "Well, there's no evidence for a stroke or for head trauma, " Zack said, "but she's clearly disoriented, I guess if I had to put a label on what's going on, I would say she's sundowning-especially if her blood chemistries all come back normal."

Out of the corner of his eye, Zack saw Doreen Lavalley nodding in vigorous agreement. Sundowning was not a medical diagnosis in the pure sense. Nevertheless, to anyone dealing with elderly, hospitalized patients, the disorientation and psychotic behavior stemming from unfamiliar surroundings and the diminished sensory input of evening were as real and reproducible a phenomenon as a strep throat. "Excellent,"

Norman said, his expression and patronizing tone making it clear that Zack had added nothing to his assessment of the case. "Good job. Listen, Doctor, why don't you dictate a note, and I'll put a formal request for a consultation in her chart." He unrolled his sleeves and retrieved his suitcoat. "If there's nothing else, I'm going to see another patient.

I'll stop back on my way out."

Zack, engrossed in Annie's chart, did not respond. "What are you looking for? " Norman asked. "An explanation."

"For what? " Zack glanced up. "Don, this woman's been here almost two weeks, during which time she's been totally with it. Don't you think it's a little strange that she should have taken this long to sundown?"

"On second thought, " Norman said, "why don't you just forget about the consult. We'll discuss this whole thing in the morning."

"It's there, Dr. Iverson, " the nurse said. Norman shot her a withering glare. "What is? " Zack asked. "The explanation. Look on the med sheet."

"Give me that chart," Norman snapped. "Miss Lavalley, you don't know a good thing when you have it, do you? You just get the hell out of here.

I'll deal with you tomorrow."

"You can deal with me tonight, Dr. Norman, because I've had enough. I quit."

"Haldol! " Zack exclaimed, slamming his fist on the page. "What in the hell is she doing on Haldol?"

The nurse's fury was not uncontained. "Dr. Norman-excuse me, Don-" she corrected herself sweetly, put her on it Tuesday when she complained about his plan to transfer her to a nursing home. He called her a harpy."

"Damn you, " Norman hissed, his face now puffed and crimson. "A nursing home? Norman, are you crazy? " Is who crazy? " Frank Iverson, hands on hips, stood just inside the unit door. Zack rubbed at the grit of fatigue and tension that had begun to g his eyes. "This whole place, that's who, " he said to no one and to everyone. "This whole place is crazy."

"Easy, Zack-o, " Frank warned. "Just stay cool. How's Annie? " Zack lowered his hand and looked up at his brother. "She's crazy. That's how she is. She's crazy because for the last five days she's been receiving a major tranquilizer. Her blood levels have been rising and she's been drifting further and further from reality until it's doubtful she even knew where she was when all this happened. She lost control of her bowels and was trying to crawl over the end of the bed to the bathroom when she fell. The nurse, here, tells me they didn't get in to check on her as soon as they should have because there's been such a staffing cutback that they're shorthanded. What kind of a goddamn place is this, Frank?"

"I… I think I'd better get back to my floor," Doreen Lavalley said softly. "Mr. Iverson, my resignation will be in the nursing office tomorrow morning." Without waiting for a response, she whirled and hurried out. "Don, what in the hell's going on here? " Frank asked.

"Your brother, that's what," Norman answered. "He barges in here, starts examining my patient without even being consulted, badgers the nurse into making some rash statements about the hospital, and then accuses me of causing the woman to fall." He turned to Zack. "You've been trouble since the day you got here, and don't think we don't all know it. This hospital needs team players, Iverson. You're a grandstander.

Ultramed-Davis ran perfectly smoothly before you showed up, and it will do just as well after you've gone."

"I'm not going anywhere, " Zack said. "Don't bank on it, " Norman shot back. "Easy, both of you, " Frank said. "First of all, just tell me, is that woman in there going to die tonight?"

"It was touch and go for a while," Norman said. "But I've gotten things under control. She's a bit disoriented, but she's not in any immediate danger. We'll wait a few days to let her cardiac situation calm down, and then Sam Christian'll fix hey hip."

"Zack?"

"What?"

"Do you think that's the way it is?"

"I think, " Zack said wearily, still resting his head on his hand, "that Suzanne ought to be called in to take care of Annie. That's what I think."

"Over my dead body, you arrogant son of a bitch, " Norman rasped.