Peter Clement - Mortal Remains

Heartbreaking as this was to witness, Earl liked Tanya’s tenderness toward her patients. She could engage the remnants of whoever they once were with a warm hello or bestow a moment of dignity on them simply by addressing them with respect. Too many doctors and nurses burned out in what the cynical called “exit medicine.”

“As to what I’m suggesting,” she whispered, once they reached a section that was free of her coworkers, “I know it sounds off the wall, but I’m just so upset. She was my patient for the last three months, and I really grew to like her. We don’t get many who can actually make it out of here, and she had a chance to end her days in style, compared to the dead ends that await these other lonely souls. Around here, that’s like a little miracle, and I got caught up in it.” She turned and stared him right in the eye, her intensity startling him. “So let’s just say I want to make sure you consider all the possibilities before you conclude what happened to her.”

Strange woman. Intense, even a touch paranoid perhaps, but sincere. Maybe she thought she’d missed a subtle clinical sign or dismissed something Bessie McDonald had said that might have warned of another stroke being imminent. Sometimes grasping at impossible scenarios was easier than admitting a mistake, especially a near-lethal one. “You’re positive Mrs. McDonald was okay? The harbingers of throwing off emboli can be very subtle, as I’m sure you know – a little shadow on the visual field, transient numbness or weakness in a limb-”

“She would have told me. She was a physician, a GP.”

The news took Earl by surprise. “Nothing on her chart indicated she was a doctor.”

“She wouldn’t allow it, nor us calling her doctor.”

“But why?” Any patients he’d ever had who were physicians usually trumpeted the fact to everyone and anyone who came near them, as if it was a Visa or MasterCard for special treatment.

“ ‘Makes people nervous, and that’s why things always go wrong when an MD is the patient,’ she used to say.”

Earl shook his head. He felt the same way, but had never prevented his profession from being stated in a medical file.

“She was so set on getting to her son’s,” Tanya continued, “she never would have ignored any warning symptoms.”

Earl nevertheless resisted joining her flight of fancy. “There also might not have been any warning symptoms.”

“I know.”

“And she had a lot of risk factors. Another stroke isn’t improbable.”

“I know that, too.”

“So why the suspicions?”

She quickly glanced around. A few steps away a woman stood with a blank, dark-eyed stare on her face and her gray hair in wild disarray.

But no staff were in sight.

“Because I think Chaz Braden is a slimeball who’s capable of anything,” Tanya said, and continued down the corridor.

Earl hurried after her. “Care to elaborate?”

“Not really. If I get caught bad-mouthing the bastard, I’ll be out on my ass.”

“Then will you answer some specific questions by ‘yes’ or ‘no’?”

“Depends on the question.”

“Did Mrs. McDonald indicate she knew anything about Kelly McShane’s death?”

“No.”

“Did she insinuate anything incriminating about Chaz Braden?”

“No.”

“Did she ever express having any fear of him?”

“No.”

“Did she indicate to you she had anything at all to tell about her admission under Chaz Braden in ‘seventy-four?”

Tanya spun about to face him again. “Yes. She said she didn’t like the man, and wanted to talk about it, but I was too busy at the time. And I repeat, when I left her that last night she was fine.”

Sounded as if Tanya did feel a tad guilty. “So you didn’t listen to an old lady go on about a former doctor she’d disliked twenty-seven years ago – not exactly a cardinal sin.”

“If I had taken the time-”

“She still would have had her stroke. I don’t see why you’re so quick to suspect foul play.”

Her shoulders rose, a sign that he had irritated her. She stopped at a closed door and gestured that he should enter. “See Bessie McDonald for yourself, Dr. Garnet,” she said through clenched teeth. “Then let’s talk about what you think happened.”

They walked in on an elderly woman laid out still as a corpse in a hospital gown. An orange tube stuck out of her mouth from which intermittent gurgling noises came as her chest rose and fell. An IV tube ran from a clear bag of fluid into her left arm. A transparent catheter protruded from between her legs and carried urine to a bag strapped on the railing at the side of the bed. A multiscreened monitor flashed continuous readings of her vitals.

At a glance Earl took in that she was breathing on her own, had been receiving sufficient hydration to keep her kidneys functioning, possessed a normal heart rate, rhythm, and blood pressure, and, according to the information relayed from a clip on her finger, just about perfect oxygen levels in her blood.

So why wasn’t she sitting up and waving at him?

A young man in a white coat looked over from where he’d been methodically tapping at her knees with a reflex hammer. He had bushy red hair, and his name tag read DR. P. ROY. When Tanya made the introductions, he practically clicked his heels.

Earl got down to business. “So what happened?”

“The night staff found her unresponsive on the floor at the entrance to her room around 4:00 A.M.,” Dr. P. Roy began. “They immediately called me.”

“She was seizing when you found her?”

“No, but there was a lot of blood in her mouth and tooth marks on her lips and tongue. Grand mal was obvious.”

“Vitals?”

“As you see now.”

“Did you do the DONT?”

“The what, sir?”

“The DONT. Dextrose, oxygen, narcan, and thiamine.” He was stating an anagram he always used to teach residents the basic ER approach to coma, listing the first variables to be thought of whenever a patient presented with an altered level of consciousness. An IV bolus of dextrose, or sugar, would have corrected hypoglycemia. A measure of her O 2saturation would have signaled any respiratory causes for the coma, and the administration of oxygen possibly turned them around. Narcan would be the antidote to reverse a narcotic overdose, and thiamine administration treated a deficiency of the vitamin that sometimes caused persistent confusional states in malnourished individuals, such as alcoholics.

Dr. P. Roy flushed. “Well, no, not exactly, sir. I did make sure her airway and O 2were okay. But it seemed pretty obvious she’d had another stroke and seized.”

“Really? Any focal signs in your neurological exam, now or then?” Earl referred to the abnormalities of sensation, movement, and reflexes that would have occurred in the specific region of her body controlled by whatever part of the brain a recent embolus might have injured.

“No, at least not any new ones that I could tell. She did have some minor abnormal reflexes from her previous event.”

“Shouldn’t there have been at least a change in those, if you attributed her seizure to another massive embolus? And it would have to have been massive to leave her comatose, wouldn’t it?”

“Well, yes-”

“Did you do bloods at all that morning?”

His face brightened. “Of course. They were all normal, including her sugar.”

“Was that sample drawn before or after you gave her an IV?”

Roy grew red in the face again. “After.”

“How long?”

He swallowed. “About an hour later.”

“An hour?”

“I ordered they be taken stat, but, well, on this ward, especially at night, we aren’t given much of a priority by the lab-”