Tess Gerritsen - Bloodstream

“What exactly happened on November third?” asked Hayes.

She answered evenly: “I drew blood from Taylor Darnell, to send off for a comprehensive drug and tox screen. I’ve already told Dr. Sarnicki who else was in the room. Who witnessed it. I didn’t abuse the patient. It was just a blood draw.”

“Tell them the rest,” said DelRay. “Or are you going to leave out the most important detail? Which is, you had no authority to draw his blood.”

“So why did you?” asked Hayes.

“The boy had a drug-induced psychosis. I wanted that drug identified.”

“There is no drug,” said DelRay.

“You don’t know that,” she said. “You never ran the test.”

“There is no drug.” He slapped a sheet of paper on the table. She stared in dismay at the letterhead: Anson Biologicals.

“I have the the results right here. Apparently, Dr. Effiot managed to get a blood tube out to the reference lab without the father’s knowledge. Or permission. Anson faxed the report to the hospital this morning.” He added, with a note of smugness, “It’s negative. No drugs, no toxins.”

Why had the lab disregarded her instructions? Why had they sent the report to the hospital?

She said, “Our own lab found an unidentified peak on gas chromatography. There was something in his blood.”

DeiRay laughed. “Have you seen our lab’s gas chromatography machine? It’s an antique. A hand-me-down from Eastern Maine Medical Center. You can’t trust our results.”

“But it did need a follow-up test.” She looked at Sarnicki. “That’s why I drew the blood. Because Adam refused to.”

“She made an unauthorized blood draw,” said DelRay.

Hayes sighed. “It’s a mountain out of a molehill, Adam. The boy wasn’t harmed, and he’s doing fine at the Youth Center.”

“She ignored the father’s wishes.”

“But one blood draw does not make a lawsuit.”

Claire’s chin snapped up in alarm. “Is Paul Darnell talking about legal action?”

“No, not at all,” said Hayes. “I spoke to him this morning, and he reassured me he wasn’t suing anyone.”

“I’ll tell you why he’s not suing,” said DelRay. “It’s because that ex-wife of his threatened to sabotage any lawsuit. It’s an automatic reflex for bitter ex-wives. Whatever the husband wants, the wife blindly opposes.”

Thank you, Wanda, thought Claire.

“Then this whole incident is now a nonissue,” said Sarnicki, looking relieved.

“As far as I can see, no action is necessary.”

“What about the letter?” said Claire. “Someone is trying to ruin my practice.”

“I’m not sure what we can do about an anonymous letter.”

“It’s signed ‘A health care professional.” She looked pointedly at DelRay.

“Now wait a minute,” he snapped. “I had nothing to do with it.”

“Paul Darnell, then,” she said.

“There were a couple of nurses who were there too, remember? In fact, this sort of sneaky letter is more a woman’s style.”

“What the hell does that mean?” she shot back in outrage. “A woman’s style?”

“I’m just calling it as I see it. Men are upfront about these things.”

Sarnicki warned, “Adam, this isn’t helping.”

“I think it is helping,” said Claire. “It shows us exactly what he thinks about women. Are you implying, Adam, that we’re all liars?”

“Now this really isn’t helping,” said Sarnicki.

“She’s putting words in my mouth! I didn’t send those letters, and neither did Paul! Why should we? Everyone in town’s already heard the gossip!”

“I’m cutting off this meeting now,” said Sarnicki, banging on the table for silence.

That’s when they all heard the announcement over the hospital address system. It was barely audible through the closed doors of the meeting room.

“Code blue, ICU. Code blue, ICU.”

Instantly Claire shot to her feet. She had a stroke patient in the ICU. She bolted out of the meeting room and ran for the stairwell. Two flights up, she stepped into the intensive care unit and was relieved to see that her patient was not the one being coded. The crisis was in cubicle six, where a crowd of personnel had massed around the doorway.

They parted to let Claire enter.

The first thing she noticed was the smell. It was the odor of smoke and singed hair, and it came from the massive, soot-streaked man lying in the bed. McNally from the ER was crouched behind the patient’s head, trying without success to insert an endotracheal tube. Claire looked up at the heart monitor.

The rhythm was sinus bradycardia. The patient’s heart was beating, but slowly.

“Does he have a blood pressure?” she asked.

“I think I’m getting a systolic of ninety,” said a nurse. “He’s so big, I’m having trouble hearing it.”

“I can’t get him intubated!” said McNally. “Go ahead, bag him again.” The respiratory tech clapped an oxygen mask on the patient’s face and squeezed the reservoir bag, forcing oxygen into the lungs.

“His neck’s so short and fat I can’t even see the vocal cords,” said McNally.

“Anesthesia’s coming in from home,” a nurse said. “Should I also call a surgeon?”

“Yeah, call him. This one’s gonna need an emergency tracheotomy.” He looked at Claire. “Unless you think you can intubate him.”

She doubted she could, but she was willing to try. Heart pounding, she circled around to the patient’s head and was about to insert the laryngoscope into his mouth when she noticed the man’s eyelids were flickering.

She straightened in surprise. “He’s conscious.”

“What?”

“I think he’s awake!”

“Then why isn’t he breathing?”

“Bag him again!” said Claire, stepping aside to let the respiratory tech back in. As the mask was replaced, as more oxygen was forced into the man’s lungs, Claire swiftly reviewed the situation. The man’s eyelids were indeed twitching, as though he was struggling to open them. Yet he was not breathing, and his limbs remained flaccid.

“What’s the history?” she asked.

“Came in through the ER this afternoon,” said McNally. “He’s a volunteer fireman who collapsed at the scene. We don’t know if it was smoke inhalation or a cardiac event-they had to drag him out of the building. We admitted him for superficial burns and a possible MI.”

“He’s been doing fine up here,” an ICU nurse said. “In fact, he was talking to me just a little while ago. I gave him his dose of gentamicin and he suddenly went bradycardic. That’s when I realized he’d stopped breathing.”

“Why’s he getting gentamicin?” asked Claire.

“The burns. One of the wounds got pretty contaminated.”

“Look, we can’t keep bagging him all night,” said McNally. “Did you call the surgeon?”

“Done,” a nurse answered.

“Then let’s get him prepped for the tracheotomy.”

Claire said, “He may not need one, Gordon.”

McNally looked skeptical. “I couldn’t get that ET tube in. Can you?”

“Let’s try something else first.” Claire turned to the nurse. “Give him an amp of calcium chloride, IV."

The nurse glanced questioningly at McNally, who shook his head in puzzlement.

“Why on earth are you giving calcium?” he asked.

“Just before he stopped breathing,” said Claire, “he got the antibiotic, right?”

“Yeah, for the open burn wound.”

“Then he had the respiratory arrest. But he hasn’t lost consciousness. I think he’s still awake. What does that mean?”

Suddenly McNally understood. “Neuromuscular paralysis. From the gentamicin?”

She nodded. “I've never seen it happen, but it’s been reported. And it’s reversed by calcium.”