Robin Cook - Godplayer

The women rushed into the room. Cassi was still convulsing wildly, her arms jammed through the rails, banging them back and forth.

Carol, who was aware Cassi was diabetic, knew immediately what was happening.

“Lenore! Call a code and bring me an ampule of fifty-percent glucose, a fifty cc syringe, and a fresh bottle of D5W.”

The LPN ran out of the room.

Meanwhile Carol managed to pull Cassi’s arms from between the rails. Next she tried to get a tongue depressor between Cassi’s clenched teeth but that was impossible. Instead she stopped the rapidly running IV, and concentrated on keeping Cassi from hitting her head against the top of the bed.

Lenore returned and Carol took the D5W and immediately changed the IV bottle. She put the old bottle aside, knowing the doctor would want to check the insulin level. Then she opened the IV all the way and transferred the fifty-percent glucose from the ampule to the large syringe. When she finished, she debated using it. Technically she was supposed to wait for a doctor to arrive, but Carol had spent enough time in crisis medicine to know that under the circumstances the glucose should be the first thing tried and that it certainly couldn’t hurt. She decided to give it. The amount of perspiration on Cassi’s body suggested a severe insulin reaction.

Carol stuck the needle into the IV and depressed the plunger. Even before she’d injected the last few cc’s, the result was dramatic. Cassi stopped convulsing and seemed to regain consciousness. Her lips opened and sounded as if she were trying to say something.

But the improvement didn’t last. Cassi sank back again into unconsciousness, and, although she did not convulse again, the isolated muscles continued to contract.

When the code team arrived, Carol reported what she had done. The senior resident examined Cassi and began issuing orders.

“I want you to draw blood for electrolytes, including calcium, arterial blood gases, and a blood sugar,” he said to the junior resident. “And I want you to run an EKG,” he said to the medical student. “And Miss Aronson, how about another ampule of fifty-percent glucose?”

While the team fell to work, Lenore picked up the bedside table, replacing the phone. With her foot she pushed the shards of glass from the broken pitcher into the corner. The drawer had come out of the table and Lenore replaced it. It was then she found several used vials of insulin. Shocked, she handed them to Carol, who in turn handed them to the resident.

“My God,” he said. “Was she supposed to give herself insulin blindfolded?”

“Of course not,” said Carol. “She had insulin in her IV and was being supplemented according to the amount of sugar in her urine.”

“So why did she give herself insulin?” asked the resident.

“I don’t know,” admitted Carol. “Maybe she was confused with all her sedatives and gave herself the medicine by rote. Hell, I don’t know.”

“Could she do that blindfolded?”

“Sure she could. Remember, she’s been injecting herself twice a day for twenty years. She couldn’t get the dose right, but she could certainly inject herself. Besides, there’s another possibility.”

“What’s that.”

“Maybe she did it on purpose. The day nurse said she was depressed, and her husband said she’d been acting strangely, I guess you know who her husband is.”

The resident nodded. He didn’t like to think of the case being a suicide gesture because he hated psych cases, especially at three o’clock in the morning.

Carol, who had been filling another syringe with glucose while talking, handed it over. The resident injected it immediately. As before, Cassi improved for a few minutes, then again lost consciousness.

“Who’s her doctor?” asked the resident, taking a third syringe of glucose from Carol.

“Dr. Obermeyer, Ophthalmology.”

“Somebody give him a call,” said the resident. “This isn’t a case for a house officer to fool around on.”

The phone rang and rang before Thomas groggily reached out and picked up the receiver. He had taken two Percodan before stretching out in his office, and he found it very hard to concentrate.

“You’re a hard one to wake up,” said the cheerful hospital operator. “You had a call from Dr. Obermeyer. He wanted to be put through immediately, but I told him you’d left specific orders. Do you want the number?”

“Yes!” said Thomas, fumbling on the desk for a pencil.

The operator gave Thomas the number. He started to dial and then stopped. Noticing the time, he was concerned. Obviously it was about Cassi. Going into the bathroom he splashed water on his face, trying to gather his wits.

He waited until some of the drug-induced fog receded before dialing.

“Thomas, we had a complication tonight,” said Dr. Obermeyer.

“A complication?” asked Thomas anxiously.

“Yes,” said Dr. Obermeyer. “Something we didn’t expect. Cassi gave herself an overdose of insulin.”

“Is she all right?” asked Thomas.

“Yes, she seems to be fine.”

Thomas was stunned.

“I know this must be a shock for you,” Dr. Obermeyer was saying, “But she is okay. Dr. McInery, her internist, is here and thanks to the quick thinking of the charge nurse, he says Cassi will be fine. We’ve moved her to the ICU for the time being just as a precaution.”

“Thank God,” said Thomas, his mind whirling. “I’ll be right over.”

As soon as he reached the hospital, Thomas rushed to Cassi’s bedside. She seemed to be resting peacefully. He noticed that the patch on her right eye was gone.

“She’s sleeping but she’s arousable,” said a voice at his side.

Thomas turned to face Dr. Obermeyer. “Do you want to talk with her?” he asked, reaching to shake Cassi’s shoulder.

Thomas caught his arm. “No thanks. Let her sleep.”

“I knew she was upset tonight,” said Dr. Obermeyer contritely. “I ordered extra sedatives. I never expected anything like this.”

“She was panicky when I saw her,” said Thomas. “A friend of hers died last night, and she’s been very upset. I hadn’t planned to tell her, but I learned one of the psych residents had the poor judgment to do so.”

“Do you think this was a suicide attempt?” asked Dr. Obermeyer.

“I don’t know,” said Thomas. “She could have just been confused. She is accustomed to giving herself insulin twice a day.”

“What do you think about a psychiatry consult?” asked Dr. Obermeyer.

“You’re the doctor. I can’t be very objective. But if I were you, I’d wait. Obviously she’s safe in here.”

“I took the patch off her right eye,” said Dr. Obermeyer. “I’m afraid the bandages may have been a large factor in her anxiety reaction. I’m happy to say her left eye is still clear. Considering the fact she just had a grand mal seizure, which is probably the severest test imaginable for my coagulation of that vessel, I don’t think we have to worry much about further bleeding.”

“What’s her blood sugar?” asked Thomas.

“Pretty normal right now, but they’re going to follow it closely. They think she gave herself a whopping dose of insulin.”

“Well, she’s been careless at times in the past,” said Thomas. “She’s always tried to minimize her illness. But this seems like more than carelessness. Still, it’s possible she just didn’t realize what she was doing.” Thomas thanked Obermeyer for his good work and walked slowly out of the ICU.

The nurses at the desk looked up as he went by. They had never seen Dr. Kingsley so depressed and anxious.

Cassi became conscious of her surroundings around five o’clock in the morning. She could see the large wall clock over the nurses’ station and thought she was in the recovery room. She had an awful headache, which she attributed to the eye surgery. Indeed, when she tried to look from side to side she got a sharp pain in her left eye. Gingerly she felt the bandage over the operative site.