A mercy killer in the ER

An excerpt from Mercy.

I love kids.

Pretty kids. Nice kids. Normal kids.

Not this. This is not a kid.

This is thirty pounds of human flesh kept alive by devices. Peg tube, tracheostomy, ventilator. He’s got contractures everywhere. He’s so folded he’d fit in my carry on. Not that I’d want to take him anywhere.

I check his chart. Evan. He’s twelve. He can’t see, he can’t talk, he can’t eat, he can’t breathe.

What’s the point of being alive? If you call this alive. He doesn’t know he’s alive. He can’t think.

Can he feel? Let’s find out.

I stick a #18 needle in his heel.

He pulls away and tries to scream. He can’t. He snorts.

He feels pain. That sucks. I wouldn’t have my dog live like this! Any dog! And he’s human, if only in name.

I look around. They’re all busy.

I turn off the alarms and I detach his tracheostomy from the vent. I cover it with my palm, pretending I’m cleaning it. I wait for the heart to stop.

It takes forever.

I reconnect the vent and leave.

Bye-bye, Evan. If they ask, tell them Carlos sent you!

***

Back in the ER for her next shift, Emma struggled to keep up. It was not a good day. Five psychiatric patients on hold, waiting for a place to go. No beds upstairs, so the ER had to hold admitted patients. Two nurses called in sick, making them short-staffed. The shit was pouring like rain. Emma hoped it wouldn’t drown her.

Then Mike called her for a meeting.

“What’s it about?”

“Quality.”

She was in the middle of a crisis. The drunk in Room 6 had pushed the stretcher across the door, taking himself hostage. They had no ambulance to transfer the brain bleed to neurosurgery.

Now this. Whatever it is, it’s not good news. He’s not calling to congratulate me. It’s got to be about the woman in 15 whose daughter complained. I still don’t know what happened.

She talked to the charge nurse about getting a helicopter to fly out the brain bleed, hoped the drunk would fall asleep, and went to the conference room. She found them waiting.

“Thank you for joining us, Dr. Steele,” Mike said.

You’d be late too if you had to work with patients. All of you, in fact. Sitting in your office all day makes you feel superior. You’re complacent and out of touch.

“We met to discuss a few issues that occurred in our ED lately. Over the last few weeks, our mortality has increased. We have also encountered a number of sentinel events.”

The quality director, a thin man with a skimpy white beard, started a PowerPoint presentation. He lusted over graphs and pie charts. Patients seen in the last thirty days. Left without being seen. AMA. Deaths. Near-deaths.

I wonder if I ordered the labs for Room 10.

“Emma!” They stared at her. “What’s your take on this?”

“We have a number of separate incidents. They involve unrelated patients who were here for different reasons. All, with one exception, were old and impaired. These incidents happened on different days, in different rooms, on different shifts. The patients had different doctors and nurses. We have no clear explanation of why these people died.”

“And?” Gus asked.

“I thought the first one was a medication error, but there’ve been too many. There’s only one possible explanation. I think we have a mercy killer.”

If she was looking to impress them, she succeeded. They started talking all over each other.

“Preposterous idea! This couldn’t happen in this hospital. This is a nice place. A quiet place, with good people. Saying something like that was an insult. Inconceivable.”

“Impossible,” Mike said. “We need to look at our practices. We need to stop giving verbal orders. We need to improve monitoring. We should round on the patients more often—in every case the patient appeared stable. They were left unattended, and then found dead. If we monitored them correctly, we may be able to detect changes before it’s too late.”

“We need to improve the pharmacy security,” Sal said. “Right now, it’s easy for anybody to take meds arriving by tube for somebody else. They can just grab and use them. People can even take medications out of the locked drawers without signing for them.”

“Who can do that?” the quality director asked.

“Anyone passing by the tube system,” Sal said. “Especially the nurses. They can get into the med room. The pharmacists too. The pharmacy techs, who refill the meds.”

“So, then what happens to the meds? They get given to the wrong patients or in the wrong amount. You’re getting back to the idea of a killer,” Carlos said.

His eyes met Emma’s and he smiled.

Rada Jones is an emergency physician and can be reached at her self-titled site, RadaJonesMD, and on Twitter @jonesrada. She is the author of Mercy and Overdose.

Image credit: Shutterstock.com

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