The night shift was beginning. I sipped at my coffee. Although I had had a full eight hours of sleep that day, I knew I would need it. The body’s overpowering need to sleep during the night hours could be countered with massive doses of caffeine and humor. I used both – extensively.
My eyes didn’t take long to adjust to the dark interior of the ER. At this time of the year, the days were shorts and I slept them away. I didn’t see the sunlight for days at a time, sometimes weeks. Combined with the frigid cold of Canada’s winter, it drained my energy. But I was wide awake that night.
I took report with Becky, a fellow nurse working with me that night. I felt relief. I was still pretty new to the department and to the profession. I had confidence in my skills and abilities, but was always glad to have someone more experienced with me.
“Seems like we have an old friend with us tonight,” Becky said, pointing a slightly trembling finger at the board where all the patients’ names were noted.
I ignored the shaking. Too much coffee at the beginning of the night shift does that. I took a look at the board and spotted the name. Mrs. Patterson. “Maybe it’s another one,” I said.
Becky shook her head at me, amused. “You keep on hoping, honey.”
I was not too surprised to find out, during report, that the Mrs. Patterson whose name we had spied earlier on the board was none other than the same one that had come to the ER during the last five months at the frequency of once a week. She was an elderly lady, about 87 years of age – no one knew for sure. She was a street lady suffering from multiple disorders. She was a demanding woman, expecting top-notch care that our ER, bursting at the seams, couldn’t offer. The massages and hour-long conversations unfortunately weren’t always offered to her, and she complained about it – loudly, and rudely. She was usually put into the isolation room, because she disturbed the other patients with her loud voice. She also smelled. A lot, and very bad.
“Who is our patient attendant for the night?” Becky asked.
“I am,” Tina grinned down at us from the counter.
I smiled back at her. “Hey Tina.”
“Did I hear you guys right? Mrs. Patterson here, again?”
Tina rolled her eyes. “However nice I am told to be to the patients, I am not giving her another foot massage. First of all, the place is packed, I don’t have the time.”
“We understand, Tina. Don’t worry about it.”
Tina didn’t seem to have heard Becky. “And secondly, her feet… You wouldn’t imagine how badly they stink. I almost fainted! We don’t need patients like this.”
“Shh,” I told her. I didn’t want anyone to hear the comments Tina was making. Although health care professionals needed to vent, they didn’t need to do so in front of the public.
Tina made a face. “Wish we could get rid of them all,” she said before turning away.
Becky shook her head. “Shouldn’t be talking like that in here,” she said. “Lots of politics.”
She frowned. “Did you hear that?”
I listened carefully then shook my head. “I must have missed it.”
Becky stood up. “I’ll go take a look.”
I did my first round after Becky came back to report that if someone had screamed, they were quiet now. Although full, the patients didn’t require much care, and all were deep in peaceful slumber, even Mrs. Patterson. I was relieved.
I came back to the nursing station to do my charting. I was met by Dr. Thierren.
“How are you, Jolie?”
“Very good Dr. Thierren. And you?”
“Good. Anything going on?”
“Everyone fast asleep, no problematic breathing patterns, nothing.”
“Not even with Mrs. Patterson?”
I shook my head.
“I can’t believe she’s here again,” Dr. Thierren continued. “What a drain on our resources. I hope she dies this time.” He said this calmly, while doing his charting, as if he were talking about mere mundanities.
I swallowed a terse reply and turned to my charts. As head physician of the ER, Dr Thierren was under a lot of pressure to cut costs. He was probably very stressed, and didn’t mean what he had said. No sense in getting in trouble with a senior physician. It would only do me harm.
There exists a false taboo that street people don’t have meaningful lives and don’t have families. Mrs. Patterson has a steady high income from smart investments. She once told me how much she was worth – and it surprised me. She could easily afford a life of luxury, yet chose the streets.
Mrs. Patterson also had a tightly knit family. Her daughter was always called when her mother was admitted to the ER, and she unfailingly came to see her mother.
“Good evening, Mary. How are you?”
She smiled tiredly. “Tired, obviously. How is she doing?”
“She has pneumonia and her kidneys aren’t functioning well.”
“No, not quite. Could get there, though.”
She signed. “You know…”
I didn’t press her. Mary and I had a long standing relationship that stemmed from our common concern for her mother.
“I don’t want to be mean or anything, but… Sometimes, I wish she would die, you know?”
I nodded. “I understand.”
I catered to her needs, knowing that a bed and a good night’s sleep were the best remedy for her at the moment. I came back to the nursing station, and was greeted by Becky. I told her about my conversation with Mary and about Tina’s and Dr. Thierren’s remarks.
Becky, who was massaging her right hand, shook her head. “Don’t listen to any of them. Just do what your heart tells you. She’s a human being, just like you and me. Take good care of her, and you’ll be rewarded for it.” She then tried holding her right hand still in the air. It started shaking uncontrollably. She sighed, continuing to massage it.
I decided to go on my second full round not too long after. I liked the fact that in the ER, I could see all my patients from the nursing station. But I still liked to walk among the stretchers, to make sure that the patients knew I was there for them.
My heart started pounding. I knew that feeling. I hadn’t been working for long as a nurse, but when that sense of heaviness invaded me, I knew that someone had just left this world for the next one. Involuntarily, my eyes fell on the door to the room of Mrs. Patterson.
I pushed it open. As soon as I spied her peaceful face, I knew. I smiled as I prayed by her bedside. She was gone; she’d be fine.
I followed the now-familiar protocol. Dr. Thierren was busy, so Dr. James, a resident, called the death, then Tina and I set out to clean the body.
“This is one wrapping I won’t mind doing,” Tina said, bringing in the equipment.
I threw her a puzzled look. She shrugged.
“No Mrs. Patterson, no problems. If only the others could do us the favor of dying, it would ease the ER overcrowding.”
She shook her head. “I’m serious. These people come in all the time, using up resources, and we don’t have anything left for people who take care of themselves and are worth something to society.”
I was shocked by the harsh words. “Tina, please. Don’t say these things in the presence of Mrs. Patterson. And myself,” I added after a moment’s hesitation.
Tina shrugged. “I will hold up the side,” she said. I smiled at her; she smiled back. I was glad the little disagreement hadn’t ruined our good working relationship.
She took a breath and leaned her weight back, rolling the slowly stiffening body on its side. A wave of nausea engulfed me.
“What is this doing here?” I asked, holding up a small vial of potassium, the contents of which were enough to stop a failing heart if injected in one shot.
Tina shrugged. “We always find all kinds of stuff in the patient’s bed.”
I hesitated, then pocketed the vial. I would have to put it in a plastic bag, just in case.
One thing I had quickly learned was that gut instinct was a nurse’s best friend. More than once, while the rest of the staff was convinced a patient was fine, I could be seen taking vitals signs and an electrocardiogram, and detect an early stroke. It had come to the point that I had only to frown, and the doctor was ready to intubate.
I believe that this ability, honed only in the ER as part of my nursing care, also spilled over, unconsciously, to the other aspects of my life. I would stop walking for no apparent reason moments before a car would come speeding around the corner. Things like that.
This is why I didn’t fight the unease that had gripped me at the sight of the potassium bottle. It wasn’t supposed to be there. And I had to find out why.
I loved to read mysteries, but somehow, it wasn’t easy to put together what had happened during the last hour of Mrs. Patterson’s life.
The first thing I did was the check the trash can in Mrs. Patterson’s room. I found more of the little potassium bottles. I then checked her chart for the last couple of days she had been in the ER, going over each page, scrutinizing each line. Sure enough, potassium hadn’t been ordered as part of her treatment.
I was also able to ascertain was that four people had been to Mrs. Patterson’s bedside between my first and second round: Dr. Thierren, Tina, Mary and Becky. All had the ability and the knowledge to use the potassium against Mrs. Patterson, Dr. Thierren, Tina and Becky for obvious reasons, Mary because she was a retired pharmacist.
Now what I needed to do was to turn into Sherlock Holmes and find out what happened.
“Becky, did anyone come into the medication room?”
Becky threw me a puzzled look. “No. Why?”
“Are you sure?”
“Yes. Jolie, why the questions?”
I shook my head. “Just making sure no one came in there. You know, after that incident, last week?” I was referring to the stolen medication a patient had been caught stashing in his underwear.
Becky nodded. “Smart. No, no one came in. I was here at all times. No one could walk past me.”
I noticed she was throwing puzzled looks around. “Is something wrong?”
She shook her head. “I am just trying to figure out who is talking right now.”
I strained my ears, but couldn’t hear anything but the low hum of the ventilation system and the steady breathing of the patients. Becky must have extremely good hearing.
“Tina, did you see anyone go into the medication room at any time?”
Tina shrugged. “No one but you and Becky.”
“What about the stock room?”
Tina shook her head. “Couldn’t tell you about that. Everyone goes past that door, and it isn’t locked.”
I went in to the stock room and checked out the packages of potassium. None of them were torn or open. I went through all of them one by one.
I left the stock room, discouraged. I was convinced that Mrs. Patterson hadn’t died of natural causes. I now needed to find out who did it, and why.
I was so deep in my thoughts that I ran into Mary.
“I’m sorry, Jolie.”
“Don’t worry about it. How are you feeling?”
Mary smiled bravely, tears welling in her eyes. “You don’t think that… You know, what I said…”
I shook my head. “It doesn’t have anything to do with that.”
“I know. Rationally, I know. But in my heart… It’s gnawing at me.”
“Have you made arrangements?”
“Yes. It’s all been taken care of. We had spoken of this not too long ago.”
It struck me then. Mary had told me about the arrangements about a month ago. They included the completion of a will that left all of Mrs. Patterson’s belongings and assets to Mary, belongings and assets the totaled more than three million dollars. I also remembered that Mary had been going through some financial rough patches. What did they call it? Motive. Mary had it.
I crossed Dr. Thierren in the hallway. He was grinning. “I just got to sign the death certificate. Finally, a load less to carry.”
I hesitated. “Dr. Thierren, I know Mrs. Patterson was very sick, but…”
He frowned ominously. “What are you trying to say, Jolie?”
“Could it be possible that Mrs. Patterson died of unnatural causes?”
He moved so fast that I didn’t have the time to react. He grabbed my upper arm with such force that I winced.
“Listen, Jolie. You have just started your career, so I won’t hold this against you. But remember one thing, and remember it well. Some things are better left alone, and some questions are better left unanswered. You understand?”
Frightened, I nodded. His grip tightened before letting me go. I rubbed the red imprint of his had while watching him leave. What was going on?
I sat for a long time at the nursing station, pondering my course of action. I was convinced that Mrs. Patterson had been killed. Not only had I found the bottle of potassium which had no reason to be there, not only the trash can had been filled with the small potassium bottles, but my senses were on high alerts. I was tempted to confide in Becky, but as I approached her, something made me ask her about the weather instead.
What could I do? Could I call the cops? The body had been taken away long ago. There was no proof left. I slipped my hand in my pocket. Unless I showed them the little potassium vials in my pocket and in the trash can…
I called my friend, who is in the police force. He told me that if I was so sure about my instincts, that I should talk to my head nurse and call in the authorities. I went to the head nurse’s office and told her about my concerns.
The head nurse looked at me, grave. “You realize the seriousness of your allegations,” she said.
“Yet you still maintain that Mrs. Patterson has been killed, and didn’t die of natural causes?”
I nodded again.
She sighed. “Jolie, you are new to the job. You are still young and inexperienced. There is one important thing that you must know. Don’t go into things that aren’t worth it.”
“Mrs. Patterson isn’t worth it?” I said, incredulous.
She shook her head. “That isn’t what I said. The situation isn’t worth it. Mrs. Patterson was a very sick woman. She is much happier where she is now. This is the first incident of its kind in over twenty years. I can promise you that if anything else happens of the same nature before another twenty years, I will call in the authorities.”
Was that sarcasm I detected?
I thanked her and left the room. I was truly alone in this. What was I to do? On the one hand, my conscience was torturing me. I had to know if she had been killed, and if so, her killer had to be brought to justice.
On the other, my career was on the line. What was I to do?
I came back to the nursing station. Becky was nowhere to be found. I went around the ER, puzzled when I couldn’t find her. No one had seen her in over thirty minutes. I asked a fellow nurse to look over our section while I went to look for her.
I finally found her outside. Once again, her right hand was shaking uncontrollably.
“Becky, are you OK?”
She shook her head sorrowfully. “I will never be OK.”
She laughed a short brittle laugh. “The question is, what isn’t wrong?”
She sighed. “Sometimes things happen to you in life that you can’t understand. You should accept them as tests from the All-Mighty. But it’s so hard!”
She made me promise not to tell anyone. “I have been diagnosed with Parkinson’s. The Cogentin I have been taking used to help with the tremors, but now,” she lifted the shaking hand, “it seems to have lost its efficiency.”
I sorrowfully shook my head. “I am so, so sorry, Becky.”
She lapsed into silence. We stood there, watching the shadows in the ambulance bay, until Becky sighed yet again.
“If you don’t mind, I will go take a short nap.”
I nodded, still moved by her situation. I remained alone for a few moments before going back to my section of the ER.
I was rounding yet again when I noticed that one of my patients was wide awake. Since she was a demented patient who had the tendency of slipping through the rails of her bed and potentially hurt herself, I went to her bedside.
“Hello, Mrs. Johnson. Why don’t you slip back in the middle of the mattress?”
I squeezed her arm. “I will take good care of you.”
“You yes. But what about the other one?”
A chill ran down my spine. I looked into her eyes, surprisingly clear and focused. “Which one?”
“The one with the pink clothes.”
The only staff member wearing pink had been working with me all shift. Was it possible? Could I believe a demented patient?
“Are you sure, Mrs. Johnson?”
“Yes, yes.” Her eyes clouded over. “Is my husband here?” Her husband had been dead for fifteen years. The moment of lucidity had passed.
I agonized. I didn’t know what to do. Was Mrs. Johnson, an old, demented woman, to be trusted? Maybe she had a little bit of paranoia going on. It wouldn’t be a first. However, there was one thing I couldn’t ignore. When Mrs. Johnson had mentioned the one with the pink clothes, it felt right. Pieces fell into places. My damnable instinct told me that was the answer.
I sat at the nursing station, dispirited. What could explain Becky’s actions? She was an amazing nurse, the most compassionate one I had ever met. I always had hoped to become at least half the nurse she is.
My eyes fell on a small bottle of medication sitting on the counter. I picked it up. It was Becky’s Cogentin. I was about to put it back down when I noticed the date. This bottle had been picked up only three days ago, and it was nearly empty.
My breathing caught in my throat as I remembered that one of the side effects of Cogentin was hallucinations. Some people have also been reported to have personality changes. Could that explain what had happened? Becky had told me that her Parkinson’s had been growing worse. In a last attempt to bring the shaking under control, could Becky have taken extra doses?
If so, Becky couldn’t be held accountable for her actions. Where was she at the moment?
“Why the frown?” Melissa, who was passing by, asked me.
I smiled. “Just some dark thoughts to match the lighting in here.”
Melissa nodded, opening and closing cupboard doors.
“What are you looking for?”
“Air freshener. We have another delinquent in, and he smells.”
An alarm bell rang. “Do you need any help?”
“No. Becky is there, helping out.”
I was out of my chair and halfway down the room before Melissa could say anything else. Becky was supposed to be taking a nap, not helping out in another section.
I careened none too gracefully into the other area. “Where is Becky?” I asked breathlessly.
The head nurse threw me an odd look. “In room 3.”
I knocked on the door, went inside and gasped. Becky was standing at the head of the bed, injecting something into the man’s IV line. Empty vials of potassium littered the bed.
“Becky, please. Stop.”
The head nurse, who had come up behind me, gasped. “Becky, what are you doing?”
Becky’s face contorted. “The voices. Everyone is telling me to. I have to. It’s my job.” Her thumb pushed on the syringe.
“Becky, it’s me, Jolie. Remember what you told me last week?”
Becky frowned at me. “What are you talking about?” Her voice was harsh. It sounded odd coming from such a soft-spoken woman.
I took a step forward. Becky took a step back. “Stop it!”
I froze. “Becky, just last week you told me that I should never stoop to the level of other nurses. That politics weren’t important. All that matters are the patients.”
“I never said that.”
“Becky, please look at me.”
“I don’t want to.”
“Look at me,” I said with force.
Becky unwillingly looked into my eyes.
“Remember me. Remember who you are. You are Becky. You are the most caring, empathic nurse in the ER. You are overmedicated, and aren’t responsible for your actions. Please put the syringe down.”
Becky hesitated. Tears welled in here eyes. “I don’t know. I can’t think. I…” Her face contorted. My heart bled for her.
Becky started muttering something. I hesitated, then took a step forward, then another, until I heard what she was muttering, over and over again.
“I am a nurse. I care for my patients.”
“Yes, you are. And you are an amazing nurse. You are sick, Becky. Let me care for you.”
Becky nodded, her hands falling to her side. “I am sick. I have Parkinson’s.”
The head nurse gasped.
“Yes, you do.”
“I can’t work anymore.”
“Yes you can. You can’t perform techniques, but you can still care for your patients. But you have to let us help you now.”
She nodded again. I stepped up beside her and slipped my hand in hers. She grasped it.
“Will you stay with me?”
I nodded, relieved. “Let’s go.”
Becky wasn’t indicted for what she had done. She had taken too much medication and couldn’t be held accountable for her actions. She had to retire as a nurse in the ER, but remained as a teacher. Her shaking got worse, but she had learned her lesson, and refused to take extra medication.
And I still trust my instinct. It has never let me down.