DEADLY REMEDY

by Gwen Hunter
A Rhea Lynch, M.D. Novel
Third in the Series

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PROLOGUE

When I stopped by on the way in to work, I tried reminding her that the rain was a welcome relief, drenching the overheated earth and straw-dry crops still in the fields, making a dent in the awful drought we had been suffering, and bringing cooler weather.  Miss Essie was having nothing of it.  When I left her, she was casting dark glances at the sky and talking to God as if He had made a mistake somewhere and needed her advice to fix things.

On the other hand, I reveled in the sudden return to fresh air and temperatures in the eighties.  Delighted in the vision of brilliant rainbows on one horizon, framed against furious purpled clouds.  Loved the weird refracted spots of light to the left and right of the sun on the other horizon.  It had been breathtaking for all of fifteen minutes just after the storm passed.  Now, as I left Miss Essie's and drove in to the small rural ER of Dawkins County South Carolina, they had all faded.  The sundogs had vanished.  The rainbows were little more than broken curves low in the sky.  And the black crows that alighted in the top-most branches of the white-oaks in the woods between Miss Essie's home and mine had not been a harbinger of death and change.  No matter what she said.

Omens.  Portents.  Hogwash. 

Simply a prism of sunlight refracted through rain-mist on one side, and sundog mile-high ice crystals on the other.  Science.  Meteorology.  And just big black birds celebrating having lived through the wind and lightning, flapping their wings and calling out to other birds.  Nothing more.  Though ice crystals in August were rare.  After all this was the South.  And crows usually didn't make that much noise.

Still, I had experienced enough of the religiously weird recently and I wasn't buying into any more.  I had helped put the Rev. Lamb of God behind bars and seen his TV station shut down.   And lived to tell about it.  I wasn't going to listen to spiritual nonsense, no matter what happened in the heavens.

At six p.m., I pulled into the doctor's parking lot of Dawkins County Hospital, where I worked under contract as an ER physician, and knew instantly that it would be a busy night.  The surrounding parking area was filled with cars and trucks, many with yellow emergency lights affixed to the roofs.  Three county ambulances, two rescue squad vehicles loaded with equipment, a fire truck, and a crowd of milling people met me.  Hot time in the old town tonight.  Busy?  Yes.  Kaleidoscopes and rainbows?  Definitely.

Omens?  Portents?  No way. 

CHAPTER ONE

Though the storm started three brush fires and kept the rescue squad on its toes, the rain put the flames out before extensive damage was done.  Fire wasn't the reason why my ER looked like a major disaster area.  The bus accident on I-77 about nine miles from the hospital had a far greater impact.  The fact that lightning had hit the hospital, resulting in minor damage to the surgical department, had brought out the rest of the county crews and volunteers. 

I spent half an hour treating minor burns, cuts, and scrapes so my boss could head home.  >We usually switched shifts at seven p.m., but I owed the hospital some time, so together, Wallace Chadwick, MD and I moved patients in and out and cleared the backlog of victims before he left for the night.  It was good to get the place cleared out and start with a clean slate.

While the nurses changed shifts, and the security guard made rounds, I settled in.  Ignoring the weakness in my newly healed back muscles, I picked up my bag, abandoned under a desk chair in the nurses station, and headed up the hall.  On the way I took in a brisk earful from Trish – Trisha Singletary – the nursing supervisor called in to help deal with the mess.  She was shorter than I, cute, buxom, and had a way with men that bordered on the mystical.

"It's mostly over now, but Dr. Rhea, you shoulda seen the smoke.  I was clocking in when it hit – the lightning, I mean.  It shook the whole building, made the lights go out.  Knocked a hole in the last surgical suite up high, near the ceiling, and let in rain and leaves and ruined any pretense at sterility.  Smoke damage in two rooms.  Thank God they weren't doing the procedure in either one."

"Someone was cutting at the time?" I asked, as I led the way to my call room.  It was calmer in ER but I didn't know how long that might last, and I wanted to drop off my bag, make sure the call room had clean sheets and towels. 

"Dr. Haynes was assisting Statler with an appendix on a seven year old with Muscular Dystrophy.  Statler was closing and the lightning hit.  Lorella Shirley – you know her?"

I shook my head no, tossed my bag to the bed, checked the room for cleanliness and decided it was fine.  Locked the door behind us as we started back to the ER.

"Well, she's an OR tech, and she said she jumped outta her skin when it hit and landed on a tray of sterile instruments.  Statler started cussing and Haynes slipped and fell on the anesthetist's equipment.  Lights were out about twenty seconds before they came back on.  And to make it worse, Lorella said she saw a bat fly through."

"A bat."  I would be careful not to mention that part to Miss Essie. It would surely feed her omen talk. 

"It musta found its way into the eaves from outside and been sleeping there till dark, then got knocked out of its place by the lightning.  Now it's inside.  The kid's ok, and the maintenance crew has a tarp over the hole, and the fire started by the lightning was put out by the rain, but fire crews are here to make sure nothing is still hot in the walls."

A fireman in full protective gear, heavy coat, boots, gloves, helmet tucked under his arm, approached.  Trisha slowed, preened and stuck out her chest a bit, though her impressive bustline didn't require any effort to draw the man's attention.  He slowed too and smiled, and after a moment, met her eyes. 

"Miss Trish.  You gonna be at McDowries Bar and Billards Friday?  They got a DJ with shagging."  The fireman's dark eyes held hungrily to Trisha as he mentioned the state dance of South Carolina.

"That divorce finalized yet?" she asked archly.  Trisha was perpetually looking for a man, but her standards were well known in the area.  Married men were not a part of her social calendar.

"Last Monday.  I'm a free man."  They both kept moving as the flirtation continued, turning and walking backward in the halls.

"I may be there.”  She flipped back an imaginary strand of hair, touching her neck in the process, the motion unconsciously sexual.  “You can buy me a drink to celebrate."

A wide grin split his face.  "It's a date."

"Well, I wouldn't go that far.  But you catch that bat, I might consider dancing with you."

"Not my job, Gorgeous.  But speaking of bats...." The fireman pointed past us at a dark corner just ahead.

Trisha jumped.  Stared.  Shivered.  A dark form moved in the corner, turning its head as we neared. 

"Lordy, I hate bats.  I'll get the cops after it now.  When’s this backwater county gonna get us an animal control officer?" she demanded of the fireman.  But he was gone.

"Close the fire doors to the other wings," I recommended, "and trap him here.  And be careful. A small percentage of bats carry rabies."

"Well ain't that just fine and dandy," Trish muttered.  "A big strong man all dressed out to save me and he can't kill a single little old flying rabies factory."

I grinned.  The recently divorced fireman had passed up an opportunity to play knight in shining armor to the damsel in distress.  If he had visions of dancing Friday night with his Miss Trish, I figured he was in for a disappointment. 

My beeper went off, the code in the little LED window displaying the ER extension followed by the numerals 911.  "Got an emergency, Trish."  I half-jogged away from her.  "If it stays quiet, I'll spring for pizza for the ER crew around nine.  Join us if you like."

"Beep me if you need help," she said.  “Oh, and we got a whole bunch a new agency nurses starting tonight, so things may be a lil’ chaotic."

“Little chaotic?” I said to myself as I rounded the corner to the ER.  The emergency scanner crackled with coded general information, and the ambulance scanner with more specific info. A report on a patient being brought to ER, code three.  I had a 16 year-old, female quadriplegic with severe headache, shortness of breath, and a blood pressure that was sky high.  My best guess from hearing the paramedic's report was Autonomic Dysreflexia, or toxic hypertension.  That was a dangerous condition in a quad, sometimes resulting hemorrhagic stroke, in respiratory shutdown, and in death.

"From the address, I can tell it’s Venetia Gordon."

The ability of a nurse to tell a patient's name just by the address was not particularly unusual in Dawkins.  The rural county had around 50,000 residents, according to the last census, and just like any business, we had our regulars.  "We got an old chart on her?" I asked.  I wanted to see the original report on the cause of the girl's paralysis, and a breakdown of everything that had happened to her since.

"She was in ER last week," Anne said.  "UTI from a permanent catheter.  But the original accident happened six months ago down in Lancaster County.  Two car MVA on a back-country road," she said, referring to a moving vehicular accident, med speak for a car wreck.  "They flew her out from the scene to CMC in Charlotte.  Except for a minor infection, you'll be flying blind."

"Lovely. Ask the crew where the break occurred."

When the scratchy words came back at C4, I sighed.  I told Anne what I would likely need in terms of meds and equipment, and asked her to get respiratory therapy down here stat.   If this girl crashed, I wanted help getting her intubated and on the ventilator.  There was an old saying, “C3, 4, 5, keep you alive.”  My patient was barely in the safety zone.  Anything could happen with spinal damage at that location.

Anne nodded, writing nothing, remembering everything.  She was a medium woman in every way except her memory.  Medium-length medium-brown hair, medium height, medium weight, medium disposition.  Phenomenal memory, as I was learning.  Tell her once and she'd remember forever. And really great in an emergency, which was a good thing, as the other RN on duty tonight was a newbie, fresh out of nursing school and likely useless.  She'd get good eventually, but for now she needed watching so she didn't kill somebody.  Coreen was her name.  Dark-skinned and brown eyed, petite as a model, and twenty years old.  So fresh faced and innocent she made me feel ancient.

Venetia Gordon, still with the healthy-looking limbs of her pre-accident life, was wheeled in strapped to an ambulance gurney.  She was breathing fast and shallowly.  Not much air was being exchanged.

  The girl was on 100% O2, her color was poor, an ashen blue shade that told me her lungs were shutting down.  I looked at the monitor, sitting atop the stretcher as the EMS guys moved with her.  230 over 145.  Pulse 72.  I bent over her head, moving with her, as she was swept into the cardiac room, and checked for papilledema of her optic nerves.  They looked fine, no swelling that might lead to blindness if not corrected.  "What is her O2 Sat?" I asked, referring to the oxygen saturation level. 

"Eighty-four percent last time we checked the pulse-ox,"  a voice answered, referring to a device that clipped to a patient's finger and measured both pulse and oxygen levels. 

"I want ABGs, repeat O2 Sat, and Catapress PO," I said, ordering the same tests and drugs I had mentioned to Anne only moments before.  I told them the dosage and stood back as the EMTs lifted the patient and moved her to the ER stretcher.  "How long on the ABGs?" I asked no one in particular.  My attention was on the patient's ragged, shallow breathing, displaying both dyspnea and tachypnea.  There was a look of panic in her eyes, a mottled appearance to her skin.

"Beth?" Anne asked the lab tech.

"Fast.  Maybe three minutes." 

The ABG's were Arterial Blood Gases, which would tell me how well or poorly Venetia's lungs were working.  I bent over the patient and positioned my stethoscope over her chest.  While not much air was moving, there didn't appear to be any fluid buildup.  Her skin was damp and cold, not feverish.  Not pneumonia, then.  Symptoms matched classic toxic hypertension.  At least so far.

"Get me an EKG after you get the ABGs back.   Family here with her?"

"I'm her mama.  Almera Gordon."

I turned away from the sight of the lab tech drawing blood gasses to the soft voice and found a timid looking woman, mousy brown all over, wearing sturdy matronly shoes, a sturdy matronly skirt, her hair pulled back in a tight bun.  Except for her eyes, she would have been unremarkable in every way, but her eyes were wide and a vivid deep blue.  Almost lavender.  Fringed around with odd double lashes, thick and lustrous.  Her entire demeanor may have been subdued, but her eyes claimed something else about her, a hidden strength, some powerful determination.  I nodded at her.  "Tell me what was happening when this started."

Mrs. Gordon checked her watch.  "At six pm I got her outta the bath.  The water temp was jist warmer than tepid, and she wasn't in for very long," she said, anticipating my next question.  Quads were not supposed to spend much time in heat, which could cause all sorts of weird things to happen to them. "I dried her off, got her half-way dressed her in PJs and swung her to the bed."

"Swung?  You have a transport sling?"

"On moveable tracks, but we usually keep the system set up between the bathroom and bed.  It makes bathing her jist so much easier," she said in her drawn-out mill-hill accent.

I nodded my understanding.

"O2 Sat on the pulse-ox is 82 percent, Doc.  BP 242 over 147," Anne said.

I checked my watch.  "Blood Gases?" 

Forty-seven minutes from the time Venetia was wheeled into the ER, I asked for a repeat ABG.  The results were good enough for me to turn down the O2 and tell the respiratory tech to stop bagging her.  At an hour and 15 minutes, Venetia was sitting up, strapped in the bed to keep her from slipping down again, laughing and telling knock-knock jokes to the respiratory therapist.  Her pressure was stabilized.  Her breathing was dang-near normal.  The respiratory therapist was satisfied with her blood gasses, her O2 Sat, everything.  The threat of fighting a legal battle while trying to save a life had been neutralized, just that fast.  

I poured a couple cups of coffee and motioned Mrs. Gordon into the office the contract doctors used when working ER duty.  It was little more than a closet, but it did have chairs and a desk and a new print hanging on one wall, the Charleston Battery under attack by hurricane winds. 

"Venetia is going to be fine," I started.  And then wished I could take back the words as Mrs. Gordon's face twisted in grief.  Venetia was paralyzed.  Fine was relative.  I took a breath and started over.  "You called 911 quickly enough for us to catch and treat Venetia's condition before it went too far.  You did well, Mrs. Gordon." 

The woman nodded her head, still biting her lips.  Her vivid lavender eyes were tear-filled but steady. 

"She developed a disorder called Autonomic Dysreflexia, or toxic hypertension.  It's a condition, not uncommon in quadriplegics, caused by stimulation of the autonomic nervous system by something as simple as a urinary tract infection, pulling on a indwelling foley catheter, a fecal impaction, or rectal stimulation.  It could have happened just by moving her from the tub, if her catheter got a slight yank.  You understand what I mean by autonomic nervous system?” 

When Almera shook her head no, I said, “That’s the part of the nervous system that controls automatic things like breathing and heart rate and blood pressure.  In quadriplegics, it can be affected by many things.  The blood pressure goes up fast and to frightening levels and if not treated, can result in stroke and death.  We have her stabilized at the moment, but I called Venetia's medical doctor, and Dr. Haynes  recommend that she be admitted overnight, to monitor her better." 

The woman's face grew hard.  Her hands, which had gripped one another repeatedly during treatment, began to work on each other again.  The skin was rough and reddened from what appeared to be constant abrasion.  "No insult to Dr. Haynes," she said steadily.  "He's a good man.  But my girl's seen enough doctors.  Can't none of them fix her.  They all say she could maybe get some feeling back.  Maybe get some use of her arms.  Maybe.  But can't not a one of 'em fix her.  And I'm not making her stay in any hospital any more than I have to.  Not unless you say she'll die tonight without it."

I shrugged, uncomfortable with the statement.  Venetia could die at any time.  Sometimes toxic hypertension could hit so fast a five minute wait for an ambulance might be the difference between life and death.  It wasn't likely.  But I had to consider the possibility. 

When I said this to Mrs. Gordon, her face hardened again, a mask of frustration that I understood.  "You're jist riding a fence like all the others.  Make sure you cover your backside so I can't sue.  Well, you ain't got to live with a sixteen year old who can't move to even scratch her nose. A little girl who has lost everything.  Who wants to die so bad I can hardly keep her alive."  The tears that had threatened for the last hour and more finally fell in a steady stream.  I forced myself not to look away.  "You ain't got to pay the bills for every overnight stay in a hospital, or listen to the bill collectors hound us on the phone.  Venetia's got a $1,000,000 lifetime limit on her health insurance, and a probable life-span of sixty years."  She sniffed hard.  "I'll be broke and dead long before then."

Disconcerted, I looked away for a moment.  "You're right."

Mrs. Gordon's brows went up.  Her hands, which had continued kneading one another, stilled.  Our coffees sat, untouched, on the desk between us, a curl of steam lifting from each.

"She initiated the living will?" I guessed suddenly.

"'Bout drove me nuts till I took her to a lawyer.  She wants to die.  Can't stand the thought of living like she is.  Tonight, jist now, is the first time I seen her laugh in six months." Almera Gordon fished in her neat handbag and pulled out a small, thin, plastic pack of Kleenex.  Delicately she blew her nose. 

I remembered the knock-knock jokes the girl had been telling.  Had the freedom from extreme fear temporarily reversed extreme depression?  I waited until Almera had put away the pack before resuming speaking.  "It's easy for a doctor to get so caught up in potential medical problems that we forget the realities of time and cost."  I focused on her bright tear-filled eyes.  Her skin was mottled and flushed with the effort of controlling the crying-jag.  The tissue she still held was already crushed and wilted.  "I'm sorry.  I know this is hard for you, but we sometimes have to save patients against their will."

The woman's eyes dropped, but not before I saw tears gather again.  She took a shuddering breath.

"Mrs. Gordon –  "

"Call me Almera."

I figured that meant I had passed some test in her eyes and I nodded my thanks.  "And I'm Rhea."  I leaned across the desk toward her.  "Almera, Venetia could get this condition at any time.   Once a patient has had toxic hypertension, it's easier for them to get it a second time.  The next time, it could come on her so fast that you wouldn't have time to get an ambulance to her before she had a stroke or expired."

"Died."

I nodded.  "Died."  This woman wanted plain talk.  I could give her that.  "But it isn't likely that it will happen again tonight, any more than it's likely to happen any other specific time.  She's as stable as I can get her in an ER." 

"I'll be taking her home then.  I followed in my van."  Almera stood, straight-backed and resolute, opened the door and stepped out into the hallway.  I accompanied her, leaving the coffees on the desk.  "I'll stay up tonight watching her," Mrs. Gordon said.  "I can check her BP every half hour if I need to."  She paused, looking up at me, her face once again hard, eyes calculating.  As if to challenge me.  "We have an appointment with a faith healer tomorrow.  I ain't missing that for nothing."

My heart fell.  I opened my mouth to say that was foolish.  To tell her they were all charlatans.  Fakes.  To tell her that in a few years medicine would have a cure or at least a good treatment for people in Venetia's condition.  But I remembered the tears in Almera's  eyes and her worry-roughened hands, and kept my mouth closed.  The words strangled there.  Right now, medicine couldn't provide the kind of help Venetia needed.  And the Gordon's needed something to give them hope.

I settled on, "Would you call us in the morning and let us know how she's doing?  We'll be here till seven."

"I'll do that.  And thank you, doctor."

"Rhea," I said again.  But she shook her head. 

"Doctor.  And you're a good one.  You talk to people."

With that, she turned her attention to her daughter and getting the girl strapped in to her specially made wheelchair.  I stood under the ambulance hood and watched as they loaded her up, the gray, panel van situated against a backdrop of vibrant fuchsia clouds and a dying scarlet sun.  It was eight-thirty and growing dark, the sunset seeming alive in the dusky sky.  I looked up.  Not a rainbow to be seen.  Temperatures were cool for August, had dropped into the high seventies, but it wouldn't last.  By morning it would likely be back in the high nineties.  For now, false fall.  Blissful.

Coreen stood beside me as the van drove off, her wispy brown curls shaded rosy in the light.  "They used to go to my church.  Now they stay home.  Watch TV preachers."  The Gordon's van turned onto the road in front of the hospital and moved slowly away, the brake lights glowing.  

In the distance, an engine revved, the whine high and growing shrill as it approached.  Headlights rounded the far curve.  It was another panel van, this one vibrant as the sunset, flying up the hill.  Foreboding gripped me. 

"That thing's moving too fast," Coreen said.  "It ain't gonna make the-"

The van, silhouetted in the orange sun, made a hard left in front of the hospital.  Tires squealed.  Its headlights flickered.  The van seemed to lift and topple all at once.  Rolled and disappeared off the road into the ditch.  The sound of it hitting earth and the telephone pole was like a bomb going off.  The pole splintered and flew up into the air.  An instant later it was over.  And I was moving. 

Excerpt from the book DEADLY REMEDY by Gwen Hunter
Mira Books - February 2003 - ISBN 1-55166-669-3 - ©Gwen Hunter

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