Compromised, page 30
part #1 of MetroGen Forbidden Love Duets Series
“Nope, got punched right here.” Michael pointed to the bruise on his face.
She palpated it gently. He winced, so she put a tongue depressor in his mouth and told him to bite down with it between his teeth. She flicked it a few times, moving it to the other side. “Teeth appear intact.”
Michael chewed on the depressor experimentally. “So they do.”
She took a penlight out and shone it in his eyes. “Any vomiting, nausea, or confusion?”
“Nothing out of the ordinary after a night of hell in the ICU,” Michael said.
“Not super helpful. How long has it been since your injury? Follow my finger.”
“I dunno. Could be an hour by now. Might be longer,” Michael guessed.
“You said you didn’t have any confusion.”
“I’ve got one more night shift before I move off ICU and into the ER. I am certain there was a domestic terrorist attack and two dying firefighters in the ICU last night. So forgive me for not being sure of what time it was before I got attacked by another firefighter.”
“Fine, so you’re sure you don’t have a brain bleed. How’s your vision? Read the sign over there.” She pointed to a sign on the opposite wall.
Michael started reciting the letters and stopped to rub his eyes. “Sorry, it’s a little blurry.”
“Which is why you are getting a head CT next. You might be with us a for a few hours.”
“Or my eyes are dry.”
“Too bad. Head CT it is. Or are you going to leave AMA?” Shaw used the term ‘AMA’ which meant against medical advice for patients who refused to do studies the physician recommended.
“Fine. I’ll get the head CT. Can you keep an eye out on the fire chief?”
“Why?”
“Please make sure they keep him on telemetry. I’m telling you, he was in SVT.”
“Not to doubt you, but did you slap an EKG on him while he was beating you up?” She was clicking orders into the computer on the wall.
“No. I felt his heart rate. It was crazy fast when he collapsed.”
“It’s hard to accurately count any heart rate above 150 by hand,” Shaw pointed out calmly.
“Then I imagined it?”
“Could it be possible you’re misinterpreting his sinus tachycardia? Why would he develop SVT for the first time today? He’s a firefighter. They get EKGs with their physicals regularly.”
“Maybe he missed his or something. Please.”
“I’ll check on him. You take a break. A nurse will bring you an ice pack now. We’ll wait on the Motrin until after your head CT.”
“Yes, doctor.” Michael sat down on the bed and pretended he didn’t have a care in the world.
No sooner was she out of the room than he hoped up and logged into the computer on his own.
He was bending a few rules, but he was a medical student. It was his job to learn, right?
Fire Chief Noah Baker certainly qualified for healthy. He didn’t smoke, worked out regularly, and had an EKG in his physical every two years. His lipid panel was pristine, and he didn’t take any medications. Not even freaking Zyrtec.
Interestingly, his chart listed his sister in Wisconsin as his emergency contact. The information about his wife Erin Hudgens must not have been disseminated to the hospital yet.
The Chief had been moved from the trauma rooms into one of the regular rooms on the standard care pod. The nursing notes indicated he was now AOx3. From their assessment, he was alert and oriented to person, place, and time. Michael wondered how in depth they had gone, because the Chief was oriented enough when he met Michael that he was at Doctors Row and Michael was an intruder in the early morning.
Then again, as they say in Britain, everyone, including the nurses, were fagged out. The day after effects of the mass casualty event were most acutely felt by the ICU and ER staff.
Michael waited a full hour before he was escorted down to CT and back. Then he waited in the room with increasing agitation. Another quick log in showed that Chief Baker had gone for his head CT first, which was negative.
Dr. Shaw came by thirty minutes later, papers in hand. “Great news. Your head CT is clear. If you don’t have any objections, this is your discharge paperwork. You can be on your way to get sleep.”
He read the papers. “No concussions? Contusions to face?”
“Med student Harper, you know very well concussion is a clinical diagnosis based on symptoms at least twelve to twenty-four hours after the fact. Since that hasn’t happened, I can tell you your brain isn’t bleeding. You can nap before your ICU shift without worrying you’ll never wake up courtesy of an undiagnosed subdural hemorrhage.”
“I expected psych to be more reassuring.”
“The best medicine now is sleep. In other cases, I’d be writing you a work excuse to process your emotions post assault. Would you accept a work excuse?”
“Not on my last day of ICU,” Michael admitted. Like he had discussed only one day ago with Angela—was it really only yesterday?—no one called in sick unless you were dead. It would reflect poorly on his work ethic if he let the small matter of being beaten up with a Halligan bar prevent him from coming to shift.
“Then sleep is the only prescription I can give you.”
“How’s Chief Baker?”
Her expression changed in a way he recognized very well after a year at the hospital. She had bad news. “He left.”
“He left?”
“Yes. He left AMA. Absconded, took flight, flew the coop, went on the lam.”
“How? Did he beat up a security guard before he escaped?”
“He walked out.”
Michael couldn’t believe it. “You can’t be serious.”
“I wish I weren’t. They disconnected him from his monitors to go to the bathroom. He never came back. Security is searching the grounds for him.”
“Wow, I’m sure he hung around MetroGen,” Michael said sarcastically.
“This is the ER. Not the locked psych ward. What did you expect us to do? He was cleared as a fall risk with a normal CT and passed his balance testing. You want us to hit him with a dose of Haldol and make sure he doesn’t get up?”
“Did cardiology even see him?”
“No, he left before the consultant made it down. They checked out his chart remotely and recommended a dose of metoprolol. He got it before he left, so it should keep him from going into SVT again.”
Michael shook his head. “It’s not enough when we don’t know what’s wrong with him.”
“He can’t have gotten far in a patient gown. This happens. They’ll find him and bring him back. Now please go home and get some sleep. Take Motrin for your cheek.”
He acquiesced by signing the papers.
Not a fool, she escorted him toward the cafeteria before she returned to the trauma pod.
Instead of leaving the ER, Michael did a right-hand turn into the empty back minor care pod. It was early enough in the day it wasn’t in use. No one would question a medical student logging on.
Chapter 54
Back in Chief Baker’s chart, he reviewed everything again. No murmurs. His heart rate was regular. The chart noted smoke on his skin, a normal airway, and the bruise on his left thigh.
What if… Michael searched his memory.
The bruise was a perfect circle. Not a fingerprint. Not a punch.
It could have been an intramuscular injection. An IM injection from a syringe would cause a circular bruise.
IM wasn’t the preferred way to administer medications because muscle didn’t absorb most medications very well. The med would have to work IM and explain the consolation of the chief’s symptoms.
Michael considered illegal drugs, but most of them didn’t work well IM, which was why IV drug use ran rampant. His negative drug screen essentially ruled them out anyway.
No heroin, fentanyl, Dilaudid, morphine, meth, cocaine, Valium, Ativan, or pot.
Besides, the man had probably been fighting fires yesterday. He’d have to have been injected with something easily available on an ambulance that wouldn’t show up on tox screen.
Benadryl?
What was the medical student teaching song?
Blind as a bat. Mad as a hatter.
Damn, he was sleepy. Come on. He’d been pimped on this in the past.
Benadryl overdose caused cholinergic block.
Ah. He had it.
Red as a beet. Dry as a bone, blind as a bat, mad as a hatter, hot as a hare, and full as a flask.
Confusion, yes. Blind, no. Red, no. Feverish, no. The other ones referred to not sweating or peeing, so not Chief Baker.
And Benadryl didn’t explain the heart problem.
Someone else had been in the chart because scanned documents kept appearing in the other materials section.
Michael clicked those open and saw the very industrious person had preserved the reams of paper from the ambulance.
The ER had probably only given the recordings a cursory glance since they were less accurate than their own and rolls of paper were difficult to read.
Still, Chief Baker had been having events on the ambulance. Michael scrolled back to the earliest recordings and tried to keep focused.
His eyes kept blurring from the strain of staying open.
No, it wasn’t his vision this time, and paused the screen. This one wasn’t a blur. It was real.
The QRS complex, the large bump on the EKG, the depolarization of the ventricles, had a slurred delta wave.
He knew this rhythm. It had haunted his dreams from OB and in the thousands of heartbeats recorded on Chief Baker; the answer stared at him.
Delta waves were Wolf Parkinson White Syndrome. Tiffany Wickwire had it. The Chief had it. He was going into SVT because he had an extra pathway in his heart.
Michael covered his eyes with his hand and concentrated. Tiffany’s pregnancy had uncovered her pathway. Something must have uncovered the Chief’s.
He stood and left the ER, not sure where he was going. Being this exhausted was exhausting.
The answer was at the edge of his consciousness. He knew it. He’d been taught it.
He wasn’t going mad.
Chief Baker was…
Dr. Shaw had said…
“Oh no. Angela,” Michael turned the corner to the stairs and sprinted up to the third floor.
Angela’s rockstar vibe hadn’t worn off for the entire call night. Not only had the Fire Marshal survived his night in the ICU, but the city wide shutdown limited the number of overnight heart attacks. She’d done one cath at midnight and bedded down until the glorious hour of seven.
She’d done a few morning phone visits of patients who hadn’t come in yesterday for the same reason. The lack of cardiology staff had led to her clinic being closed for the morning.
Then, she’d done phone sign-out of her minimal number of patients to Pegg. While she’d done that, he immediately got paged by the twelfth floor and the ER at about the right time.
As much as it sucked for the rest of the hospital and Mr. Taggert’s likely colon cancer, Angela had a nice white cloud call night.
Unless, of course, your secret boyfriend barges into your office.
“Angela. We need to talk.” Michael came in, skipping knocking completely.
* * *
Usually Angela would have been upset, except Michael was in terrible shape. She was out from behind her desk. “What happened to you?”
“The Fire Chief beat me up. At your house. It’s not important because he escaped from the ER and could die any minute.” Michael went directly to her computer.
“Wait? The Fire Chief? Blonde guy? I met him yesterday checking on the Fire Marshal,” Angela said. The guy had seemed pretty intense, though not the violent type.
“Very blonde. Excellent puncher. Has Wolf Parkinson White after Haldol injection.”
“So you injected him with Haldol? Why were you carrying Haldol?” Angela had difficulty following Michael’s line of reasoning. “Do I need to get you down to the ER? Head CT?”
“We both already had head CTs.” Michael took a deep breath, collecting his wits. “Here’s a short version of the situation. The Fire Chief mistook your house for Erin Hudgens’s next door. He thought I was breaking in and fought me.”
“Okay. Time to find a new place that doesn’t attract lost firefighters,” Angela said. “You fought him off with Haldol?”
“I didn’t give him Haldol. While he was fighting me, he had chest pain and collapsed. His heart rate was over 300, and I’m telling you, he was in SVT.” Michael waved his arms. “See this?”
She turned to the computer screen. “This is a normal EKG.”
“Oh, wrong one. Hang on.” Michael opened a new window showing a rhythm strip. “See, right here, this is from the ambulance. See the delta wave hidden in this QRS?”
Angela traced it with her finger on the screen and recalculated the EKG intervals. Michael was onto something. “You’re right. Intermittent firing of WPW.”
“I knew it!” Michael jumped up and celebrated. “Sorry, finally someone agrees with me. I think the Haldol unveiled it.”
“Why do you think he had Haldol?”
“He was pretty confused, spouting gibberish on and off, overly sleepy. Then I saw a circular bruise in his leg, which could be from an IM injection. Haldol is in the ER and ambulances for agitated patients. It won’t show up on the drug screen, unmasks WPW, and has a half-life of at least eighteen hours. Nothing else fits.”
Angela followed her own overly tired boyfriend’s logic. “You were in the ER. Did you tell them all this?”
“They didn’t believe me. Then he escaped.”
“So he’s not on a monitor?” Angela clicked more boxes. “Did they give him metoprolol?”
“Yes. Pegg hadn’t come down yet, so they gave Chief Baker metoprolol under his advice.”
His confirmation pretty much took care of Angela’s good vibes and a rock settled in the vicinity of her stomach. “You’re sure they gave him metoprolol before he escaped?”
“I’m absolutely sure. See, here’s the record of him getting his dose,” Michael reached over her to scroll to the medical administration record (MAR).
“We have to find him. Forget about the Haldol. The metoprolol could be a death sentence on its own.”
“I thought Haldol increased the risk of sudden death.” The blood drained out of Michael’s face.
“It does, but metoprolol… Chief Baker has two electrical pathways firing in his heart right now. Usually we use metoprolol to keep the heart from beating too fast. Except here it will keep the normal good pathway from firing and leave the bad, confused pathway to work unopposed.”
“This sounds bad. Or worse than I thought,” Michael said.
“The metoprolol will last four to six hours. If his heart tries to speed up, the metoprolol will kick in.” Angela glanced around her office frantically, hoping the Chief was hiding behind a plant.
“What can we do? Security isn’t going to find him.”
“Someone has to. Did he have a cell phone? His emergency contact?” Angela suggested.
“He didn’t have a cell phone or ID on him at your place. His sister is in Wisconsin.”
“Any idea on where he’d go? Why was he trying to reach Erin Hudgens?” Angela asked.
Michael paused for a long moment. “Well, it hasn’t been updated in his chart yet… she’s his wife.”
“Do we have her number?”
“We might. It should be in her chart from when she had the appy.” He perked up and located the correct patient chart. “Voicemail. This is Michael Harper from MetroGen. We need to get in touch with you ASAP. You can call me on my cell phone.”
When he was done reciting, Angela put her white coat on and made a few calculations. “He might go back there. How are you feeling? Strong?”
“Umm, yes. Oh, what if we call her emergency contact Theo Jefferson? He’s a firefighter at her station,” Michael suggested.
“Good idea,” Angela watched him dial. Someone picked up on the other end.
“Is this Erin Hudgens-Baker? It’s medical student, Michael Harper. I tried calling your phone, but you didn’t answer.” Michael said, “I’m calling from MetroGen because your husband, Noah Baker, is missing.”
A rapid conversation ensued, and Michael scrambled for a piece of paper and started writing.
HALDOL. YES.
“Where are they?” Angela mouthed.
“Twenty minutes away.”
Michael listened a little longer before reciting his cell phone number. “Call me when you’re close.”
“So it was Haldol?” Angela confirmed.
“That’s what she said. He didn’t go to sleep, so they thought it missed. Her cell phone battery is dead. What now?”
She hated to take the next step, but it had to be done. “He’s not on hospital grounds anymore, and you said he was searching for Erin?”
“Yeah. She was one of the things he had latched onto,” Michael said.
“Save the number on your cell, and come with me.” Angela led him out to the hallway. She got to the crash cart and checked both directions in the hallway. “Take this.”
Michael almost dropped the portable defibrillator she handed him. “What are we doing?”
“I can’t believe I’m saying this. We need to go back to my place. Take that.”
“The crash cart?”
“No, the bag mask, the IV kit, and these emergency intubation supplies.” Angela gave him the aforementioned items and used her badge to open the crash cart. “Epinephrine. Amiodarone. More epi. Propofol. Succinylcholine.”
Michael was staring at her as she rummaged through a drawer, filling her pockets with various syringes. “We’re leaving the hospital to find him?”
“Exactly. We have the best guess of where the Chief might go, so we have the best chance of finding him before he collapses.”
He was having trouble keeping up, so tired. “Right. Find him at Doctor Row. After we steal all this stuff.”
