HARMED - Book 1: First Do No Harm Read online

  HARMED

  BOOK 1

  HARMED

  BOOK 1

  FIRST DO NO HARM

  (Abridged)

  Dr. L. Jan Eira

  © 2015 Dr. L. Jan Eira

  All rights reserved.

  ISBN-13: 9781519544377

  ISBN-10: 1519544375

  Library of Congress Control Number: 2015919966

  CreateSpace Independent Publishing Platform

  North Charleston, South Carolina

  CONTENTS

  PROLOGUE

  CHAPTER 1

  CHAPTER 2

  CHAPTER 3

  CHAPTER 4

  CHAPTER 5

  CHAPTER 6

  CHAPTER 7

  CHAPTER 8

  CHAPTER 9

  CHAPTER 10

  CHAPTER 11

  CHAPTER 12

  CHAPTER 13

  CHAPTER 14

  CHAPTER 15

  CHAPTER 16

  CHAPTER 17

  CHAPTER 18

  CHAPTER 19

  CHAPTER 20

  CHAPTER 21

  CHAPTER 22

  CHAPTER 23

  CHAPTER 24

  CHAPTER 25

  CHAPTER 26

  CHAPTER 27

  CHAPTER 28

  CHAPTER 29

  CHAPTER 30

  CHAPTER 31

  CHAPTER 32

  CHAPTER 33

  CHAPTER 34

  CHAPTER 35

  CHAPTER 36

  CHAPTER 37

  CHAPTER 38

  CHAPTER 39

  CHAPTER 40

  CHAPTER 41

  CHAPTER 42

  CHAPTER 43

  CHAPTER 44

  CHAPTER 45

  CHAPTER 46

  CHAPTER 47

  CHAPTER 48

  CHAPTER 49

  CHAPTER 50

  CHAPTER 51

  CHAPTER 52

  CHAPTER 53

  CHAPTER 54

  CHAPTER 55

  CHAPTER 56

  CHAPTER 57

  CHAPTER 58

  CHAPTER 59

  CHAPTER 60

  CHAPTER 61

  CHAPTER 62

  CHAPTER 63

  CHAPTER 64

  CHAPTER 65

  CHAPTER 66

  CHAPTER 67

  CHAPTER 68

  CHAPTER 69

  PROLOGUE

  Dr. Ian Rupert entered the research laboratory. As the door closed behind him, the tension in the department became almost palpable. With an air more befitting a Roman emperor than a modern-day department head, Rupert sauntered toward the back of the laboratory, passing by busy employees, who took turns greeting the director. With every few steps, he would fake a smile and slightly nod his head in response to the venerations. He strutted toward the animal laboratory as the workers smiled and greeted him politely—some out of respect, most out of fear. Dr. Rupert was influential and world renowned in the field of research, especially in the area of cardiac investigation. He was a middle-aged, tall, lean, gray-haired, distinguished-looking man whose work had contributed significantly and often to medical literature. He was in charge of the research department at the medical school in Indianapolis, a position that engendered esteem and commanded respect. When Newton Memorial was designated as the major research hub of the medical school, Rupert moved his office to the hospital in Evansville, leaving behind the large campus of the mecca in the state capital. Besides a full complement of research PhDs, MDs, techs, and assistants, Dr. Rupert had under him several research fellows, doctors in training who pursued the acknowledgment of having worked under the tutelage of the great professor. The research department cranked out multiple scientific papers in many fields of medicine, giving the school a reputable name and recognition in the medical world.

  The odor in the animal lab was distinct and unmistakable. It was a combination of animal urine and feces intertwined with the scents of cedar chips, chlorine bleach, air deodorizer, and God knows what else, used in a feeble attempt to mask the stench. Multiple small-animal crates were on display throughout the large room. Rupert entered a smaller area inside the animal lab, pushing past a door labeled Cardiovascular Research. Just beyond the door, a group of scientists in white lab coats gathered around several small cages. Each cage was marked with a sign, LFJ659, and contained four rats, one tagged with an ankle bracelet. Underneath the large-print label, the sign also indicated, in smaller print, the dosage that had been administered to the marked rat in the cage. The research team was somberly discussing and documenting the results.

  “How are these beauties doing today?” inquired Rupert regally of no one in particular as he approached. None of them uttered a word, but their body language spoke volumes, all eyes fixated on the contents of the cages in front of them. There was a sense of failure and sorrow for the animals. The initial smile on Rupert’s face faded rapidly. The small creatures in the cages were all dead.

  CHAPTER 1

  Dr. Jack Norris arrived at meeting room three. He looked around the room and took his usual seat in the front. For a thirty-one-year-old doctor in his last year of training, Jack had accomplished quite a lot. His demeanor and determination had been obvious to those in charge, who bestowed upon him the title of chief of cardiology fellows. His duties consisted of dealing with the everyday routine of supervising the training of young doctors and medical students. Jack was nearly six feet tall with dark-brown hair and eyes. Today he sported his green scrubs under his white lab coat.

  This morning, like all others, morning report would start at eight o’clock. Jack would meet with all the resident doctors and medical students rotating through the cardiology service and discuss the cases admitted during the on-call period, which began at five o’clock the evening before.

  Meeting room three contained many seats, which gave it the appearance of a classroom. On display were several x-ray viewing boxes, a large blackboard, and a retractable screen, which would be used to display images from an old-fashioned projector for PowerPoint presentations. A podium was to be used by the presenter.

  The room was filled with young doctors in training, eighteen in all, ranging from first-year interns to third-year medical residents. Also present were cardiology and electrophysiology fellows and twelve medical students. Three of them were complete newbies. They were the students assigned to Jack’s group for the next two months on their cardiology and electrophysiology rotations.

  As he perused the list of the admitted patients, Jack announced, “Before we begin, let’s welcome the three new med students. They will be with us for the next couple of months. Who knows the difference between medical students and a pile of dog shit?”

  “Nobody goes out of their way to step on a pile of dog shit,” answered all the residents monotonously, slowly, and in unison.

  “No, no, no,” said Jack. “Dog shit is crap. Medical students are invaluable members of our mean and lean team. They’re here to help us and to learn. Let’s teach them.”

  “You better come up with fresh material, Jack,” said George Snyder, a second-year cardiology fellow. “Or give up stand-up comedy forever.” Snyder was rotund and vertically challenged. He had light-brown hair surrounding a large, balding head and appeared much older than he really was, especially today with his unshaven face. His eyes were brown and piercing but this morning looked spent from exhaustion.

  Jack tossed a fake smile. “You keep coming to the same show, you’re going to hear repeated jokes sometimes.” His fake grin morphed into a genuine one. “Let’s start this morning report.” He scanned the list of admissions one last time. “Let’s hear about Lucille Hart. What’s wrong with Mrs. Hart’s heart?”
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br />   Snyder was in charge of the allocution. He gathered his notes and walked to the podium. Using the typical presentation format, he told the audience about the patient’s ailment, after which he would discuss the pathology and formulate a management plan. Jack interrupted here and there to make a teaching point and often questioned the junior staff and students to offer opinions regarding treatment choices.

  “Let’s hear from the new med students,” interjected Jack. “What’s wrong with Mrs. Hart’s heart?”

  “Her heart is freakin’ awful, and she needs a doctor,” said one of them, the serious facade of his mug slowly morphing into a smile.

  “You’re right about that!” Jack said. “You are…”

  “Peter Joseph, sir,” answered the student.

  “OK, Peter, you’re Mrs. Hart’s new heart doctor,” said Jack. “I’m assigning you to her case. Know all there is to know about her heart problems and give us a ten-minute discussion tomorrow morning.”

  Peter’s smile slowly mutated into a mock tense scowl. He nodded.

  As Snyder continued with the details of the patient’s case, it became clear that Mrs. Hart’s cardiologist was not very good. He wasn’t following guidelines for proper management of her particular heart condition. But since her cardiologist was out of town for the week, her care during this admission would rest on Jack and his team. He resolved to get her on the right track by changing her medical regimen.

  Morning report ended at nine o’clock, and Jack convened a meeting with his new medical students by the exit. “Let me see if I got your names right,” he said. He pointed as he went. “You’re Peter, you’re Chris, and you’re…you’re…” Jack shrugged his shoulders. “I’ve forgotten. What’s your name?”

  “Taylor Twelly.”

  “Welcome all, again,” said Jack. “OK, boys, let’s go make rounds.” He began to walk to the exit door. “Follow me.”

  The four men walked out of the meeting room in silence for a short moment.

  “Jack,” said Chris, “how come Mrs. Hart’s cardiologist hasn’t been prescribing the right medications for her?”

  “What do you call the guy who graduates last in his medical-school class?” inquired Jack a few beats later, briefly looking back at the students who were walking slightly behind him.

  The three young men shrugged their shoulders. “Doctor!”

  They arrived at the elevator as the car reached their floor. Jack held the door open for the others to enter. He pushed a button, and the number eight became illuminated. Four older people stood quietly in the elevator, staring up at the numbers over the door.

  The complete silence inside the car was broken by the sound of the motor revving up. The car ascended slowly with an almost imperceptible jerk. Jack looked at the students and then back at the numbers, imitating the others. On the third floor, one older woman exited the elevator, and an even older man entered. He pushed floor number six. On the fourth floor, a beautiful woman entered the elevator. No words were exchanged. All stared at the numbers over the door, although they would’ve much rather ogled the woman.

  As the door opened on the sixth floor, all exited except the medical team and the gorgeous woman. She was to die for. She was blond with beautiful hazel eyes and long hair. She stood straight, resembling a model about to strut down the runway of a fashion show. All her features were perfect. Her lips were just right, resembling a doll’s. She wore a skirt and blouse that revealed close to nothing but concealed a world of sensuality, the likes of which the young men could only imagine. The elevator door closed, and the car resumed its upward climb.

  “The one of you who can tell me what number I’m thinking of gets to have an unforgettable evening with me,” she said, her voice soft and sensuous.

  The medical students looked at one another. A very beautiful woman, a stranger, just proposed to go on a date with the one guessing the right answer. Was she toying with them? Was this a dream?

  “Zero?” asked Jack.

  “That’s right,” she replied, her eyes on Jack’s. She turned to the medical students. “Do you guys mind getting off at the next floor?” She slithered her elegant body toward Jack. Behind him, she massaged his shoulders and ran her hands down his chest and pressed her right leg up Jack’s thigh. Her skirt rose up her leg ever so slightly, exposing her knee and the lower portion of her shapely thigh.

  The medical students were flabbergasted. Speechless. They couldn’t believe their eyes; their hearts began skipping beats. Suddenly the elevator door opened. It was the seventh floor. A well-dressed older man in his sixties walked into the elevator in front of the medical students, who moved aside to give room for the older man in the car. He glanced at Jack and then the pretty woman.

  “Hi, Dr. Lindsborg,” said Jack. “How are you this morning?” He and the woman stood up straight, as if the principal had just almost caught two mischievous teenagers engaged in a high-school prank.

  “Hi, Jack,” said Lindsborg. Then his eyes turned to the woman. “Claire, good to see you. I wish my wife worked in the hospital, too. You are a very lucky man, Jack.”

  “Good morning, Dr. Lindsborg,” she said. “Yes, I love to come and see my husband now and again. I want to make sure he doesn’t stray with all the beautiful nurses on campus.”

  “Claire, Jack is so in love with you, you need not worry about such things. Isn’t that right, Jack?” He looked around the elevator. “Oh, are these your medical students for the month?”

  “Yes, sir. This is Pete, Taylor, and Chris. We just finished morning report and are about to start ward rounds,” said Jack.

  “OK, carry on. I’ll meet up with you later,” said Lindsborg, as the elevator door opened on the eighth floor, and all got off, except Lindsborg, who continued on to the tenth floor.

  “Claire,” said Jack, sounding irritated, “what if I didn’t get the number right this time and one of these guys guessed it?”

  “Baby! Honey! Don’t you know you and only you have my number? No one else,” said Claire, using a sweet tone of voice. “Good to meet you, boys. Did he tell you the one about the dog pile yet?”

  Mesmerized and totally enthralled, the wide-eyed students nodded nervously, still unable to speak.

  “Meet you later for lunch?” said Jack.

  “Sure. See you all later,” said Claire, with a stunning smile. She walked in the opposite direction and turned the corner.

  Practically paralyzed and dazed, the young medical students stood there speechless, silent, and motionless, the events of the last few minutes still playing wildly in their heads.

  “Wow,” whispered Taylor softly, finally breaking the tense silence.

  Amused by it all, Jack walked ahead. “Come on, knuckleheads! We’re behind schedule already.”

  It was then the medical students gasped. Their beepers, clipped to their belts, went off simultaneously, emanating god-awful shrieks. This was followed by an excited verbal message. “Code blue, CCU, bed five… code blue, CCU, bed five!”

  CHAPTER 2

  The beepers still yelping, the young doctors made a beeline to the Coronary Care Unit. On their arrival, they saw many people inside the small cubicle that contained bed number five. A petite brunet nurse kneeled on the bed, her knees touching the seemingly lifeless body of the patient. She was performing chest compressions. Other nurses in the room performed the other duties necessary for a successful outcome in a case of cardiac arrest. Dr. John Connor was already in the room.

  “What’s the four-one-one?” asked Jack.

  CPR was ongoing with a distant cadence: “One-one thousand, two-one thousand, three-one thousand, four…” At each count of five, a respiratory therapist squeezed a bag that was hooked up both to the oxygen outlet on the wall as well as to a tube coming out of the patient’s mouth, which had previously been inserted into the windpipe.

  As words were exchanged, Jack automatically and almost unconsciously eyed the chest excursion when the bag was squeezed. Jack compared the pa
tient’s chest movements to that of the stomach area, which was minimal. The patient’s color was generally pink. With this rapid visual assessment, Jack was confident that the tube was properly inserted into the airway and that oxygenation was being performed adequately.

  “This is a fifty-seven-year-old man who presented with chest pains. Cardiac markers negative times two. He just arrived about ten hours ago. Sudden arrest with v-fib, shocked times three; we’re on our second atropine and second epi. No results. Asystole on the monitor,” reported Connor.

  “OK, John, run the code. I’ll look up the chart and see if there is anything important in there.”

  Jack exited the cubicle to find the patient’s chart. He wanted to assess all the lab data for this case. “Where’s bed five’s, Bessie?” he asked of the ward clerk who anticipated the request and immediately handed him the chart. As he sat down at the nurses’ station with the chart in front of him, in the background the telltale escalating hum indicated that the external defibrillator was charging up to deliver another shock.

  “Clear,” and then a thump was heard coming from the cubicle.

  “No pulse. Again at three sixty. Continue CPR until ready to shock,” requested Connor in a firm but calm voice.

  The process was repeated.

  “No pulse,” assessed Connor a few seconds after the shock. “What’s the down time, Heather?”

  “Thirty-two minutes, Dr. Connor,” answered a woman’s voice from within the room.

  “OK, let’s call it; the time of death, nine fifty-three,” said Connor. Soon afterward, one by one, the rescuers exited the room.

  “Is this a coroner’s case?” asked Jack, as Connor and the medical students joined him at the nurses’ station.

  “No,” answered Connor quickly. “This is a clear-cut cardiac event.”

  “Well, the guy just came in less than twenty-four hours ago. He ruled out for a heart attack. I think we need to call the coroner’s office,” Jack said.

  “OK, I’ll call them in a bit; first, I need to call the family,” said Connor.

  “What are you doing here, John?” asked Jack.

  “I was here trying to recruit the patient into one of the research studies,” said Connor, sitting down on a couch heavily.