HARMED_First Do No Harm_ Book 1 Read online

  Jack nodded. “Guys, this is John Connor. John, these are the guys.”

  The three medical students and Connor shook hands, each stating his name. As they greeted one another, Jack continued. “John is one of our research fellows. He’ll tell you what types of patients he needs so you can scout for him.”

  “I’ll give each of you the inclusion and exclusion criteria for what I need. I’ll have my beeper number on there so you can contact me ASAP if you find a potential candidate,” said Connor. The students nodded.

  “What time’s the game on Sunday?” said Jack.

  “What am I, your secretary? Look it up yourself.” Connor then turned to the students. “Any of you bozos play soccer? We need a goalie on Sunday.”

  The students shook their heads. “Sorry,” said Taylor. “Not since preschool.”

  “You gotta stop taking on students who don’t play soccer, Jack,” scolded Connor.

  Jack smiled. “Well, to pass this rotation, they have to learn soccer. If we have time, we’ll teach them a little cardiology.”

  “Oh, you’re a laugh a minute,” said Connor. “Good to meet you, boys. I hope you can be a good role model and provide adult supervision for Dr. Jack Norris these two months. Got to go make a phone call.” Connor changed his pronunciation to that of a Transylvanian vampire accent. “And get back to the laboratory.” He left the nurses’ station.

  Heather McCormick and Julie Gerharp entered the room and sank down onto a large couch, expelling deep breaths as they did. They were both young but dedicated nurses. They were bright and thorough, qualities Jack really admired.

  Julie had been in charge of doing CPR. Heather took notes and gave the intravenous medications ordered by the code leader. Here and there, Julie would give a suggestion that was usually respected. She would say, “It’s been five minutes since the last epi.” This would be a clue that it was time for the doctor in charge to reorder the administration of epinephrine in the efforts to resuscitate the dying patient. Instead of saying, “Don’t stop CPR for so long,” she would ask, “Doctor, do you want us to continue CPR?” She knew very well that the answer was yes, but she had mastered the way to contribute positively to the situation and yet give the appearance that the doctor was really making all the decisions.

  Heather was totally devoid of this quality. She called it like it was. If something was being done incorrectly, she would simply point out the facts and demand an explanation for the deviation from protocol.

  “Dr. Norris,” started Heather. There was something bothering the two nurses.

  “What’s up?” said Jack. The students remained quiet.

  “Why do you think Mr. Roper died?” she said.

  “Because of the cardinal rules of our profession, ladies,” said Jack. “Rule number one: patients die; rule number two: doctors and nurses can’t always change rule number one.”

  “Come on. We’re serious,” interjected Heather. “No teasing now. We’re concerned.”

  “We’ve noticed a few patients, usually young, in their forties or fifties, who come in with chest pains, are ruled out for a heart attack but die for no apparent reason. Like Mr. Roper,” said Julie.

  “We’ve had three between the two of us over the last couple of weeks. Roper is number four,” said Heather.

  “That is weird,” Jack said, “but it could just be a coincidence.”

  “You don’t believe in coincidences, remember?” said Heather. “You always say that to your med students and residents.”

  “They all become agitated,” persisted Julie. “The cardiac monitors suddenly show racing heartbeats out of nowhere. Then they die for no good reason.”

  “Dr. Norris, there seems to be an epidemic of cardiac arrests in otherwise healthy, relatively young male patients,” said Heather.

  Jack took a deep breath and gazed at the nurses. “OK, I’ll look into this. Get me the charts. Put them on my desk.” He tossed them a wan smile. “But chances are it’s just a run of bad luck.”

  CHAPTER 3

  The ambulance drove rapidly, slowing down at red lights but not stopping completely. The emergency lights and siren signaled something dreadful was going on inside the emergency vehicle.

  Floyd Sullivan had called 911 when he developed pain in the middle of his chest at work. He was only thirty-nine, although he was constantly reminded he looked much older. There was no history of heart trouble in his family, and Floyd had stopped smoking three years earlier. The paramedics had started an intravenous line, and a bag of IV fluid was hanging, slowly dripping into his vein. The cardiac monitor indicated a steady heart rhythm at eighty-two beats per minute. Though things seemed stable, a rapid transfer to the hospital was nonetheless customary. No words were spoken during the twelve-minute ride to Newton Memorial Hospital.

  “What ya got?” asked a nurse as they arrived at the emergency department’s ambulance bay.

  “Chest pains,” said the paramedic as the team rushed the stretcher with the scared patient into the depths of the emergency department.

  “OK, put him in room three,” commanded the nurse.

  The paramedics wheeled the stretcher to the appropriate cubicle where another nurse and technician greeted the team.

  “This is Sully. His full name is Floyd Sullivan. He had chest pain relieved by nitro. Monitor shows frequent PVCs.” As the paramedic spoke, he and the others slid the patient from the stretcher to the hospital bed. The heart-monitor leads were exchanged, replacing the ambulance gear with like hospital equipment. These multiple steps were accomplished in less than fifteen seconds, as if by a well-synchronized machine. It was easy to imagine that this process was skillfully repeated numerous times each shift and was now attained without conscious effort by the emergency workers. The paramedics said good-bye to the patient, wished him well, and left.

  “My name is Teresa, and I’ll be your nurse while you’re here,” said the nurse. “How are you feeling now, Sully?”

  “The chest pain is back a little bit. It’s not as bad as it was at work.”

  Teresa’s eyes found the other woman’s in the room. “Go ahead and get an EKG. I’ll get a cardiology consult.” The woman nodded, and Teresa left the room.

  The technician began to hook Sully up to a machine.

  “Hold still while I get an EKG on you. If you move, the signal doesn’t come out right, and the doctors make me do this all over again,” she said. Sully complied.

  • • •

  Jack and his entourage had been summoned to the emergency department to consult on the newly arrived patient.

  “Room three,” said Teresa. She led Jack and his group into the cubicle. “Chest pains relieved by nitro but returned. Can you look at him for me?”

  “For you, anything, Teresa.” Jack smiled as he took the chart. He shook the patient’s hand. “I’m Dr. Norris. What does the pain feel like?” Jack took a glance at the electrocardiogram on the bedside table. He picked up the EKG printout and handed it to Dr. Kathryn Mansfield, a first-year cardiology fellow. Kathy accepted the tracing and stared at it inquisitively.

  “It’s like a fire on the inside of my chest, Doc,” said Sully.

  “I see,” said Jack. He then turned to his followers. His eyes met Kathy’s, who was still holding the EKG tracing. “What does the EKG show?”

  “Pretty normal,” she said.

  “Agree!” said Jack.

  Kathy passed the electrocardiogram to one of the students. The three medical students hunched up and began to scrutinize the tracing as they listened to the exchange.

  Jack turned to Sully, whose face was covered with consternation. “Your chest pain does not sound like it is from your heart. We’re going to do some tests to be sure, but I’m not too worried at this point, OK? We’ll give you some medicines to help your pain go away.” Jack smiled. Placing his hand on Sully’s shoulder, he continued. “This doctor is going to stay with you and get you admitted to the hospital for observation. We’ll know more by tomorro
w morning.”

  Sully smiled. “OK, Doc.”

  “This is Dr. Taylor Twelly,” said Jack. “He’s a med student, but he’ll take good care of you.” Taylor approached Sully and shook his hand.

  Jack turned to Taylor. “Do your thing and call me when you’re done so we can go over the orders. The rest of us will go finish rounds upstairs.” Both nodded. As Taylor grabbed all the paperwork and sat on a chair right next to the patient’s bed, the others exited the room.

  As he walked away, Jack couldn’t help but rehear in his head the words spoken by the two young CCU nurses, Heather and Julie: “Dr. Norris, there seems to be an epidemic of cardiac arrests in otherwise healthy, relatively young male patients.” They’re not usually worrywarts. They really think there’s something going on. Is there something going on? Jack smirked. In boring, good ol’ Evansville, Indiana? Where nothing exciting ever happens? Jack imperceptibly shook his head. He looked side to side, noticing all others wordlessly concentrating on their hurried steps. Sully, here, would fit the bill. Young. Healthy. Chest pains that are not due to his heart. He swallowed hard. I wonder if Sully, too, will die for no reason at all.

  He grinned, and then he dismissed it all.

  CHAPTER 4

  The doctors entered Sully’s room, smiling.

  “How was your night, Mr. Sullivan?” said Taylor.

  Sully’s smile was ear to ear. “No more pain. That medication you gave me really worked. Am I going home today, Doc? Please say yes.”

  Sully’s still alive, mused Jack. The boogeyman didn’t come get him overnight after all. He smirked, dismissing the notion.

  Taylor winked at Sully and turned to Jack. “His cardiac markers were negative times three. His stress test was negative for cardiac ischemia or infarction, and his LV function is normal. Protonix stopped his chest pain completely. I think he can go home.”

  Jack nodded. “Your pain was not due to your heart, as we suspected. Your blood tests tell us you didn’t have any heart injury. You had indigestion. Take the medication called Protonix, and follow up with your regular doctor. Your heart’s in great shape!”

  Sully gave a thumbs-up and an even bigger smile than he had mustered before. “Thanks. I’ll call my wife to come pick me up.”

  Taylor and Sully shook hands as the cardiology team left the patient’s room.

  The morning routine continued without incident. A few patients were discharged and as many admitted, each assigned to a medical student and a resident doctor.

  After rounds were over, it was 12:34 p.m. Growling stomachs indicated it was lunchtime. The team walked downstairs to the cafeteria.

  “Who’s going to make Starbucks rounds today? It’s on me,” said Jack, looking for volunteers. Before anyone had time to volunteer, the pagers beeped rapidly and in unity, followed by an excited voice: “Code blue, emergency department…code blue, emergency department.” The group proceeded briskly to the stairway that led down to the ED.

  On their arrival and to their dismay, they saw that the man receiving CPR by the emergency-department staff was Floyd Sullivan, whom they had just discharged in great condition just a few hours before. Disheartened, the cardiology team added their services to the ongoing efforts. The patient was intubated, and ventilation was attained via a bag that was being squeezed periodically, delivering oxygen through a tube directly into the dying man’s lungs. Chest compressions were rhythmically delivered to the singsong: “One-one thousand, two-one thousand, three…”

  None of them dared ask the question they all had on their minds: What the hell just happened? This guy was well a couple of hours ago.

  Despite all efforts, the code was unsuccessful, and Sully was pronounced dead. Nothing was said. The team would discuss the case later, entertaining different theories about what might have happened. For now, they all stood at the bedside in silence, flabbergasted, defeated, and despondent. The worst was yet to come—to explain all this to Mrs. Sullivan.

  • • •

  An autopsy would reveal later that Sully died from an acute aortic dissection. The second the walls of his main artery split apart and then burst, Sully was a dead man. How he died was easy to explain. What remained mysterious was why this would happen to a healthy man like Sullivan. He had none of the risk factors associated with this clinical entity.

  Jack felt his jaw muscles clench as his mind began wondering again. Dr. Norris, there seems to be an epidemic of cardiac arrests in otherwise healthy, relatively young male patients.

  Jack fished out his cell phone from his pocket and dialed CCU. “This is Dr. Norris. Let me talk to Julie or Heather.”

  CHAPTER 5

  Joe McIntyre was happy to be out. The last five days had been frightful, but now that he was leaving the hospital, he could breathe a sigh of relief. In fact, as he exited the front door, he did.

  I’m too young for this shit, he thought, still in disbelief that at age forty-two he’d had a heart attack. His father had his at fifty-four, but unfortunately, the heart attack had suddenly stolen his life. Joe still remembered how his dad collapsed to the floor, lifeless, while scolding him about smoking. Though Joe’s father smoked for years, he had always forbidden Joe and his brother to take up the nasty habit. He sometimes would go on a rampage about how bad smoking was while puffing on a cigarette. The advice had been fruitless and in vain.

  The guilt was inevitable. Joe had been told many times that his father’s demise was not his fault. Nevertheless, he had never forgiven himself. Yet despite it all, Joe had taken up smoking, having succumbed to peer pressure. Joe smoked one and a half to two packs of cigarettes a day. Despite nicotine being a stimulant, smoking gave him the feeling of calmness he had grown to enjoy and require. The nicotine abuse, the doctors had explained, had been the major factor predisposing Joe to coronary artery disease and the subsequent heart attack.

  He had gotten up at a quarter to six with the alarm clock, as he had done for the last eight years since he started working at the plant. Soon after getting up, Joe started to feel a squeezing sensation in the middle of his chest, like a vice becoming ever so tight. He also noticed a cold sweat and a bit of nausea. One of his coronary arteries had become occluded by an expanding mass of clot a few seconds earlier, preventing all downstream blood flow. At that occlusion site, the plaque had suddenly cracked, exposing its inner materials to the streaming blood cells. Without blood flow, the front portion of his heart muscle would start to suffer irreparable damage.

  Joe took an antacid to no avail. By then, his wife, Sheila, noticed his obvious discomfort as he paced the bedroom floor. Joe looked ghastly. She couldn’t say why or how, but he didn’t look like the man she knew for the last twenty-seven years. Sheila knew about heart attacks. Her father had one a few years before. In a few seconds, she relived the pain and agony of the moments spent with her father at the time of his event. She knew Joe was having a heart attack. She dialed 911, gave details of the situation, answered some questions, and an ambulance was dispatched. Fortunately, Joe had reached Newton Memorial within thirty minutes of chest-pain onset, so the degree of heart-muscle damage was minimized. As the ambulance arrived in the emergency department, he was rushed to the cardiac catheterization laboratory where doctors used a wire to disrupt the clot that had formed in the coronary artery. This was followed by a balloon that stretched the blockage in the artery, allowing normalization of blood flow. The angioplasty procedure was concluded by placing a metal mesh tube, or stent, that would stay in place, forever scaffolding the area, hoping to minimize the risk of reocclusion.

  Thanks to the rapid actions by the whole team—from the paramedics at the home to the emergency-department staff, cardiologists, and catheterization lab personnel—blood flow was restored quickly, and cardiac markers would later indicate only a small amount of heart damage. Because of some short episodes of rapid heart beating emanating from the site of the small heart attack, the cardiologists had sought an electrophysiology consultation. Dr. Jack Norris and hi
s team had evaluated this and opined that the arrhythmia would not require further specific treatment other than the usual post–heart attack management already in place.

  Dr. Norris was all business, straight and to the point. “If you smoke, you pay the piper in the end. On average, smokers live seven to ten years less and with reduced quality of life. Alternatively, you can decide to quit now and enjoy more years of productive life. Your choice! I can’t do it for you, but I will meet you halfway, if you are interested.”

  Joe had only met him five days before but had an instantaneous connection to the young doctor. He appreciated his directness. Joe vowed to quit, even if it killed him.

  Armed with a handful of pills and educational booklets entitled Percutaneous Coronary Interventions, Coronary Risk Factor Modification, and How to Live after a Heart Attack, Joe left his hospital room determined to live.

  Joe and Sheila finally sat down to relax. They had supper consisting of a meal low in sodium, fat, and cholesterol. To drink, they had water. Despite the horror of the last few days, the couple had learned many important facts about heart disease and its prevention. Newton Memorial Hospital offered patient and family education for those admitted with heart disease. Joe participated in all the available exercise classes and smoking-cessation programs and met with a nutritionist who provided guidance in what to eat and drink. Sheila was supportive and attended the classes, whenever possible. Today’s evening meal was their first solo attempt to follow the lessons. They were both feeling accomplished.

  The dishes were washed and put away. The kitchen table was cleaned and set for the next day. A vase with beautiful fresh flowers in the middle of the table provided balance and esthetics. Joe and Sheila curled up on the couch in front of the TV.

  Sheila picked up the TV Guide and leafed through it. “What do you want to watch? Law and Order, reruns of ER, CSI, or—”