A RACE AGAINST DEATH
A Lenny Moss Mystery
By Timothy Sheard
Originally published by Five Star Books, 2006
CHAPTER ONE
Nurse Gary Tuttle, seated at the foot of the bed, was writing his first note of the morning when he heard his patient mutter, “I’
m a dead man for sure.” Looking up, Gary saw a sour look on Rupert Darling’s face.
“It’s no fun, being sick is it?” said Gary, offering a sympathetic look.
“You can’t fool me,” Darling said. “I know these doctors like to experiment on you, and when you die they cut you open to see
where they screwed up.” He scratched his chest with long boney fingers and looked with despair at the other patients in the
Intensive Care Unit.
Gary knew Darling had put off coming to the hospital until he lost the feeling in his legs. Unable to walk, he finally called the
paramedics, who wrapped him in a shabby blanket and brought him to James Madison University Hospital.
Tests revealed a progressive paralysis that might be permanent or might go away on its own, the course was wholly
unpredictable. Darling took the uncertainty of the prognosis as proof that the doctors were idiots and that his life was in greater
danger from them than from any disease.
While the patient muttered complaints, a housekeeper mopped the floor a few feet away, and the stinging odor of bleach
tickled the young nurse’s nose. The soft sssh-ssssh of a ventilator filled the room with its gentle rhythm. Gary closed his eyes
and tried to imagine how the blind navigated through the world by their other senses. He was a sandy-haired fellow just a few
pounds over his ideal weight, dressed in a green scrub suit. Rimless glasses framed sleepy blue eyes and a gentle countenance.
“You are perhaps not getting enough sleep, Mr. Tuttle?” said a puzzled voice in the darkness.
Gary opened his eyes, saw Dr. Samir Singh, the ICU attending physician, watching him with a bemused look on his face while
a gaggle of residents and medical students stood by. The nurse felt his face begin to color in embarrassment.
“I’m sorry, Dr. Singh, I was just . . . listening.”
“An excellent skill to develop,” said the physician, speaking with a polished British accent that reflected his London training.
He stepped to the bedside. “Good morning, Mr. Darling. How are you today?”
“Lousy! I don’t want you draining all my blood and replacing it with some synthetic crap. I know how you doctors operate!”
Dr. Singh turned to his team. “Mr. Darling is under the misperception that the plasmapheresis treatment we are planning is an
experimental procedure.” To Gary he said, “Tell me please, what is the level of the patient’s loss of sensation?”
“I, uh, haven’t checked that yet,” said Gary, realizing he hadn’t finished his neurological exam.
“It is very important to assess the level of the paralysis every four hours,” said Singh. “May I have a Q-tip, please?”
Gary pulled a Q-tip from a bedside cart and handed it to the physician. Singh broke off the end of the wooden stick, leaving a
tip as sharp as a splinter.
“In the past we used a needle to test for the sensation of sharp,” he explained. “But with the advent of HIV, a needle used to
prick the skin becomes a potential source of exposure for the physician.”
Beginning at the chest he alternately jabbed the patient with the sharp end and pressed gently with the cotton-padded tip. “Is
that sharp or dull?” he asked. When the doctor reached the groin, Darling found it difficult to distinguish the sensations. At the
thigh the patient, frustrated, gave up answering.
“Note that the paralysis is symmetrical and ascending. When it approaches the level of the cervical spine, there will be loss of
enervation to the diaphragm. At that point we will have to─”
“Attention! Attention! Code Blue, Intensive Care Unit, third floor.”
The physician froze in place at the sound of the hospital operator in the loudspeaker overhead. Perplexed, he looked up and
down the ICU, but saw nobody rushing to a bedside.
“The operator must mean the CCU,” said Dr. Singh. “Nobody is coding in our—”
Whoosh!
The automatic doors to the unit opened as a stretcher came hurtling through.
“She’s brady’d down!” yelled a nurse who was pushing the stretcher. “I called a code from the phone in the elevator!” He
squeezed an ambu bag connected to oxygen with one hand while guiding the stretcher with the other. A young African-American
woman lay motionless on the stretcher while a woman in a white lab coat pressed vigorously on the patient’s chest.
With nurses and physicians rushing to assist, Dr. Singh said, “I was led to believe that this patient was going directly from the
Emergency Room to the OR.”
The ER nurse grabbed a fistful of sheet. “They told me she was coming to the ICU to be tanked up first.”
After they moved the lifeless figure the bed, the charge nurse told Gary, “I wasn’t expecting this admission for a couple of
hours. Can you handle a second patient?”
“Uh, I guess so,” he said, feeling a knot in his belly tighten at the thought of caring for a patient in cardiac arrest.
The charge nurse saw the worry on his face. “Relax. I wouldn’t give you a train wreck your second week of orientation. You’ll
pick up Dillie’s pneumonia; she can take the admission.”
“Okay,” said Gary, feeling the knot begin to loosen.
Dr. Singh asked the Emergency Room nurse, “What medications have you given her?”
“One amp of atropine and one epi.”
“Stop CPR, feel for a pulse.”
The woman in the lab coat took her hands away from the patient’s chest and felt at the groin. In the space between the
patient’s legs a pool of bright red blood glistened beneath the harsh fluorescent light.
“She’s got a pulse!” the woman announced. “It’s thready, but palpable.”
Singh turned to Dillie. “Run a liter of normal saline in under pressure.” While Dillie was preparing the intravenous fluids, Singh
asked the woman in the lab coat, “Why hasn’t the OB team taken this patient to the OR, Doctor . . . ?”
“I’m a fourth year student,” she said. “Kate Palmer. The ER Attending told me that Doctor Odom was reluctant to accept the
admission onto his service.”
“What do you mean ‘reluctant’? This is his patient, is it not? Dr. Odom performed the abortion on her four days ago. Is that
not correct?”
“She was his patient last Saturday, yes, but I understand he told the ER that this patient should be on the Infectious Disease
Service, so we paged ID. They haven’t answered yet.”
Perplexed, Singh said, “This patient’s infection is due to remnants of the fetus adhering to her uterine wall. Dr. Odom must
take her to surgery and remove the source of the infection before ID can help her. It is her only chance of survival.”
Noting that the first unit of blood was nearly completed, he told the charge nurse, “Hang two more units of blood, please.”
“I’ll send the aide right away,” she said, hastily scribbling numbers and a name on a pair of blood bank requests.
“Tell them also to thaw two units of frozen plasma in the microwave right away.”
Dillie informed Dr. Singh that the patient’s temperature was one hundred and four degrees. She hurried to the supply closet for
the hypothermia blanket.
Feeling his frustration mount, the attending physician turned to his medical resident. “Page Dr. Odom and tell him he must
come and see the patient right away. Page him STAT. And page Infectious Disease as well.”
“Got it,” said the resident, hurrying to the phone to make the calls.
Dr. Singh studied the patient, worry dragging his handsome features down. He watched the young woman gasp for breath
like a fish out of water. Despite the one hundred percent oxygen being forced into her lungs, she was experiencing severe air
hunger―a grave sign.
The resident returned to the bedside. “OB said they’re doing an emergency C-section. They’ll be up as soon as they’re
through.”
As Dillie pulled back the top sheet in order to put the cooling blanket in place, she saw a stream of bright red blood pour out
of the patient’s vagina. “The blood is a river,” she said to Singh, her face grim.
“She has perforated her uterus. She must have the surgery right away.” Singh watched the blood pressure reading on the
monitor slowly fall. He turned to the surgery resident.
“Have you ever done an exploratory laporotomy?”
The young resident, heavily muscled and darkly handsome, hesitated, knowing what was coming.
“I’ve assisted with one. I’ve never actually done one.”
“You may have to begin the procedure, it is the only way to control her bleeding.”
“You mean, open her abdomen? Here in the unit?”
“Yes,” said Singh, his face deadly serious. “She is losing blood faster than we can replace it. If you can clamp off the uterine
artery it will give us time to stabilize her and transport her to the OR. Dr. Odom can complete the hysterectomy in a more
controlled setting.”
He asked Dillie to bring a cut-down tray. As the pool of blood between the young woman’s legs grew, her blood pressure
continued to fall.
CHAPTER TWO
Dr. Singh looked with growing alarm at the young woman’s falling blood pressure and at the blood pooling in the bed. He was
worried even more by the patient’s oxygen saturation, which was only eighty-fivetoo low to sustain the vital organs, especially
the brain. He glanced at the doors to the ICU, looking for the obstetrics team to come take her to surgery, but there was no sign
of them.
Handing the young surgical resident a sterile gown and a pair of gloves, Singh began to don similar garments. Dillie peeled
open the cut-down tray and set it on the bedside table, exposing the shiny, stainless steel instruments. Once gowned, the young
surgery resident’s voice cracked from anxiety as he instructed the nurse to pour beta dine into a bowl. He cleared his throat,
dipped a wad of sterile gauze into the antiseptic, and began to wipe the abdomen with a trembling hand.
“First try to find the perforation,” Singh told him. “If you cannot locate the bleeding site, clamp off the uterine artery.”
The resident selected a scalpel from the tray. Holding it above the patient’s abdomen, he went over in his mind the layers that
he would be cutting through, anticipating the bleeding that would follow the incision. If the young woman even had enough blood
left to ooze from a fresh wound.
As he slowly brought the scalpel down to the skin to make the first cut, the cardiac monitor alarm sounded, startling him. He
looked up.
The heart was flat line.
“Begin CPR,” said Singh, his voice calm and business-like.
The resident gratefully put down the scalpel, moved his gloved hands to the chest, and began the compressions. With each
compression another rivulet of blood was expelled from the vagina. When the stream of blood spilled onto the floor, Dillie threw
towels over the pool to try and keep people from stepping in it amidst all the confusion and excitement.
Crystal, the charge nurse, sent the nurse’s aide running to the Blood Bank for more blood and plasma. She called to Gary to
mix another bag of epinephrine, reminding him of the concentration. He was happy to be of help, having felt useless during the
initial emergency.
After administering adrenalin and atropine, Dr. Singh said, “Stop CPR, feel for a pulse.” The resident froze, his hands
hovering above the young woman’s bare chest, while another resident felt for a pulse. The heart monitor still showed a flat line,
the most difficult of all arrhythmias to correct.
“Resume CPR,” said Singh. “Give three more amps of epinephrine, an amp of bicarb, and hang another unit of blood.”
Kate Palmer, frustrated at being pushed away from the patient by the residents, made her way to the head of the bed. Taking
a pen light from her lab coat pocket, she pried open the patient’s eyelid and shined the light into it. The pupil was enormous and
nonreactive. The other eye’s pupil was equally fixed and dilated. The windows to her soul were broken; the spirit had fled.
Dr. Singh saw the look on the medical student’s face and knew at once what she had found. He stepped back from the bed
and surveyed the scene. Looking at his watch, he noted that they had been working on the patient for thirty-five minutes without
restoring a pulse. The death of the brain convinced him that further efforts would be futile.
“You may stop,” he said, his words laden with sadness and finality. “Thank you.”
The sadness in his voice was matched by the sorrow in his eyes. The others looked equally dispirited. Nobody spoke as they
peeled off their gloves and dropped them in the trash bucket on their way out of the cubicle.
Turning away from the bed, Singh reflected on the fact that the dead woman had no underlying medical problems, having
reviewed her history when his team examined her in the Emergency Room. She was not a diabetic. Did not have lupus or sickle
cell. Her only significant history was the abortion that had been performed four days ago.
He couldn’t understand why Dr. Odom had failed to take the patient from the Emergency Department directly to the OR.
* * * * *
On Seven South, Lenny Moss lifted a bag of trash from a patient’s trash receptacle and turned it around, looking for
hazardous material. Seeing nothing dangerous, he swung the bag into the wheeled cart, along with the rest of the trash. He was
a nondescript white man in a blue custodian’s uniform, not very tall, with coarse features and a face that would win no beauty
contest. His face showed a five o’clock shadow, though it was only eight-thirty in the morning.
As he walked by the tiny pantry, he saw his housekeeping partner Betty stirring a large pitcher. Betty was a middle aged
black woman, with gray hair, bow legs, and an unrelenting optimism.
“Hey, Boop,” said Lenny, sticking his head into the pantry. “What are you cooking up?”
“Well, dear heart,” said Betty. “Since the Lord has seen fit to visit this heat wave upon us, I’m making us some lemonade.
Moose brought a bag of lemons and a pound of sugar.”
She vigorously stirred the pitcher, added more sugar, then poured herself a cup and sipped it. “Mmm-ah,” she said, smacking
her lips. “Perfect.” She poured a cup for Lenny.
“This is great,” said Lenny, delighted by the sharp flavor. His blue custodian’s shirt was already wet from perspiration, as
were his coarse black hair and thick eyebrows. He took off black framed glasses and wiped his face with a paper towel.
“I’m afraid some of my co-workers will be heading out for a cold beer come lunch time,” he said.
“Beer is a mighty temptation with heat like this,” she said. “Did you go around with the thermometer today?”
“Not yet. I checked several sites yesterday. I got a reading of a hundred and one in Central Sterile. The laundry hit one-ten.”
“Lord have mercy! Can’t the union do nothing about it?” She dumped more ice cubes into the pitcher and stirred.
“I filed a grievance with the hospital over unsafe working conditions,” said Lenny. “Engineering claims they have a new
condenser unit they’re gonna put on line today. Maybe tomorrow.”
“Huh! It’d take a miracle to get this old place running like it should.” Betty put the pitcher and a sleeve of cups on her
housekeeping cart and pushed it into the hall. A carved marble figure of Jesus on the cross sat among the rags and spray bottles
of cleaner.
At the nursing station she gave a cup of lemonade to Mai Loo, a slim, pretty Filipino nurse with long black hair and full scarlet
lips. Mai Loo took it gratefully, thanking Betty for her thoughtfulness.
The nurse sipped her lemonade as she checked a chart with doctor’s orders. Her lipstick left a scarlet stain in the shape of
her lips on the Styrofoam cup. Signing the order sheet, Mai Loo felt eyes staring at her. She looked up, saw one of the hospital
messengers staring at her over the out box. His dark eyes and blank, expressionless face made her shudder with fear.
She closed the chart and went into the medication room behind the station to get away from the messenger, who continued
on his rounds.
Noting the interaction, Betty thought of the birds and the bees. She couldn’t blame Maurice, the messenger, for looking a little
too long at the girl; she was awfully pretty. As Betty made her way along the corridor, she softly hummed, “Bringing in the sheaths
. . .”
Lenny emerged from room 712 with a bag of trash in either hand. Hoisting the bag to drop it in the cart, he felt a sharp pain in
his leg. Looking down, he saw an intravenous needle sticking out of the bag.
“Shit,” he muttered. “Look at this, Boop. Another fricking needle in the trash!”
He ripped open the bag, pulled out the needle and held it up to the light. Betty inspected it with him. Although the shiny steel
needle had no blood on the outside, they knew it could easily have been used to inject a patient.
“You got to go to Employee Health and let them check you out,” she said.
“Aw, Boop. They’re gonna ask me to take that HIV medicine.”
“Don’t be a stubborn old mule. If the doctor tells you to take the AIDS medicine you take it. It’s better to be safe. You know
that.”
“I know,” said Lenny. “I just wish I knew if the needle was contaminated.”
“Well, you’re a detective, sure as I’m standing here,” said Betty, wagging a bony finger at him. “If there’s anybody in James
Madison Hospital can figure out if a needle was stuck in somebody’s be-hind, it’s Lenny Moss.”
CHAPTER THREE
Carrying the needle that had stuck him in the leg, Lenny walked to the nursing station. He asked Mai Loo if either of the
patients in room 712 had received injections. The nurse opened her medication book and ran her finger down the column.
“No, I don’t think so, Lenny. I didn’t give them anything by injection. There’s no record of the night nurse doing it, either.”
“Well, somebody used a needle in there, and I’d really like to know if it’s dirty.”
The young nurse screwed up her face. “Let’s look in the chart. Maybe one of them had some kind of procedure last night.”
She pulled the two charts from the rack, opened each one, and read the doctor’s and nurse’s notes for the last twenty-four
hours.
“I’m sorry,” she said. “I don’t see anything that needed a needle.”
“Damn! Do either of the patients have any disease I should know about?”
Mai Loo hesitated. “You mean, like HIV?”
“Yeah, like HIV.”
“That’s confidential information. I can’t tell you.”
“But I was stuck with a needle!”
“Do you want me to lose my license? The only people who are allowed to know the patient’s condition are the ones who take
care of him.”
“Great. So they could have AIDS or hepatitis and nobody’s going to let me in on it.”
“It’s not like that, Lenny. If you go to Employee Health, the HIV counselor will come review the patient’s medical history. If
either one of them has a communicable disease, they’ll tell you.”
“They will?”
“Of course. Go see Employee Health.”
Lenny called his supervisor and told him what happened. After filling out an Incident Report, he made his way to the
Employee Health Clinic. Without knowing if the needle was contaminated, he doubted that they would be able to tell him anything
he didn’t already know. But as a union steward he knew better than anyone else that if he came down with AIDS and he hadn’t
followed the hospital protocols for a work injury, workman’s compensation would refuse to pay his benefits.
* * * * *
Dr. Leslie Odom, an attending physician on the Obstetrics-Gynecology service, advanced on the ICU nursing station, his
phalanx of residents, interns and medical students guarding his flanks and the rear. He was a short, trim man dressed in an
expensive pinstriped suit, silk shirt, and a tie of understated elegance. Seeing Dr. Singh writing in a chart, he said, “Good-
morning. I was in the OR when I heard the code being called. Was it the young woman from the ER with sepsis?”
Looking up, Singh concealed his anger beneath a neutral demeanor.
“Yes, it was she. I am very sorry to report, Charyse Desir has expired.”
“That is regrettable,” said Odom, keeping a perfect poker face.
“I believe she was a patient of yours recently.”
“The removal of her products of conception was without complications. I have no reason to believe that this admission is
related to the procedure.”
Singh had to call on all of his training as a Buddhist and as a critical care physician in order to remain calm. “The etiology of
her infection and her hemorrhage is most certainly related to the abortion. Why else would a young, otherwise healthy woman
develop overwhelming sepsis and massive vaginal bleeding?”
“I have only a cursory knowledge of her medical history,” said Odom. “No doubt she had other risk factors for an infection.”
“What sort of risk factors?”
“She is young. Black. Unwed. Who knows what sexual partners she may have had, before or after the procedure. She may
have used illicit drugs. There are many possible explanations for an infection.”
Singh felt his patience stretch to the breaking point. “Whatever the source of her bleeding, I fail to understand why you did
not take her directly from the ER to the Operating Room. Surgery was her only chance for survival.”
“My information from the Emergency Room physician was that the patient was stable. I was unaware of any urgency.”
“But my resident paged you STAT,” said Singh.
“And my resident informed you that I was doing an emergency C-Section. I came as soon as the baby was delivered and the
mother stabilized. It was you who failed to inform me of the patient’s critical condition.”
Before Singh could respond, Odom turned and led his group out of the ICU.
The frustrated ICU Attending went back to the dead woman’s chart. He removed the death certificate from the front and
began filling in the form. Under Cause of Death he wrote: Septic & Hemorrhagic Shock, leaving it to the pathologist in the Medical
Examiner’s office to determine that the woman’s tragic death was due to a badly executed abortion.
Unnoticed where he sat at the nursing station, Gary Tuttle listened to the dispute in silent horror.
* * * * *
Stepping into the Employee Health Office, Lenny noted a fresh coat of paint on the walls and bright, new ceiling tiles. Even
the old broken chairs had been replaced by new curvaceous plastic seats with thick padding.
As he stepped up to the nurse’s desk, he said, “Wow. Margie, you’ve done a great job fixing this place up. Who’s your
decorator?”
“Harry Potter,” said Margie, a stout, graying nurse with a furry upper lip and a perpetual frown. “But it’s still as hot as a
Swedish sauna in Texas.”
“Engineering says they’ll have the A/C upgrade completed any day now.”
“Fat chance!” Margie wiped her face with a towel. “I think they’re secretly filming some sort of survivor show for TV.”
Lenny held out the needle from the trash.
Margie shook her head. “How many times have you been stuck?”
“This is the second time this year.”
“Only two? There are some guys in housekeeping been stuck four, five times.”
“I’m usually careful. Listen, can you tell me if it was used on a patient?”
“The best I can do is flush it with sterile water and see if it has blood in it.”
“Let’s do it,” said Lenny.
The old nurse shuffled back to a little cubicle with a door like a lavatory stall. She drew up some sterile water into a syringe,
attached the syringe to the offending needle, then squirted the water into a specimen cup. She submerged a test strip in the
water, took it out, and held it up to the light.
“There’s no sign it had any blood in it,” she said. “See? The strip isn’t registering any hemoglobin.” She poured the water in
the sink. “It could have been used to give an injection. There’s usually no blood in that case.”
“Fricking great,” said Lenny. “What are my chances of getting AIDS if it was?”
“The chance of sero-conversion for a hollow-bore needle that doesn’t contain frank blood is less than a tenth of one percent.”
“But it’s not zero,” said Lenny.
“No, not zero,” she said, dropping the needle and syringe into a sharps container. “Fill out the Exposure Form and leave it
with me. I’m going to draw your blood to document that you don’t have HIV antibodies at the time of the incident. Later on, when
you’re dying of AIDS, the hospital will have to pay your hospital bills.”
“I want them to cover the funeral, too,” said Lenny.
“The funeral’s a tougher case to win, but it’s worth a shot.” She smiled angelically as she assembled the blood drawing
equipment. “Do you want to take a three-week course of the antiviral cocktail?”
“I don’t know,” said Lenny. “I defended a guy in Maintenance who got really sick from it. The hospital didn’t want to pay his
sick leave; he had to use up his own time.”
“There are serious side effects.” She deftly stuck Lenny’s vein with a needle and drew a tube of blood. “It’s entirely up to you.”
“The needle came out of room seven-twelve. If I knew one of the patients had AIDS, it would help me decide what to do.”
“Hmm,” said Margie, watching his blood fill the tube. “I’ll ask the AIDS counselor to review the patients’ histories. But unless
she’s sure that one of them is the source patient, she won’t ask for permission to test them.”
“You need permission to test somebody for HIV?”
“In Pennsylvania you do. It’s the only blood test that requires written consent. It’s stupid, but it’s the law.”
“Liability,” said Lenny.
“The lawyers rule the world,” said Margie. “But you know that.”