Once again David was presented with the same trio of symptoms affecting the central nervous system, the GI system, and the blood or immune system. He was seeing a complex, but he had no idea what the underlying factor could be.
David agonized over what to do next. The life of a thirty-four-year-old woman hung in the balance. He was afraid to call any consults, partly because of Kelley and partly because the consults had not provided any help in the three similar cases. And calling in consults for Eakins had resulted in David's removal from the case. David was even reluctant to order further diagnostic or laboratory tests since nothing had proved to be of any value with the other patients. He was at a loss.
"We have a seizure in room 216," one of the nurses shouted from down the hall. David went running. Room 216 was Sandra's room.
Sandra was in the throes of a full-blown grand mal seizure. Her body was arched back as her limbs contracted rhythmically with such force that the whole bed was bouncing off the floor. David barked orders for a tranquilizer. In an instant it was slapped into his hand. He injected it into Sandra's IV. Within minutes the convulsions stopped, leaving Sandra's body spent and comatose.
David stared down at his patient's now peaceful face. He felt as if he was being mocked for his intellectual impotence. While he had been indecisively sitting at the desk puzzling over what to do, the seizure had taken over Sandra's body in a dramatic gesture.
David erupted in a whirlwind of activity. Anger replaced despair as he pulled out all the diagnostic stops. Once again he ordered everything: consults, lab tests, X rays, even an MRI of the skull. He was determined to figure out what was happening to Sandra Hascher.
Fearing a rapid downhill course, David also made immediate arrangements to transfer Sandra to the ICU. He wanted continuous monitoring of her vital signs. He did not want any more surprises.
The transfer occurred within half an hour. David helped push Sandra down the hall to the ICU. Once she was moved off the gurney, David started for the ICU desk to write new orders, but he stopped short of his goal. In a bed directly across from the central desk was Nikki.
David was stunned. He'd never expected to see Nikki in the ICU. Her presence there terrified him. What could it mean?
David felt a hand on his shoulder. He turned to see Dr. Pilsner. "I can see you're upset about your daughter being in here," he said. "Calm down. I just don't want to take any chances. There are some fabulously skilled nurses in here who are accustomed to taking care of patients with respiratory problems."
"Are you sure it's necessary?" David asked nervously. He knew how tough the ICU environment was on a patient's psyche.
"It's for her benefit," Dr. Pilsner said. "It's purely precautionary. I'll be moving her out of here just as soon as I can."
"Okay," David said. But he was still anxious about this latest turn of events.
Before writing the new orders on Sandra, David went over to talk with Nikki. She was far less concerned about the ICU than David was. David was relieved to see her taking it so well.
Returning his attention to Sandra Hascher, David sat down at the ICU desk and began writing her orders. He was nearly through when the unit clerk tapped his arm.
"There's a Mr. Kelley out in the patient lounge to see you," he said.
David felt his stomach tighten. He knew why Kelley was there, but he wasn't eager to see him and didn't go immediately. He finished writing the orders first and gave them to the head nurse. Only then did he go out to meet Kelley.
"I'm disappointed," Kelley said as David approached. "The utilization coordinator called me a few minutes ago…"
"Just a minute!" David snapped, cutting off Kelley. "I've got a sick patient in the ICU and I don't have time to waste with you. So for now stay out of my way. I'll talk to you later. Understand?"
For a second David glared up into Kelley's face. Then he spun around and started out of the room.
"Just a minute, Dr. Wilson," Kelley called. "Not so fast."
David whirled around and stormed back. Without warning he reached out and grabbed Kelley by the tie and the front of his shirt and roughly pushed him back. Kelley collapsed into the club chair behind him. David shook a clenched fist in Kelley's face.
"I want you to get the hell out of here," David snarled. "If you don't, I don't take responsibility for the consequences. It's as simple as that."
Kelley swallowed, but he didn't move.
David spun on his heels and marched out of the lounge. Just as he was about out the door, Kelley called out to him, "I'll be talking with my superiors."
David turned back. "You do that," he said. Then he continued into the ICU. Returning to the desk, he paused. His heart was pounding. He wondered what he really would have done if Kelley had stood up to him.
"Dr. Wilson," the unit clerk called out. "I have Dr. Mieslich on the phone. He's returning your call."
"My husband teaches at the college," Madeline Gannon explained. "He gives courses in drama and literature."
Calhoun had been eyeing the many shelves of books that lined the Gannons' library walls.
"I'd like to meet him sometime," Calhoun said. "I read a lot of plays. It's been my hobby since retiring. Especially Shakespeare."
"What is it you wanted to talk to me about?" Madeline asked, diplomatically changing the subject. From Calhoun's appearance she doubted if Bernard would be terribly interested.
"I'm investigating Dr. Dennis Hodges' murder," Calhoun said. "As you know his body was recently found."
"That was distressing," Madeline said.
"I understand you worked for him for some time," Calhoun said.
"Over thirty years," Madeline said.
"Pleasant work?" Calhoun asked.
"It had its ups and downs," Madeline admitted. "He was a headstrong man who could be stubborn and cranky one minute and understanding and generous the next. I loved him and disliked him at the same time. But I was devastated by the news when they found his body. I'd secretly hoped he'd just had enough of everybody, and had gone to Florida. He used to talk about going to Florida every winter, particularly the last few."
"Do you know who killed him?" Calhoun asked. He glanced around for an ashtray but didn't see one.
"I haven't the slightest idea," Madeline said. "But with Dr. Hodges, there sure are a lot of candidates."
"Like who?" Calhoun asked.
"Well, let me take that back," Madeline said. "To be perfectly honest, I don't think that a single one of the people Dr. Hodges regularly infuriated would have actually done the man harm. In the same way Dr. Hodges would never had carried out any of the threats he voiced so frequently."
"Who did he threaten?" Calhoun asked.
Madeline laughed. "Just about everybody associated with the new administration at the hospital," she said. "Also the police chief, the head of the local bank, the Mobil station owner. The list goes on and on."
"Why was Hodges so angry with the new administration at the hospital?" Calhoun asked.
"Mostly on behalf of his patients," Madeline said. "Rather, his former patients. Dr. Hodges' practice fell off when he took over the directorship of the hospital, and then again when CMV came into the picture. He wasn't all that upset about it because he knew the hospital needed the HMO's business and he was ready to slow down. But then his former patients started coming back to him, complaining about their health care under CMV. They wanted him to be their doctor again, but it wasn't possible because their health care had to come through CMV."
"Sounds like Hodges should have been angry at CMV," Calhoun said. Before Madeline could respond, Calhoun asked if he could smoke. Madeline said no but offered to make him coffee. Calhoun accept her offer, so they adjourned to the kitchen.