She plopped a pocket breathing mask over the dead woman's lips and nose, then blew.
The breath squeaked out the sides of a rubber seal that should have molded itself to the face.
Elizabeth Matthews's chest barely rose.
Monica tried again.
The same resistance blocked her effort.
Still, she had to go all out. Or would that only make her appear more guilty? Garnet would be looking ultra close at what happened here. And given his reputation for digging up shit, he'd be bound to discover the others. If he did, the nurses on the night shift would have to watch out.
She swiftly positioned her hands on the midpoint of Elizabeth Matthews's sternum and began the compressions. It felt stiff, so she applied more force to get the required inch of downward thrust that would squeeze the heart's ventricles and pump blood through the body.
Ribs snapped with a crunch under her palms.
"Shit," she muttered, easing off a bit. Still, she continued, not at all sure her efforts wouldn't make Garnet more suspicious.
"We got a code, eighth floor!" Jane Simmons yelled. She turned from the phone and ran to where they kept a portable bag of airway equipment. Grabbing it, she sprinted for the door, right behind Thomas and the rest of the team. At the elevators they commandeered a car with an override key.
In less than a minute they were on the ward. Jane arrived at the patient's room to find the night supervisor, Mrs. Yablonsky, and a nursing aide administering CPR, both women red-faced from the exertion.
Out in the hallway the sounds of running feet and a familiar wobble of wheels announced the arrival of ICU residents with the crash cart. This chorus of youngsters with fear in their eyes followed Thomas through the door and swarmed the patient. Some ripped open her nightgown, while others slipped a board under her back. One of them applied well-lubed defibrillation paddles to her bony chest.
The monitor screen showed a flat line.
"I've got the airway," Jane said, shouldering Yablonsky aside and flipping off a pocket mask that the aide had been using to provide ventilation. As she worked, the sticker bearing the patient's name at the head of the bed caught her eye.
Questions flew.
"She's not a DNR?"
"When did she arrest?"
"What's her diagnosis?"
Amid a flurry of hands, additional IVs went up.
Jane tried to pry open the mouth; she found it unusually stiff but slid a curved airway into place anyway. She then connected a ventilation bag and mask to an outlet in the wall, sending a hiss of oxygen into the room. But when she applied the mask over the patient's face and squeezed, the bag remained rigid in her hand. She couldn't force air into the lungs. The woman's tongue must be blocking the way, she thought. She tried to reposition the head, but it resisted manipulation as much as the mouth had.
A pretty blond girl who had attempted to take over the chest compressions, her long hair repeatedly flopping in the way, slowed after a dozen thrusts. "This one doesn't feel right!" she said, her eyebrows bunched into a frown, but she continued to labor over the dead woman's chest.
Thomas walked over to the bed, reached through the crowd, and placed the tips of his fingers along Elizabeth Matthews's neck. "You're not producing a pulse." He signaled the young intern to step back- she'd already grown flushed from trying- and attempted a few compressions himself. A puzzled expression crept across his forehead. He stopped pumping, threw the covers entirely off, and turned the woman's body to reveal large purple blotches on her hips and the back of her shoulders. He looked up at the supervisor. "The woman's been dead four hours, minimum." He pointed to the discolorations and turned to the residents. "These markings take at least that long to appear. We call the phenomena lividity, where venous blood pools at the lowest point of the body once a person has died." His voice had slipped into the clipped tones most seniors used when teaching. He threw the bedsheet back over Matthews, allowing it to float down on her like a shroud. "A code blue never should have been called."
Yablonsky's cheeks burned red at the rebuke.
As the others cleaned up their equipment, Thomas Biggs led her to the corner of the room. "Why'd you do it?" he asked.
He may have intended their conversation to be private, but Jane easily overheard them.
A flicker of alarm shot through Mrs. Yablonsky's eyes. "I beg your pardon?" she puffed with indignation.
"Why'd you call the code? You could feel and see her as well as I did. The skin had gone cold. The lividity formed where she lay."
Mrs. Yablonsky's face flamed further, and the cords of her neck muscles tightened.
Oh, boy, thought Jane, who knew from other visits up here that the woman had a temper. And Thomas could be less than diplomatic when pointing out someone else's mistakes.
But thankfully, this morning Yablonsky seemed set on avoiding a fight. Her rigid posture relaxed a notch. "Sorry," she said, "I should have checked."
Thomas studied her, then his eyes crinkled good-naturedly as he gave her a smile. "That's okay. We can all forget something sometimes. It just surprised me. Calling a code on her"- he gestured at Matthews's body-"is a rookie move."
Yablonsky's eyes hardened.
Ah, shit! Jane thought. Now why did he have to add that? He seems set on provoking her.
The supervisor adopted a time-to-put-this-smartass-on-the-defensive look. "Oh, really? Well, I'd advise you to write it up by the book, Dr. Biggs, because Dr. Earl Garnet himself is going to be taking a big interest in her death."
The merriment in the corners of his eyes slipped a notch. "What do you mean?"
"Just what I said. Dr. Garnet will want to know what happened here, believe me."
"Why would Dr. Garnet be interested in a terminal cancer case?" he asked. The cockiness in his voice had faded a bit more.
"Because he personally doubled her morphine dose last night without her physician's knowledge."
Thomas's mask elongated as his jaw sagged in disbelief. "What made him do that?"
The other residents had started to pay attention.
"Ask the man yourself," she answered, making no attempt to lower her voice. "All I know is, he intended to jump-start some kind of audit into how we medicate pain. Well, it backfired. He'll get his audit, but now it'll be him on the hot seat."
"But surely a terminal patient's death won't be questioned." Thomas sounded more incredulous by the second.
"Oh, but it will, Dr. Biggs, because according to her doctor, she still had months to live."
"Nobody can predict that sort of thing with any certainty."
"That may be. But I advise you to write this one up without skipping any details. It's going to be gone over with a microscope, I promise you."
The ridges in Thomas's forehead thickened a little. "I see," he said.
"I should hope you all do," she added, addressing everyone in the room as if they'd all been errant schoolchildren.
The bitch! Jane thought, as wide-eyed with astonishment as everyone else at what she'd just heard. But the part that most shocked her was not that the woman had pulled a classic shift-the-focus-and-cover-your-own-behind move but that she'd done it specifically at Dr. G.'s expense. Thanks to her big mouth, rumors of his having possibly overmedicated the woman would be the talk of the hospital by breakfast. In the court of innuendo, he'd be convicted before noon. Getting out from under that kind of cloud, even if the official verdict cleared him, could be a struggle, and Yablonsky had been around long enough to know it. So why the hell would she do something so vicious?
If anyone hadn't heard about his connection to Elizabeth Matthews, Earl Garnet didn't run into them on his way to the eighth floor.
Among the groups of nurses, residents, or doctors he passed in the corridors, conversations stopped dead as he rushed by, replaced by whispers and embarrassed glances in his direction. Some he encountered avoided eye contact altogether. Even the janitors looked away. But everybody had a good gawk at him behind his back. He could feel their stares like a thousand arrows.