Deep Pockets

Deep Pockets

A Harry Grouch Mystery

By Robert Tell

Smashwords Edition

Copyright © 2017 by Robert Tell

License Notes

All Rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means without the prior written consent of the author, nor be otherwise circulated in any form of binding or cover other than that in which it is published and without a similar condition being imposed on the subsequent purchaser. Your support and respect for the property of this author is appreciated.

This is a work of fiction. Names, characters, places, and incidents either are the product of the author's imagination or are used fictitiously, and any resemblance to actual persons, living or dead, events, or locales is entirely coincidental

Deep Pockets

A Harry Grouch Mystery

CHAPTER ONE

Code Blue ICU! Code Blue ICU!

The blare of the overhead speakers added to the noise and bustle throughout the hospital. Any patient still asleep was probably sedated.

The 8 a.m. to 4 p.m. shift at Bard Memorial Hospital had just begun. At the nursing stations, nurses did chart rounds with the departing night staff. Janitors used large floor scrubbers to polish the tile in the corridors to a high sheen. On every floor, maids gathered their supplies to begin cleaning patient rooms. Dietary aides brought food carts up from the kitchens, parked them in alcoves, and delivered breakfast trays to hungry patients. Physicians visited their hospitalized patients, and senior doctors in long white coats made scholarly comments to the medical residents, students, and technical staff who trailed along after them hoping for pearls of wisdom. They sometimes received them.

Once again, the speakers announced: Code Blue ICU! Code Blue ICU!

On the fourth floor Medical Unit, call lights lit up for almost every room. Anxious patients demanded information about what the situation might mean for them, so staff had no choice but to quickly circulate from room to room with reassuring words.

It was only a few seconds between the two announcements, but it felt like forever to Dr. Fred Gibbel, a family practice doctor who came in early to check on his patients.

They really should ditch this obsolete paging system, he thought as he fingered a small pocket pager issued by another hospital he attended. He replaced the chart he was holding in the wall holder outside his patient's room, and wondered if he should rush to the ICU. As an attending general practitioner, he was not expected to respond to in-house emergencies, but what if Mary Bedford is in trouble?

Throughout the hospital, specialized caregivers sprang into action. To them, a Code Blue ICU page meant a patient had gone sour in the Intensive Care Unit. They'd trained for this mission and were well prepared for rapid response and focused action. The corridors, stairways, and elevators soon filled with resident physicians, respiratory therapists, nurses, and others rushing to the ICU. Some would not be needed and would be dismissed when they got there, but until the extent of the patient emergency was known, all had to show up.

Back on the Medical unit, Fred Gibbel made a decision. It's unlikely I'll be needed, he thought.

But then, the speakers sprang to life again:

Dr. Gibbel! Dr. Gibbel! If you are in the house, ICU please. ICU please. Urgent.

Mary Bedford, he thought. It has to be Mary Bedford!

***

Dr. Ralph Stone, knew the battle was almost over, but he kept working on the patient in the hope he might be wrong. The red-haired Medical Director of the Intensive Care Unit didn't lose patients complacently. No, each loss represented a personal failure to him, and Mary Bedford was a serious challenge. Until this moment, he thought she was under control and on the mend.

When Marigold Pepper, the head nurse in the ICU, spotted Bedford's vital signs going south, she grabbed Stone by the arm and dragged him away from another patient.

Come with me, Red, she said. Her tone was urgent.

In a minute. I need to finish this procedure.

Now!

Stone glanced at Marigold Pepper's face and knew she meant business. He asked a surgical resident to finish the procedure, and raced after Pepper who was rushing across the ICU. They both arrived at the Bedford cubicle just in time to hear her gasping for air. They checked her respirator, but the machine wasn't the problem. Bedford was failing.

The 49-year-old charity patient appeared to be semi-comatose. All her monitors were beeping frantic alarm signals, and wave lines were zigging and zagging all over their screens. Her blood pressure was dropping rapidly, and her cardiac monitor was going wild.

Within moments, Nurse Pepper arranged for a CODE BLUE announcement to be paged by the hospital's operators. Minutes later, an emergency crash cart materialized by the patient's side, the hospital's first responders began arriving, and the entire team of doctors, nurses and technicians, led by Stone, began a desperate attempt to save the woman.

She's slipping away, Stone said. She's in cardiac arrest again. Quick, dump some more Adrenaline in her IV line and maybe, just maybe, we can bring her back. Use some Lidocaine too. Who's her doctor?

Nurse Pepper looked at the patient's chart. Fred Gibbel.

The family doctor?

Ginny Croon, another nurse assisting with the patient, looked up. Croon was usually a night shift nurse, but she sometimes worked days when staffing required it. That's the one, she said. He's in the hospital making patient rounds. I saw him on the Medical Unit twenty minutes ago.

Stone grunted. He should be here, and someone should call her family.

What do you think, Red, Pepper asked, how much time does she have?

Stone shrugged. I don't know. If she responds to the meds, maybe an hour or two. I haven't given up on her yet, but it doesn't look good. Better page Gibbel now.

***

Rufus Bedford and his twenty-two year old son, John, were alone in the ICU Family Waiting Room at 9 A.M. Bedford's creased jeans, uncombed hair, and scruffy beard reflected the haste with which he dressed and rushed to the hospital when awakened by an 8 A.M. phone call.

Rufus stretched out on one of the sofas. It was kind of worn in spots and lumpy. He was wide-awake and couldn't get comfortable. Having missed breakfast in his haste to get to the hospital, he was also hungry.

The hospital's dietary department had not yet serviced the room's coffee machine and donut dispenser, and his stomach grumbled in protest.

John Bedford lay with his eyes shut on another sofa across the room. He hadn't moved in awhile, and his father thought he might be sleeping.

Rufus cleared his throat. Johnny, are you awake?

John opened his eyes and turned his head toward Rufus. I'm awake, he said. I'm just very scared about Mom.

Me too, Rufus said. He sat up and leaned forward with his elbows on his thighs and his head in his hands. Then he sighed deeply, stood and walked toward the door. I'm heading to the hospital cafeteria for a donut and coffee. Want anything?

Uh huh. Bring me the same. Chocolate, if they have it.

Rufus grinned. Okay. If any of the doctors or nurses come by, hold them here. I'll be back as soon as I can.

John sat up and put his feet on the floor. They said Dr. Gibbel would come to see us. What should I do if he does?

Rufus paused at the door to the waiting room and turned to look at his son. After a moment, he said, He's been so good to us during Mom's illness. Try to hold him here if he comes. I want to talk to him.

It didn't take Rufus long. In less than twenty minutes, he was back in the waiting room with two take-out breakfasts of coffee and donuts in a large paper bag with the words: Bard's Breakfast Bag, clearly printed on one side. Dr. Fred Gibbel arrived at the waiting room at the same instant, and greeted father and son by name.

Thank God you're here, Rufus said after he and the doctor shook hands. We're worried sick about Mary, but no one has told us anything.

Gibbel frowned. Do you mean you haven't seen anyone yet?

Rufus took the breakfasts out of the bag and placed them on an end table. He took a sip of his coffee from a hot paper cup, burned his lips and replaced the cup on the table. John got up and took his donut and coffee back to his seat.

Rufus wiped his mouth with a napkin and looked at Dr. Gibbel. When we first arrived this morning, a nurse stopped in for a moment to say Mary was having a rough night and that you'd be the one to give us details. She wouldn't answer any questions. Then she left.

Gibbel shook his head. That's disappointing. Look, I have to tell you the truth. It's very serious or you wouldn't have been called; but she's in good hands. Our ICU team is the best in the State. There's every reason to hope.

Rufus looked at his fingers. Tell me the truth. Is she dying, doctor?

Gibbel didn't answer the question directly. Rufus understood the process. The doctor couldn't be specific yet, but he had to prepare the family for the worst. That was his job.

It doesn't look good, Gibbel said. When I checked a few minutes ago, she was fighting hard. She had a cardiac arrest, you know.

John Bedford jumped to his feet and came rushing toward his father and the doctor. His face was red and he was sputtering. What...what...what did you say?

Rufus waved him away and addressed Dr. Gibbel. No, we didn't know. No one told us. That means her heart stopped, right? He stared intensely at the physician.

Gibbel met his gaze and did not look away. Yes, but they brought her back. It's too soon to say if she'll make it...or not. Look, she had a TIA at home, a transient ischemic attack. It's kind of a mini-stroke. That's why she lost consciousness. The heart attack happened here at the hospital. She's had a long history of cardiovascular disease. Your wife's body is starting to fail, but she still might rally. She's a tough lady.

John Bedford started to cry. He stood and screamed at Gibbel. Mom knew her heart condition would get her. She wanted to die at home with dignity and with her family around her. She made us promise we wouldn't let it happen to her in a hospital, half naked in a flimsy gown, and all tied up with tubes and wires.

Rufus Bedford hugged his son. Don't yell at Dr. Gibbel, Johnny. He's our friend and understands Mom's desire.

Dr. Gibbel squinted. Of course, I do. She wanted to be kept pain free and to avoid heroic attempts to save her life. That's why I arranged for her to have hospice care at home. The problem was the call to 911. When the paramedics are on the scene, their mission is to pull out all stops and keep the patient alive, intubate if necessary, and get her quickly to a hospital. Once that's in motion, it's hard to undo.

Rufus bit his lower lip. I knew that, but I panicked, When she started losing consciousness, I called 911. I just couldn't ignore it. I'm sorry.

Dr. Fred Gibbel faced Rufus Bedford, put his hands on the man's shoulders and looked him in the eye. Don't be sorry. We don't know the outcome yet. Maybe she'll recover enough strength to go home again. Let me go back to the ICU to see what's happening. I promise I'll come back with an honest report as soon as I can. Just keep praying for her.

***

She's gone. Dr. Ralph Red Stone declared. It's over.

He dismissed the other staff who helped him work on Mary Bedford, and asked Marigold Pepper, to begin preparations to remove the body to the morgue. Stone gave her a friendly pat on her rear and moved his attention to another patient fighting for life. Pepper knew the gesture meant nothing. It was just sociable banter, neither harassment nor affection. She was attracted to Stone, but she knew her wish for a romantic relationship with him was unlikely to go anywhere.

As the doctor walked away, the nurse tried to return the pat, but she missed her target. I'll get you later, you lech, she teased, with a sardonic grin, and a sparkle in her eye.

Stone looked back toward her with a broad smile. What was that?

Nothing, she said, turning her back to him. Go do your job.

The teasing, she knew, was their way of coping with the loss of Mrs. Bedford. Marigold Pepper loved her work in the ICU. Every day, she went home to her empty apartment, exhausted and emotionally spent from the life and death demands of her job. She always felt gratified, believing she made an important difference in the lives of many ICU patients and their families; but she felt guilty about the ones she lost. Deep down, she knew that she and her team were not to blame for these deaths, that they had done everything modern medical technology and professional skill could do, and that some patients were going to die no matter what. Still, she couldn't help asking herself: What did I miss? Was there something else I might have done to save this patient?

It was in this frame of mind, no longer thinking about bedding Dr. Red Stone, that she disconnected Mary Bedford's IV lines, tubes, catheters, and monitors. The corpse was already showing some of the subtle changes of the recently expired. Pepper covered the deceased's face with a sheet and phoned the morgue for a pick up.

That's when Dr. Fred Gibbel arrived. He looked from the sheeted corpse to Pepper and he grimaced. When did she die?

Tears formed in her eyes, but the nurse fought them off and looked away from Gibbel's penetrating gaze. Ten minutes ago, Fred. I'm sorry. The team did everything it could. Her heart just stopped. We used all the right drugs and equipment, and managed to bring her back several times. For a while I even thought she'd make it, but I guess, corny as it sounds, her time had come. She's the third loss in this ICU in as many days.

Gibbel's forehead creased. Do you ever get used to it?

She shook her head, Never. I bond with each patient as a viable, but ill, human being. They're real people and each loss hurts terribly.

He ran his fingers through his hair. I've been in practice for twenty years, and I never get used to losing a patient. But I don't have to deal with it every single day like you do. Why do you do it?

Marigold Pepper had asked herself that question at least a hundred times, and she always came up with the same answer.

I'll tell you why, she said, but I need a break first. We have a coffee alcove in one of the far cubicles. Will you join me?

Gibbel looked at his watch. Just for a moment or two. I don't want coffee now. I have to report to the family.

Why do I do it? Pepper repeated over a coffee cup and muffin. Here's what I tell myself. We save more than we lose. It's the ones who recover that keep me going.

Gibbel reached out and squeezed her shoulder. I admire that in you. I could never work here.

Nurse Pepper finished her snack and stood, indicating she was ready to return to the action. So, what will you do now? she asked.

Gibbel stood too. He frowned. The Bedford family is in the waiting room. I have the horrible job of telling them their wife and mother is dead.

The nurse cocked her head and whispered, And you think my job is hard? I could never do what you do.

He shrugged. Yes, it isn't easy. I'm supposed to save their loved ones. When one dies, I usually feel like I failed. And speaking of bonding with patients, Mary was a terrific person. I developed a feeling of real attachment to her and her family. They're financially strapped, you know?

I see she's a Medicaid patient, Pepper said.

The doctor nodded. Right.

She raised her eyebrows.So, many of your colleagues wouldn't even have seen her.

Again, right. The government's fees are much too low. Her husband is a skilled tool and die maker, but he lost his job a year ago. He's had a tough time finding another, and his son had to drop out of Wayne State and take a job flipping burgers at Wendy's. How could I not take the case?

Marigold Pepper, R.N. looked at Fred Gibbel, M.D. And you admire me? You're one of a kind, Fred Gibbel and, believe me, I've seen them all.

***

The ICU waiting room was busy when Dr. Fred Gibbel returned to tell Rufus and John Bedford the bad news. People chatted with neighbors or watched CNN on a TV set in the corner. Some leafed through magazines or read a book. Others just sat quietly staring into space.

A middle-aged woman in a tan pantsuit dabbed her eyes with a tissue while listening attentively to a physician in a white coat with a stethoscope draped around her neck. Dr. Gibbel recognized the doctor as Jan Shank, a pulmonologist to whom he sometimes referred patients. So as not to disturb her intense conversation, he smiled a subtle greeting at her. She briefly acknowledged him with her eyes, but she continued her comments to the woman without interruption.

The Bedford's weren't there. Fred Gibbel looked at the wall clock and was surprised to note that almost two hours had passed since he'd left the Bedford's. They may have tired of waiting for me here, he thought, but where could they be?

He felt vaguely guilty about the way Mary Bedford died. The experience of seeing her corpse had drained him, and he couldn't stop wondering whether he'd done everything he could. The poor lady begged me to make sure it didn't happen this way. Did I let her down?

Deep down, he knew that some things were beyond his control. He was only a human being, a doctor, and not a miracle worker. It made him feel helpless at times like this. He didn't like that feeling, but there it was.

Gibbel's stomach alerted him to the fact that it was past his lunchtime, so he decided to look for the Bedford's in the cafeteria. If they weren't down there,