October 5, 2018
Galveston, Texas
Louise walked briskly down the busy ER hallway to Room 11. She had started the swing shift, 3 p.m. to midnight. It’d been busy when she arrived, and she knew it would be busy when she tried to extricate herself. As she passed room 9, she heard a voice call out over the hum of activity in the department.
“Hi Dr. Finnerty, did you change your hair? Looking good!”
Louise didn’t need a visual to recognize the voice of Vance Smith. He was a frequent visitor to the ER. On this day, he was accompanied by a police officer and was handcuffed to the gurney. This was a common presentation for Vance. Louise and her colleagues had cared for him numerous times over the years. In a city the size of Galveston, and in a state like Texas, an uninsured drug addict had few options for health care. On this occasion, Vance definitely had no other choice, as Louise’s hospital was the designated hospital for the emergency care of inmates.
Louise had cared for Vance’s multiple injuries and resisted his blatant drug seeking for conditions that could never be fully diagnosed. She also recognized his legitimate medical emergencies. She diagnosed his case of appendicitis when the jail staff, as well as Louise initially, thought he was malingering. Since then, he seemed to seek her out for his medical care when he could.
None of the doctors in the ER had regular schedules, so it was hit or miss, but he did seem to turn up more often when she was on duty. Over the years, Louise had tried to help him with his addictions. His most recent drug of choice was tramadol. He got hooked on it after extensive dental work for his methamphetamine damaged teeth. She made referrals to rehab programs and enlisted social workers. Vance was never able to kick his opiate addiction.
Louise stopped outside his cubicle. A beefy, redheaded constable was sitting on a plastic chair with thin metal legs. It was straining under his weight and stabilized by his splayed legs. His nametag said Tudor. He looked content to be at rest for a few hours, maybe more, and was engrossed in his word jumble paperback. Louise knew it made sense to take care of the formalities with Vance now. She would have to pass his gurney many times before he was treated and returned to jail.
“Hi, Vance. What’s going on?” Louise said, declining to acknowledge his compliment.
“Oh, it’s that same chest pain I get, Doc. Dr. Forrest did an EKG and said he’d be back in a bit.”
Vance gave Louise a gap-toothed smile, evidence that the dental work was never completed. He looked thin, but his eyes were bright that day and his blonde hair was cut stylishly and looked clean. She knew that chest pain was a sure way to get out of jail for several hours. After being successfully sued for several bad outcomes, the jail administration no longer ignored an inmate’s complaint of chest pain. The ER staff took good care of the inmates, but once an emergency was ruled out, they were not a high priority.
“Well, I’m sure Dr. Forrest will figure it out for you,” she said. “Take care, Vance.”
She felt no need to find out why he was in custody. Constable Tudor never looked up from his brain training.
Scanning her laptop as she walked, she continued to her original destination, Room 11. Mrs. Betty Howard, age ninety-three. Chief complaint of fever and altered mental status. Louise had already looked at her medical history. Mrs. Howard had been in the ER three times in the last four months and admitted for a complicated urinary tract infection each time. This was the first time Louise had cared for her.
She introduced herself to the 70ish woman who was close to tears as she stood next to Mrs. Howard’s bed. She had fluffy white hair and blue eyes that matched the light denim jumper and Keds she was wearing.
The woman spoke, “I’m her daughter, Dottie Howard. I don’t know how much more of this either of us can stand, Doctor.”
Understanding that Dottie was exhausted by the ER visits and hospitalizations, Louise confirmed the recent course of events. She gently performed a quick physical exam on Mrs. Howard, who appeared to be sleeping restlessly, muttering unintelligibly. Afterwards, Louise suggested to Dottie that they speak outside the cubicle. She reminded herself that patients in Mrs. Howard’s state could still hear.
“Your mother is critically ill right now. The lab tests we did show her kidneys are failing. Her potassium is dangerously high, putting her at risk of serious heart rhythm problems. Her blood pressure is low, and her heart rate is high. She’s on the verge of sepsis.”
“That’s what I thought, so I brought her here. Her doctor, Old Doc Pope, died himself last year, so she hasn’t been seen except when she comes here.”
“We’ll take good care of her, but I need to ask if your mother made her wishes clear about end-of-life care. Did she let you know what she wants?” Louise asked.
Dottie sniffled a bit before she collected herself. “She said she didn’t want to die hooked up to a machine with all those tubes like Daddy did. What happens is that every time she goes into the hospital, my sister flies in from New Mexico and tells the doctors she wants everything done. When Mama gets better, I guess we’re not in the mood to talk about it.”
Louise saw a version of this family drama every shift. She had been a doctor for twenty years and still didn’t know the definition of “everything.”
Louise explained that there were plenty of things that could be done to make her mother feel better without putting her on machines. She would get Mrs. Howard admitted to a hospitalist who gave a damn about this kind of situation. She promised to contact the hospital chaplain and social services to help Dottie negotiate the next few days.
Unfortunately, during their conversation the hallway was crowded and noisy. Louise and Dottie were pressed against the flimsy barrier between Rooms 9 and 11. By the end of the conversation, Dottie was sobbing and had grabbed Louise’s hand. Louise knew the least she could do would be to stay by Dottie’s side until she regained her composure.
As she stared down the hall, Louise could hear Vance’s voice from the next room.
“Officer, can I please at least get up and use the restroom?”
“You know the rules,” replied the officer. “You get the fancy urinal.”
When, as if by divine intervention, two members of the Howard’s church appeared with coffee, donuts, and words of comfort, Louise extricated herself. She started down the hall, checking lab results as she walked.
“Dr. Finnerty!” Vance called out from Room 9. “I know you’re busy, but I need help with a situation.”
Louise stopped, still looking at her laptop’s screen. “Yes, Vance,” she said with poorly disguised irritation.
“It’s not medical, I mean, maybe it’s adding to my chest pain and all.”
He stopped talking until he saw Louise turn her attention to him from her computer.
“Long story short, Doc. I need a good lawyer and wondered if you could recommend one.”
“Don’t you have one appointed to you?” Louise asked.
“I need to talk to a real lawyer about some information I have. A lawyer who can help me get my charges reduced. It relates to murder.”
Vance drew out the last sentence dramatically. Constable Tudor snorted.
“Did you know the lady doctor who was killed last week? I heard the nurses talking last time I was here. Someone said she was your friend. That broke me up, about her getting killed and being your friend and all. I need to talk to someone about some stuff I overheard in the showers last week. There was a new guy in there. He looked like he was kind of jonesing. He was talking to himself, trying to calm down, and said something about a body, a woman. He said that he thought she was dead. She went in the water. It wasn’t making sense. It was the guy they brought in from the rig last week.”
Vance had her attention now. “I’ll see if I know someone. In the meantime, you need to bring this to the attention of the lawyer you have and ask to talk to the detectives on the case.”
Tudor broke in at this point. “C’mon, Smith, leave the good doctor alone. She’s too busy to listen to your BS.”
Louise used this as an opportunity to keep moving. Vance was still talking.
“Shit, man, can you at least hand me the bottle to pee in?”
Before seeing her next patient, Louise cleared off a patch of counter space for her laptop and placed a call to Detective Iliana Sudhan.
“Hi Louise, are any of my family members in the ER again?” she asked.
“Not today, as far as I know. Hey, listen, I’ve only got a minute. An inmate told me a jailhouse story that might relate to Gen’s murder.” Louise gave Sudhan the gist of Vance’s story.
“Sounds like a prison snitch trying to trade information for a get out of jail free card. Happens all the time.”
“I know, but what if this guy’s telling the truth?”
Louise didn’t let Sudhan know how unreliable and manipulative Vance could be. She told her that Tudor was the escorting officer.
“Okay, I know you’re still upset about your friend. I get it. Let me talk to the guys tomorrow. I’ll track down Tudor.”
Louise thanked her and hung up. She was dismayed by Sudhan’s lack of urgency but assumed the detective’s days were as busy as her own and involved constant prioritization. That was exactly what she did when she looked at her list of patients. She was off and running until the end of her shift.