1
Arlington, Virginia
Monday, 3:29 p.m.
Tension eased out of Dr. Harper Justice’s shoulders as the last of her rotation in the Emergency Room at Arlington Community Hospital (ACH) faded into history. She exited the doctors’ lounge, barely putting one foot in front of the other. The long walk from the building to the Metro station after pulling a three-day shift would seem like a marathon, but the reward would be a few days of sleep and doing nothing serious requiring brain cells. As she approached the exit door, a voice from behind ripped her from the pleasant thoughts.
“Dr. Justice!”
Harper turned to see one of the ER nurses coming from the opposite direction. At the same time, the code alert shrilled through the hallway.
“Dr. Justice, the patient in room four, went into cardiac arrest. Dr. Gordon is in with another patient and said to call you back to assist.”
“I’m off duty. No one else is here?”
The nurse shrugged.
“Let’s go.” Harper’s first lesson about surviving in the real world outside of the pampered one she’d inhabited a few months ago became brutally apparent.
Giving up on a patient wasn’t in her playbook and never would be. Though exhausted, Harper hustled with the nurse while she asked all the vital stats on the patient so that upon arrival, she’d know how to proceed.
“Okay, people, what do we have here?” Harper pulled the sheet back from the patient and then glanced at the monitor. The flatline and other indicators showed no heartbeat or blood pressure. She searched for a pulse and got none.
Nodding at the LPN on the other side of the bed, she ordered, “Diane, start bagging him.” She glanced at the end of the bed. “Laura, get me a cardiac needle.” Her demand was tense but controlled.
Immediately, Harper began chest compressions. “Can one of you get a blood pressure on this patient? Stat! Where’s the crash cart?”
Neither nurse responded verbally or physically. The attending staff stood motionless, staring at Harper.
“What is wrong with you two? Stop standing around doing nothing. Do what I said.”
“You need to call the time, Dr. Justice.” The attendant lowered her head as she spoke. “He’s gone.”
“No, we can save him. Now, do as I say before it’s too late.”
“I’m sorry, but no, ma’am.”
At this point, Harper stopped compressions. “Why am I here if you don’t do as I ask? Who do you answer to, if not me?”
“They’re following my orders.” A woman stepped into the bay area.
“Who are you?” Harper was too tired and too angry to buffer the tone in her voice.
“Barbara Latimer, Administrative Department Chief for Patient Services. Mr. Ramirez has a Do Not Resusitate on record. Therefore, our responsibility is to honor his directive.”
“Wait a minute. I may be new here, but I swore an oath to save lives. Directive or no directive, I’m obligated to help. Mr. Ramirez came in for stitches and a fractured ankle from falling off a ladder, not a cardiac episode. He was fine when I checked out thirty-odd minutes ago. Now, you want me to declare him dead?”
“Dr. Justice, perhaps you’re exhausted and misread his injuries. If you continue to refuse, you’ll violate the laws of the National Universal Healthcare Association Code three-twenty-eight dash two. I’ll have to report this incident to the hospital administrator. Considering your record and the circumstances you came to ACH, I suggest you call the time, sign the proper form, and enjoy the next few days off. You’ll feel better when you return.”
Harper switched attention from the tablet to the attendants, each with their eyes lowered. The healthcare codes were many, and she didn’t know all of them. She had no choice but to sign because transferring to another hospital couldn’t happen without going before the Medical Board again. Reluctantly, Harper complied. Nothing was familiar with the situation, but what alternative did she have? Noting the time on the large wall clock, she marked the hour and minute. “Laura, notate Mr. Ramirez passed at four-ten.”
“Yes, ma’am.” The nurse made the entry into the EMR, the electronic medical record, on the touchscreen computer tablet. “You can sign now, Dr. Justice.”
Latimer thrust the tablet at Harper. After scribbling the signature, she handed the device back.
“Thank you for your cooperation, Dr. Justice. You’ll learn that the protocols set here aren’t the same as they were when you worked as a concierge physician for Senator Ruiz-Gozon. I hope we don’t have another misunderstanding during your tenure.”
Does this woman know about my past? Of course, she does. Everyone knows my fall from grace. “No, no, we won’t.” Harper took the tablet and stylus in hand. With a few initials in a few boxes, she added the final signature and handed the tablet back to the administrator. “What about notifying his relatives? What am I supposed to say to them when they ask how he died?”
“He had no relatives. That’s why the DNR, so he wouldn’t be a burden to public services healthcare. You won’t have any worries, either.” Turning on her heels, Latimer left.
An inadequate silence lingered. When Harper heard the poor man had no family to depend on, she got queasy in the pit of her stomach. They shared similarities. She didn’t have a close family, either. Suddenly, she had to get out of the hospital. Fighting against in-grained protocol wasn’t what Harper signed on for after entering the Public Healthcare doctorate program, but she had ten more years on the government contract. For now, she had to suck up any disgust with the system to survive.
Before the concierge dismissal, she never paid attention to what went on in medicine’s public sector. This life was her new normal. The secure and privileged world blew up six months ago. She thought she knew who she was, where she wanted to be in ten and twenty years, and felt comfortable in her skin. Now, not so much.
Working in a trauma emergency room tested her skills, her endurance, her sanity. She had real live patients with serious problems, and they expected her to fix them. She’d failed Mr. Ramirez, and she didn’t know if she could lose another. Trapped between doing what she loved and what others wanted hadn’t been her first choice as a doctor.
The attending nurses departed the room without a word, leaving Harper with Mr. Ramirez.
“I’m sorry.” She took the sheet edge and gently pulled the cloth over the dead man’s body and head. A tear slipped from the corner of Harper’s eye. Memories of the little girl she’d lost several months ago flashed in her mind. That death wasn’t right then, and this wasn’t right now.
As Harper walked the long hallway to the hospital exit, she had no idea how she would suffer the heartache again of losing a patient, but she’d find a way after sleeping on it.
Arlington, Virginia
Monday, 3:29 p.m.
Tension eased out of Dr. Harper Justice’s shoulders as the last of her rotation in the Emergency Room at Arlington Community Hospital (ACH) faded into history. She exited the doctors’ lounge, barely putting one foot in front of the other. The long walk from the building to the Metro station after pulling a three-day shift would seem like a marathon, but the reward would be a few days of sleep and doing nothing serious requiring brain cells. As she approached the exit door, a voice from behind ripped her from the pleasant thoughts.
“Dr. Justice!”
Harper turned to see one of the ER nurses coming from the opposite direction. At the same time, the code alert shrilled through the hallway.
“Dr. Justice, the patient in room four, went into cardiac arrest. Dr. Gordon is in with another patient and said to call you back to assist.”
“I’m off duty. No one else is here?”
The nurse shrugged.
“Let’s go.” Harper’s first lesson about surviving in the real world outside of the pampered one she’d inhabited a few months ago became brutally apparent.
Giving up on a patient wasn’t in her playbook and never would be. Though exhausted, Harper hustled with the nurse while she asked all the vital stats on the patient so that upon arrival, she’d know how to proceed.
“Okay, people, what do we have here?” Harper pulled the sheet back from the patient and then glanced at the monitor. The flatline and other indicators showed no heartbeat or blood pressure. She searched for a pulse and got none.
Nodding at the LPN on the other side of the bed, she ordered, “Diane, start bagging him.” She glanced at the end of the bed. “Laura, get me a cardiac needle.” Her demand was tense but controlled.
Immediately, Harper began chest compressions. “Can one of you get a blood pressure on this patient? Stat! Where’s the crash cart?”
Neither nurse responded verbally or physically. The attending staff stood motionless, staring at Harper.
“What is wrong with you two? Stop standing around doing nothing. Do what I said.”
“You need to call the time, Dr. Justice.” The attendant lowered her head as she spoke. “He’s gone.”
“No, we can save him. Now, do as I say before it’s too late.”
“I’m sorry, but no, ma’am.”
At this point, Harper stopped compressions. “Why am I here if you don’t do as I ask? Who do you answer to, if not me?”
“They’re following my orders.” A woman stepped into the bay area.
“Who are you?” Harper was too tired and too angry to buffer the tone in her voice.
“Barbara Latimer, Administrative Department Chief for Patient Services. Mr. Ramirez has a Do Not Resusitate on record. Therefore, our responsibility is to honor his directive.”
“Wait a minute. I may be new here, but I swore an oath to save lives. Directive or no directive, I’m obligated to help. Mr. Ramirez came in for stitches and a fractured ankle from falling off a ladder, not a cardiac episode. He was fine when I checked out thirty-odd minutes ago. Now, you want me to declare him dead?”
“Dr. Justice, perhaps you’re exhausted and misread his injuries. If you continue to refuse, you’ll violate the laws of the National Universal Healthcare Association Code three-twenty-eight dash two. I’ll have to report this incident to the hospital administrator. Considering your record and the circumstances you came to ACH, I suggest you call the time, sign the proper form, and enjoy the next few days off. You’ll feel better when you return.”
Harper switched attention from the tablet to the attendants, each with their eyes lowered. The healthcare codes were many, and she didn’t know all of them. She had no choice but to sign because transferring to another hospital couldn’t happen without going before the Medical Board again. Reluctantly, Harper complied. Nothing was familiar with the situation, but what alternative did she have? Noting the time on the large wall clock, she marked the hour and minute. “Laura, notate Mr. Ramirez passed at four-ten.”
“Yes, ma’am.” The nurse made the entry into the EMR, the electronic medical record, on the touchscreen computer tablet. “You can sign now, Dr. Justice.”
Latimer thrust the tablet at Harper. After scribbling the signature, she handed the device back.
“Thank you for your cooperation, Dr. Justice. You’ll learn that the protocols set here aren’t the same as they were when you worked as a concierge physician for Senator Ruiz-Gozon. I hope we don’t have another misunderstanding during your tenure.”
Does this woman know about my past? Of course, she does. Everyone knows my fall from grace. “No, no, we won’t.” Harper took the tablet and stylus in hand. With a few initials in a few boxes, she added the final signature and handed the tablet back to the administrator. “What about notifying his relatives? What am I supposed to say to them when they ask how he died?”
“He had no relatives. That’s why the DNR, so he wouldn’t be a burden to public services healthcare. You won’t have any worries, either.” Turning on her heels, Latimer left.
An inadequate silence lingered. When Harper heard the poor man had no family to depend on, she got queasy in the pit of her stomach. They shared similarities. She didn’t have a close family, either. Suddenly, she had to get out of the hospital. Fighting against in-grained protocol wasn’t what Harper signed on for after entering the Public Healthcare doctorate program, but she had ten more years on the government contract. For now, she had to suck up any disgust with the system to survive.
Before the concierge dismissal, she never paid attention to what went on in medicine’s public sector. This life was her new normal. The secure and privileged world blew up six months ago. She thought she knew who she was, where she wanted to be in ten and twenty years, and felt comfortable in her skin. Now, not so much.
Working in a trauma emergency room tested her skills, her endurance, her sanity. She had real live patients with serious problems, and they expected her to fix them. She’d failed Mr. Ramirez, and she didn’t know if she could lose another. Trapped between doing what she loved and what others wanted hadn’t been her first choice as a doctor.
The attending nurses departed the room without a word, leaving Harper with Mr. Ramirez.
“I’m sorry.” She took the sheet edge and gently pulled the cloth over the dead man’s body and head. A tear slipped from the corner of Harper’s eye. Memories of the little girl she’d lost several months ago flashed in her mind. That death wasn’t right then, and this wasn’t right now.
As Harper walked the long hallway to the hospital exit, she had no idea how she would suffer the heartache again of losing a patient, but she’d find a way after sleeping on it.
© 2014-2021. All rights reserved and no exceptions. All personal works on this site are the exclusive property of I Heart Book Publishing, LLC. Work may not be transmitted via the internet, nor reproduced in any other way, without prior written consent.
© 2014-2021. All rights reserved and no exceptions. All personal works on this site are the exclusive property of I Heart Book Publishing, LLC. Work may not be transmitted via the internet, nor reproduced in any other way, without prior written consent.
