The Good Nurse: A True Story of Medicine, Madness, and Murder by Charles Graeber Read Free Book Online Page A

head and feet and all. Charlie was good. She told him so. He told her it was easy. He’d had plenty of practice.

    T he Rev. Florian Gall had arrived by ambulance before being delivered to the Somerset Medical CCU, nearly nine months to the day after Charlie’s own arrival on the unit. His fever was three-digit and his lymph nodes swollen to stones, both symptoms of an overwhelming bacterial infection, probably pneumonia. His lungs, sodden as wet facecloths, labored to deliver minimal oxygen to his heart or brain. A machine would have to breathe for him. Gall’s chin was raised, his mouth opened, and a plastic tube was shoehorned into his windpipe, fitted into an accordianed length of plastic ductwork, and attached to a ventilator. Meanwhile, Gall’s overwhelmed kidneys began to fail. They would recover if he did; until then, a machine would filter his blood as well. 14
    The reverend’s sister visited his bedside daily. Lucille Gall was a senior nurse at a nearby hospital, which allowed her to stay at his bedside late, a professional courtesy. The sister had opinions about her brother’s care. Charlie wasn’t always assigned to the reverend, but he always checked up on him, and he didn’t appreciate her proprietary attitude. She had argued with him, more than once, about which drugs he was giving her brother and why, acting as if she was in charge. She didn’t, for instance, think Tylenol was a good idea, considering the reverend’s failing liver. Her attitude bothered him, to the point that when he thought about Gall, the image in his mind was not him, but her. It was only when she left that Charlie could get down to business.
    Gall’s real problem was his heart—atrial fibrillation, probably, meaning that one of his heart chambers was contracting too rapidly to effectively fill or pump. The cardiologist on call prescribed digoxin. It would slow theatrium, and oxygenated blood would once again circulate through the reverend’s body. At least, that was the idea.
    At that point, and for that whole first week, it was impossible to know whether the Reverend would live or die. His family consented to a Do Not Resuscitate order; if Gall’s body did quit on him, at least he would pass unto the Lord without the earthy indignity of dramatic and “extraordinary measures.” But then, gradually, the reverend started to improve. The DNR order was rescinded and his digoxin was discontinued. By the second week, Gall began to sit up and take his meals. As his pneumonia subsided and his heart rhythm stabilized, he would chat with his sister, who remained vigilant by his bedside. Grousing about the nurses who cared for him, unhappy to be hooked to tubes and drips and bleeping machines, the reverend was his old self again, cantankerous but familiar. He could eat and talk. Eventually, if he continued to improve, he would leave.

    C harlie would study the man at night, his bald head glowing in the light of the machines, his clerical vestments exchanged for a disposable frock. He looked nothing like the priests of Charlie’s youth, nothing like God’s man on earth—he looked sick, and very human. That was his prognosis. Charlie knew the charts, he’d pulled the little computer cart to the corner of the Cardiac Care Unit to pore through the drama of numbers.
    Rev. Florian Gall coded at approximately 9:32 a.m. the morning of June 28. He went unexpectedly into cardiac arrest, and heroic measures were undertaken. They were unsuccessful. His time of death was noted in his chart: 10:10 a.m. Gall’s bloodwork showed that his digoxin levels were off the charts.
    The Somerset Medical Center administration had a problem. It was not a natural death. And Gall wasn’t the first. They called him “Patient 4.”
    The plan was to deal with it internally 15 and as quickly as possible. Pharmacy would examine the Pyxis around the dates of the digoxin deaths. Assistant Pharmacist Nancy Doherty was assigned to contact New Jersey Poison Control