Lethal Injection

Chapter 1

Diane passed through the scarred hospital double doors and scanned her surroundings. Flashes of memory rushed through her mind—squashing peas into her dinner plate.

She recalled her younger sister, Emily, who also marveled at how easy it was to flatten the tiny green balls into mush. Diane wanted to laugh, as she had so long ago, but could not—the pea-green tiles were mocking her, just like the vegetables her father had forced them to eat. Her senses teased her. Certainly, after two years of a general surgery residency in Hartford such hospital sights and smells were familiar, but the outdated decor at the Level 2 Trauma Center reminded her of Emily, recovering in a psychiatric hospital with the same splash of unappetizing green on the walls.

Diane snapped back to reality when the doors burst open, and an emergency was rushed into the ER. April 1st, 1998, her first day at Boston County General Hospital, had begun, and a brief moment of reflection was quickly replaced with the urgency of life as a resident specializing in trauma surgery.

Two paramedics wheeled in a heavyset man. One spoke rapidly: Male, thirty-two, gunshot. Hit three times in the chest. BP stable. Breathing regular. Another on the way.

Take him to OR Three, Doctor Colbert, the attending physician, said, and noticed the unfamiliar face. You one of the new residents?

Diane Saunders.

Assist, Doctor.

Paramedics wheeled in the second victim, and Doctor Colbert confirmed his condition; the patient had died. Diane gasped when she saw the boy’s bloodied face, and quickly regained her composure. As they wheeled the first patient toward the OR, she squeezed his hand, asking if he could hear her voice. From under his oxygen mask, the patient nodded.

What’s your name? she asked.

Reggie, he said, his voice muffled by the mask.

Take a deep breath, Reggie. She noticed Doctor Colbert observing, saying, Good breath counts bilaterally. I think his extra padding saved his life. She asked Reggie if he could move his fingers and feet, and was pleased with the results. As several men transferred Reggie to the OR table, she inquired about who shot them.

My brother. We’re in rival gangs.

Diane removed his shirt, surprised by the number of healed wounds she saw. You’ve been shot before?

Five times. I need water. Get me some water!

You have to wait. Diane thought for a second about what to do next, the adrenaline running as fast as her thoughts. To Susan Oakes, a resident nurse, she said, We need X-rays and Polaroids.

And notify the police, Colbert added.

They’re coming in now, John Burke, a resident doctor, said.

Ten minutes later, Diane and several residents reviewed the patient’s X-rays with Doctor Colbert. Studying the film attached to the light box, she noticed one bullet had deflected off of his rib, close to the anterior chamber of his heart. It’s lodged right there. She pointed, suggesting an angiography injection of dye into his blood to check for other damage.

Colbert concurred. Are you a first-year?

I transferred from Hartford, where I spent two years as a surgical resident.

Welcome to the majors, Doctor. Go to work.

Diane moved quickly down the hospital corridor, past the nurses’ station, and into the OR. She studied her surroundings as resident doctors and nurses connected Reggie to an array of monitoring equipment. During scrubs, she wondered how he had survived three gunshots to the chest, and how he could be so calm about his life-threatening injuries. An uneasy sensation consumed her. She closed her eyes and felt the butterfly necklace against her chest, calming her down. Opening them, she focused her thoughts on the procedures needed to save a life. Even with a surgeon’s mask covering her face, she could smell torn flesh permeating the sterile room.

Doctor Colbert moved the operating table toward the anesthesiologist. People, we have only minutes! The pace intensified as nurses and doctors performed separately, barking directions to keep everyone updated on the other’s progress.

Susan entered the ER, saying, He checks out. Angiogram shows no internal bleeding.

Diane prepped for surgery and asked for updates on Reggie’s vital signs.

BP and pulse are stable, Doctor Burke said.

Diane inhaled deeply, lowering the scalpel to Reggie’s skin that split open as the blade made contact. She had performed minor surgeries in Hartford, but with a man’s life now on the line, she felt as though her previous experience had not fully prepared her for this event. With green and white gowns splattered into violent red, she worked with precision to remove the bullet from Reggie’s lung, listening to Doctor Colbert’s coaching and reassurance. Sweat burned her eyes; she turned to Susan, who wiped her forehead. She closed her eyes for a second, briefly clenching her fist. Opening them, she saw Colbert staring at her.

You okay? he asked.

I’m fine, she said, although he detected nervousness.

Aware of the consequences of puncturing Reggie’s lung, Diane slowed her pace. Signs are stable. Just ease it in and take it out. Doctor Colbert walked around to the other side of the table, where two nurses sutured an incision near his liver. She located the last bullet as Colbert apprised her of Reggie’s life signs. As she removed the caliper from Reggie’s lung, playing the game Operation with her younger sister popped into her mind. Diane almost expected the patient’s nose to light up whenever her caliper grazed the side of his flesh. Shaking the child’s game free of the corners of her mind, she removed the clamp holding the bullet.

Nice work, Colbert said. The nurses will finish. You’re done, Doctor Saunders.

Diane placed the clamp on the evidence tray and stared at the lead from her first gunshot surgery, knowing it would not be her last. Doctor Colbert told her the police would need a statement about what she had learned from Reggie. He turned to his four resident doctors and nurses.

Good work. He’ll live to see another battle.

The irony of his comment surprised Diane. Is that all we’re doing? Fixing them up to be shot again?

* * *

Are you new here? the officer asked, standing beside the nurses’ station an hour later. Diane handed him a Polaroid of Reggie’s injuries and introduced herself. I’m Frank Stauffer, he said, shaking her hand. What happened to Reggie?

He said his brother shot him.

A second officer approached. We just searched Reggie’s car. Looks like a gang thing over drugs. Can we talk to him?

He’s stable. It’s amazing he’s even alive. She escorted them to the patient’s room. Reggie, the police want to talk with you.

Shit, Reggie gasped incoherently. I didn’t do nothin’!

Relax, Frank said, his hand raised. Just tell us what happened. Diane was impressed with Frank’s calm approach; Reggie seemed to cool down.

It’s a family thing.

I see, Frank said, glancing at his partner. We found guns in the car. Yours? He walked around to the side of the bed and looked into the patient’s eyes. We have some bad news, Reggie.

Look, he snapped, fear replacing the calm. I didn’t do shit!

Easy does it. What about the gun?

Self-protection!

Frank cleared his throat, adding, And the bag of dope in your car?

Reggie thrust his head against the pillow. Shit!

You want us to leave and come back so you can start again? Frank said. Because we got problems with your story. He read Reggie his Miranda rights, and asked Diane when she could release him into their custody. She told them she was going to admit Reggie, and they would need to speak with the attending physician. We’ll be back later, Reggie. Frank looked at Diane. We may have more questions for you, too, Doctor.

I’m here all day and night. To another resident, she said, Can we get this guy to ICU? Reggie, you’re not out of the woods yet. You need to stay for a while.

Oh, I’d love to stay and have a Tall Boy with you all. Invite the pigs.

Just doing my job, she said, her hands open. I’ll check on you later.

Two residents wheeled Reggie out of the OR toward the Intensive Care Unit. Later, Diane approached the admitting area, placed her hands on the counter, and smiled at the other residents.

I just put my nametag on, and suddenly I’m in full rotation.

That’s the way it works, a nurse said. Long on hours and short on pay. I’m Susan Oakes, first-year. They shook hands.

John Burke, second-year, another resident doctor said.

After joining his crew, Doctor Colbert studied his team of exhausted pupils, grinning with pride. Finally, a break in the wave. Doctor Colbert’s smile was engaging, and he seemed upbeat and encouraged his team. An older physician with gray hair and glasses, he looked distinguished to Diane, reminding her of her elementary school clarinet teacher. For a moment, she remembered private lessons she and Emily had taken with Mr. Katzin many years ago. She was impressed by how much Doctor Colbert focused on her every move during the surgery, his close attention and encouragement fueling the confidence needed to take chances. The challenge in the OR attracted her, and she felt energized by her first success.

Doctor Saunders, Colbert said after the introductions, I’m one of the senior physicians. I just got back from vacation, and our head of surgery, Doctor Harris, had assigned me to the morning shift.

Several residents mirrored the grin on his face. We’re glad to have you here, Doctor Colbert, one said.

He glanced at Diane. Take a break.

We actually have breaks?

For all of twenty seconds, Susan said, laughing as her beeper sounded on cue. Between trauma beeps. Gotta run. As Susan walked away, Diane noticed Doctor Colbert turn to watch her until she had rounded the corner.

Initially, the ER was a pool of disorganized equipment, compared to Diane’s previous residency in Hartford, but on closer examination of the eight trauma bays, she knew they had everything at their disposal to take quick action. She was excited to be a member of a new ER/OR Pilot Program at Boston County General that began as a result of a shortage of staff. She looked forward to more challenges of quick decision-making in the ER, and the opportunity to research patient care and procedures before scheduled OR surgeries.

The ER admitting area had three outdated computers that ran on old software. Part of the renovations planned for the following year included a network of new computers for retrieving case files. She didn’t know much about computers for checking on patient histories, scheduling, and research. Susan Oakes boasted her proficiency with the system and suggested training sessions for the afternoon. Behind the admitting station was a large four-by-eight board. Using erasable markers, residents cataloged ER emergencies. Down the left-side column were twenty patient name slots.

It’s never been that full, Doctor Colbert had earlier said to her, but we’ve come close.

Across the top were columns indicating the specific injuries and current status of each patient: attending physician, date of admission, trauma specific, disposition, medication, released, admitted to hospital—all the necessary information for the next shift to understand the current patient load. At the far end was information regarding the patient’s insurance status: HMO, state employee, contact agent, no insurance, released. It saddened her to see patients with severe injuries who did not have proper coverage. For a moment, she thought of Emily, alone in Chicago, and found herself wishing she could be closer to her sister. There was just no way to change her own situation in order to help. Her mood would have worsened if three emergencies had not interrupted her thoughts and demanded complete focus.

* * *

During a late-morning lull, Diane sat in the doctors’ lounge reflecting on the earlier events—my first day here thrust into immediate action—but she wouldn’t have wanted it any other way. Twenty-eight years old with light brown hair, Diane’s friends thought she resembled Snow White. She didn’t mind the comparison. Snow White was one of her and Emily’s favorite movies.

Diane had graduated in the top five percent of her class and, after replaying the morning surgery in her mind, knew all the things she would have done differently in the OR. The reputation of Boston County General spoke for itself as a public teaching hospital in a tough area of the South End surrounded by communities with rival gangs. During her break, she clutched her coffee cup, sensing the warmth through the foam insulation as the intercom blared one emergency after another. Doctors ran past the lounge with stethoscopes dangling from their necks; nurses quickly responded as seconds became the difference between death and survival. All the textbooks in any medical library, all the A-pluses in school, all the dissected cadavers in the world didn’t seem to matter anymore.

Sometimes she found it easy to question her abilities, like when she and Emily had performed in an elementary school talent show to play music she had practiced for months until memorized. Diane could still recall her terror after following a boy who had played a convincing rendition of the drum solo to Iron Butterfly’s In-A-Gadda-Da-Vida. Everyone in the auditorium had given him a standing ovation for playing something she did not even recognize. She and Emily were next in line to play, as a clarinet duet, a medley of Christmas songs.

On the school stage beside her younger sister, Diane had sat in a daze, trying to remember the notes. She froze as Emily continued playing her part to the end, trying to coax Diane with her eyes to keep playing. Too embarrassed to start the song again, Diane stood and walked off the stage. Months later, they returned the loaned instruments to the school because their parents could not afford the lessons. At the time, Diane was relieved. Mr. Katzin had given them each a wooden recorder, but, eventually, she lost all interest.

As she finished her coffee and reverie, Diane browsed through the hospital’s official orientation packet, studying the outdated literature and inaccurate floor plan. She stepped into the main corridor, relieved the pace had slowed, and thinking if she didn’t find a bathroom soon she would burst. In the hallway, she scanned her surroundings. Boston County General was one of the oldest hospitals in the city, and the interior reflected the outdated decor. The hospital was scheduled to undergo major renovations during the following year. The green tile walls were depressing, the corridors lit with harsh fluorescent bulbs that dangled from fixtures hanging from swing set-like chains.

In addition to hospital staff and patients, she noticed the maintenance crew trying to keep up with the failing building as if tending to the giant patient known as Boston County General. She envisioned the team with glib scalpels cutting into the building to repair failed heating ducts like a surgeon performing a bypass, or cleaning clogged ventilation systems that resembled arteries squeezing cholesterol through veins. Thinking she had deciphered the hospital map, she walked into the staircase from the first floor, embarrassed to discover it was not the ladies’ room.

Come on, she muttered, where did they move the bathroom? She stepped back into the main corridor and discreetly placed the hospital floor plan in the garbage.

As a young girl, Diane used to think just being in a hospital was a reason for the injured to recover, as if hospital walls represented a shrine put here on Earth by the Almighty. Bring him in and he’ll be fine. But she grew up, quickly learning that people died within hospital walls. They did not die gracefully; they died with tubes sticking out of their bodies and machines blaring. Men and women with gunshot wounds died violently. Loved ones with cancer died slowly and painfully. Seemingly healthy people living active lives died from sudden heart attacks.

As Diane entered the bathroom, she still couldn’t understand how God had taken her mother in this way. How Martha Saunders could be laughing and baking cookies with her two daughters one minute, and clutching her chest and tumbling to the floor the next. In medical school, she had studied an array of complex diseases and treatments of the human body, but knew very little about mental illness and the lonely psychological world that consumed her sister.

Chapter 2

That first morning flew by, but the afternoon seemed to linger. Diane knew her second test would occur during afternoon rounds with the head of surgery, Doctor Harris, a brilliant neurosurgeon whom she had been warned to answer quickly and concisely. She spent the early afternoon refining her computer skills with Susan, who sat next to her in front of an ER terminal.

Good. Now type in the patient’s name, last name first. And hit enter.

As he passed by, Doctor Colbert said, Can’t wait for the new systems to arrive. I find the antiquated system confusing, and I’ve been here for twenty years.

Diane smirked. Great, I get to learn this all over again.

You watch, Susan said. Those new babies will be speed demons. We’ll have patient files loading in seconds. Diane scanned the keyboard, her fingers moving over the keys, trying to find the print key. Susan noticed the suspicious grin. Very funny. Tech support is ready for a break. Let’s grab a yogurt. Today they have banana.

As they walked toward the cafeteria, Susan waved to a woman down the corridor. Stephanie, this is Diane Saunders, a third-year resident surgeon from Hartford. To Diane, she said, Steph is our staff psychiatrist. If you ever need a thoughtful ear, she’s your gal.

Stephanie extended her hand. Nice to meet you, Diane.

Care for a frozen yogurt? Diane asked. My treat.

Sold.

Stephanie McLellan was dressed conservatively and didn’t wear makeup or jewelry, a trait she and Diane had in common. During their yogurt break, Diane was impressed with how Stephanie carried herself: quietly, reflectively, and with few words.

* * *

As Diane and the other residents stood outside Doctor Harris’s door, she sensed her fellow resident doctors sizing her up. They exchanged cordial words, as each mentally prepared for his appearance. She glanced at Doctor Burke, who stared at her, and looked past him at the green wall tiles.

What’s up? John asked, her distant expression making him curious.

What? she said, focusing back on him. I was— She stopped mid-sentence when the office door opened.

Afternoon, Doctor Harris said, barely looking at them. He held a clipboard and flipped through several pages. Doctor Harris was an attractive man in his mid-fifties with a medium build and only a trace of a belly. Neatly shaven, he had bushy brown eyebrows. Diane caught a hint of his cologne—Drakkar Noir—the same worn by a fellow resident and ex-fiancé, Doctor Mark, back in Hartford. What fascinated her most were his hands, wrinkled from thousands of surgical scrubbings. She had heard during her residency in Hartford that Doctor Harris was a respected neurosurgeon. Whenever patients in Hartford had a severe brain or spinal cord injury, the medical staff there suggested they consult with Doctor Harris. It excited her to be standing next to a man with his qualifications, even though his ego was rumored to match his skill.

Peering over his clipboard, he scanned his pupils and walked briskly down the corridor. The residents followed, with Diane bringing up the rear. They entered the first patient’s room. Harris smiled at the elderly woman who lay on her back.

How are we today, Mrs. Platchard?

We are fine. Her next comment was to the residents. And how are we all?

Harris laughed. I’d like one of my residents to review your chart.

Perhaps now we’ll find a cure for what ails me.

Indeed, he said, motioning for John to step forward. Take your time, Doctor.

As John Burke formulated his diagnosis, Doctor Harris casually chatted with the patient about gardening. Diane was impressed with his bedside manner and felt relaxed during their first patient visit. He turned to John, his eyes narrowed and his mouth closed. John looked dumbfounded.

I can’t be sure at this time, but it looks—

That’s fine, Harris interrupted, snatching the file from his hand.

I wasn’t finished, Burke said, but upon seeing Harris’s angered expression, he avoided further comment.

Harris turned to the patient, his voice calm. I’ll come back and visit you later, Mrs. Platchard. When he put his hand on hers, Diane saw the trust in her eyes.

Harris left the patient’s room, followed by his devotees. Once out in the corridor, he stopped and turned to Doctor Burke. "Don’t you ever question my authority in front of a patient again! To them all, he added, If you don’t know, don’t bullshit! As you fumble for a diagnosis, do not play me for a fool. I did not earn this position by bullshitting my diagnoses. Now—he inhaled deeply—let us try again. And, Doctor, I expect a report of your diagnosis on my desk tomorrow morning. Burke nodded his head. Anger echoed in Harris’s next command: Say it!"

Y-yes, Doctor, he stammered. On your desk, tomorrow.

They entered the next room and, as before, Doctor Harris began a casual dialogue with the patient, this time a young male. A different resident stepped forward and spent several minutes reviewing the file. Diane remained toward the back, watching silently with the others.

How about that putt on seventeen by Tiger Woods? Harris asked the patient.

I about shit my pants, he said, glancing embarrassingly at Diane.

Quite all right. Diane smiled.

Harris turned toward her, grinned, and stared at the resident reviewing the file. Well?

Medical Boot Camp, Diane thought to herself. As she had discovered, she learned the most from teachers who came down on her the hardest. Harris turned to the resident and extended his hand; the resident handed him the chart. No bullshit.

What do you have to say about his condition, DS? Harris said.

For a second, Diane wondered whom he was speaking to. Recognizing her initials, she stepped forward to review the patient’s chart. After a few moments, she said, Initially, I would have guessed stomach ulcers. But, his stomach gas is just above normal, suggesting the possibility of intestinal swelling. He’s not diabetic, so I might recommend intestinal cultures.

Incomplete, but you’re on the right track. Harris looked back at the patient. We’ll catch up on the tournament later.

They left and progressed two rooms down the corridor. Good afternoon, Mrs. Hanson, he said, approaching her bed. We’ve come to see you off. You’re scheduled to leave this evening with a brand-new kidney.

Bless you, Doctor, she said, holding his hand with both of hers. I feel terrific.

It’s easy to take the credit, but there have been a lot of people who worked on you. Some kind of higher power is probably also involved. I’m going to leave you now and see some sick people. You no longer qualify for that diagnosis. Don’t come back unless it’s social.

Once back in the main corridor, Harris turned to them. We will discuss these cases tomorrow morning in the lecture hall. Be prepared to formulate treatment protocols. Check in with your supervisors for assignments. As Diane neared the door, he said, One moment, Doctor Saunders. He brushed past her, and she followed him into the hallway. I understand you assisted with an emergency surgery this morning.

That’s correct, she replied, not sure if he was angry.

And who gave you the authority?

Doctor Colbert. A man’s life was—

I don’t need a case history, he interrupted. Doctor Colbert gave you an excellent report. Keep up the aggressive work. He turned and walked away.

Diane remained still