Contaminated

By Cynthia Monet

An earthquake rocks Southern California, damaging Parker Memorial Hospital and the neighboring Simfact genetic research lab. That night, patients suffer critical lung symptoms and the medical staff claims the nurses spread bacteria from a patients wound. As the disease spreads, those with chronic illness or risky life-styles are dying, and bioterrorism is feared. When NIH and Centers for Disease Control specialists take siege of the hospital, the medical brotherhood begins to crumble. In the worsening crisis, a nurses stubborn search for truth jeopardizes her life and others before illegal and unethical medical practice reaching far beyond PMH is revealed.

• Language: English
• Publisher: Xlibris US
• Release date: Sep 15, 2005
• ISBN: 9781469106243

Cynthia Monet

Cynda Monet has extensive experience in healthcare and publishing. On faculty in a major California university system, Cynda has a rich background in hospital nursing, management, and trauma settings in California. She is listed in multiple Who’s Who citations, including Who’s Who in Medicine and Healthcare. Cynda believes it is vital to bring the color and conflict of healthcare workers and their relationships alive in her stories. DANGEROUS TRUST is Cynda’s 2nd full-length healthcare suspense novel in a series, with CONTAMINATED first in the series, published in 2005.

Book preview

PROLOGUE

In 1972, 134 countries on Earth signed the Biological Weapons Treaty, which banned the use and manufacture of biological weapons. The United States was one of the powerful supporters of the Treaty.

Producing biological warfare weapons that can inflict mass casualties takes the kind of facilities that probably only governments have.

What happens if someone in power decides to create an illegal civilian facility for the development of bioterror pathogens and vaccines?

CHAPTER ONE

Tuesday Morning

As she reached overhead to hang a small IV antibiotic bag, Anne Winters stopped when the large windows began moving in and out as though an electric current had been suddenly turned on. She turned her head toward the warm Southern California morning sunlight streaming into the room, and sensed sound of a low decibel in the steel girders four levels below. Her knees began to quiver. In the next instant, the building groaned, the floor lurched, and she was thrown across the patient’s bed.

The man screamed. My leg, my leg!

Anne dropped to the floor, gasped, and tried to catch her breath. The fetid odor of an infected leg wound filled her nostrils. She covered her mouth, afraid she would be sick.

The shaking intensified. Anne pulled herself around the bed frame, crawled across the slippery linoleum, and was tossed sideways. In disbelief she watched her stethoscope slide across the floor and under the bed.

Steel and wood rumbled, windows creaked, patients screamed, and IV poles crashed to the floor. Anne pressed her back against the doorframe and threw her arms over her head.

She wanted to cry, to find a safe place. Nothing like this had ever happened in her eleven years of nursing. But she was the charge nurse and had to stay in control. Priorities! What should I do? I don’t want to be here, we’ll all die in this old hospital. The disaster bell began to sound and the heavy door swung toward her. Anne rolled out of the room and fell against the med cart.

Breathe—am I breathing? Patient safety first, secure injuries. Help patients to bed, restart IV lines. Get out of here!

Another nurse stumbled into the hallway. I’ve got a code blue!

Handle a code during a quake? Fear tingled up Anne’s spine, across her thighs, and down her legs. Suddenly warmth flowed down her pants. Then the shaking and rumbling stopped. The lights flickered and the fans silenced.

Anne froze. No power. Everybody move the plugs to the red outlets. And Gina, call a code! Anne ran down the hall, maneuvering around gurneys and equipment, conscious of wet warmth in her shoes. As she rolled the crash cart to the room, the operator’s voice boomed overhead and the bells refused to cease.

All medical and nursing staff report to your units STAT!

Twenty-one bells! Gina, start the disaster protocol. Grab the red manual off the shelf.

After a brief whining generator noise, power was restored. Thank God for the generator.

She ran to 506, tossed the ambu bag at Suzie and hooked up the EKG monitor. The man’s face was ashen white, and he smelled of fear. Anne tipped his inert body to the side, placed the backboard beneath, and started compressions. The code team arrived and pushed her aside.

Hey—this flowmeter has no reading! Get another one. The code doc barked at Anne.

Anne nodded, her arms shook and her throat ached. Suzie pressed the mask tight against the man’s nose and mouth and forcefully squeezed the ambu bag with both hands. Anne grabbed the second flow meter off the crash cart, pulled the dead meter out, and pushed its replacement into the small holes in the wall. She spun the dial and watched the gauge.

Nothing happened. Anne wiggled the connection again. The doctor shoved her aside, pulled the meter out, and slammed it into the outlet above the other bed. Still no oxygen pressure. Without oxygen, Suzie may as well have been giving noxious gases to the patient.

Suzie removed the mask and screamed. Her patient’s lips resembled purple sausages.

Doctor Seiffert grabbed Anne’s arm. Portable O2 now!

Anne ran into the hallway to grab the unit’s only portable oxygen tank. Patients were crying and some nurses were sobbing. Anne prayed someone would help her unit, now.

Curtis Webb finally stood and gazed at the disorder in the main conference room at the La Sierra Inn. The jolt of adrenalin made him feel anxious and unreal. He watched others crawl from under tables and chairs. Ceiling panels lay like crumbled chalk tablets against the oak tables and deep red carpet. Fluorescent light boxes dangled precariously from steel beams. The crystal chandelier lay in the middle aisle, surrounded by scattered shards of glass. Fine white dust cast an eerie haze across the melee. The dust and debris had the scent of an old garage. The relative calm and harmony of the conference was now shattered and cacophonous.

The shaking had begun just as his coworker, Steven, was giving his closing pathology lecture remarks. Curtis could no longer see Steven at the podium.

Painful cries surrounded him. Curtis imagined the worst, having ridden out the San Francisco World Series quake years before. Roadblocks, fires, power out. General confusion, and a discordant internal sense of more disaster to follow.

He also heard wheezing. As he turned to his right, his chubby friend Paul, from Baton Rouge, leaned close gasping and red-faced. On the other side, Frank, from St. Louis, sat with jaws tense and eyes darting. Blood trickled in a thin river from his forehead to his chin. Curtis felt sorry for them, as though he were responsible. He pulled a tissue out of his pocket and held it to Frank’s head. More than anything, Curtis wanted to leave before more ceiling fell.

Hey, Paul, I remember you wheezing when we spent long hours at LA County Hospital. Those were the days. Curtis shook his head. You need your inhaler.

Paul nodded. In my shaving kit. He coughed and wheezed again.

You need to get out of this dust. Frank grumbled. Give me your key, Paul. He stood and clutched the tissue to the gash on his forehead.

Curtis looked at the blood on Frank’s face. You sure you’re up for the stairs?

Frank swung his eyes toward Curtis. I’m fine. He left the room, scowling.

Finally, Steven limped over, holding his hand to his side, and grimacing. Guess I really brought the house down. Steven gasped and bit his lip.

Anne thought you’d have us rolling in the aisles with your wacky— Curtis raised Steven’s jacket. You’ve been hit. He helped Steven to a chair and palpated his back. Looks like cracked ribs—already bruising. Does that hurt?

Steven moaned. The ceiling got me. Thank God the chandelier missed us.

You might have internal injuries. I’ll take you to the ER.

Steven winced. No, they’ll have enough to worry about. Just patch me up.

Curtis groaned at the pathologist’s stubbornness. We’ll have to use your tee shirt. In a moment Curtis wrapped Steven in a makeshift splint. Paul wheezed, trying to help.

When Curtis offered to drive him home, Steven pulled away. Let me go. I’ve got to check on my family.

As Steven limped away, Curtis knew he would do as he pleased. He wondered how others had survived the quake. He envisioned his file cabinets toppled and hoped he had locked the drawers. His office staff would be swearing at the potting soil from trees and hanging plants. But, it was his cats he worried about the most. His Siamese were home alone and would come unhinged by the rumbling—and probably shredding his blinds and drapes by now. He had the odd feeling that his toaster and coffee maker were dangling, about to set on fire in his home.

Curtis breathed a sigh of relief as Frank breezed into the room, waving the inhaler. When they reached the Lobby, broken windows startled Curtis. A loud voice announced first aid.

Go get your head stitched, Frank. I’m going outside to use my cell phone and maybe see what I can find out on my car radio. Curtis watched Paul and Frank join the first aid line.

Once outside, Curtis was thankful he’d been early and found a spot in the front lot. Slabs of concrete jutted downward in the second level of the parking garage. He couldn’t help thinking that Fate had somehow protected him from an even worse operatic outcome. Sirens pierced the air, calling, rushing. Curtis felt a chill run up his spine as he put his key in the Acura’s ignition. Rich jazz music poured from the speakers before he hit the radio knob. He glanced in the rearview mirror and saw the dark frown on his usually calm expression. White dust peppered his black and silver hair, and redness surrounded his pale grey eyes. He wasn’t a pretty sight.

The temblor, which registered 5.9 on the Richter Scale, lasted a long forty seconds, centered off the coast approximately twelve miles in the Santa Barbara Channel, according to Cal Tech seismologists. Reports of moderate to severe damage are coming in from most of Citrus County. Please do not call 911 unless it is absolutely . . .

Curtis took out his PDA, turned it on, and made note of the time of the quake, its strength, and its duration. Everyone had known southern California was due for a big one, and now here it was. Exactly 24 hours after his conference lecture on the hospital infectious disease doctor’s role in managing and containing acute care infections. If it had hit yesterday, he would be the one with broken ribs, not Steven. He felt a chill run down his spine as he shook his head.

Curtis sensed his life would change from this point forward. Not because the quake made a mess of day to day living, but because he worked in an old hospital. From previous experience, he knew aging buildings were often ruined, or collapsed after earthquakes or fires. It would make his job so hard; everyone’s work for that matter would probably become intolerable. Even worse, Curtis wondered if the band would practice this week with all this mess. He always needed time to relax and play his piano, and the Grunion band had provided that for the last two years.

As he sat and listened to the agitated announcer give details of the quake, Curtis leaned his head back and groaned. It had all been going so well for him and the PMH staff. As part of his ongoing plan to update the infectious disease program, he was anticipating new electronic microscopes for the hospital pathology and laboratory departments. But now, as he imagined cracked walls and burst plumbing, Curtis could not fathom putting expensive technology inside the old hospital. It would be like new piano strings in an ancient but cheap piano. A nice touch, but not worth the effort.

Curtis reached into his coat pocket and found the other half of the Almond Joy he had not finished during Steven’s lecture. If he was going to survive the ordeal ahead, he would need the energy only a steady supply of his favorite candy would provide. It was a ridiculous need, but he worked such long hours, he often had no time to stop for a meal. The thought depressed him, and he cursed the gods who wrought the quake upon his already hectic life.

Alex Regis had hurried back to Parker Memorial Hospital as fast as the road conditions allowed. Many traffic light poles lay on the ground, and there were widespread power outages. As Chief of Staff, Alex was required to take charge of all medical concerns during an emergency. He also had his own practice to handle, and after a crisis like this, his cardiology skills would be in demand. Chest pain, arrhythmias, heart attacks, strokes.

But now, he felt childish—he couldn’t look out the windows. The brown smoky skyline and flashing red lights made him feel ill. The large windows at the end of the hall worried him. Without warning, those windows could implode upon him. With each aftershock, he was certain the floors above would crash down. After all, PMH had been around for half a century.

The eerie absence of ringing phones stunned his ears, as did the sound of frantic nurses. It should be the other way around in this efficient community hospital—ringing phones and lots of business, buzzing pagers, and overhead calls, along with adept nurses caring for their patients.

Alex left the 4th floor noting an acrid taste in his mouth from the odors of blood and bile in the room he’d just left. He spit into a tissue, and then dug in his lab coat pocket for a Red Devil. As he wrapped his tongue around the red ball, Alex took a breath. Better, much better. He trotted down three flights of stairs, running his palm along the cool metal rail for good measure.

The lobby buzzed with anxious voices. Strangers clamored around the reception desk like hungry sharks, demanding attention and answers about loved ones. Alex darted into the men’s room. His reflection showed beads of sweat on his tan skin, and dust in his jet-black hair. He wet a paper towel and wiped it over his head and face. He adjusted his geometric silk tie and straightened the collar of his once crisp white lab coat.

Alex was on the way to the Vice President’s office and had reason to believe the Press would be waiting. PMH was the backbone of this Southern California retirement-friendly town and served all from the foothills to the Pacific coastline. The injured would arrive seeking care for their assorted wounds and trauma. Alex and the VP would see that PMH was ready.

Anne soon learned the problem wasn’t limited to room 506. Her nurses said that within minutes of the first jolt, the usual hissing sound of oxygen flowing in the patients’ rooms had stopped. But no one did anything about it during the overall chaos.

By the time Anne had changed into dry pants, the coding patient was sent to the ICU, barely alive. Her nurses were coming unglued. Her friend Suzie was the worst.

Turner’s not the only one. Everyone’s going bad. She grabbed Anne’s hand and pulled her down the long hallway. They ran in and out of half a dozen rooms.

Back in the hall, Anne covered her face with her hands. Patients on their medical unit were on oxygen therapy. Most were now pale and had low pulse oxygenation levels. They looked as though they had become oxygen starved.

Okay, did anyone page the respiratory therapist? Anne felt sweat slip into her bra.

No, our phones are dead. Suzie stomped her foot, clearly agitated.

Anne felt her pulse bounding in her neck. Well—has the engineer been up here?

I don’t think so. And Gina says you want a nurse and aide to go to the ER. That’s muy loco. Suzie waved her arm in the air. Her long brown ponytail swung sideways.

It’s the disaster protocol. But I’m not following it. Anne strode toward the nursing station. Gina—use the intercom to find the nursing assistants. Nicki can go to the ER. Send Dan down to the RT department—we need a whole bunch of oxygen tanks.

Gina shook her head as she pressed the intercom buttons. It doesn’t work! The intercom doesn’t work! I can’t call into any of the rooms, Anne.

Anne slumped against the top of the nursing station and let out her breath.

Nicki ran toward the desk. There’s water all over the floor in the tub room! Mrs. Birch slipped and is lying on the floor, crying. The pipe burst and I can’t turn off the water.

Suzie, you need to check on your patient in 510. His IV line separated and there’s blood all over his bed. Dan stopped and washed his hands at the sink. I did the best I could. He looked at Anne. You don’t look so good. Are you about to pass out?

Anne shook her head and wiped back a tear. No, I’m angry and about at my wits end. If we don’t get some help up here, someone’s bound to suffer, or worse, die. She paused and took a deep breath. Dan, we need portable O2 tanks. Our oxygen line is broken.

Dan nodded and dried his hands. I’ll go drum up some tanks while you guys take care of the patients. If I see any of the hospital engineers, I’ll send them up.

Anne sighed and smiled. Dan Chavez was a former military medic, and the best nursing assistant she had ever worked with. He was amazing as he was in school to become an LVN, and then an RN later.

And if you see any docs, tell them we’re dying up here—figuratively and literally.

Commander Peter Stoltz gazed across the Captain’s massive mahogany desk, avoiding eye contact by studying the odd paperweight. A lava lamp, no, a wave maker of some sort. Almost hypnotic in its lazy undulations of thick blue liquid in clear glass. A memento from Glenn’s recent trip to San Diego.

Damn, where is he? Captain Glenn Gibson spun sideways in his leather chair.

Peter checked his watch. Fourteen hundred hours D.C. time and still morning in California. That was amazing footage on CNN, sir. A considerable disaster.

The Captain stared at him. There was a knock on the closed door. Enter!

The lieutenant saluted. Sir, communications to Citrus County are still down. Short-wave links are functional, and we are attempting to reach your contact at this time.

Gibson stood. No, that’s no good. Dammed amateur waves are not secure.

We’re using a civilian call sign and the assigned code name, sir.

Gibson exhaled sharply. I demand complete security in obtaining the status report.

Yes Sir. The lieutenant’s face flushed. He nodded and left the office.

Peter was proud. The project had been going on successfully for more than five years. An innocuous private lab in a sedate civilian community. Equipped with technology rivaling the Army’s Medical Research Institute. Peter felt his pulse quicken. National security was in their hands. Always on the edge, just beyond acceptable bounds. Sometimes the thrill of it made it hard for him to sleep. Maybe it was time for him to go check on the project himself.

Captain Gibson coughed. Stoltz, if we have any problems you need to get out there.

Yes sir. Peter stood erect. I’ll stay on top of it.

The Press had indeed been there, but Nate Berg did not have a facility report ready. His boss had collapsed an hour after the quake. Alex had offered to examine the CEO, but the ER Director, Chad Coleman, took over. Alex felt his stomach burn thinking about CC’s arrogance. Alex rolled the dissolving candy ball around in his mouth. Through the large window in Nate’s office, Alex could see the Channel 10 van, and several cameramen milling about the ambulances in the ER parking lot. Nate wisely did not report the status of their CEO, Bud O’Brien.

Alex turned back toward the VP. The young man in preppie clothing looked frustrated, as though trapped in his own large office. The sleeves of his crisp white Brooks Brothers shirt were rolled up to his elbows. He held a wooden pencil in his left hand, and squeezed it hard as though trying to snap it in two. Alex swung his eyes to the row of family photos on Nate’s large walnut desk: a tidy family of four.

As though shaming Alex, the door swung open and the Chief Engineer lunged inside.

Nate jumped from behind his desk and ran his hand through his light brown hair. Oscar, how bad is it? His pale green eyes were open wide and his left eyelid twitched.

The large black man pulled up a chair, sat down, and wiped his shiny face against the sleeve of his light blue uniform. He wheezed. Got about halfway up the building so far.

Alex was worried. What about 5 North? Is everyone okay?

Nate shook his head and leaned toward Oscar. Never mind. Give us what you have.

Oscar’s old Timex wristwatch clicked against his shiny metal clipboard. He began to read. Basement: cracks in the North end concrete walls, and flooding in the environmental services department. No fires or escaped gases. Three of the four elevators damaged. Phones and pagers inoperative. Red emergency line open to ICU, OR, and the ER. Getting area status reports on ham radio. Emergency Room: noted two—

Ham radio? Nate waved his hand in the air. Explain.

The engineer grunted. Emergency comm. channels. You know—short wave. Staying in contact with La Habra and St. Joe’s. Oscar paused. Part of the disaster protocol. Oscar laughed. Some guy was going crazy trying to contact someone in town, and after about five CQ calls from him, I told him to try later, because the power is out and fires are all over town.

Nate shrugged. Some family member back east must be worried.

Alex was vaguely familiar with amateur radio. He remembered an uncle in West Virginia who was a perpetual ham fanatic. A room full of transistors, fat silver microphones, hot tubes and wires, and postcards from all over the world. Alex was proud when he talked to another ham in Australia when he was eleven years old. He’d never forgotten that odd feeling of broadcasting his boyish voice over the ocean. Let us know if our neighbors have serious damage, Oscar. And if you have time, maybe handle some family emergency messages on the ham radio?

The older man nodded. If we have time and it’s okay with the main coordinator in Long Beach who seems to have it under control. Oscar dropped his eyes to his clipboard. In the ER two overhead light boxes hanging loose. He looked up. Wanted to peek at Bud, but I was chased out by the ER charge nurse—said I was in the way.

Alex shook his head. If the burly man would shed some pounds he’d make less of a roadblock. He was wheezing in a way that made his generous middle wobble.

Oscar wiggled a finger in his ear and coughed. 1 South Outpatient Center: no structural damage noted; most seismically safe zone here. 2 North: probable structural damage. Cracks in drywall in rear wall of nursing station, and several cracked windows. 3 North: all ICU life-support equipment on generator power. One sliding door cracked. Will be replaced.

Nate stared at the Engineer, as though stunned or expecting even more.

Alex tapped his foot against the carpet. What about four, five and six? Our units with the highest census? FEMA will be checking in for a complete building evaluation.

Oscar’s two-way radio squawked. Everyone listened, but Alex could barely make out the garbled words against the background static. Oscar stood and hitched up his sagging pants.

Heading there next. My assistant is already up there. He just said 5 North is in trouble, a real mess. I’ll go there and then handle FEMA. His chest heaved as though he was nearly out of breath. Alex could hear him wheeze quietly.

Will FEMA need to talk with me or Dr. Regis? Nate looked worried again.

I imagine primarily for directions about your Press report. Oscar checked his list again.

Well, keep them busy for a while. I don’t know what we’ll tell anyone yet. Nate sighed.

Oscar laughed. Damn, it’ll take a long time to check all our floors. He nodded at Nate and left the office.

Alex crunched the remaining candy with his molars. Five North is way up there, Nate. I bet sixth floor really rocked too. We may need to evacuate the patients.

Nate stared at him. What? Where in God’s name would we send them? No one else in a fifty mile radius can help us—no one.

As he bit his lower lip, Alex closed his eyes. How about a gymnasium or community center? We’ll have traumas to handle anyway. Alex looked at Nate and waited.

Alex, you know better than that. As a former ICU nurse, there is no way I will put oxygen-dependent, ill patients in a public place. It just doesn’t work. Nate shook his head. Besides, even if we could do it, we would have to send our staff along to take care of them.

Alex laughed. Like we have extra staff to send? He let out his breath and clapped his hands together. Let’s start thinking about a solid media statement.

Conference physicians who were infectious disease whizzes and poor urgent care docs, tended to the multitude of injured hotel guests. Curtis decided the change of pace was good—no thick charts, no tests to order and review. But it was nothing like his well-equipped clinic. The disaster supplies dropped off by the Red Cross seemed to evaporate in moments.

Thirteen doctors began to argue over the last few boxes of gauze dressings and paper tape rolls. Curtis watched as two yelled and cursed at each other.

Is this how quake-infested California prepares for disasters? Is your hospital just as poorly equipped? Frank shook his head and seemed to growl at Curtis.

No, I think PMH is fine. Everyone expects earthquakes, so the place had some seismic retrofitting. Curtis paused. But, it’s still a great old hospital.

Yeah, like the great old Balboa Naval hospital, when San Diego was small. Time changes and hospitals have to get updated or they die out. Frank sighed. Same as all of us.

What’s that suppose to mean—same as all of us? Curtis thought it was odd.

Frank stopped as he taped a dressing to a woman’s forehead. Let’s change the subject. I’m thinking it’s time to get out of the cold St. Louis weather.

That’s why I left Boston. So don’t get any ideas about taking my job, Mellow.

The day couldn’t get much worse as far as Anne could see. When Dan Chavez didn’t return with the O2 tanks, she found him in the ER. The ER charge nurse scolded Anne for failing to send a registered nurse.

Get off my case, Lou. We have no oxygen upstairs. Everything’s going wrong.

The nursing supervisor grabbed Anne’s arm. Let’s go, I’ve got the master keys. Karen strode out of the ER, and Anne shoved Dan, the nursing assistant, out the door behind her.

At the RT storage room Anne and Dan rolled portable tanks into the hallway, piling most of them on a gurney. Karen watched with a perplexed look while Anne counted fifteen tanks.

Karen slammed her clipboard against the desk. What do you think you’re doing?

Getting tanks—our entire unit’s in trouble. Anne brushed past her.

Karen blocked her at the doorway. How do you know others won’t need these?

I don’t care about any others right now. Anne shoved past.

Dan nodded. You’ve got to see 5 North yourself. It’s a mess.

By the time they snagged the elevator, Anne knew too much time had elapsed. As staff connected oxygen tanks in each room, several patients were in respiratory distress. She needed to find out exactly how compromised they had become, to cover her and the physicians.

It had been over two hours since the quake, and finally Alex was getting the nursing supervisor’s report on how patients were flowing into the system. His preliminary report to the Press, prior to receiving the FEMA report, assured Citrus County that in spite of the quake’s magnitude, all was well within PMH.

Karen joined Alex and Nate at a table in the doctor’s dining room. She was the height of efficiency in her crisp white lab coat over a sensible blouse and slacks, and low heels. Her clipboard held pages of vital information. A wonderful example of control and nursing superiority. To Alex, a necessary evil. Karen pulled out a chair and perched on the edge, as though ready to run should her name be called overhead.

Okay, here’s what I’ve got so far. Karen blew through her lips. ER is packed with patients in the hallways. The CEO still has chest pain. Extra ER staff are coming in, but many moonlight at Kaiser and St. Joe’s, so we’ll be short-staffed. The Outpatient Center is taking ER overflow. Dr. Norberg has canceled today’s outpatient cases.

Nate groaned. Shit, were sunk. He rubbed his eyes with his knuckles.

Karen flipped the pages. All units are identifying the walkables. Acute care sent staff to the ER per protocol, except 5 North. She glanced at the men. That compounds ER problems.

Alex felt his temples throb. Anne knew better than that.

The VP groaned. With the Manager on LOA, Winters is accountable for 5 North. He licked his dry lips. Is Bud okay? I mean, I know he’s got a bad heart, but if he’s down, that means I have to run the entire show. He coughed nervously.

Karen nodded. He’ll go to telemetry until his problem is resolved. She turned toward Alex. CC will be his doctor, since he admitted him through the ER.

As the Chief, I should be Bud’s doctor. Alex bit his cheek to hold back a retort. Nate, you won’t run PMH alone. The Board of Directors oversees PMH. And I will supervise all medical problems.

Nate slumped back into his chair and twirled a spoon in his coffee cup. Right.

This nurse turned administrator was going to learn his job the hard way. Alex did not look forward to holding the VP’s hand. Give us the rest of your report, Karen.

ICU will transfer bumpables to acute care. Surgeries are canceled to make room for traumas. I’ve authorized the lab and radiology to call in registry staff to handle the diagnostic load. Their extras also double at LA County and Kaiser, so we’ll be short-staffed.

The key word is short-staffed. Nate shook his head. Like I said, we’re sunk.

Karen hugged the clipboard to her chest. We’ll do the best we can, Nate, within our limitations. She looked at Alex. Dr. Regis, have you called our physicians back from the conference? We need them to handle the discharges and triage the new admits.

Alex took a deep breath. I can’t get a call into the La Sierra Inn, and the pagers are down. We have to trust that they’ll return when they can.

Nate looked from Alex to the Supervisor. His face blanched. We’re accepting quake victims on a shoestring. Citrus County trusts that we can handle this.

Alex was about to argue with him, when Karen looked outside the dining room doors and jumped. Oh, it’s Oscar and the FEMA director. Karen looked at Nate and nodded.

As the two men entered the dining room, Oscar nodded in Nate and Alex’s direction.

That’s Nate Berg, the VP, and the other one is Doctor Regis, the PHM Chief of Staff. Oscar paused and looked uncomfortable. This is Jim Connor, the Southern California FEMA Director. He needs to speak with both of you.

The FEMA Director had razor-close black hair, black eyes, and tan skin, with a thin scar running in a loose arc from his left lower jaw to his left ear. He was shorter then Alex’s five foot nine height, but he had huge shoulders, as though he spent hours in a gym hefting weights. He wore a stern look on his face, as though his job was both profound and dreadful.

Connor nodded at them. Mr. Berg, Dr. Regis. I’ll get right down to your problems.

Alex almost laughed, as though he was going to discuss their personal problems, not PMH.

As I have just found out, you released a Press report to several TV stations before we gave you the FEMA report. Connor frowned and nodded at Nate.

Nate looked at Alex and his brows went up, as though saying help!

Alex cleared his throat. Let me explain. We needed to provide a quick report, as so many people were coming through the ER with quake injuries.

Connor waved his hand. But did you report your inability to help those people?

Nate’s mouth dropped open. What?

Alex stood up. Of course not! We have to help them! This is one of the only hospitals in the entire area. We can’t turn patients away.

The hell you can’t! Connor stepped closer. You have to close the second floor and move your patients to Long Beach immediately. You also have to prepare to close all of the floors on the North side of the hospital should further damage be noted.

Alex sat back down, stunned and surprised.

Nate put his face in his hands and groaned. Damn. I knew it!

Oscar moved closer and coughed. Karen, put calls out to Long Beach for the OB and Peds patients, okay? You’ll need to have ambulances provide their transfer to Long Beach.

Alex listened and shook his head. We can’t move all of our patients.

There is no time to argue about the OB and Peds patients, Dr. Regis. Get them out of here. Connor checked his watch and nodded. Oscar, give him the report.

Oscar handed the FEMA report to Alex. Alex skimmed the old North side’s report and the newer South side’s report, and sighed. So we can keep the South open for sure, and the North side open for now?

Technically, yes. But I have instructed Oscar to immediately contact my office for further assistance should additional signs of damage appear anywhere on the North units.

Alex nodded, relieved that above the second floor, work and patient care could continue.

Oscar also nodded. And I’ve called in my extra staff to immediately work on the oxygen line that goes to 5 North.

Nate gasped. What happened to the oxygen line?

Connor nodded. There appears to be a break between the fifth floor and its access to the oxygen line.

Alex was surprised that didn’t bother Connor. Not serious enough to close that unit?

Connor hesitated. The staff quickly accessed portable tanks for all patients on oxygen. I believe they have it under control. Connor paused. For now, give this updated report to the TV stations, please. Then prepare to watch all the other units in case of further trouble.

After Connor and Oscar let the room, Alex let out a long breath. Shit.

Before you give your update, let me finish my report. Karen’s brows peaked. We’ve got Coleman and Timmons in the ER, Freeport just got here and is handling asthma attacks, and of course, Norberg is in the Outpatient Center. Two OB docs who were doing rounds are also here. They agreed to help moving the patients.

Nate’s jaw sagged. In addition to those moving patients, we have only four doctors for a hundred-thirty bed hospital? With dozens of quake victims still rolling in? That’s unconscionable.

Alex felt his face flush. Five doctors. I’m on duty as well.

The supervisor looked startled. Oh. If that doesn’t interfere with your leadership.

Nate stood. He looked ready to yell at them. We have to close the ER to any further traffic. We have to tell Channel 10; they’ll get the word out.

Alex stood and grabbed Nate’s sleeve. Hold on, Nate. We are not closing the ER, only the OB and Pediatric units. We need to help these patients and get good Press coverage. It’s our job. And I need the cardiac consults. It’s my life, my only source of income. I cannot let this work slip away. I’m in control here, not this VP. Granted, Nate had a few years on Alex’s thirty-seven, but that didn’t matter.

Nate spun around. Is that so? Then go do your job. Make room in the ICU for whatever we’ve got rolling in our doors. And, Karen, put those calls through to move everyone from the closed units! He pulled his arm free and strode from the room.

CHAPTER TWO

Later Tuesday

After the engineer and FEMA staff left the unit, and patients were settled into their oxygen tanks, Anne found Karen at the desk instructing Gina to pull the charts of the least ill patients. Anne interrupted.

Karen, I need a doctor. Who’s in-house?

Karen hesitated. A few. They’re busy right now. Do the best you can.

I need orders to draw arterial blood gases on some of our patients. Right away.

The supervisor looked up and paused a beat. You’re kidding.

Anne shook her head. They were off oxygen too long. They don’t look right and there’s no way for me to call the docs. She felt dread in the pit of her stomach. They were too reliant on telecommunications. A simple thing like a quake had cut them off from the doctors. The FEMA Director had seemed ready to close the unit as soon as Oscar mentioned the oxygen problem, but the fact that Anne and Dan had found tanks so quickly seemed to lower the importance. Even the broken water lines did not concern FEMA too long. Anne wondered what really did worry them. Cracks in the walls, broken floors and windows? She sighed.

Come on, Karen, can’t you do verbal orders in an emergency?

Karen hesitated, flipping through her clipboard as though she’d find the answer there.

Anne moved to the supply cart and gathered syringes, betadine and alcohol pads, gauze, and tape. Her hands trembled. She wasn’t allowed to draw arterial blood samples. As she gathered supplies, again it surprised Anne that FEMA had kept her unit open. In the long run, they were more interested in the broken water pipes then her trouble with the oxygen. Oscar hadn’t seemed surprised by this either, although he told Anne he had other staff coming in to work on the oxygen line.

What’s going on up here? The nasal tone came from the hallway.

She spun around, clutching her trappings tight. Dr. Gardiner! You’re just in time.

The short man shoved his wire-rim glasses higher on his large pink nose. Anne knew Joel was not crisis-oriented, preferring calm methodical care of his diabetic patients. His suit coat was dusty. He ran his fingers over his groomed beard, as though looking for debris.

I saw Alex downstairs and he asked me to come here. Joel looked dazed.

Why didn’t the Chief come himself? We’ve got a huge crisis up here, and most of these patients need a cardiologist like Alex. Anne was frustrated and now angry with Alex. She cared deeply for him, and that was why being in love with someone you worked with was a problem. Personal feelings got all mixed up with your work. It meant she couldn’t rail at Alex for avoiding her floor, even when she knew that’s what he was doing.

Joel shrugged and coughed. Alex is helping out in ICU, and making sure they’re evacuating the second floor units. Guess that floor is pretty damaged.

Well, we’re damaged, too. Anne felt some hope. Is he evacuating our floor?

Joel frowned. Why should he? As far as I know, FEMA didn’t tell him to do that.

Anne sighed. Then let’s go do some blood gases, Gardiner.

It took them more than half an hour just to draw blood samples on ten patients. Anne cleaned the skin and palpated each radial artery, moving out of the way as Joel punctured the site. While he held pressure to stave the blood flow, Anne labeled each syringe. When they were done, she had Dan Chavez put them in a large zip lock bag, and then have him find the nursing supervisor so she could take them to the ICU, to be run through the ABG analyzer.

While they waited for the results, Anne joined Joel as he returned to assess each patient carefully. She watched him sneeze and sniff as he checked skin turgor, pulses, and lung sounds. The patients seemed relieved to finally have a doctor checking them, which Anne could understand. As he moved toward the desk to chart his physical assessments, Anne followed.

Your nose is acting up, Joel. You don’t need to get the bugs these people carry. She offered him a box of tissues from the supply cart.

He brushed it aside. I have my own handkerchief.

Then why don’t you use it? Anne noticed his eyes, red as though from crying.

His eyes narrowed. Can you find room for Julia’s staff?

Julia’s staff? Anne knew he was engaged to Dr. Julia Debrinsky.

He looked at her as if she were crazy. Greene was in the Simfact Lab when it blew up. He’s in surgery right now. Joel sneezed. The other two are stuck in outpatient beds.

It blew up? She felt a chill. Was Julia . . . I mean, is she okay?

Joel removed his glasses, rubbed his eyes, and then replaced his glasses on his red nose. She’s not injured, if that’s what you’re asking. He frowned. I was at the conference, but . . .

That’s good. Anne tried to smile in a reassuring way. How’s the La Sierra Inn?

He appeared distracted. A mess when I left. Who knows.

Most of the PMH medical staff attended the infectious disease conference. They had to with both the epidemiologist and the pathology Director giving lectures.

Was anyone hurt? I mean, like Webb or Newman?

Joel glanced at his watch. I don’t know.

Newman’s your partner and you don’t even know if he’s alive? Anne swallowed hard.

As he turned his back to her, his chest shook. I really don’t know.

Anne exhaled slowly. He was too self absorbed, or in shock. He would do best if kept busy. As she turned to get Joel’s attention, Dan Chavez hurried toward her from the stairwell.

Anne, I found Karen on the second floor. It’s a madhouse down there, with parents complaining, kids crying, and women with infants also crying. Dan paused to catch his breath