Luger rounds; the expression implies ending the life of a patient whose illness requires an overwhelming effort to maintain, while being too sick to survive. Is it an ominous coincidence when Dr. Phillip Thomas moves from the chief residency to being a patient in the ICU? Here he is left trapped, dying and alone in a tortuous world. Earlier he had confronted the possible assassin, but is soon deathly ill, comatose; a luger rounds candidate. Thomas realizes that he is the target of a hospital serial murder as he drifts into nightmarish dreams, while the silent assassin skulks in the darkness. An excerpt from "Luger Rounds": "My mind returns to the cramped ICU room; aware of my condition, and continuous pain. The morphine has cleared, the dream state resolved, but my misery goes on. I then sense an evil presence, and fear overwhelms every aching fiber of my dying body. An ominous air fills my darkened room. I am overwhelmed by dread. A tormentor sits; an assassin silent, starring, and waiting. I feel eyes on me; penetrating and bulging like a vulture's, their proprietor seeing me as easy prey. I hear the assassin's breathing, slow and ominous. In the menacing quiet evil eyes pierce me again. The tormentor is staring and willing me to crash; an assassin with a white coat covering a wicked heart". The reader will be captivated by this tale of medical suspense. Told from the view point of the coma patient; medical intrigue and the reality of the critical care environment are captured in the life and death hospital setting.

Luger Rounds

A Medical MysteryBy William Lynes

iUniverse, Inc.

Copyright © 2012 William Lynes, MD
All right reserved.
ISBN: 978-1-4759-5013-7

Contents

Acknowledgments......................................vii1. Comatose..........................................12. Medical School....................................83. Assassin..........................................224. Pacheco...........................................335. The Jazz Man......................................456. Munchausen Syndrome...............................567. Macrodantin.......................................608. Septic Death......................................669. Titanic...........................................7510. Lidocaine........................................7811. The Call Room....................................8412. Michael Albee....................................9313. George Frommel...................................11514. Julie Maxx.......................................11915. PSA..............................................12716. Hospital-Acquired Infections.....................14317. Confrontation....................................15018. Claire Simmons Suspects..........................15319. Serogroups.......................................16020. Sarah Fowler.....................................16421. Execution........................................16622. Decision.........................................16823. Finale...........................................173

Chapter One

Comatose

I AM COMATOSE: "AN unconscious state from which a person cannot be aroused even with powerful stimulation; insensible, lifeless, and cataleptic." A prisoner in the intensive care unit, I appear unconscious to those around me. In reality, I am locked in. The horrible truth is that I am aware—I hear, feel, and even see everything. Ensnared in this real-life nightmare, a victim of an attempt on my life, I lie trapped and dying. Death would be preferable to my tortured condition. I am a nonperson ensnared in a medical prison, hurting, frightened, and angry.

Unbearable pain is my constant nemesis, an agonizing bedfellow, a continuous and horrifying reality. Existing is anguish; searing hurt is never far from my tortured consciousness. Pain is intense when I am turned from side to side; lying on my back is an incessant agony. Fever racks my useless body, its explosive appearance or rigors unbearable, its occasional absence excruciating as well.

With pain comes merciless fear, my gripping and unrelenting acquaintance. Vivid, demented dreams haunt my every moment. I long for the occasional image of peace. Through every moment of every day, I live a helpless and lonely life, racked with pain and unable to escape the terror that is the ICU.

It's obvious to me now. The state of coma is nothing like the unresponsive, unaware condition I was taught about in my medical-school hall of learning. I hear, I feel, and as a blind person knows everything about his or her environment, I see all that is around me. I am acutely aware. My existence includes daily doses of medically caused torture. As a physician, I treated comatose patients without knowing this reality. I have gone from healer to trapped patient: agonizing, fearful, tormented, and slowly dying in the ICU.

To colleagues and guests who visit me, I will not survive. Somehow I see them through closed lids as they stand quietly at the foot of my bed, diverting their eyes and staring without expression, my incredibly poor prognosis written on their faces as my monitor monitors away and my ventilator forces breath after painful breath. I am gorked, brain-dead, a train wreck, a Luger rounds candidate—all variations of the same hopeless theme that percolates behind their silent eyes.

Luger rounds—the term now sits bitterly, such an ironic and cruel phrase. The expression implies ending the life of a patient whose illness requires an overwhelming effort to maintain while it renders the patient too sick to survive. It is a pessimistic, gloomy, sarcastic idiom floated from one overworked staff member, intern, or resident to another. In the past, I used the term myself in an offhand and sick manner. It's an insensitive concept tossed around by physicians stressed by the never-ending hours of their postgraduate training. They spend many spans of forty-eight or seventy-two hours unsure when they last saw the light of day, hustling, writing orders, seeing patients, and hurrying through the wards. They're in the hospital seven days a week in a never-ending pattern, day after day. This ongoing, oppressive lifestyle eventually affects even the most noble of us.

I can hear myself in my past life, casually joking and using the term: "He needs Luger rounds. The guy in the unit—what a train wreck! You're covering for me tonight. Promise me! Luger rounds, please!"

Now, ironically, I am one: a clinical disaster, a dying corpse, a Luger rounds candidate. There is a difference, however. In my case, someone took the phrase to heart—at least metaphorically; the weapon was not a bullet. Keeping me alive now requires immense medical effort, and my chances of survival are so low that I myself, the victim of an attempted murder, have indeed become a Luger rounds candidate.

Over time, a patient in the ICU becomes a withering corpse, depressing for visitors and horrendous for patients like me who are trapped here. As time passes, fewer will arrive to pay their respects. As my case drags on, day after tragedy-filled day, visitors will become infrequent and rare.

To guests and staff, I am nonresponsive and brain-dead. Oh, I wish that were the case, for much worse than that, I am totally conscious and feeling inside. My eyes are closed, but I regrettably see everything. I am nonresponsive, but somehow I hear all, even at the nursing station. Here, imprudent conversations seem common.

"Page the resident on call," the nurse says to the ward clerk.

"Yeah, this is Dr. Wyburn. I was paged."

"Are you on call for Dr. Thomas in bed seven?"

"Yeah, what's up now?" the doctor wonders sarcastically.

"His temp is up again. He's febrile, 103 rectally. The Trendelenburg and the fluid bolus raised his BP for a while, but his MAP is down below sixty again. Can I get an order for another fluid bolus?"

"What was his last hemoglobin?" Dr. Wyburn asks. She woke him up again for this?

"It was seven this morning," the nurse responds.

"How much dopamine and Levophed is he on now?"

"Ah, let me look at his flow sheet," she answers while scanning her notes to see the dosage of IV medications. "The dopamine is at five micrograms per kilogram per minute. The Levophed is running at three micrograms—"

"What about his urine output?" the resident asks abruptly.

The nurse pauses. "He has put out only sixty cc's in the last eight hours."

"Okay, he's dry," he says to himself. "Give him two units of blood, packed red cells. And yeah, give a bolus of five hundred cc of normal saline for MAP less that sixty."

"Can I give him some more Tylenol?" she asks. "He's not due yet, though."

"Yeah, ten-grain suppository." Click.

"He is so rude," the nurse says to herself as she replaces the phone and walks to the supply room. She grabs one half-liter of saline and returns to the nursing station. On the phone, she orders two units of cross-matched blood from the blood bank. The nurse turns to her colleague, asking for help.

Upon returning to my room, she hangs the saline and begins infusing the five hundred cc through one of my IVs...