Tuesday, October 04, 2011

Desert Adventure, Part 6: Of Pogues and Diversion

I walked home at the end of my second shift deep in thought. If the Weasel’s behavior was any indication, I was in for an arduous three months. The Annoying Little Chihuahua of Discouragement that had stalked me for days began to nip at my ankles.

Screw this, I said to myself, shaking off the imaginary dark cloud that hung over me. I’m not going to let that little fink wear me down.

I took a deep breath and looked up; it was then that I noticed, for the first time, the genuine black cloud- a very angry and large black cloud- that loomed menacingly over me. The sky unloaded on me, and by the time I got to the house, I was soaked and shivering. Jack met me in the hallway with a scotch.

“Here,” he said, holding out the glass. “You look like you could use this.”

I thanked Jack and went in my room to dry off and change into an old pair of jeans, a ratty tee shirt my wife had threatened to throw out about five years ago, and flip-flops. I went downstairs to find Jack on the patio, slumped in a lawn chair and watching another approaching storm. The air was dead calm and muggy. I sat down next to Jack and let the scotch warm me up.

“The good doctor has split the scene for greener pastures,” Jack mentioned casually.

“Oh?” I said without the slightest trace of interest.

“Yep. We’re getting two new housemates; a kid in pharmacy school and a PA student. They’ll be here in the next day or so.”

“Great,” I said. “I hope they’re more fun. The doctor was a fart in the crowded elevator of life.”

Jack snorted into his scotch.

We sat quietly for a while, commenting on the tendrils of lightning that squirted randomly out from the storm. As long as I wasn’t caught outside in the middle of it, I have always loved a good old Southwest gully-washer. I sipped the last of my scotch and went into the kitchen.

“Feel like eating a steak with me?” I called over my shoulder.

“If you’re offerin’, I’m acceptin’,” Jack replied.

I pulled a couple of monstrous top sirloins (apparently carved from a brontosaurus) out of the refrigerator and proceeded to rub in some seasoning I had mixed beforehand as Jack got out the briquettes and got the barbecue started. I wrapped a couple of ears of corn in aluminum foil and pulled out some baked beans. I replaced the steaks in the fridge to keep until the charcoal was ready, pulled out a Guinness, and rejoined Jack on the patio. As I emerged through the sliding door, a brilliant branch of lightning shot completely across the dome of the sky and thunder boomed across our little valley, shaking the house and rattling the windows. Jack and I channeled our inner little boys and jumped up and down, whooping and slapping each other on the back. We grilled and dined in the middle of a high desert electrical storm, commenting between bites of succulent corn and perfectly seared steaks about the quality, duration, magnitude, and frequent alarming closeness of the lightning strikes.

As the storm worked out its frustrations on the earth, my friend and I put our forks down and our feet up to take it all in. My blood was shunted from my brain to my stomach to process my dinner, and I sank into a warm state of complacency. Finally, Jack broke the silence.

“You know, once you settle in a bit you’ll find that this is a pretty nice deal. This is a beautiful part of the country, and the Navajo are some of the nicest people you’ll ever meet.”

“Yeah, I sense that already,” I replied. “I don’t even mind the relative isolation, really. That’s just culture shock after having lived in the city for so long. But dealing with my manager is going to be a drag.”

“You mean the Weasel?” Jack asked with a knowing grin.

“Oh, you heard about it, huh?”

“Within the hour, buddy,” Jack answered with a chuckle. “You sure hit the ground running. I heard what he did to you, though. He pulls stuff like that on the agency nurses all the time; guess he likes to feel omnipotent or something. But you’re the first one to stand up to him like that. It must have rattled his cage.”

“Yeah, well I’m not exactly crowing about it myself. And I’m not looking forward to tomorrow, either.” As I said this, I could sense that obnoxious Chihuahua of Doubt lurking in the shadows. I shook off the feeling and pulled another Guinness out of the cooler. “You know, Jack, this is the reason why I have worked night shift my entire career.”

“Don’t like being around the pogues, huh?” Jack chuckled.

“Aw hell, I can deal with them if I have to. But our job is challenging enough without the added hassle of tripping over a bunch of self-absorbed dweebs who dispense rules that have no practical basis and often hinder the staff’s ability to function as an effective team. And I hold a particular dislike for pogues who think they can do whatever the hell they want to staff with impunity.” I paused to take a sip of my stout and to cool down from low boil. I concluded, “I just think it’s better for me to not have to be around them. And hell- I make more money from the shift differential on top of that. Avoid the pogues and make more money doing it; that’s a winning proposition any way you cut it.”

“Can’t argue with that logic,” Jack said as he poured another scotch. He watched the amber liquid as it swirled around in his glass and continued: “But you will find that the number of pogues per capita is much higher here than in any non-rez hospital. This has been IHS Country for decades. And you know as well as I do that once a government program becomes entrenched, it’s nearly impossible to even change it a little. And let me tell you, buddy: the pogues have found their way to the top here. They are the ones who elected to stay on when the hospital went Tribal, and they are making serious bank because of it. The hospital needed administrators, chiefs of medical staff, chief nursing officers and department managers in place to get this thing up and running. And where do you think the Tribe got all those people?”

“IHS,” I replied.

Hell yeah, IHS. And not just any IHS. These holdovers are people who have been in the government-service bureaucracy for decades. They’ve learned how to connive, sneak, manipulate, and bully their way up the food chain. They became very, very good at what they do best- protect their asses and make everyone else expendable. And right there,” Jack said as he waved his glass of scotch toward the hospital, “is the perfect setup for them.”

I sighed and took a long pull of my Guinness. “So the pogues get fat, the Navajo Nation gets soaked, and the people get screwed. Does that about sum it up?”

“That about sums it up, “Jack answered.

“Well, it isn’t the first time I’ve had to deal directly with the pogues, and I know it won’t be the last. I just hope the Weasel gets a clue and leaves me alone. Pogues get pretty vindictive and mean when their cages get rattled.”

“It’ll work out,” Jack said, patting me on the back as he stood- rather unsteadily- and put the lid on the barbecue grill. “Well, I have to hit the sack. I’ll see you tomorrow.”


I looked up at the sky. The clouds, thinned out now and almost translucent before the bright full moon, scudded past on the heels of the spent storm. I buttoned down the patio, locked the house up, and went to bed.

I arrived in the ER the next morning and was greeted by Ramona’s smiling face.

“Hey, Don Quixote, how’s it goin’?”

“Oh, ha-ha.” I retorted as I scanned the staffing sheet. “Nobody’s been called off, I hope?”

“Not today. Lucille is putting her stuff away and powdering her nose. That new agency nurse is here, too. We got a full crew. Yee-haw!”

From around the corner, Veeyore trundled her immense self into the nurses’ station. Her face was pale and sweaty, her hair was straggled around her face, she was out of breath (go figure), and as she saw me she threw her hands up in the air and exclaimed, “Oh, thank God you’re here! I can go home now!” I caught Ramona rolling her eyes. I smiled and asked Veeyore if she had any patients to hand off to me.

“No, honey. We cleared them all out for you. Try to return the favor, huh?”

As I faced her, I sensed something was amiss. The lights in the department were dimmed (which is not all that uncommon for night shifts in the ER), but as I looked into Veeyore’s eyes, I noticed that her pupils- which should have been dilated in the low light, were tightly contracted pinpoints. Her speech, appearance, and mannerisms were a little sloppy- even for her. I made a mental note of my observations and bade her goodnight.

As Veeyore exited huffing and groaning from the department, Ramona sat down next to me and whispered conspiratorially, “I think she’s high.”

I chose not to comment. Diverting medications is a career-ending offense, and I was extremely reluctant to participate in a conversation that could damage a colleague’s reputation when a number of plausible alternative reasons for her behavior existed. I offered a noncommittal “Hmm,” And logged on to the computer. Ramona set off to stock the rooms.

Lucille came to the desk and asked me quietly, “Did Vera leave?” I turned to face Lucille and noted the grave look on her face.

“Yeah, she just left,” I answered.

“Did you happen to notice if she came out of the med room?”

“Well, she came around the corner from that direction, but I wasn’t in a position to clearly see if she was in the med room before coming around the corner.” Clearly something was wrong. “What happened?”

“The medication dispenser drawer is wide open. The door to the med room is also wide open and a key is still in the lock.”

“Is it Vera’s key?” I asked, forcing myself to remain objective.

“Let’s see…” Lucille grabbed the key assignment log, traced her finger down the list, and in frustration shut the book with a soft whomp .

“She never signed for a key,” Lucille said. “Dammit, she always does this!”

“Are the other keys accounted for?” I asked, hoping to help Lucille refocus. She reopened the log and checked the keys in the box with what was on the list.

“Hmm… yeah. All the keys are accounted for, signed in and out by each nurse. The only key that isn’t signed for is the one with the red clip that I pulled out of the med room door. Nobody else signed for it. Vera was the only nurse here after 0100. She’s the only person who needed a key. And she’s the only nurse that didn’t sign into the key log. And she never signed for any other key.”

“Can we call her?”

“She never answers,” Lucille said. She sat down with a sigh. “The Weasel is gonna be pissed.” Ramona snickered, but straightened up the moment she caught Lucille’s icy glare. “We’re gonna catch all kinds of hell from him if we don’t get this straightened out.”

I suddenly remembered something. “Oh, crap. I just had a thought.”

“What is it?”

“The off-going nurse is supposed to do a count of all controlled substances with an ongoing nurse. I completely forgot about that, and I didn’t have Veeyore- I mean Vera- do the count before she left. I’m used to the charge nurses doing that where I used to work. I totally goofed.”

Lucille put her hand on my shoulder and said, “This is only your second full day here. You can’t be expected to know all of the rules yet. Don’t beat yourself up.”

“But I know how the Weasel is going to look at this. He’ll ask who Vera reported off to, and of course it was me. And the first question he’ll ask is, ‘What is our policy regarding med counts between off-going and oncoming nurses?’ I know the rule. I read the rule. I just forgot it because it isn’t habit yet. And the Weasel will conclude that no matter how new I am, if I already know the rule I am responsible for following that rule. And you know I can’t argue with that. Aw, crap- he’s got me dead red,” I groaned. “And I’m sure he’ll have yesterday fresh in his mind, and I don’t think he’s exactly the forgiving kind.”

Lucille doinked me on the chest with her finger. “Calm down.” I took a breath and settled a bit. “Let’s do the med count, and whatever the result is, we’ll go from there.”

I followed Lucille to the med room and we commenced the count. Five minutes later, we stared at each other in quiet horror. The inventory was short by six 2mg vials of Dilaudid and four 10mg vials of Valium. They were signed out about fifteen minutes before Lucille and I had arrived, and the patient for which they were obtained was manually entered into the dispenser’s computer rather than by the pharmacy. There were no patients in the department at the time the meds were obtained.

And the nurse who obtained the medications was Vera.

Lucille and I stood shocked, bound in a moment of sad revelation. Finally, Lucille collected herself and ripped the count printout from the machine, secured the dispenser, and led me out of the med room. She locked the door with the red key and went to the nurses’ desk, where she sat down and quietly stared at the floor. I sat down next to her and carefully rejoined her in discussion.

“Lucille, I have some other data to go along with this.”

“What is it?”

I shared my observations from my conversation with Vera, including the pinpoint pupils, slurred speech, and euphoric mannerisms. Lucille lowered her head and sighed. When she looked up again, she was crying.

“This sucks. Dammit, this just really, really sucks,” she said softly. I nodded.

I stood up and patted her on the shoulder. “We need to talk to the Weasel. We need to do it now.”

I followed Lucille to the manager’s office. Lucille knocked on the door and we were invited in. The Weasel looked up over his reading glasses, first at Lucille, and then at me, at which point his eyes narrowed slightly.

Folding his hands with his elbows on his desk, he sighed and said, “I sense that we have a problem.” He looked at me again, perhaps curious if I was the problem. I shifted uneasily.

Lucille spoke up: “We have found a discrepancy in our med count this morning.”

Weasel’s eyebrows raised slightly. “Are you unable to resolve it?”

“Yes, sir, we think it can be resolved,” I answered.

“Then I don’t see a problem.”

“The problem is that it’s possible-“Lucille paused and took a deep breath- “Actually, it’s probable- that the meds were diverted.”

Weasel took off his reading glasses, rubbed his eyes, and looked at me again. Seeing what must have been obvious unease in my expression, the trace of a smile tugged the corners of his mouth and he asked, “And this is why he is here?”

“No, sir,” Lucille answered emphatically. “He is here because he found the discrepancy.”

I stole a glance at Lucille. That wasn’t exactly how it happened. Why would she put it that way? Still, Weasel’s demeanor changed to that of a cat that had lost its prey. He sighed and invited us to sit down.

“Tell me what happened.”

Lucille explained the events, my observations, and our findings. She laid the printout on Weasel’s desk. Weasel did not interrupt, and he sat quietly for a minute after we finished. Finally, he drew a deep breath and spoke.

“Thank you both for bringing this to my attention. I’ll take it from here, but I may need to speak to each of you later on today if I need clarification. William, if I could have a word with you in private, I would appreciate it.”

Lucille left. I stayed. Weasel tapped his desktop idly as he considered his words.

“Did you do the count with Vera before she left?”

“No sir, I did not.”

“Did Vera provide the end of shift report to you?”

“Yes, sir, she did. May I speak, sir?”

“Go ahead.”

“I realize that it is the responsibility of the oncoming nurse to go through the count-“

Weasel raised his hand, and I stopped talking.

“Even if you had caught the discrepancy, I’m sure Vera would have provided a plausible explanation. She could have just said she wasted it and forgot to enter it because she was busy, or didn’t because there was no other nurse to witness it. It’s a pretty generic scenario with these sorts of things.”

“Knowing that doesn’t make it suck any less for me, sir.”

Weasel smiled. “But that’s not where I’m going with this. I want to be clear in my mind that you are certain without a doubt regarding your observations. Is there any possible alternative explanation for your findings that you can think of?”

“I have actually tried to avoid coming to any conclusions and to remain objective. This kind of thing is a career killer, and if I cannot be completely certain, then I am extremely reluctant to offer my personal opinion. The only appropriate input I can offer is what I saw and heard in such a form as to be admissible in court. I would be wrong to offer more or less than that.”

Weasel pondered my answer and concluded, “I agree. However, we may need to talk to you later for further clarification. Right now, I have some phone calls to make. Thank you for your help. Please close the door behind you.”

I left the office thoroughly puzzled, and I had a vague impression that in spite of my previous clashes with Weasel, perhaps he was not the pogue that I had thought him to be. In spite of the stunt he pulled yesterday and the resulting verbal blast he got from my agent, he clearly could not have been fairer to me that morning. We didn’t exactly like each other, but on a purely collegial level we had made a positive- if tenuous- connection. Time would tell if we could reach a mutual understanding. I hoped we could. It would really suck pond water if I had to spend the next three months having to worry about it.

Vera did not show up for her shift that evening, and nobody here ever saw her again.