Joe set the box on her bench at seven-forty and stepped back from it like it might go off.
“Nursing education made these,” he said. “They want one on every pump by Monday.”
The box once held a case of printer paper. Inside were cards, about four hundred of them, each a little bigger than a postcard, laminated, with a hole punched in one corner. A bag of zip ties sat on top.
Dolores took one out.
INFUSION — DEVICE UPDATE DOWNTIME
Interim Procedure CL-0417 · Rev. 2
- Drug NOT IN PUMP LIBRARY → program in BASIC MODE
- Calculate rate using table on reverse
- INDEPENDENT DOUBLE CHECK REQUIRED before start. Both RNs document in MAR.
- Green-tagged pumps REMAIN IN SERVICE. Do not attempt updates.
Questions → Clinical Engineering x4471
That was her extension.
She turned it over. The back was a table of patient weights and rates for the new heparin, in type small enough that she had to pull her glasses down off her head to read them.
“They spelled everything right,” she said.
“They worked on it all night.” Joe looked at the box and not at her. “And I need you at the ten o’clock.”
“What ten o’clock?”
“Incident command. Second floor, the boardroom. Barbara wants the device count from you.”
“I hate meetings.”
“Barbara hates meetings. She’s having two a day.” He was already in the doorway. “Just give her the number.”
At a minute after ten, when Dolores got to the boardroom, there were three donuts left in a box on the credenza. They were all plain glazed ones.
Barbara Kostelnik, the chief nursing officer, wore an orange vest over her cardigan that said INCIDENT COMMANDER across the back in reflective letters. Karen Mazur’s said SAFETY OFFICER. Joe’s said LOGISTICS. They looked like crossing guards. Dolores sat in a chair against the wall.
“Okay,” Barbara said. “This is the briefing for operational period five. Let’s keep it tight.”
Dolores had no idea what an operational period was. She guessed it was a day.
IT went first. The speakerphone crackled as a guy named Brian spoke, clearly in his car. The vendors were saying weeks. It wasn’t the hospital and it wasn’t the vendors, it was upstream, and everybody in the country was in the same boat.
“Weeks plural?” Barbara asked.
“That’s what they’re saying.”
Dolores imagined she was going to need a lot more green tags.
Barbara wrote it down. “Clinical engineering.”
Joe turned around in his chair. “Dolores?”
“Seventy-one tags out,” Dolores said. “Pumps, monitors, two vents.”
Barbara wrote that down.
“That’s what’s tagged,” Dolores said. “That’s not what’s affected. Nothing in this building has taken an update in nine days. Not one thing, from anybody. I stopped trying them all because there was no point. If I had enough tags I’d put one on everything.”
“But they’re running,” Barbara said.
“Yes.”
“Okay. Good.” She looked down at her list. “Pharmacy.”
Ron from pharmacy had the card in his hand. He went through the table on the back of it, row by row. Two pharmacists had checked every number.
When he was done, she put up her hand. She felt stupid doing it, like she was in school.
“I thought of this in the Squirrel Hill Tunnel this morning,” she said. “The pumps still have the old library on them. The update never went on, so the old one never came off. The old heparin is in there with all its limits. If you made the new bags the old strength, the nurses could pick it off the list and the pump would catch it if they typed a hundred and eighty.”
Ron nodded while she talked, which she took as a bad sign.
“That’s compounding,” he said. “Every bag goes through the clean room. I’ve got two techs in there and they’re already making the stuff we can’t buy anymore. I can’t add heparin. I don’t have the hood time and I don’t have the people.”
“Could you do it for one floor?”
“Then I’ve got two strengths of heparin in the building. That’s how you kill somebody.”
“Ron,” Barbara said, “can you take that offline?”
“Sure, but it’s going to be the same answer.”
Dolores noticed her hand was still up and put it down. She agreed with Ron. Oh well, at least she had an idea.
Karen went next. The patient from 412 was back on 4 West and doing fine. The root cause was a programming error and a second check that had not been performed independently. “The agency has been notified that she won’t be returning,” Karen said. “The second nurse has been coached.” She held up a card. “And going forward, both nurses document the check in the MAR, so we’ll have it.”
Dolores felt sick. She had never even learned the agency girl’s name.
“I also want to recognize the charge nurse on 4 West,” Karen said, “for an outstanding catch.”
Everybody clapped. Dolores clapped. Terri would have hated it.
“Anything else on the clinical side,” Barbara said, “before finance?”
“That card isn’t going to stop anybody,” Dolores said.
Everyone at the table turned around to look at her.
“The pump would have stopped her. The card just tells her to be careful. Then the next time somebody isn’t careful, it’s in the chart, and we know whose name goes on the event.” She stopped and then decided to say what she really was thinking. “The card is just to cover our asses. It doesn’t really solve the problem.”
Joe was looking at the table.
Barbara took her glasses off. “Thank you, Dolores. I mean that. That’s exactly the kind of input we need in this room.” She put her glasses back on. “Finance.”
The woman from finance said that about a third of the direct deposits hadn’t posted that morning. It wasn’t the hospital. The money had gone out, and the employees’ banks weren’t accepting it from the hospital’s bank, and nobody could tell her why. They were resending everything tonight through a different bank and hoped it would land by Monday.
Dolores took her phone out in her lap and opened her credit union’s app. The deposit wasn’t there.
She had thirty-one dollars in her wallet and a quarter of a tank of gas. She had an hour drive home today and an hour back on Monday. At least she had food in her fridge for the weekend.
Afterward Joe took his vest off in the elevator and folded it over his arm.
“That went fine,” he said.
Dolores just looked at him. He rode down to the basement with her anyway, and she took a stack of cards out of the box on her bench and handed them to him.
“You’ve got 5 and 6,” she said.
She got the book down off the shelf, third from the left, and turned to the day’s page, wrote the date and:
IC mtg. Asked pharm for old-strength heparin so library catches it — no. Said the card is for blame. Thanked for input.
She capped the pen and put the book back.
Then she took what was left of the box and the bag of zip ties up to 4 West. The first pump was on a pole in the hall outside 401, clean and switched off. She threaded a zip tie through the hole in the card and around the pole and pulled it snug. The zip tie tore straight through the plastic. The hole had been punched too close to the edge.
She tried a second card. It did the same thing.
She put the cards back in the box and went to find a hole punch.