The Pain Nurse: A Cincinnati Casebook #1

The Pain Nurse: A Cincinnati Casebook #1

Cheryl Beth Wilson is an elite nurse at Cincinnati Memorial Hospital who finds a doctor brutally murdered in a secluded office. Wilson had been having an affair with the doctor's ...

About The Author

Jon Talton

Jon Talton is a fourth-generation Arizonan, the author of 11 novels, and a former columnist for the Arizona Republic. Talton now ...

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Chapter One

The pain always gets worse when the sun goes down. As often happened, it brought Cheryl Beth Wilson back to Cincinnati Memorial Hospital that December night. And like most nights, Cheryl Beth beat the pain. Mrs. Dahl told her how she loved her, tears in her filmy, gray eyes. She started telling a story Cheryl Beth had heard four times before, but she sat and listened. Then the old woman instantly dropped into sleep, the stencil of cancer momentarily leaving her face. Mrs. Dahl, who an hour before had been screaming from the postsurgical mess that had once been her belly. Cheryl Beth eased the old woman’s hand down to the sheet, checked her IV flow one more time, turned down the light in the long fixture on the wall at the head of the bed, and walked out into the quiet, darkened hall. The room’s persistent smell of decaying flesh, ointment, and deodorizer faded.

She walked to the nurses’ station. With most of the hall lights off, it stood brightly lit in the distance like a truck stop on the interstate. After making notes in Mrs. Dahl’s chart, she turned to her own notebook, drawing a happy face next to the woman’s name: her shorthand for a patient in pain, just that. She knew she could fix that easily. In another situation, she might draw a face with slits for eyes—someone who was oversedated. She could fix that, too. Then there was the face she would draw with wide eyes and wide mouth, an addict seeking pain meds. To this she would add her FC scale—one through ten—for  “fucking crazy.” Fucking crazy and mean can get you in trouble. The faces told it all.

“Saved again by the pain nurse.” Cheryl Beth saw the heavy brown hand on her shoulder and turned to smile at Denise, a large woman in green scrubs who had worked on this floor for the past two years. Tonight she was the RN in charge.

“I don’t know what we would have done without you,” she said.

“You guys did the hard work.” Cheryl Beth had a pleasing, musical voice with a hint of the Kentucky drawl she had worked hard to lose. “I just helped.”

“You always share the credit. I know how you work.” Denise smiled at her fondly. “Pizza?” She indicated an open box in the adjoining storeroom.

“That’s a big no-no. Don’t let Stephanie Ott catch you.” Cheryl Beth walked back and took a small piece, holding it on a paper towel and taking a bite. She needed something in her stomach besides liquor.

“I don’t have to worry about that,” Denise said. “Ott doesn’t even come to the floors, much less at this time of night. If the suits don’t like it, they shouldn’t close the cafeteria at eight. They can’t close things fast enough at this old place. At least you helped poor Mrs. Dahl.”

Cheryl Beth spoke between bites. “The woman’s been in pain every night. Then when her doc comes by in the morning, she’s finally fallen asleep. He says, ‘What’s the problem? She’s sleeping.’ He didn’t see how bad it had been the night before.”

“Did Dr. Miller enjoy you calling him during his Christmas party?”

“I’m lovable. It just pisses me off when people suffer. We had a nice chat. He hadn’t wanted to adjust her meds.” She washed and sanitized her hands. “But he didn’t like her lung sounds. I gently reminded him it was because she was too exhausted to try sitting up and walking. So I finally convinced him to change her meds and he signed the order to use a fentanyl patch. We’ll have to monitor the dose carefully.”

“Well, he wouldn’t have done it for me,” Denise said. “No wonder you were Nurse of the Year. Thanks, baby girl.”

Denise had called her that for years. At forty-four, Cheryl Beth felt far from being a baby girl. She was older than many of the docs now. She had watched as more patients turned up who were her age or younger. It was a battle now to keep weight off her average build, keep her hair something approximating the light brown she had been born with. On close inspection, a net of wrinkles was etching its way around the edges of her eyes. When she was younger, people had told her she looked like Jodie Foster, and she had sometimes believed there was a passing resemblance. But that was a long time ago.

She said, “The truth is, if I waited for every doc to return calls I’d never get anything done. That’s why I have my guardian angel docs who will sign off on my orders.”

“You know more than half of them anyway. You ready for Christmas, baby girl?”

“I haven’t begun.”

“Christmas, 2000.” Denise shook her head slowly. “Can you believe it? A whole new millennium and old Cincinnati just seems the same.”

Cheryl Beth laughed. “About the best I did today was to rake the leaves out of my flower beds and buy a couple bottles of wine. Is that Christmas-y?”

“I’d love to go have a drink with you right now. But since they stuck me on this night shift, about all I can do is drink a little scotch on my days off. Salve my pain, pain nurse.”

“Actually, tequila has the best pain management properties. And that’s data driven, not Cheryl Beth driven.” She finished her charting and replaced the pen in her white lab coat, which tonight she wore over her street clothes. She slid the chart in its place, which at Denise’s station was neatly kept.

“Dr. Lustig called for you.” Denise dropped a pink message slip on the desk beside Cheryl Beth. She checked the pager on her belt, but it was blank. Why hadn’t Christine just paged her?

“Can you believe we’re still using this ‘While you were out’ shit?” Denise folded her arms over her large breasts and surveyed the station’s file drawers, shelves, chart caddies—all the paperwork grown high around them. “My kids have better technology than this place. We’re still doing charts by hand like when I got out of nursing school. If we weren’t buried in paperwork all the time we could actually commit medicine.”

“I hear they’re working on a big new system, put all the records on computers. Dr. Lustig’s one of the big movers behind it.”

“Well, I guess she’s working late tonight. I can’t believe they put people in those offices off in the A-wing basement, especially a woman. Want me to walk with you?”

Cheryl Beth did a fake karate move. “I don’t scare easily.

Anyway, it’s just where the residents go to screw in privacy.”

Denise gave a knowing nod. “Not just that, baby girl. Used to be the morgue down there, the mental health wing. There’s lots of stories. Some say it’s haunted. Back in the day, they started having the toe tags disappear from the corpses down there. About a year later, they found out this girl who was working there had taken them and made them into an art project—it was on display in some gallery!”

They were both still laughing as Cheryl Beth walked to the elevator.

Dr. Lustig. Dr. Christine Lustig. Christine. The name conjured a mess of emotions inside Cheryl Beth as she rode down in the big empty elevator. She was glad for the distraction when the door opened two floors down and one of the patient transport guys wheeled in a heavy gurney. He was a tall, thin man with very dark skin. She had seen him before but couldn’t remember his name.

“Where to?”

“To one,” he said. “Imaging. But they already told me on the way back I got to go through the basement. Can you believe that? Got to go the long way. They brought a shooting victim to the ER and they’re going to close off the first floor in a few minutes. ‘Security concerns,’ they say. What they mean is they don’t want black folks coming down to see what happened.” He gesticulated fiercely. “This man in ER was shot by the cops. Man was unarmed. What is it? Fifteen black men shot by the police the past five years? Nights I go home I think I could be next, know what I’m saying? They disrespect the whole black community. Last month, police pointed guns at my neighbor right in front of his kids.”

He shook his head in disgust, then stared at Cheryl Beth. “Now everybody’s going nuts, afraid his friends and family are gonna come down and start trouble.” He looked around the elevator, up at the ceiling, then back at Cheryl Beth. “Some day this town’s just gonna blow, you know? Down there on Main Street, all them white yuppies coming to the new nightclubs, coming in from the suburbs. A block away you got six kids living in a room of a tenement, no heat, and a black man can’t walk on the street without a beatdown from five-oh. How long before those black folks look over on Main Street and see how goddamned poor they really is? Then what’s gonna happen, huh?”

Cheryl Beth looked at the patient on the gurney. He was a big man with wavy dark hair and a handsome face, even with the nasty blister on one lip. He must have been through a long surgery. He briefly looked at her, smiled, then closed his eyes. His eyes were tired and afraid. She had seen the look thousands of times. When the elevator opened at the first floor, she held the door while the patient was wheeled out. The transport guy was moving fast. He probably had a dozen more transports waiting for him, even at this time of night. Then she rode down another floor alone.

In a few moments she stepped out into a dim corridor. The floor was a uniform checkerboard, aged and scuffed. It was narrower than in the more modern parts of the hospital, and most of the lights were off to save money. This had been a main part of the original hospital, when the twenty-story, art deco tower had been a proud civic monument and Cincinnati Memorial had been one of the top hospitals in the Midwest. Generations of docs had trained here. Now the hospital was struggling and the basement was mostly forgotten. It still had a black-and-white tile floor that seemed right out of the 1930s. The wall was plaster, fading white with an institutional green stripe running horizontally. Cheryl Beth liked to imagine the medicine that had been practiced here once, when nurses had worn white uniforms and neat caps, when pain management had been, if someone was lucky, morphine.

It was better than thinking about Christine. Why was she even coming down here? What more was there to say?

The darkness of the corridor seemed to swallow sound. Other hallways, narrow alleys, and double doors led off at regular intervals. The doors had small, darkened windows. Old beds and laundry carts were lined along the walls and tucked into intersecting hallways. Then a metallic crash, muffled, short-lived, somewhere behind her. She jumped and looked back. Had the sound come through those two dark doors off to the left? She stood for a moment in the gathering silence. It was silly. Cheryl Beth was not the jumpy type. She liked walking the old corridors, taking shortcuts. The old building made its own sounds, never mind the reality that the basement also attracted horny staff members and the occasional transient. And for some reason, Christine had moved her office down here. In the distance, she heard an elevator bell sound, heard anonymous hums of large electric machines.

She could see warm, golden light breaking out of Christine’s office door, which was partly opened onto the corridor. Christine hated the overhead lights and often worked with only her desk lamp lit.

“Hey, it’s me.” Cheryl Beth knocked as she opened the door. For an instant, the world seemed out of phase, not right, almost comically not right. Red spatter on the floor. Christine on the floor, undressed. Among the tide of emotions washing in was almost a millisecond of laughter: this was a practical joke.

Then heavy breathing. Cheryl Beth’s own.

“Christine?” It took Cheryl Beth a moment to recognize her own voice.

Dr. Christine Lustig lay on her side, completely naked, her pale skin luminous except for the blood. Everywhere. Cuts lashed her arms, legs, side, face; in places, the skin had been viciously avulsed, like work a butcher might do. Cheryl Beth’s training effortlessly overcame the hysterical instinct boiling up in her and in two strides she was at the doctor’s side, reaching for a carotid pulse. Her fingers sank into gore. The knife had found its fatal target in Christine’s neck. Around the other side of her neck the skin was unbroken and pulseless. Her finger felt her thigh, the femoral artery; again, no pulse. She felt a ballerina’s spinning light-headedness. She felt disembodied but no, connected to another body, one that would take barely a breeze to float away. So much blood—maybe there were other victims. The average human contained 5.6 liters of blood. Then she realized how much blood she was standing in. It betrayed the unevenness of the floor, pooling here, flowing like scarlet canals between the aged tiles. It inundated her red patent leather Danskos. Suddenly she felt a touch slither against her neck.

Her disembodied hearing heard a sharp breath, a small “oh!”

Her own.

Cheryl Beth pulled the stethoscope off her neck and stuffed it into her lab coat. The white coat was now streaked with Christine’s blood. Behind her was the doorway, with the empty black hallway beyond. The entire world seemed monstrously soundless, even the distant electric hum gone. Cheryl Beth sprang up, crossed the room, and closed the door, locking it. She carefully walked to the desk, her shoes now hopelessly hydroplaning on the bloody floor, and grabbed the phone receiver. Even before her ear registered the dead device she could see the cord ripped from the wall. Her own cell showed no signal.

Panic finally threatened to overwhelm her. Her breath came harder and she reached into her pocket for the small inhaler, shook it, and took a puff. She made herself breathe slowly. Buried beneath the vast hospital, the cell phone stubbornly refused to find a signal.

“Oh, shit.” She leaned against the wall and looked back at Christine. That’s when she saw the strange shape of the woman’s left hand. Christine’s ring finger was gone, leaving a dark red tangle of tissue.

Cheryl Beth walked quickly to the door, unlocked it, and ran down the hallway toward the elevator, but not before finding a disposable scalpel in the cabinets of Christine’s office, unwrapping it, and brandishing it before her like life itself.

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