Monday, June 11, 2012

Bad Doctors & Bitchy Nurses


           Nursing has a kind of collective intelligence. Like the beehive or ant mound a nursing station is aware and competent to deal with problems that the individual nurse may not even know exist. Unlike the independence of medicine in which each doctor is a law unto him or herself, nurses are always watching each other, commenting, suggesting—for good or bad. Because it’s still a profession largely made up of women there’s a lot of talk on a nursing unit and not all of it is helpful, but regarding the patient the differences in opinion often average out and a plan of action is chosen either explicitly or implicitly.
            When dealing with a bad doctor however—a physician who may not know what he or she is doing—the group can be a long time coming to a decision. At first there’s just a single nurse, or one or two nurses who have that feeling that “something’s not right.” And in between the time that the individual becomes aware and the group takes action sometimes the patient dies.
            The patient who died in this case was named Frankie, an African-American woman about fifty years old, with long fake pink fingernails and a difficult personality. Being African-American myself, my habit is always to keep an eye on black patients even if they are not assigned to me because in a healthcare system that is almost exclusively run by white people and in which minorities and the poor have traditionally been used as training cases for white doctors, blacks may be suspicious and resentful when in the hospital and therefore benefit from a little extra TLC. Frankie wasn’t suspicious enough—if she had been, she might still be alive. She trusted the doctor, she just didn’t want to be in the hospital, an attitude that showed surprisingly good sense. She was resentful, yes, but mostly about life, it seemed to me, and although she was not my patient she was my concern as a fellow black person in the white healthcare world.
            Frankie was in the hospital to have a tumor removed from her pituitary gland. If you’re interested in the functions of the pituitary gland—look it up, because to take care of someone with her condition, post surgery, a nurse doesn’t necessarily need to know the details, doesn’t need to know the physiology. “RN” is a generic title and unlike medicine, once you’re a registered nurse you can work anywhere, in any field. You’ll need to be oriented—to obstetrics, for example, or the emergency room certainly—but that training will only last weeks, at most a few months, and then you’re theoretically competent, because you’re mostly dealing with set procedures and watching for or controlling symptoms and you don’t really need to know that much about what’s going on inside, under the hood, the pathology, under the skin. The doctor is doing that. You hope.
            Still, some knowledge about pituitary tumors is helpful for purposes of understanding what happened to Frankie. The pituitary, at the base of the brain, is called the “master gland” because it secretes hormones that control bodily functions and control other glands that secrete other hormones. For the surgery, they go in through the nose. After the operation, the nurse is drawing blood and checking the dilution of urine to see if it’s been successful. Don’t ask me any more. That’s all anyone had told me—except, like in every other kind of surgery, there are possible complications. The most common unwanted outcome, according to my limited knowledge, is a leak of cerebral spinal fluid. If clear liquid starts dripping out of the patient’s nose, you have a problem. But that’s all you need to know here. So, Frankie had her surgery and was in and out of the hospital in two days. She didn’t like being there and if you were her nurse you didn’t particularly like having her as a patient but luckily for everybody, including Frankie, she was soon gone.
            Not for long. A couple of days later, as my shift began, the charge nurse told me to set up a tray of instruments for the placement of a lumbar drain in one of the rooms. The lumbar drain is what’s used to repair a cerebral spinal fluid leak.
           The patient this time—once again—was Frankie who was “back in the house,” in the hospital, lying on her side in a room, her hospital gown hiked up to reveal her backside and an impatient but pretty nice neurosurgery fellow gloved and waiting for me to assist. Three meds were needed: Versed to put Frankie in a state of “conscious sedation” where you’re not asleep but you (hopefully) won’t remember what happened; Fentanyl for generalized pain and lidocaine to deaden the place on her back where the big needle was about to enter the skin. My first job in nursing had been in a pediatric emergency room so this was nothing new. Every baby with a fever of unknown origin who came into the emergency room got a spinal tap, that needle in the back to get a sample of cerebral spinal fluid. My job was to bend the baby in two, so that the head approached the feet, to open the spaces between the vertebrae so the needle can enter easily. It looks pretty barbaric and probably is. Like a hundred years from now people will be viewing the videos with an expression on their faces that mimics what we would show today if doctors were still bleeding patients or reciting chants at bedside. Barbaric. The docs say a spinal tap looks worse than it is and that newborns who have a memory span of like two minutes max, forget the pain immediately afterward and that may be true. But they’re screaming their little heads off when you’re bending them and when the needle is going in, no doubt. Parents are “anxious,” to put it politely, and ask to stay in the room to provide support to their munchkin. Frankie was all alone.
            Luckily she was semi out of it, half-drugged and half-awake, she was somehow holding her lower back bent to expose the openings between the vertebrae, the doc missed the first couple of times and even with the pain medicine the patient was moaning in the fog. The solution to that problem was to give her more meds, which we did, but you had to be careful, checking her blood pressure and her breathing the whole time because she was getting a drug cocktail and different people react differently, in the calculus of drug administration, in a situation like that, two milligrams of a narcotic and two milligrams of a sedative add up to more than four milligrams. If my memory is correct, she had to get a little extra oxygen but the fellow eventually got the drain in.
                 My question was why they put a drain in her back if she was leaking spinal fluid from her nose? His explanation—this may sound like Brain Surgery for Dummies, an oversimplified view, but it worked for me—was that cerebro-spinal fluid circulating around the brain and along the spinal cord, was drained off down low to stop it from leaking out the nose and to give wherever the tear was, up in her head, a chance to heal without the constant drip drip drip. Who knows? It sounded kind of cool though—logical, you know, the way doctors explain something to the public, even to nurses? Besides, a RN doesn’t have to know why to do something, only how to do it or how to take care of the patient after it’s been done. Or how to recognize complications. So, like, the explanation fit all my conditions for compliance, and the neurosurgery fellow maintained sterility and was attentive to the patient, so like what was there to object to and would he have really given a shit even if there had been an objection from the nurse? Probably, yes, he would have, because his head had not yet gotten too big. Which is what this is all about.
            A nurse can stop a procedure if the patient is not being protected but it takes a pretty large pair to do that. Most of the time we just watch, we do what we’re asked to do and keep our mouths shut—until after the procedure, in the break room, talking trash, we might say something like “I wouldn’t let him clip my toenails!” or somebody goes off on the doctor for a wide variety of reasons that may actually have nothing to do with his surgical skill.
           

            The lumbar drain is a pain for everybody involved. For the patient it means a couple of days of bed rest, only able to get up to go to the bathroom and sometimes not even that. For the nurse it means going into the room every hour and checking the flow of fluid into the drainage bag to make sure it’s not too little or too much and checking the site to make sure there’s no infection. Frankie went through a couple of days of hell and went home again.
            Then she came back for another leak and had to have another drain placed. And then there was another leak after that—if my memory is correct.
            The last time she wasn’t my patient but something took me into her room, probably just covering for her nurse who was on dinner break or taking a pee or whatever. Frankie’s complications had been going on for a while, a few weeks, at that point. We—her and me—we’d never really gotten into a discussion about what had led her to have the surgery in the first place, how bad her symptoms were, what grade of tumor it was, because pituitary tumors, in the ranking of bad shit that can happen to you are not nearly the worst. This was somewhere between an elective surgery and a major surgery. My feeling was if she had the choice to make again, to have surgery or not to have surgery, guess what she would've decided?
            In her hospital room that last time we met there was no longer a drain but she was pretty much still out of it: sleeping all the time, not really eating, not refusing to take meds but taking them listlessly, without interest, you could have told her you were giving her anthrax capsules she just didn’t care anymore, lying there in a pretty summer dress that she had refused to trade for a hospital gown. No one visited her, she had no support network, no money, apparently no job, the hospital didn't turn anyone away. Well, maybe that’s not right—someone did call the nurse’s station once about her, during my shift. A friend. And since our interaction was only on night shift, maybe during the day someone did come to see her. And her bank account—well, that’s just a guess, she could have been a millionaire but don’t bet on it. In any case, that was it. She died a little while later. Can’t remember if it was in the ICU or the ER or at home. But one day somebody told me she was dead and it was clear to me what had killed her. She just got tired and gave up.
            The details escape me because we had a lot of deaths on the unit at that time. One of my sister African-American nurses who was about Frankie’s age was feeling bad one night: a diabetic and a smoker, working a lot of extra shifts at night to keep her family afloat which, in retrospect, seemed like a pretty lethal combination.
            So she went down to the ER on her shift and she was admitted to the hospital for testing and during the scans they found her insides full of cancer. She only lasted a few weeks—never left the hospital she worked in, she came in for a night shift and that was it. Another former nurse from the same unit died of a brain tumor in a room down the hall. Then an important anesthesiologist from another hospital came in with an advanced tumor and it was something to see because our staff neurologist, instead of ordering this and that, instead of trying this and that, and despite the wishes of the family who wanted everything done—the neurologist said no way, this is simply not survivable, and we will treat him—even though he is an important physician—we will treat him like anyone else and that means comfort care only.
            Another lady who had been my patient, we’d spent a rocky night together a few weeks before, not entirely her fault either—died too. She was in her seventies, had some kind of spinal tumor or messed up vertebrae, can’t remember which, and was diabetic, and she was my patient pre-operatively like the night before she got cut. She had mild Alzheimer’s or something missing from the attic and she had eaten dinner and forgotten she had eaten dinner and insisted despite my best efforts to convince her otherwise on ordering and eating a whole second dinner so that when we checked her blood sugar later that night it was in the ozone and she had to get enough insulin to put Charlie and the chocolate factory out of business. The surgery was a success, as they say, but the wound got infected—uncontrolled diabetes can do that, so they tell me, make wounds hard to heal—and she was getting all these antibiotics which didn’t help, and finally she just said to the docs that she was tired and wanted to be let go, she was tired like Frankie, may she rest in peace, not let go from the hospital but let go from life. That’s what the doctors did. They let her go. A couple of nights later another nurse called me into a room to help with a body and it was the same old lady. We zipped her up to roll her over to the morgue. Two more nurses came in. Everybody treated her very gently. Made me feel really guilty about our fight over that second dinner. As it turned out she didn’t have many more meals to go, right? She should have ordered the pie and ice cream while she had a chance.
            This isn’t about me. Nursing is about the patient not the RN, unlike medicine which is very often about the doctor. But, not to get weepy or anything, it wasn’t a good time for my career in the healing arts. Most of my prior experience had been in pediatrics and in pediatrics the patients don’t die so much. That may not sound scientific but it’s true. Unless you’re working on a cancer ward, kids are more resilient. They live to get sick another day. In contrast, the unit where Frankie died, most of the patients were middle-aged, at least, and had thirty or forty years of bad habits that make ordinary complications worse. One day the bill just comes due and you have to pay for the cigarettes and the booze, the fast food and fornication, Frankie was a smoker too and it may not have killed her but it definitely didn’t help. So, it was a confusing time for me. Didn’t much like the job—didn’t like working with adults—and certainly didn’t like them dying, especially not on my watch. Luckily, most people seemed to pass away on day shift.
            Still it was depressing like you wouldn’t believe. You felt, a lot of the time, like saying to the patient, “Excuse me, if you aren’t going to take that Valium, do you mind if I do?”
            But one thing that you couldn’t help but notice in the fog that was then my life as a RN was that on my unit we seemed suddenly to have a lot of these fuckin' lumbar drains and most of them traced back to surgeries by the same physician.

           
            There are only two kinds of doctors.
            Wrong, you say.
            There are surgeons and internists, pediatricians and clinicians who only take care of older adults—intensive care docs, cardiologists, emergency medicine, obstetricians.
            Infectious disease guys. And girls.
            Orthopedists. Ophthalmologists. Space medicine—sports medicine—psychiatristry, neonatalogy. Pathology. Many, many kinds of MD, right?
             Wrong.
            To a nurse, there are only two kinds of doctors. And you’ll know almost immediately when you interact with them which kind they are: if they are the kind of physician who listens to nurses, or the kind who doesn’t.
            The kind who do listen to nurses can be praised and set aside to discuss another day. Those who don’t listen are the subject for today. This group can be further subdivided into those who know exactly what they’re doing at every minute of the day and night and those who don’t have complete God-like supreme knowledge.
            Speaking of the first subgroup, it’s been my pleasure to know only one doctor who fit in that particular box, who knew exactly what he was doing at all times. He was a neurosurgeon at my first hospital and his example is instructive because you don’t see docs like him often. An example of his omniscience—because it’s important to get a feel for the good and the bad—especially among surgeons: One night the hospital pharmacist called me, there was trouble with one of this all-knowing doc’s medication orders.
            So, we had a patient belonging to this neurosurgeon and the patient, who was prone to violent seizures, had been prescribed an amount of anti-seizure medication that was higher than the recommended dose. Like twice as much. Medication errors kill a lot of patients and although we wanted this guy, the patient, down for the night, and not seizing, we didn’t want him out permanently, as in brain-dead or not breathing. So the task fell to me to call the doctor. This particular surgeon was not on call that night, so his partner answered the page and listened carefully to my concern about over-medication. He ordered the dose cut. We went about our work, me and the pharmacist, crisis averted, our asses covered for the shift or so we thought.
            The next night, the all-knowing neurosurgeon himself came to the nurse’s station and asked who had called his service the night before about Patient X. There was nowhere to run. So, for like the next ten minutes he ragged me in front of the nurse’s station, bent me over like his bitch, all the other RNs, residents, even the house supervisor came to watch: Why had his order been questioned? Well, sir, the pharmacist said the dose was too large. “The pharmacist? The pharmacist said? Is the pharmacist going to come and run the code if the patient goes into status [epilepticus, that is protracted seizures]?” Actually, the pharmacist was this really hot Vietnamese chick named Wendy who, in my juvenile imagination, was capable of many wonderful healing acts but probably not running the code if this patient went into status epilepticus. So, the answer was no. Score one for the doctor.
            “Will the pharmacist be doing the surgery on this patient?” No sir, again. “Are you going to do the surgery to ablate—” that is, burn away whatever the site was of the abnormal electrical activity in the brain that was causing the seizures? No sir, that would not be me.
            He went on for a while. Like anything else in life an ass-chewing at the nurse’s station has a rhythm and timing and you just have to let yourself go, become one with the abuse and the abuser, nodding at appropriate times—yes sir, no sir, you’re completely right, sir or ma'am—a glance or two at the clock on the wall to remind the physician of his busy schedule, with the sure and perfect knowledge that the doctor is going to run out of electricity in a moment or two and you can give Ms. Johnson, in Bed 712, who you can hear screaming across the unit, her long-overdue pain medication.
            But the thing about this guy, this neurosurgeon? He was right. He knew what he wanted, a high dose in this case, and he wanted his orders followed not because he was on a power trip but precisely because he wasn’t. That same surgeon who chewed my ass had been the first doctor to show an interest in me as a nurse, coming into the room during my care of one of his patients, like my second day in the house, nursing diploma in my back pocket with my stethoscope. He reminded me to get the patient up in a chair that day, so that Patient Y could sit up in the sun for a while, and then came by later to make sure that it was done. Which it hadn’t—for a variety of good reasons—none of which need to be explored here. This guy, the doc, was a senior surgeon and he took time out of his schedule to check back in to make sure the nursing staff (me) got his patient up to sit in the sunshine? Imagine. Some of his meticulousness was dictated by practicalities: he told me once that his yearly malpractice insurance premium was $100,000, and this was Texas, one of the most litigious states in the Union, so he was guaranteed to get sued. So when he ragged me in front of the nurse’s station that was actually cool with me. He knew what he was doing and the pharmacist and me had been just as worried about our licenses as the patient’s needs. But most of the doctors who rag nurses don’t have their act together like this guy did. So to my eyes he was the sort of the standard for ragging nurses and for care by a physician.
            Not all of the tension between doctors and nurses can be attributed to bullying and arrogance on the part of the doc. Much of the problem is that nurses get into a passive-aggressive mode with each other and with the physician. There's a big education and income gulf between the two, a class difference that plays itself out very often in petty behavior by nurses which doesn’t mix well with overbearing MDs. There’s also the lingering gender divide from the days in which nurses were all female and the doctors were mostly male, that has changed of course, now the majority of admissions to medical school in this country are women, and men are trying to make inroads into nursing, but not much has changed, really, because male RNs can be bitchy and jealous just like women, and female doctors can be bull-headed and self-delusional just like guys. In this high-tech age of smart drugs and gene therapies and laser surgeries, one of the great unresolved issues of healthcare is how for the nurse to bring something to the attention of a physician. And something they still don’t teach in med school is how for a physician to listen to a nurse.
            This is what they taught me in nursing school not too long ago: Say you see something wrong with little Bobby in Room 513 down the hall. First you call the intern and if he or she blows you off or if you’re still worried after speaking with him/her, you call the second-year resident, and if you still don’t like the answer you call the third-year, and if he says he’s busy, which he is, because the residents are always busy, and by now inter-professional relations are starting to fray and if you’re old-school, not literally but you were taught to be old school—from the days when doctors threw coffee cups at nurses and got away with it, which the nursing instructors, who really are old school, average age in their fifties, haven’t forgotten, believe me—or you’re just a little resentful of that little pediatric resident prick, or bitch, and this is the last time before they finish their residency that you’ll have a chance to make their lives hell, maybe you tell the third-year to get his butt down here and see the freaking patient or else you’re goina call the attending physician at home. Get the message? Sometimes there doesn’t even have to be that kind of bad blood for things to get nasty. As a new nurse my first calls to a surgeon at home, for whatever reason, bad karma you could call it, always seemed to be something minor that still needed to be addressed by the doctor, a low-grade fever, for example, or more pain meds, and the calls were always made at one-thirty in the morning, and from the heavy breathing on the other end of the line you knew right away what extracurricular activity you had just interrupted the surgeon in the middle of. He had been operating, yeah. Next day he comes in and looks at you like you’re a fool and asks couldn’t you write a Tylenol order yourself? And you could, but writing the medication order you know the doctor is going to write himself, if you ask him, seems like a slippery slope. You pick up the phone instead and interrupt his quality time with little Debbie, who may even work with you on the unit.
            So, there’s, like, a lot going on, behind the scenes and in front of the camera. Every call you make, every question you ask, can be interpreted as questioning somebody’s intellect or ability. God forbid that you say something in front of the patient. That really is wrong. Just a while ago, also in Texas, a physician who was accused of bad practice by a couple of nurses had the nurses arrested and charged. What do they call that at the Supreme Court? A chilling effect, that's right. You bet your ass—but more than that—when you question the doctor you bet your license to practice nursing. You bet your paycheck.
           You bet your livelihood.




            My personal suspicions concerning the surgeon who had operated on Frankie began one night, a month or two after she was gone. Another nurse called for the rapid response team on a patient who was showing signs of a blood clot or bleed in the brain. He was beginning to stroke out, yeah, but luckily for him the night was still young.
            Rapid response is a wonderful invention just short of a full code (when everybody runs around and beats on the patient’s chest or zaps him/her with electricity) that can be called anytime a nurse is uneasy. The patient doesn’t look right, not responding as they were a few minutes ago, labored breathing—whatever—you’re never wrong if you call. Suddenly everybody shows up like with a code, ER docs, senior nurses, respiratory therapy, the house supervisor, they all get together with the nurse who has the patient and everybody tries to problem solve, to decide if something needs to be done, transfer to another unit or surgery, a trip to MRI or CAT scan. Everybody just gets a look at the patient in case a full code really does have to be called later. It’s a great system that saves a lot of lives.
            So, after the rapid response that night, the docs were gone and the nurses were standing around in the hallway chatting and somehow the number of lumbar drain patients on the unit became a topic of conversation. There were three or four drains and at least two of them were patients who had been operated on by the doctor who did Frankie’s surgery. There was some clucking about that. "Does he know what he’s doing?" The charge nurse mentioned that this particular surgeon was very well-known in his field and he probably operated on more difficult cases, which might explain the number of complications, he was doing the hard ones. So the surgeon had his defenders. The house nursing supervisor, who had been a nurse for quite a while, mentioned that when she was in school and coming to this same unit for her clinical practice, an unspecified number of years previously, that same surgeon was already working here. That raised the obvious possibilty: Was he too old? That became the unspoken question. We all started clucking again. Completely unscientific, yeah, but that’s how the system works. Eventually, after enough un-informed discussion, the subject dropped again, until more drains or more complications arose, and someone suggested that maybe the issue should be brought to the unit’s nurse manager.
            Part of our reaction may have actually been personal. The surgeon in question was pretty much a dickhead. If you think something like personality or bedside manner doesn’t matter, you’ve never spent time on a nursing unit. This guy would do a handful of surgeries back to back every week or so and we had his standing orders on how to care for his patients, what labs he wanted drawn for example, and he would show up at six in the morning to see how the post-ops were doing. He never talked to the nurses, even the older ones who had been there a while.
            He didn’t have to stand at the nurse’s station to review the labs because he had computer access at home and saw the labs before he ever came in. So there was no interaction with us. If somebody tried to talk to him about Mrs. Johnson’s dilute urine he would just keep walking. He never brought brownies or candy at Christmastime—nurses are aware of that shit, believe me. So he was nobody’s favorite on the unit. It could have been personal and probably was. But there was still the matter of those lumbar drains that kept appearing. Something didn’t seem right.
            Then something happened—completely unscientific again—that raised my “index of suspicion,” as the diagnosticians say, even higher.




            There was a big supermarket near the hospital, complete with Starbuck’s and bakery where it was my routine after work, bleary-eyed and strung out from twelve hours of mostly-night work, to go and buy a bagel. One morning Frankie’s surgeon was there too, walking along a grocery aisle—and this sounds totally unscientific—but he looked disoriented.
            All the boxes of breakfast cereal on either side of him, this fifty-five or sixty-year-old guy, eyes bleary like mine, a pathetic figure looking like he didn’t know if he was coming or going. Problem was he wasn't just coming off shift. He didn't operate at night. Not only was my index of suspicion raised, my mind was made up. He was dangerous. Cocoa puffs or corn flakes and he looked like he not only couldn’t make up his mind but that the question itself involved relativisitic math. Worse. He just looked like he was past it, like a cop who can’t chase suspects anymore, or a salesman who can’t do cold calls anymore—a reporter who can’t dig anymore and who just rewrites other people’s copy.
            You see the same thing on the faces of nurses who have been at it too long, who need to retire, who mistake the digoxin for the diprovan and it’s just a matter of time until they kill somebody. You see it eventually on most people’s faces who are involved in stressful work. Maybe someone is already seeing it on mine. But with doctors you can’t say anything. Nor, in this case, was it my place to say anything because nothing had happened to any of my patients. But seeing him on the corn flake aisle, in the cruel first light of day, it was clear: he needed to spend more time teaching, telling people how to do it instead of doing it himself, or just get on his sailboat and float away. That was my feeling but there was no one to tell. You could bitch at the nurse’s station, or turn the incident about confusion among the breakfast cereals into a story for the break room, or the bar after work, but there was no real mechanism for sounding an alarm.
            Until a few weeks later, the end of my time at the hospital.
            My experience in the world of adult healthcare was coming to an end and none-to-soon, at a point in time when it was still my decision to make and not, for example, my clinical manager’s. Two years was long enough, thank you very much. Being on the rag all the time—being unhappy with the patient population—had left me just a step away from being an asshole with my coworkers, which was a point for me that was never that far away to begin with but that was suddenly too too close. Time to move on. That night though there was another of the pituitary tumor surgeries, the same surgeon, and like before the patient was doing well at first, the night after the surgery, they might even let her go home the next day. Then she called me into the room, a pretty young chick with her son or little brother staying with her on a cot next to her bed.
            Said she had gotten up to go to the bathroom and something started dripping out of her nose.
            You don’t want something bad to happen at night because your reactions are slower than during the day. It’s harder to recognize complications and if it requires action you’re usually slower doing what needs to be done. Luckily this complication was apparent and, for once, my patient load was reasonable and so we did it by the textbook. Told her not to get out of bed again . . . called and got an order for labs . . . called and told the internist on duty to come and check her out. Her neuro reactions were intact—the patient was scared more than anything else. The internist saw her and put her on bedrest, which didn’t quite reassure the patient because she got frightened with attention the same way she would have gotten frightened if no one was paying attention. The neurosurgery fellow on duty that night happened to be nearby seeing another patient and he went in to see her too. Ordered IV fluids and nothing-by-mouth, in preparation for surgery in the morning. Or—you guessed it—if they had to do a lumbar drain. Which they did. My mind was made up. A couple of days later was my exit interview with my manager and something needed to be said.




            Janie, who would be interviewing me and telling me goodbye, was my favorite supervisor. The best supervisor ever, in my modest opinion. She was a former ICU nurse, no nonsense, no favorites, no moodiness—the only thing important to her was whether you were taking care of the patients to her expectations or not. Nice but serious—serious all the time, which is cool because you always knew what to expect.
            Some nights she would get dressed in scrubs and come in and hang out and see how the shift team worked together, something none of my other managers had ever done before. My first day on the unit with her had actually not gone well. My patient assignment included this lady with messed up anatomy in one room, who needed to be catheterized because she was unable to pee on her own. The patient was talking me through the procedure, guiding me among her extraordinary body parts when two calls came in back to back about another of my patients, the lady in room 512 who had come in from an assisted living center with some kind of pseudo-stroke. The lady in 512 was on a cardiac monitor and the monitor, which actually was downstairs on the cardiac floor, showed she had gone into a low-degree heart block and a nurse from downstairs had informed me per protocol. We were cool so far. Next minute there was a call from the physician at the assisted living center telling me that what had actually happened was not a stroke but that they had mistakenly given this lady another resident’s daily medication. So, in the room, she was completely out of it and then her blood pressure started to drop. Rapid response. She wasn’t in bad trouble yet but she was headed that way and the idea was to get her problems dealt with before she crashed.
            Suddenly, after the rapid response call went out overhead, the room was filled with nurses and doctors and they listened to my explanation of what had happened, that she wasn’t really a stroke victim but a potential poisoning, with heart problems, so she needed to be watched closely and, frankly, not on a brain surgery unit.
           Then there was this sound of heels clicking down the hallway and it was Janie, the unit manager, she had heard the rapid response call overhead and she came into the room and someone said to her straight off, “She got the wrong patient’s meds,” and Janie, who doesn’t panic, but can show attitude, was about to show attitude, and said, “Well, I hope not in this hospital,” looking at me, meaning it better not have been my medication error, not on my first shift, and someone explained to her, no, at the nursing home, and Janie kind of relaxed, and got into her rapid response mode, problem-solving. The obvious solution was to get the patient out of neurosurgery. The doctors ordered her sent to a medicine-cardiac unit where they could deal with the wrong meds she had been given and watch her heart. Later, Janie came up to me in the medication room and listened to my apology for calling rapid response on a situation that might have been dealt with more calmly. But we were really busy and tracking down a doctor to write an order and getting a transfer done takes time, which no one had to devote to this lady, and rapid response cuts through all the usual hospital bullshit, especially if you’re not sure where the patient is headed, as in downhill or not, when you don’t know if the patient is really crashing or what. “You’re never wrong to call rapid response,” Janie said, something every nurse knows, but sometimes you need to hear your boss tell you nonetheless. After that, Janie was my hero.
            The first part of the exit interview was spent with me ragging the charge nurse from day shift, who had many faults, the biggest of which was that she was a stone cold bitch. It’s a nursing unit, what can you say? Bitchiness goes with the territory but that shit can be wrong, especially if it’s done at seven shift change with people who want to go home and solely because you have the power to do it.
            The good part was that everything was said in the charge nurse’s presence, with her having a chance to respond to every word, which made it professional, not gossip, which it would have been if it had been said behind her back. Janie and the assistant unit manger both listened calmly, watching the charge nurse sweat and letting me have my say, since, like my connection to the unit was history anyhow. Another nurse told me later that she walked by the room and heard me going off, which made me proud. Confrontation is not necessarily a bad thing if it's a controlled environment, you know?
            Then it was time to say what needed to be said about Frankie’s surgeon.
            Janie stopped me in mid-sentence.
            “It’s being tracked,” she said. And that was the end of the discussion.
            Janie was no fool. She kept her ear to the rails of the unit, in meetings just like this, and obviously someone had mentioned a concern already. A consensus had formed: not that the surgeon was fucking up, no one could say that yet, if ever, but that his number of complications needed to be reviewed. This was a decision that probably not even Janie could have made on her own. She, like me, was only a nurse and the surgeon involved was a very powerful and well-respected individual in the hospital hierarchy. He was better educated than either of us, or both of us combined. He also knew more about pituitary tumors and pituitary tumor surgery than we would ever know. Janie couldn’t have made the decision on her own. She would have probably taken it to the hospital’s chief executive, or practice committee, or whoever, to get permission to do the review of cases.
            Who knows how it turned out? Not me, motherfucker. That was my last time on the unit. The physician may have been okay after all, may simply have been what the charge nurse had suggested one night: he was famous and he took the tougher cases that had worse outcomes.
            Or maybe he really did fail the breakfast cereal test.
            The real issue is that there’s no way for a nurse, or even a family member, to question a doctor. Doctors are taught that omniscience shit, which allows them to deal with life and death issues the way other people don’t. When it comes down to it they have to make life and death decisions and sometimes they aren’t omniscient they’re just human. And you have to be able to question their performance without burying someone first.
            If not, you can end up like Frankie. You just don’t care anymore, or you’re dead, or both. 

Sunday, June 3, 2012

Babylon on the Colorado



Every fifteen minutes of the day a tour begins on the first floor of the Texas Capitol. The guides are mostly fresh-scrubbed college students, young women in identical skirts and blouses and the young men in button-down shirts with conservative striped ties. They begin at the south foyer offering visitors a view of the flags illustrated in the marble floor representing the six countries that have, at one time or another, ruled Texas.
In recent decades after the $288 million renovation of fire-damage and construction of a massive underground extension the tour has become longer and requires the guides to memorize more facts, to answer more questions. The subterranean extension is developing its own story like the main building and will one day be historic in its own right. But it’s the original granite-faced big house completed in 1888 by prison labor and Scottish stonemasons, paid for by a swap of 3,000,000 acres of public land – an area twice the size of the state of Delaware – that remains the soul of Texas.
            From the rotunda the guide leads the way to the Senate floor. When the Legislature is not in session, tourists oooh and aaah over the paintings of heroes and ask more questions. Except for the velour ropes and portraits of dead white men the Senate chamber has the feel of an elaborate bordello parlour. The tour leaders were previously warned by the State Preservation Board, responsible for the Capitol’s maintenance, “Do not add material or stories to your tour that are not in your packet. If someone asks you a question that you don’t have information on, tell them to stop by our office after the tour and we will try to answer it." Nowadays a little adlibbing is permitted. Invariably it’s in the back of the mind of any Texan of a certain age that a fire took place here on the Senate side – a very destructive fire, in which someone died. The occasional tourist may even know that the fire led to the renovation of the capital and eventually, in a sense, to the creation of the extension itself. “Wasn’t it something about an apartment?” visitors may ask, referring to the origin of the blaze. It was so long ago that details only buzz vaguely in the back of minds as a sense more than a concrete knowing.
            If the visitor asks how the fire started the official story is that a television set shorted out in what was then the lieutenant governor’s apartment behind the Senate floor. Specifically, it was a Zenith TV although that’s not mentioned. The set originally cost $425 and had a “self-extinguishing cabinet,” which isn’t mentioned either, yet it spontaneously melted down and nearly took the soul of Texas with it.
            That is the official story.
            The “official story” has survived three decades, but in recent years old evidence that was suppressed has come to light – and a key witness spoke a few words before dying. Both contradicted the official explanation. The official story of the Capitol fire now appears to be exactly what it is, a complete fabrication told to protect a very powerful political family – a family that has included a governor and lieutenant governor and once defined the Texas establishment the way the Bushes do now. Actually two people died in the fire. One of the victims of the Capitol fire was a 23-year-old horse trainer from a barn in New Caney, outside Houston, who succumbed to smoke inhalation on February 6, 1983 in a bedroom of the then-lieutenant governor’s then-apartment, behind the Senate chamber. The other was a Capitol policeman who breathed his last breath after a minor car accident in Guanajuato down on Mexico’s central plateau a year later.
Those are the latest two victims of the Texas myth – or, in this case, the Texas lie.


February 5, 1983: The 68th session of the Texas Legislature had just begun and Lt. Gov William P. Hobby was in town, staying at a duplex he shared with his wife a few blocks from the Capitol as was their custom. There were two apartments in the Capitol then, dating from the days when the legislative leadership might come to Austin only for the legislative session, every two years. The Hobbys preferred to use their state quarters (consisting of four bedrooms, a kitchen, dining room, a den and four baths) as a guest house for out-of-town visitors. The other apartment is on the second floor on the west side and belongs to the Speaker. Kate Pettus Hobby, a high school senior at St. John’s in Houston, and a couple named Waterman, owners of the stable where Miss Hobby rode, and Mathew Hansen, her riding instructor, were all in town that day for the Texas Riding and Hunting Association banquet at the Driskill Hotel where Miss Hobby was to receive an award. She and her party stayed in the Capitol apartment. A dance followed the awards banquet and Kate Hobby and Matt Hansen left at two in the morning, driven the few blocks from the hotel by an older Hobby sibling, Andrew, who did not stay. In the apartment the Watermans, who were in their mid-30s, were already asleep. Kate Hobby poured a glass of juice for herself and a coke for Hansen, she recalled in a statement, and the two sat eating Fritos on the couch in the den where the fire started. Kate stayed with Matt Hansen a few minutes, she said to investigators the next day, and then went to bed. When last seen alive by Kate Hobby, Matt Hansen – who had been drinking all night – was stretched out on the couch, smoking cigarettes and watching Music TV.
Two hours later Kate and the Watermans were awakened by smoke and noise, according to the official account, as glass and wood cracked in the flames. Heat detectors designed to sound an alarm in the security office on the Capitol’s first floor summoned police. Officer Joel Quintanilla had been on patrol on the grounds outside and was called in, raced upstairs and heard Hansen beating on the walls of the apartment but the smoke was too much to penetrate. Quintanilla was burned on his hands, arms and face, as his lungs filled with soot. The Watermans and Kate Hobby escaped but firemen found the riding instructor, dressed only in pants and socks, lying between the twin beds in a guest room. That’s the official line. “This particular [television] set, we can prove that it was defective and that it caught fire and damaged the Capitol,” Attorney General Jim Mattox said following a legal settlement under which Zenith agreed to pay $600,000 to the Hansen family, $300,000 to Quintanilla’s survivors and $1.3 million to the State of Texas for repairs to the then 95-year-old red granite building.
“We got ninety or ninety-five percent of what we wanted,” Mattox told the public.



From the beginning, there were doubts about this account of events related to both the progression of the fire and its cause. First the timing did not make sense. Capitol security officers clocked the smoke detectors’ alarm at 5:25 in the morning and the fire department was alerted at 5:33. Yet every physical indication was that the blaze had begun much earlier with Officer Quintanilla testifying that he had been called in from patrol on a report of smoke at 5 a.m. Acting Chief Brady Pool who led the firefighters that morning was the first to hint that something was not right.
“Anybody who was in the business, any professional,” he said later in an interview, “could tell that the fire had been burning for a while before we got there. It hadn’t just started five minutes before [the alarm] was turned in.” He cited as an example a hot-water heater, normally in position in one of the false ceilings above the den. The first firemen to enter the apartment found the heater on the floor – the whole ceiling had already burned away. Chief Pool first thought the cause was electrical, sparks from a short circuit – the usual house-fire kind of thing—just on a bigger scale. At first the trauma of the fire itself trumped the search for a cause. It was a mind boggling scene that dawn at the north end of Congress Avenue downtown. Mark White, sworn in as governor the month before, walked over from the Mansion and was put to work dragging water hoses. The first firemen to arrive called in a second alarm and a third was turned in almost an hour later. At one point the governor, lieutenant governor, secretary of state, the mayor and city manager were all on the scene together with 100 firemen and at the height of the fire Chief Pool informed Governor White that he needed to be prepared to give the order to abandon the building. Almost a century before the first Texas Capitol lso burned down – no one could believe it was happening again.
Eventually the flames were “knocked down,” as firemen say, before reaching the Senate chamber. In addition to Mathew Hansen who was already past help when he was dragged by firemen from the apartment, that morning three Capitol police officers and eight firefighters were also injured.
Early that same morning, not long after the first alarm, city fire investigators were already on their way to the scene. As they drove along Festival Beach Road looking north they saw smoke a mile away, rising from the most prominent building in Texas. The State Fire Marshal’s people began arriving too. The city and state investigators had joint jurisdiction – or so they thought. Because of the nature of the damage, the origin of the fire was quickly narrowed down to the den of the lieutenant governor’s apartment. Malcolm Light, the city’s chief arson investigator, focused first on the two likeliest causes. “In this fire, like most where damage is particularly severe,” he wrote in his notes, showing particular literary care in what was likely to be a highly scrutinized investigation, “determination of the exact point of origin is extremely difficult.
“Barring any unexpected event in the investigation, there appear to be only two possibilities regarding fire cause. Either a fault or shorting occurred in an electrical conductor in the vicinity of the northwest corner [of the lieutenant governor’s den] resulting in the fire, or the fire was initiated by a carelessly discarded cigarette or smoking materials.”
In the northwest corner of the den there was a television on a shelf, near bookcases, and an easy chair. “During excavation operations in the room of origin,” Chief Light wrote, “remains of a television were recovered from the northwest quadrant of the room along with remnants of electrical conductors. What appeared to be the operating cord to the television was recovered intact with no evidence of faults or melting.” A piece of unidentified electrical wire was found nearby with blisters indicating a short. A short can cause a fire, sure – but a fire can also cause a short.  
 Officer Quintanilla was interviewed in Brackenridge Hospital where he was in intensive care. He had joined two other Capitol policemen on the first floor of the east wing that unhappy morning when he came in from patrol and from the hospital bed he told Chief Light, “The three of us ran to the elevator. As soon as we got off the elevator, we looked down and we could see smoke coming from the door leading to the den.” They entered the apartment, and down the hall Quintanilla could hear someone shouting, “Help me, get me out.” Quintanilla moved toward the den where the door was still closed. Seen from another perspective, one of the other officers explained how Joel Quintanilla made a fatal mistake. “Officer Spinks told [Officer Quintanilla] that the fire and smoke were too bad and for him not to open the door; however, at that minute, Quintanilla kicked the door and the door exploded open onto Officer Quintanilla. The hallway was immediately filled with smoke and fire, all the lights went out and we were unable to see anything.”
In that half-second view inside the den, which he would eventually pay for with his life, Joel Quintanilla said he saw fire to the left ("Fire, man," he said specifically in his formal interview about what he saw, "and lots of smoke") in the northwest corner near the television, and also straight ahead, to the east, on the sofa.
Subsequent examination would determine odd burn patterns on the sofa itself.


In a house in North Austin an old man sat two decades later with his wife and reminisced. This former public official held two major positions in his life, both related to the detection and prevention of fire. For the last fifteen years of his professional career Ernest Emerson was Fire Marshal of Texas.
On the morning of February 9, three days after the Capitol fire, Marshal Emerson was on a “walk-through” of the ruins of the east end of the building with other state officials, including Attorney General Jim Mattox. The cleanup already begun and investigators from the city and Emerson’s office were trying to determine a cause. As the tour ended Mattox asked the fire marshal to stay for a moment. “I accompanied Mr. Mattox and his group on the tour and remained behind, at Mr. Mattox’s request,” Emerson included in his notes written at the time, which can be found in state archives, “for a short discussion concerning the matter of overlapping jurisdiction and the need to coordinate investigative efforts.”
“He told me,” Emerson recalled two decades later, at home in his Austin living room, “that he was taking over the investigation of the fire.”
Chief Emerson knew Attorney General Mattox from Dallas. Before coming to the capital five years earlier Ernest Emerson had ended a 31-year career in the Big D – rising from fire fighter to chief arson investigator to fire marshal. Mattox had been there too as an assistant district attorney before winning a seat in Congress.
Did Marshal Emerson object to General Mattox taking over the investigation? “He was the attorney general,” Emerson said years later at home. He showed discomfort, as investigators do when confronted with interference by powerful interests. Of what happened later, Emerson added, “I believe he [Mattox] was trying to protect some people.”
 When Jim Mattox took over the Capitol case he hired an outside consultant to solve it. General Mattox had in effect removed both the city and state fire marshals from the case, yet the attorney general is not in the fire-detection business and therefore needed expertise. Mattox named a private consultant to head the investigation, a man named Leland Priest who had preceded Malcolm Light as the City of Austin’s fire marshal. While not satisfied with the attorney general assuming authority for the investigation, State Fire Marshal Emerson was reassured because he knew Priest on a professional level and knew “he was a good man.” A few days later Ernest Emerson got a call from Leland Priest, who had discouraging news. Although never made public at the time, a “confidential supplemental report” can be found in the state fire marshal’s records in the William P. Hobby State Office Building reflecting that the Capitol fire had taken a dangerous turn. 
The report is one paragraph written by Emerson and dated February 18, 12 days after the statehouse had almost burned down: “I met with Leland M. Priest, who had been retained by the Attorney General as a fire cause consultant. He said that he had been dismissed by the Attorney General on Tuesday, February 15th. He said that he had in his possession fire debris samples taken Friday, February 11th, from the den (fire scene) at the Capitol. He said the sample of carpet taken from the northwest corner of the den near the TV was hot.”
“Hot,” Emerson explained in his home during the later interview, “is what investigators say for evidence pointing to the cause of a fire.” Without referring to his notes, the 80-year-old Emerson recalled certain circumstances of what was happening among the ashes of the East Wing. The attorney general had fired Priest, a strategic decision, but doing so made a tactical error – he had not recovered the evidence Priest had collected in the Capitol apartment. Specifically Leland Priest had discovered suspicious burn patterns in the carpet of the room. “Priest called me and said Mattox had let him go. He said Mattox wanted the cause of the fire to be one thing and not another,” Emerson recalled twenty years after the fact.
“Priest said he trusted me and he would only turn over the evidence to me, and only with a subpoena. I drew up a subpoena and went to see him.”
Without telling anyone – and even though he had been taken off the fire cause investigation – Ernest Emerson collected the evidence and assigned one of his men to drive to the Metroplex, to the private Armstrong Forensic Laboratory outside Dallas.
“The purpose of this trip was to deliver and submit five (5) fire debris samples for complete laboratory testing and analysis,” Emerson’s man, who made the trip north, wrote in his own “confidential supplemental report,” dated Feb. 22. “These five debris samples were those recovered from the fire scene by Leland M. Priest, Fire Cause Consultant. …”
“It was requested of Dr. Armstrong that all testing and analysis of the debris samples be aimed at determining any presence of flammable hydrocarbon or other substances in the samples, and, if possible, to identify such substances.” The firemen had already guessed what they were looking for. Among the ruins of the den were unidentified fragments of green glass, as well as a small silver or silver-looking instrument, found melted beyond recognition. Three years earlier comedian Richard Pryor had put “freebasing” in the dictionary after he burned himself while preparing a potent form of cocaine for smoking. Today’s fashion in cocaine is crack but at that time freebasing – essentially home-cooking your own crack – was the thang to do.
To freebase requires “washing” cocaine in a strong solvent, a hydrocarbon like ether, to remove impurities and prepare the drug which is then placed in a pipe. Freebased coke is almost instantaneously absorbed by the lungs. The narcotic effect is fast, ecstatic and short-lived. The preparation, mixing hydrocarbons with fire, is also very dangerous as Pryor discovered to his horror and, later, bitter humor.
The suspicion among firemen was that someone had learned the same lesson in the Capitol.


While he waited for the results of the lab tests, Marshal Emerson kept busy. His official duty assigned by General Mattox was to investigate any possibility that the building had been intentionally torched which no one believed from the beginning but which was presumably intended to keep the fire marshal’s men occupied. In practice it meant talking to a lot of crazies.
Emerson said in an interview that, surreptitiously, “I still had people looking at things.”
One avenue of inquiry was to see if the party at the Driskill Hotel had carried over into the Capitol. To find out if the awards banquet spread beyond the ballroom one of Emerson’s men spent a week trying to track down a musician named Mark Stuart, leader of “Dash Rip Rock and the Dragons,” the band that had played Top 40 for the equestrian crowd that night.
Emerson’s agent finally contacted Mr. Stuart by phone at his home in Dallas. The results were disappointing – slightly comical – but remain part of the record in the fire marshal’s “report.” “Mr. Stuart stated that he had talked further with all members of his band about remarks they may have heard at the dance on this particular night, and none of them remembered any comments or remarks about anyone going to another party or a meeting of any kind at any other location. He stated that after a period of time playing in a band, most musicians don’t pay much attention to talk or actions in the attending crowd unless something out of the ordinary occurs.” Emerson’s investigator had just been introduced to after-hours life in the Live Music Capital of the World. Dash Rip Rock and the Dragons were crossed off the list.
In the meantime, the results had come back from the lab.
Leland Priest was right.
The carpeting from the den was hot.
The fourth sample, debris taken in front of the bookcase, “had a strong odor of aromatic components,” the chemist Dr. Armstrong reported. To chemists, “aromatic” does not mean a good smell like perfume – but rather that the source is petroleum-based and volatile, meaning it catches fire. Further testing identified the remains in the carpet as a methyl-ether compound with “strong solvent capabilities.” Because solvents necessary for freebasing can be created from household products the fire marshal’s office quietly contacted the Capitol police, to determine if any supplies of the same ingredients might have been stored in the apartment den. The answer, recorded in another “confidential supplemental report” was that “No materials of this kind were kept or stored in the den at any time.”
Marshal Emerson said he talked with Armstrong by phone, to confirm his findings.
“It was our belief that,” the marshal said, those years later, of events leading to Texas’ big burn, “they were freebasing.” By “they” Emerson said he means a person or persons unknown, but presumably Matt Hansen and perhaps someone else as well. The lab report was ordered sent to Attorney General Mattox. When it became clear what Emerson had done – ordering tests without permission of the AG – Emerson said that he incurred the displeasure of certain high-ranking state officials. As to why no cocaine was found if freebasing had been taking place, former Fire Marshal Emerson suggested an obvious possibility: “That room was pretty well burned-up.” Any cocaine could have been destroyed, just as in a pipe. The attorney general, meanwhile, as part of his investigation, had decided to consult that National Aeronautics and Space Administration on the origins of the fire – for reasons that to this day remain unclear. NASA has wonderful scientists but they aren’t known for their fire forensics work. But it looked good in the press. NASA. Oh wow. In the end, the state of Texas sued Zenith Radio Corp. and Mattox said he had found evidence of other fires in similar products. The state’s trump card was that the state was prepared to introduce the testimony of Lt. Governor Hobby’s servant, responsible for care of the apartment, who would testify that on a previous occasion the TV had blacked out and made a “popping’ noise. During the civil suit which never went to court Zenith’ lawyers (Fulbright & Jaworski) tried to get their hands on Emerson’s notes, a collection which came to be known popularly as “the state fire marshal’s report” – although the “report” really is a series of memoranda written by Emerson and his men for their files in the days following the fire, as the search for a cause developed into intrigue. Once a much sought-after document, never made public until now, these famous slips of paper can actually be viewed in the state archives.
Zenith’s lawyers apparently having been tipped to the fire marshal’s covert activities asked for Emerson’s papers at the time. The request was refused by the state’s lawyer, Jim Mattox. The appeals court refused to force the document's release. Zenith’s lawyers said privately that even had they won in court the case would be a public relations nightmare for the company. A frustrated lawyer for Fulbright & Jaworski noted privately, after the settlement had been reached, “One question you need to look at is, did the television set the fire, or did it burn up in the fire?”


A year later Officer Quintanilla remained on complete disability. He was seeing the old homestead in Mexico when he was involved in a minor traffic accident in Guanajuato. While hospitalized his lungs failed. He received a posthumous Carnegie Medal in recognition of his heroism that morning. Leland Priest, who broke the case, died in a freak accident a few years later.
Ernest Emerson who died the year after he gave his final interview was the last real witness – not to the fire but to the investigation. Emerson spent 12 years of his later life on the national board that sets fire-code standards, he said that the men who maintained the integrity of the investigation are not the heroes of this fire or any blaze – but the firefighters themselves who on the morning of February 6, “knocked down” the flames before they reached the Senate chamber. It would be dramatic to say that the Capitol fire haunted Chief Emerson through the decades until he spoke out but that’s simply not true. The fire that haunted him took place almost thirty years before that – the Golden Pheasant restaurant in Dallas. It was seven alarms and the legend is that every firefighter in Dallas worked that night. Four died. At least, Chief Emerson saidd, he got the Capitol blaze down on paper and out of his head.
As the reconstruction of the east wing of the Capitol was underway the Senate led by Bill Hobby chose to turn the lieutenant governor’s apartment into offices and a lounge for lawmakers. You like to think this was a way of making up for what happened, a kind of noblesse oblige in reverse, doing the right thing to make up for a wrong. You can also believe that the fire did some good. All those false ceilings and dead spaces created through a century of makeshift engineering and quick fixes—after the Scottish masons and prison cons finished work—were removed. The entire Capitol is now fitted with a sprinkler system. Looking back what’s intriguing about the Capitol fire is that the official story was almost contradicted from the very beginning. When Joel Quintanilla first opened his eyes after kicking in the door of the den he was in the lobby-floor Capitol security office having been carried down by his comrades and the first person he saw was Kate Hobby seated across from him with a policeman’s raincoat over her shoulders. What really happened in the apartment might have been discovered then and there if investigators sat down with her, an official lamented long after the fact. Miss Hobby was allowed to leave and gave a brief statement hours later at her father’s townhouse, a few blocks away, signing her name the girlish “Katie,” which she’s still called by some today. She would later testify in a deposition, “There were no drugs or anything in my presence at any time,” Kate Hobby now leads a presumably quiet life doing good deeds in Houston, married to a man who was a pallbearer at the funeral of her grandmother Oveta, the first secretary of the U.S. Department of Health, Education and Welfare. “It is a complete fabrication,” she said once of any idea that drug use led to the fire. And, as her patrician backbone rose she added, “You will hear from my lawyer.” She didn’t reveal if she still rides. Only days after the embers had cooled people were already whispering that something wasn’t right about the story that high officials of the Democratic Party were trying to feed the public. Some of the rumors could be attributed to Richard Pryor’s sensationally unhappy experience – the sort of innuendo you might have heard after any suspicious blaze at the time. But in the case of this tragedy, some of the rumbling could be traced to investigators themselves who thought the fix was in. Even the initial excavation of the fire scene had suggested that someone was not telling the truth. The apartment’s “panic button” installed to enable the lieutenant governor to alert security in case of an emergency was found in the “on” position. Someone had tried to summon help. The switch was known to be properly functioning because it had, by coincidence, been inspected the night before the fire. The officer who checked wrote in his log that the apartment was strewn with beer cans.
In the mind’s eye you can almost see Kate Hobby, young, horsey, rich, with a powerful father and a place to crash in Austin for an early spring break. Kate, like her matriarch grandmother – owner of the Houston Post, Oveta Hobby – and the Hobby men, mostly named William or Bill, who mostly went into politics, was part of a family that meant a great deal in this state. The Hobbys have rendered considerable service to Texas—although they’ve also tended to run a little wild, especially in their last generations in power. It’s unlikely that the Watermans or Matt Hansen, first-time visitors to the apartment would have known of the panic button’s existence. The Watermans were described by rescuers in documentation as half-asleep and dazed when pulled from their rooms. Kate Hobby would have known though. 
She said she was in her bedroom the whole time and was only awakened by the arrival of the officers. She came out the door into their arms. That’s what she’s always said. That's part of the official story too.
A few hours after the last flames were extinguished, a search began of the bedroom where Mathew Hansen’s body was found. “This investigator noted that a leather jacket was located on the foot of the west twin bed,” an officer of the fire marshal’s office wrote in his report that morning as he surveyed the ash and ruin. “This leather jacket appeared to be the size of one that belonged to a male subject. A maroon and white athletic type jacket was found on the middle portion of the east twin bed. This was a small jacket which appeared to possibly be one belonging to a female.
“Several other articles of clothing were found on the floor next to the victim and upon the east twin bed. All of this clothing appeared to be of male design with the exception of one shirt. This light blue and white shirt actually appeared to be a blouse.” A search of the bathroom found a toothbrush, a “Lady Shick” razor and a tube of muscle ointment. The ashtray on the vanity between the beds contained two cigarette butts of different brands.
The victim’s travel bag held “a small ‘shot glass’ type container containing a clear liquid. The container was clear in color with the opening covered by ‘masking’ tape.” Attorney General Mattox’s office would later describe the contents of the shot glass as “horse liniment.” Burn patterns on the bedroom door indicated the door had been closed after the fire began. That meant Hansen was probably not in the bedroom at the time the blaze started, and may have taken refuge there. “This investigator noted a very unusual circumstance within the bedroom,” the officer recorded that morning in the bedroom. “Neither of the twin beds had been slept in. All of the linens and bedspreads were still in a ‘made-up’ position.
“Additionally, the general appearance of the bedspreads indicated that neither bed had been laid upon prior to the fire. Considering the time frame involved, this investigator considered this circumstance very unusual.”
It was.