Читать книгу No Ordinary Heroes: - Demaree Inglese - Страница 22

The truck finally broke down twenty feet from the courthouse steps. I climbed down and waded over to the stately building, then sped across the inlaid marble floor of the lobby, to the corridor that led to the Old Prison. The medical clinic was downstairs, on the building’s ground floor, and I ran down the steps as fast as I could in my flip-flops and soggy cargo shorts. The building had lost all power, but light from an overhead window lit the damp hallway, which was already beginning to flood. I paused for a moment when I realized I was going into a maximum-security prison with no electricity, but I pushed on. Sandbags protected the offices on either side of the hallway from the ankle-deep water. A damp, musty smell clung to the cinderblock and steel walls.

A second later I burst through the clinic door into total darkness, turned on my flashlight, and shouted, “Jan!”

“Dr. Inglese?” Jan Ricca, the nurse in charge, called back. The beam from her flashlight blinded me as she stepped around a corner. Five-foot-six with short red hair, glasses, and freckles, Jan looked like an Irish angel in green scrubs. “I’m glad you’re here. We’ve got a man down in the back.”

“That’s why the sheriff sent me,” I said, following Jan past metal desks, storage cabinets, and the station where another nurse and a medical assistant were busy at work. In the windowless examination room a big husky black man dressed in orange prison scrubs was stretched out on the table. He was motionless with his eyes closed and looked to be in his twenties. “What happened?”

“He was on the tier, and he fell and hit his head,” Jan explained. “At first, he seemed to be okay. He was able to walk to the clinic with a deputy, but after he got here, he passed out. His name is Williams.”

“Any vitals?” I slipped my flashlight into a pocket to free up my hands.

“His last blood pressure was low—fifty-nine over palp,” Jan said, “with a pulse of eighty-six.”

This man’s in big trouble, I thought. Immediate loss of consciousness was common with a head injury, but losing consciousness a short time after the injury was potentially serious. My mind sifted through possible explanations. One stood out: the potentially fatal brain swelling that occurs in some cases of head trauma or brain hemorrhage.

“This might be cerebral edema.” I felt the same rush of adrenaline I used to experience when I worked in a hospital intensive care unit. “We’re not going to lose this guy,” I said, as much to reassure myself as Nurse Ricca.

Conditioned by years of training, I set my fear aside and focused. I fired questions at Jan. “Any medications? Allergies? Any significant medical history I need to know about?”

“No,” Jan said. “Nothing.”

“Well, his airway’s intact, and he’s breathing on his own.” I paused to measure the inmate’s respiratory rate. “Eighteen a minute. Do we have IV access?”

“No, Dr. Inglese.” Jan followed my actions with her flashlight. Around us the darkness was absolute.

The patient still hadn’t moved.

“Get me another set of vitals.”

Jan handed me her light and wrapped the blood pressure cuff around the patient’s limp arm. I couldn’t make out his plastic ID wristband, but I knew Williams was a red-bander. All the inmates in the Old Prison had been charged with crimes that ranged from armed robbery to rape and murder.

“His pulse is still eighty-six,” Jan said, “but his blood pressure is eighty-nine over sixty.”

“That’s better.” I used Jan’s flashlight to check the patient’s pupils. They were round, equal, and reactive to light. So why isn’t he awake? I wondered, handing the light back to Jan.

“Mr. Williams, can you hear me?” I gently slapped his face in an attempt to rouse him. Williams moaned but did not open his eyes.

“Do you know what he hit his head on?” I asked.

Jan shook her head. “No.”

“He walked here under his own power?” I was looking for confirmation.

“Yes, and he was talking,” Jan said. “He only became unconscious after I started to examine him.”

“I doubt we have to worry about cervical spine injury, since he walked down from the tier. Did he complain of any neck pain?”

“Not to me,” Jan replied.

I ran my hands over the inmate’s face and head, feeling carefully for the characteristic crunch of shifting bone. There was no evidence of bleeding or laceration on his scalp. I had to rely on touch as much as the faint beam from Jan’s flashlight. A CAT scan could have provided the information I needed, but Katrina blocked the way to the nearest hospital. If I was going to help Williams, I’d have to trust my instincts and make do with whatever limited examination I could perform in the dark. In Korea, I had learned to function without state-of-the-art technology. I never imagined I’d need those skills again, but then I’d never been in the middle of a hurricane in a jail.

“No spinal fluid in his nose.” I shifted my attention from the man’s nostrils to his ears, looking for other signs of a skull fracture. There was no blood anywhere.

Williams groaned again, moving his arms and legs, and I suddenly remembered that medical staff was never left alone with a red-bander.

“Where’s the deputy who brought him to the clinic?” I looked at Jan as I finished checking Williams’s neck for misaligned vertebrae.

“He went to see about another sick inmate,” Jan explained. “He should be back soon.”

Not soon enough, I thought. Williams was lying quietly again, but that didn’t eliminate the threat. He could be a multiple murderer with nothing to lose if he killed again. I glanced out through the treatment-room door.

The other nurse’s flashlight created a play of shadow and light on the walls. She was packing medications and supplies into boxes, in case the clinic had to be evacuated.

Williams grunted. With his improved vitals, he should be awake.

“Mr. Williams!” I spoke loudly and motioned Jan to move her flashlight beam so it didn’t shine directly onto the man’s face. “C’mon, open your eyes.”

The patient obeyed, squinting in the dim light.

“Can you hear me?” I asked.

“Yeah,” Williams mumbled.

His response was encouraging, but I still had to ascertain his mental status. “Do you know your name?”

“Albert Williams.”

“What day is it?” I asked.

“Monday.”

“What’s going on outside?” I continued.

“There’s a hurricane.” The man’s voice got stronger with each answer.

“Do you know where you are, Mr. Williams?”

“The Old Prison.”

Satisfied that the inmate was conscious and oriented, I turned to Jan. “Start a large-bore IV and get some fluids into him.”

“I can try, Dr. Inglese, but…” Jan hesitated. She was obviously uncomfortable voicing her reservations, but facts couldn’t be ignored. “It’s dark, and everything is wet. This isn’t the best place to put in a line.”

She had a point. Under normal circumstances, the medical clinic in each jail building handled only minor ailments and injuries. Patients with more serious problems were sent to the infirmary, the acute-care clinic in Templeman 1. Life-or-death cases went directly to local emergency rooms.

“Why not just get him to the hospital?” Jan asked.

“Because there’s a hurricane outside,” I countered, more sharply than I intended. “No one’s going anywhere without a boat, and the sheriff won’t put medical staff or deputies at risk unless it’s absolutely necessary.”

“A boat?” Jan sounded surprised.

Her reaction stopped me cold. I suddenly realized that, without windows in the medical clinic, the nurses here had no idea what conditions were like outside.

“Everything’s flooded,” I explained. “There’s water everywhere—as far as you can see. And it’s deep. Even if we could transport Williams, the hospitals may not be open. You’ll have to keep him here, at least until the hurricane’s over and we have more information.”

“Here?” Jan looked appalled. “But we don’t have power, and when you’re gone, we won’t even have a physician.”

“And we’re in the middle of a major disaster,” I said. “We’ll have to make do the best we can.”

Jan sighed, then shrugged in resignation. “I guess we don’t have a choice.” As practical as she was pleasant, she didn’t waste energy fighting battles she couldn’t win.

I turned back to the patient. “You doing okay?”

“Yeah.” Williams slowly sat up.

“Feeling dizzy?” I asked. “Any headaches? Neck pain?”

The man shook his head. “No, Doc.”

“That’s good.” I motioned to Jan, and we stepped away from the exam table. “He’s got a concussion but doesn’t seem to be really hurt. Just keep monitoring his level of consciousness and vital signs. He should be all right.”

The man was feeling better. Which might be a problem. Even my muscular build and seven years of military training wouldn’t hold off someone as big as Williams. If he decided to run, I probably couldn’t stop him. I hadn’t found a shank—a homemade knife—when I examined him, but you never knew. Many Old Prison inmates concealed them.

“You better lie down, Williams,” I said, pulling the flashlight out of my pocket. It wasn’t an ideal weapon, but I gripped it firmly and added, “Any sudden moves might give you a bad headache.”

Williams stared at me through narrowed dark eyes. The effect was chilling.

“You don’t look like no doctor,” Williams said, shifting his gaze to my shorts and T-shirt.

I used my doctor voice to support my authority. “Lie down.”

The inmate paused, then nodded. “Whatever you say, Doc.”

I breathed easier when he stretched out and closed his eyes.

“Got another one for you, Doc,” said a voice from behind. “This guy says he’s sick.”

I turned to see a deputy standing by the nursing station with a tall, thin, black inmate. The young prisoner swayed as though he was about to fall.

“Bring him in, Deputy,” I said, “and come keep an eye on Mr. Williams.”

“Is he going to be all right?” the deputy asked as we switched places.

“He’ll live.” I wasn’t so sure about the new patient. It took a minute for me to find his chart in the dark. The eighteen-year-old kid had been arrested and screened just yesterday, and he had denied having any medical problems. But the youth now had a high fever and body rash, and his overall wasted appearance strongly suggested HIV.

“He should be in the infirmary,” Jan said as I finished the examination and wrote orders for both patients.

“If the flood gets much higher, the infirmary will be under water,” I said. “He’s better off here for now, with or without an IV. Keep giving him Gatorade—and Tylenol for the fever. At least we can make him more comfortable.”

“We’ll do what we can,” Jan replied.

Anxious to get back to the Correctional Center, I gave Jan a final instruction. “If there’s a change in either patient’s condition, call me.”

“Call you?” Jan raised an eyebrow. “Our phones aren’t working. Most of the time there’s no dial tone, and if we do get a connection, it doesn’t last. I haven’t heard from my husband and son since last night. I can’t call you.”

“Then find an officer with a radio and have them call.” Everyone at the jail was dealing with the same failing systems. I caught Jan’s eye. “You’ve got this under control, right?”

“We’re good,” she said with an uncertain smile. “If the water rises, we’ll probably have to evacuate to a higher floor, though. We have a lot of packing to do. No sense leaving anything behind we might need later.”

The clinic was in good hands with Jan, but the broader implications of the Old Prison situation were more troubling. Katrina had barely passed over, and Jan already had two patients. God only knew what was happening at the other ten clinics, I thought as I walked out.