Читать книгу Silent Pledge - Hannah Alexander - Страница 14

L ukas was drifting to sleep in the call room early Sunday morning when he heard the blare of a siren. He opened his eyes to the sight of orange and red flames racing across the wall, and he sat up with a shout.

And then he realized that the flicker was from an ambulance outside. Its lights penetrated the window blinds in fiery streaks of color. Lukas pushed his blanket back and got out of bed. Sometimes he still had nightmares about the explosions in October, of following Buck Oppenheimer through the collapsing E.R. and fighting the inferno that nearly engulfed them.

The telephone rang. He reached over, felt for his glasses on the desktop and picked up the receiver.

“Dr. Bower, this is Tex,” came the voice over the phone. She sounded irritated, but with Tex’s deep voice it was hard to tell. “Quinn and Sandra are bringing somebody in. Of course they didn’t radio us, so I don’t know what’s going on. I tell you, that man should not be wearing a uniform. Want to join us?”

“I’m on my way.” Lukas grabbed his stethoscope from the desk and rubbed at the lenses of his glasses with the hem of his scrubs as he squinted his way out of the call room.

When he reached the E.R. he saw Quinn and Sandra wheeling a slightly overweight, unresponsive young woman into the E.R. from the ambulance bay while Tex held the door and helped push. Quinn was doing chest compressions and an IV had been established, with a needle and tubing connected to her left arm. The patient had been intubated, and an ambu bag was attached to the tube, which Sandra squeezed rhythmically to help the woman breathe. Sandra was pushing the cot with her free hand. The woman had been stripped to the waist. The odor of sour milk lingered around her.

Lukas rushed toward them. “Carmen,” he called to the secretary over his shoulder, “call a code and launch a chopper.”

Carmen swiveled in her chair and stared at him blankly. “What?”

Lukas shook his head. “Get me a nurse down here from the floor. Tell her we’ve got a code. Then call our airlift service and get them here.” He grabbed the end of the gurney and helped Sandra and Tex push it inside. “What’s the rhythm?”

“V-fib,” Quinn said. “I’d just intubated her on scene, and then she crashed.” His words came fast, almost as if he were trying to convince Lukas he’d done everything right. “She was unresponsive, and she had inhalers in her pajama pocket. Had to be asthma—”

“How many times have you shocked?” Lukas asked.

“Three with one dose of epi.”

“What?” came an irritable voice from the doorway.

Lukas turned to find Tex already in the trauma room, snapping the plastic lock from the tool chest-shaped crash cart beside the exam bed. “That’s not current ACLS guidelines,” she muttered.

On the count of three, they transferred the patient from the gurney to the bed, and Tex immediately replaced the leads to the hospital monitor on the woman’s bare chest. The v-fib rhythm continued, with the line racing across the monitor screen above the bed in an irregular steak knife-edge pattern. The monitor emitted a high, continuous beep.

“Well, you got your intubation this time, Dr. Bower,” Quinn muttered. “Hope you’re happy, because it’s not doing her any good.”

Lukas ignored the comment. “What drugs have you given?”

“I just finished the first dose of epinephrine as we pulled in.”

“Then we’ll have to shock again quickly. Stop compressions but keep bagging.” Lukas positioned his stethoscope on the woman’s chest, listened, frowned. “I don’t hear good breath sounds.”

“So? She was obviously in broncho spasm,” Quinn snapped. “She had inhalers, remember? Or weren’t you listening?”

“And you just took that for granted?” Tex’s voice rose like mercury in a hot room. If she saw Quinn’s flush of anger or glare of growing resentment, she didn’t acknowledge it. “Did you even check the placement of the tube when you did the procedure?”

“What good would it do if she was in broncho spasm?” Quinn’s lips thinned and whitened.

Lukas raised his hand for silence and repositioned the stethoscope over the belly. Now he heard breath sounds, and he felt a chill of foreboding. “It’s in the wrong place. The tube’s in the esophagus instead of the trachea.” The oxygen was flowing straight into her stomach. She wasn’t getting any oxygen. “We have to reintubate.” He turned to the others. “Sandra, stop bagging and take over the compressions. Hurry! Tex, get me a syringe, then get the suction ready.”

Tex moved quickly. “It’s one thing to miss placing the tube correctly, Quinn,” she said as she worked. “That’s happened to all of us. But to leave it there…unforgivable! You might as well have placed a pillow over her face and suffocated her! Why didn’t you check?”

Quinn’s jaw jutted forward. “I told you she had inhalers. If you hadn’t made such a big deal about that old man’s tube earlier, I wouldn’t have even wasted my time on this one.” He took a step backward, then pivoted and stalked out of the room.

“No!” Lukas shouted after him. “Quinn! You don’t walk out on a code!”

“Just let him go, Dr. Bower,” Sandra said, her soft voice growing softer as she worked hard to continue chest compressions. “He won’t listen to anybody. I tried to get him to check his work, but he was in too big of a hurry. If I can’t get another partner I might as well quit. This is stupid.”

As soon as Tex handed Lukas the syringe, he attached it to the tiny balloon at the mouth end of the endotracheal tube and deflated the air from the gear that kept it in place. He pulled the tube out of the patient’s mouth and checked the monitor to make sure the rhythm was still v-fib.

“It’s time for another shock. Sandra, bag her again.”

Sandra stood at the head of the bed and placed the bag valve mask over the patient’s face. Tex charged the defibrillator to 360 joules and handed the paddles to Lukas.

“Clear,” he called, and made sure everyone was out of touch with the bed, then pressed the paddles to the patient’s chest. The body jerked into an arch with the sizzle of electric current, then fell back onto the bed. Everyone looked at the monitor. The rhythm had changed.

“All right!” Tex exclaimed. The v-fib had stopped, and now the blip danced across the screen with more powerful strokes.

Lukas pressed his fingers against the woman’s throat, feeling for the carotid artery, and the hope that had flared within him died painfully. There was nothing. “Oh, no. Pulseless electrical activity.” This was worse! They couldn’t break this new rhythm with a shock. What was happening here?

“Sandra, bag her again,” he said.

The nurse from upstairs came rushing into the room, and Lukas gestured to her. “You’re just in time. I want you to do chest compressions.” What could be causing this? “Let’s intubate now, Tex. And let’s get some fluids in.” What would cause respiratory arrest and pulseless electrical activity in such a young woman?

“Dr. Bower,” Sandra said softly, “the bra we cut off her was a nursing bra.” She indicated the young woman. “She’s been nursing. She was all alone outside the apartment building.”

Lukas felt as if he were on a treadmill going twenty miles an hour. He had to keep up. “Carmen, contact the police,” he called toward the secretary as he worked. “They need to check the area for a baby!” He had to focus. If the woman was recently pregnant…severe respiratory distress…pulseless electrical activity…He caught his breath.

“Oh, no, Dr. Bower,” Tex groaned. “That sounds like massive pulmonary embolism.” Lukas nodded. A blood clot in the lung was deadly.

Quinn came rushing back into the room, puffing from exertion and wiping his eyes with the back of his hand. “I’m sorry, Dr. Bower. That won’t happen again. I mean it. I’m sorry. I was just so—”

“Can it, Quinn,” Tex snapped. “We don’t have time tonight for your theatrics.”

Lukas ignored the interruption. “Let’s get her set up for a pacer, and get me dopamine.” Now he knew what to do. But was there time?

Marla drifted in a dark fog, for a few moments far from the pain and cold and terror. But the drifting didn’t last. Her baby…Jerod! She could hear echoes of his cries, and she couldn’t get to him. He needed changing. He would have to be fed again soon, and there was no one to help him.

And then another voice reached her from some distant place…. “We’ve got a pulse….” Marla’s chest hurt again, and somebody was pushing her, hard. Her throat hurt. She felt the pressure in her ribs and heard more people talking around her…. “We’ve got a blood pressure, Dr…” She felt something hard pinch her arm…. “The helicopter’s landing, Dr….”

Something brushed across her shoulder, and light beamed past her closed lids. But she couldn’t open her eyes. She felt the rise and fall of her chest, and the continued sharp pain under her ribs, as if someone was stabbing her from the inside out.

The pain was too much. Even with the echoes in her memory of Jerod’s cries, she couldn’t force past that barrier of pain. She tried to form words on her lips, but something was in her way. She couldn’t speak. Jesus, take care of Jerod. He’s so little and helpless.

She could almost hear her baby’s cries again, wished she were back in the cold, grungy room with wet diapers and neighbors banging on the wall for silence.

And then, as if from somewhere besides the room where she lay, a strong, familiar voice reached her, a voice different from the ones that shot around her with businesslike efficiency. This one was unhurried, calm, even joyful. “It’s time to come home, Marla. I’ll be here with you.”

The sound of the voice permeated her and gave her a feeling of warmth, and she wondered if she were in a coma. But that voice… Dad? She thought the word and heard her own voice, though her mouth did not move.

“Remember the verses I read for you so often when Mom died? ‘The righteous perish, and no one ponders it in his heart—devout men are taken away, and no one understands that the righteous are taken away to be spared from evil.’”

You mean I’m dying? she asked.

“‘Those who walk uprightly enter into peace—they find rest as they lie in death.’”

But, Dad, I’m not righteous, she said sadly. Look what I’ve done.

“Your righteousness has been purchased. It’s time to come home.”

But my baby…

“Dr. Bower, I’ve lost the pulse,” came a brisk voice from nearby.

The wall of pain slipped down and pulled away. Marla felt as if a blanket of comfort were being wrapped around her. She could see again. Her father was holding out his hand.

“No blood pressure,” came another voice, this one receding, growing fainter. “Doctor, we’ve got asystole…flat line!”

But the alarm in the fading voices did not disturb her. Dad spoke again. “I have some people for you to meet.” And he took her in his arms and led her home.

Lukas called the code long after they lost the pulse and the rhythm flattened, battling his own sense of horror and pain as he’d battled to keep death from taking this young mother. He called time of death for the record, then took a deep breath and willed himself to be composed.

Sandra sniffed with silent tears as she gathered the trash that had collected on the floor. Tex muttered under her breath as she disconnected the monitor from the leads. She paused and glanced at Quinn, her green cat’s eyes narrowed with angry disgust. She shook her head and resumed her work.

“What’s your problem, Texas, can’t take the pressure?” Quinn reached over to remove the equipment from the body of the deceased. “No wonder you couldn’t handle your resident training.”

“No!” Lukas reached out to stop Quinn’s movements. “Don’t touch anything on her.”

Quinn raised his hands in an exaggerated show of obedience. “Hey, Doc, lighten up. I’m just trying to help out. After all, she was alive until we brought her to you. ”

Sandra gasped and looked over at her partner.

Tex shoved some trash into a biohazard container and straightened to tower over the man. “Breathing into her belly all the way here was what killed her. We might have saved her if you’d given her a chance in the first place, but no, you didn’t even bother to check.”

“Tex.” Lukas was too tired and grief-stricken to break up any more fights on this shift. “Quinn, everything has to stay in place in case the coroner wants to have an autopsy performed. Tex, will you go call him?” Maybe that would get her away from Quinn long enough to get her temper under control. To see that she did so, he walked out with her.

“That man shouldn’t be allowed to touch patients,” she muttered to him as they left the curtained room.

Lukas shushed her. Her voice carried past the thin barrier of curtain like the growl of an angry crocodile. Even though he agreed with her, he had to look at both sides. “You know an intubation like that can be difficult. Even the most skilled practitioner could have missed it under those circumstances.”

“Yeah, but I’d’ve at least checked her breathing. Couldn’t you tell by Quinn’s expression that he hadn’t?” She lowered her voice at last to a hoarse whisper. “I’m going to talk to Sandra later. That girl’s scared of her own shadow, but maybe I can bully her into telling the truth. Quinn’s incompetent. It’s probably because he works too many hours, but that doesn’t excuse his disregard for human life. They need to get rid of him.”

“And who would they find to replace him?” Lukas asked dryly.

She grimaced. “Good question. The hospital doesn’t want to pay anything. That’s why we’ve got a bunch of losers here already.”

“And where does that put you and me?”

She didn’t even blink. “You’re here to keep busy until the E.R. is rebuilt in Knolls.”

“And why are you here?” Lukas asked. “You’re no loser. I’ve seen you work. You know your stuff. I couldn’t help picking up on Quinn’s reference. Are you a resident?” He studied her more closely and saw the sudden tightening of her lips, the hooding of her eyes.

She looked away. “I’m a paramedic right now, Dr. Bower. I’m here because this is home…or it was.” She sighed. “The guy you’re replacing? Dr. Moss? He thought he was coming here for a break from family practice. Ha! Now he’s on suspension here and his license is in question, and it’s not even his fault. You’d better look over you shoulder around here. No telling who’ll try to stab you in the back.” She glared in Quinn’s direction and walked off to use the phone at the nurses’ desk.

Carmen swiveled in her chair to face Lukas. “Dr. Bower, a friend of mine from the police department just called. They didn’t find any baby, but they called the landlord of the building where the woman was living. He’d gotten complaints from the neighbors for the past two or three days about a baby crying.”

“Did he say how many people lived in that apartment with her?”

“Just the woman. Last time he saw her she was pregnant, and that was last week, when he dropped by to try to get rent payment from her, which he didn’t get. Looks like she was broke, and the room was a mess, like she’d been sick for a while. The baby was obviously a newborn.”

“Did they give you a name?”

“Said the woman was Marla Moore. She stayed inside a lot. I guess the landlord’ll have to come down and make identification or something. The police haven’t found any relatives yet.”

“But the baby,” Lukas said, “what about the baby?”

Carmen shrugged. “If it’s a newborn, it couldn’t’ve crawled off. Somebody’s got to be taking care of that baby.” The telephone buzzed again, and she turned back to the desk.

“Hey, Dr. Bower?” came a quiet male voice from behind him.

Lukas turned to find Quinn standing there, head bowed, arms folded across his chest. “I shouldn’t have given you such a hard time in there. I guess I was pretty nervous.”

“You don’t walk out on a code, Quinn. We needed you. Where did you go?”

“I…I’m sorry. I nearly lost my cool for a little bit. I mean, we were fighting for a young mother’s life, and Tex made it sound like I’d really blown it.” He shot a quick glance toward Carmen and Tex, who were both on the telephone at their desks. “What are you going to put on your report?”

“What do you mean?”

Quinn shrugged. “I need this job bad, and I can’t afford to lose it. What are you going to say about me?”

Lukas felt the fresh weight of grief sharpen his tongue. “The truth usually works.” He turned away and left Quinn standing there.

He went into the call room for a moment. He had reports to fill out, work to do, but he knew from experience that if there were no other patients who needed him, it was best to spend some quiet time after a painful event like this one. If there was any time he needed prayer more…

And then he realized something. During that whole code, in all the confusion and angry words and difficult decisions, he’d forgotten the most important thing. A habit that he’d developed in his first E.R. rotations years ago was to pray on the run while treating victims of severe illness or trauma. Praying had become second nature for him; he did it without thinking. But this time…this time he’d been caught off guard. He’d allowed his anger at Quinn to divert him from the most important treatment.

“Forgive me, Lord.” He covered his face with his hands. He knew God didn’t need his permission to save a life or to guide the hands and minds of the staff when they were working with patients. Still, he had no doubt that prayer was an energizing touch, a powerful connection between God and the caregivers. Yes, prayer operated on a spiritual level, but weren’t human beings as much spirit as body?

And what if Marla Moore did have a baby? Was there a husband? She was so young….

Just three months ago Lukas had lost a drowning victim, a young woman like this one. Some fishermen had found her at the shore of the lake and had contacted him by car phone as they raced with her from the lake to the hospital. They’d been devastated when they couldn’t save her. So had Lukas. The loss always hurt the worst with the young ones, as if fresh new canvas had been ripped from the center of a painting in progress. With Marla it looked as if an even newer life was involved.

“Lord, please take care of Marla’s baby. When they find her family, touch them with Your healing power and give that baby an earthly mother. And help me not to push You to the side next time.”

He paused and took a new breath. He had to return to work, but he might not have a chance to get back here soon, and he needed to eat something to keep his strength up and his mind sharp—he hadn’t eaten for eight hours, and he’d barely slept.

Quickly he pulled open the top side drawer of the desk and reached in for the peanut butter sandwich he’d packed yesterday before coming to work. He unwrapped the aluminum foil and pulled it back, then recoiled with disgust. Someone had taken several bites out of his sandwich—he could see the teeth marks clearly. In place of those bites was a dead fly.

He smashed the foil back together over the sandwich and threw the whole thing into the trash can.

He was beginning to hate this place.

A soft call reached Mercy through the darkness, indecipherable through the haze of the drug she had used so she would be sure to get some rest before returning to the hospital. But in spite of the drug, her eyes flew open. She listened. Had her mysterious visitor at the clinic followed her home?

“Mom?” Her bedroom door slid open, and a glow came through from the hallway night-light to reveal the dark outline of Tedi’s sleep-mussed hair. “Can I sleep with you?”

Automatically Mercy scooted over and pulled the covers back. Tedi came forward quickly and climbed into the nest of warmth Mercy’s body had generated. She placed her icy feet on Mercy’s legs, then giggled when her mom gasped.

“Nightmares?” Mercy asked, grimacing at her daughter’s late-night-snack breath. She should have let Tedi say at Mom’s for the rest of the night instead of waking her again and dragging her out into the cold air to come home. She felt so lonely without her…but that was a selfish motive.

“Yeah.” Tedi paused a moment, then said more softly, “And I missed you.”

“I’m right here.” Mercy reached out and gathered her daughter close, bad breath and all.

Tedi snuggled against her. “You’re gone so much, though. Can’t Lukas just come back and help you at the clinic until the E.R. opens up and you don’t get as many calls?”

“I don’t think so, honey.” Mercy sighed and glanced at the clock. She’d only slept three hours. This was going to be another tough one. Now she would lie awake and worry that she wasn’t giving her daughter enough attention, that too many of her patients were falling through the cracks, and that if she did get back to sleep she might miss another emergency call. Had she done the right thing keeping Odira and Crystal here at the community hospital?

And if she continued to worry like this, would she ever sleep again?

Tedi’s rhythmic breathing deepened and her body relaxed. Mercy couldn’t even close her eyes. So she started doing what she’d been practicing lately when the nagging specter of insomnia attacked her—she prayed. And she began with a prayer for Lukas to return.

Lukas struggled with his frustration as he returned to the E.R. proper. All his life he’d wanted to be a doctor, although when he was growing up he envisioned himself as the faithful family practitioner who had an office attached to his home, who made house calls and whose wisdom and compassion alone could make people feel better. He’d watched too many Marcus Welby, M.D. reruns. By the time he reached his third year of premed, he’d been forced to acknowledge that medical practice wasn’t what it used to be. Still, being a doctor was all he’d ever wanted to do.

It wasn’t until his first experience in an emergency room during fourth-year rotations that he felt the adrenaline rush of life-and-death decisions. He’d been addicted ever since. He could get high on a successful pediatric code. His heart could break at the death of an elderly nursing-home patient. And it was still all about people.

People were also what made the job difficult. There were so many extremes, and so many burnouts, and he kept in mind that it could also happen to him. His first burnout with people had come before his ninth birthday.

When he was a skinny, shy kid of eight, he’d had to get glasses. His two older brothers picked on him and teased him when their parents weren’t watching. Because of that, he remembered backing further and further into a shell until he barely spoke to anyone at all, and their teasing only grew worse.

One day Dad took him on a walk, just the two of them, out through their vegetable garden to a small grove of apple trees that always produced the crispest, sweetest apples in the farming community where they lived.

Dad picked an apple from the tree and held it out to Lukas. There was a brown, worn-looking spot near the top. “See this, Lukas? The apple grew too close to the branch, and that branch rubbed against it when the wind blew. Some years these are the apples I like the best, because a lot of times they seem to have the sweetest taste.”

Lukas took a bite of the apple, grimaced at the hard bitterness and heard his dad chuckle.

“Oh, yeah, I forgot to mention something,” Dad said. “Strange, isn’t it? The same rubbing that makes a lot of the fruit sweet some years can also make the fruit bitter and hard other years. Guess it has to do with how much sunshine they’ve had.” He placed an arm around Lukas’s shoulders. “Anyway, that’s my opinion. People are like that, and you’re not too young to learn the lesson. God’s love is your sunshine, you know. Just let Him shine through you in spite of the bad weather and the teasing you always get from your brothers. You’ll be glad you did.”

And so as Lukas approached Carmen at the front desk he forced a smile. This was her first office job, and she was understandably nervous, especially with the unforgiving attitude of many of the staff. Her harried expression always seemed on the verge of panic when an ambulance came in or when Lukas gave orders. She was one of the youngest on the staff.

“How’s it going, Carmen?” he asked as he stepped up to the computer where she worked.

She jerked and looked up at him, her fingers fumbling on the keyboard. Her gaze darted quickly to an item on her desk, then away again. “Fine, Dr. Bower. The coroner’s on his way, and Quinn and Sandra took off a few minutes ago. Tex finally went to grab a bite because she’s starving, and nobody else has checked in.” She got to her feet, eyes wide, movements nervous.

Lukas wished the poor woman could relax a little. If she didn’t, she wouldn’t last here very long. He frowned and glanced again at an item on her desk that he’d noticed earlier—a blue-and-white tube of surgical jelly.

He shrugged and started to walk away when the phone buzzed beside Carmen’s left elbow. She jumped and jerked it up, answered sharply and listened, catching Lukas’s gaze. When she thanked them and hung up, she shook her head. “That was Sandra. She and Quinn went back to the apartments where they found Marla. Did you know that’s where the bikers are staying? The police checked the place out. They found baby stuff, but no baby. A couple of the neighbors heard the commotion and came out. They said they’d heard a baby crying for a while, but they’d gotten used to that in the past couple of days. Nobody can find anything now.” She shrugged and sat back down in front of her keyboard.

Lukas stared at her. “But they’re still looking, right?”

She repeated her shrug. “I don’t know, Dr. Bower. Quinn said the police are busy tonight. Maybe they just don’t have time to look.”

Lukas glanced at the wall clock. It was 4:00 a.m. Sunday and freezing outside. “Where could a newborn baby possibly be? Surely if someone found a baby they’d call the police immediately.”

“You would think,” Carmen said darkly, “but I’ve already heard some rumors. You know the little girl who disappeared from the park last week? Some people think she was kidnapped. Quinn told Sandra there was a black-market baby ring in the area, and he thinks those bikers have something to do with it. I wouldn’t put it past them.”