Читать книгу Sacred Trust - Hannah Alexander - Страница 9

A delicate carpet of spring-green crept across the central Arkansas-Missouri border. The buds of serviceberry and dogwood had clothed their trees in pristine white just in time to welcome Dr. Lukas Bower to his new place of residence in Knolls, Missouri. He refused to call it home yet. After his most recent experiences in the job market, he couldn’t place his trust in these strangers. Nevertheless, nestled between patchwork properties of Mark Twain National Forest, this Ozark community of ten thousand promised to meet the needs of a country boy who loved the outdoors, especially hiking. When he had driven down from Kansas City to check out the area, the first order of business, before interviewing for the position of full-time emergency room physician, was to count the logging trails and off-road-vehicle paths that crisscrossed the forest. He’d even followed several of the trails in his Jeep. By the time he’d appeared for the interview with Mrs. Estelle Pinkley, the hospital administrator, he was sold on the place.

He was just finishing his usual morning repast of grease and eggs in the hospital cafeteria when the phone rang for him. He recognized the voice of an emergency room registered nurse.

“Dr. Bower, this is Beverly. We have a man by the name of Jacob Casey on his way here in his own car. He says he’s been bitten by his pet cat. He sounds pretty excited about it.”

Lukas frowned. “His cat bit him?”

“I gathered that the bite was pretty bad,” answered the RN.

“Rabies?”

“He specifically said there were no rabies. From the way he talked, the secretary thinks he’s been here before.”

“Okay, Beverly, I’ll be there shortly. Would you please pull his chart?” How much damage could a house pet do?

“But I’ve got good news,” she said. “We’ll have double nursing coverage through the noon rush.”

“As far as I know, this cat bite is the noon rush.”

Beverly chuckled. “Don’t worry, when Lauren and I do a double-coverage shift together, we always have some excitement.”

“I’ll trust your judgment.” Lukas hung up and took the one-minute walk to the emergency room.

He stepped in to find everything quiet. “Beverly, did Mr. Casey estimate how long it would take him to—”

The sudden blare of a car horn interrupted him and continued, obnoxiously loud.

“What on earth…?” Beverly walked through the open E.R. entrance and disappeared down the hallway. In less than fifteen seconds the honking stopped. Beverly came running back.

“Dr. Bower, Carol, I need your help.” She reached for one of the two gurneys sitting just inside the entrance. “There’s a man parked in the ambulance bay who looks like he’s bleeding all over the place. He’s alone.” She pushed the gurney out the door, with Lukas and Carol, the secretary, close behind.

By the time they reached the bay, the forty-odd-year-old man had opened his door and now clung to it desperately as he tried to get to his feet.

“Can’t seem to stand up,” he grated in a deep voice. His face was the color of recycled paper, and even his lips looked bloodless. “Cat bit me.”

Lukas, Beverly and Carol grabbed him and eased him onto the gurney.

Beverly gaped at him, then at the blood around his upper right thigh. “A cat did this?”

He held out a set of keys to her. “I always wanted a beautiful redhead to drive my Mustang. Take good care of her.” His eyes shut and his head dropped sideways.

“Let’s get him inside.” Lukas closed the car door. “Beverly, give those keys to Carol. She can drive this car out of the way and park it as soon as we get him transferred to a bed.”

“Oh, come on!” Beverly protested. “He told me I could take care of it.”

“He needs you worse than his car does.” Lukas held out his hand as they pushed the gurney through the automatic sliding glass doors. “The keys, please.”

Beverly curled her lip at him, but handed over the set of keys. “I’ve never driven a Mustang before.”

“Thank you.” Lukas handed them to Carol. “Would you do the honors? Beverly, let’s get an IV established on this man immediately, and we need to get his clothes off and see where the blood is coming from.”

While they worked on him, the double-coverage nurse arrived. Lauren groaned when she saw Beverly. “We’ll be swamped.” Even as she spoke, the ambulance radio blared. She pulled her long, blond hair into a ponytail and fastened it as she sat down at the desk to take the call.

In fifteen minutes, the emergency room was nearly full. The man in exam room seven had a deep laceration in his right forearm from an industrial accident. Lukas called industrial accidents his “graveyard specials,” because they happened most often during the predawn hours when the need for sleep was at its highest. Lukas used them as an example when arguing against twenty-four-hour shifts for emergency room physicians. This patient had worked since midnight, having had no sleep the day before. Dangerous?

A high school track student in room two had a possible broken wrist. The E.R. staff was waiting for parental consent to treat, enduring endless telephone calls from classmates to check on the patient’s progress while the track coach searched for the completed consent form. Naturally the parents were out of town for the day.

A baby in room three had a red ear, and Lukas was still trying to decide if it was serious enough to treat with an antibiotic. The young mother had come in crying almost as loudly as her baby, and for a while no one had known which of them was here for treatment.

Two unwashed females stood out at the reception desk complaining loudly because they hadn’t been treated yet for their head lice.

“No, you did not ‘wimp out,’ Mr. Casey.” Lukas stood beside the bed of their first arrival, thirty minutes after they’d wheeled him in. The man still looked weak, although his color had improved. “You lost a couple of pints of blood. Your loving pet nicked an artery in your thigh.” He indicated Casey’s bare leg.

Lukas traced the stablike wounds on the inside of Casey’s right thigh. “That’s some cat.”

“This is just a love bite, Doc. My name’s Jake, or Cowboy, but don’t call me Mr. Casey.”

“A love bite?”

“Male African lion.”

“A pet?”

“Had him for four years, since he was a cub. I raise exotic animals for parks and zoos, but I kept Leonardo. He’s good company.”

“When he’s not eating various parts of your anatomy. You must live alone.”

“How’d you guess?”

Beverly entered the trauma room to recheck Cowboy’s vitals and help Lukas finish irrigating the wound.

Covered in nothing but a towel, Cowboy’s whole body blushed. “Uh, Doc, I’d be grateful if you could spare one of those skimpy hospital gowns. It’d cover a whole lot more.”

Lukas grinned at him. “I think that could be arranged.” He glanced at Beverly. He had already seen the way Cowboy looked at her—and the way she looked back. “Maybe I should help him dress.”

“You don’t have time,” Beverly said. “I hear the ambulance phone now, and we have a mom out in the waiting room with three children she wants to have checked out for sore throats and earaches.”

“How long before our surgeon arrives?” Lukas asked.

Beverly wrote down Cowboy’s vitals on a clipboard. “Any minute now, Dr. Bower. He laughed when I told him who it was. He says he’s had this patient before.” She grinned at Cowboy. “I hear you’re pretty adventurous.”

He returned her smile and blushed again. “The folks I work with aren’t always predictable. Dr. Wong took care of a gash I got in the head when a scared zebra kicked me.” He looked at Lukas. “But why do I need a surgeon for this bite? Can’t you just sew me up and let me get home? Leonardo will be hungry before long, and he’s probably worried.”

“Good,” Beverly said. “Let him worry. Maybe he’ll remember this the next time he confuses you with a beefsteak.”

“Sorry, Cowboy,” Lukas said. “Leonardo bit into a deep artery. That’s surgeon territory.”

“But you’ve stopped the bleeding.”

“With pressure. When we remove the pressure, we’ll be leaving an unstable wound that can burst open at any time. You’ve lost enough blood already. You can’t afford to lose more.”

“But, Dr. Bower—”

“Listen to your doctor.” Beverly laid a hand on Cowboy’s arm. “He knows what he’s doing. Besides, if you’re too eager to get out of here, we’ll think you don’t like our company.” She winked at him. “You never want to offend your local emergency department personnel. You can’t tell when you’ll need them.” She dug into her pocket and pulled out the set of keys she had retrieved from Carol. “I’ll make a deal with you. If you’ll let me drive your car and give me some instructions, I’ll go out to your place when I get off work and feed Leonardo for you.”

Both men stared at her.

“Uh, Beverly,” Lukas said, “you do realize we’re talking about an African lion.”

“I heard through the crack of the door. Besides, I’ve read the chart.”

“Sorry,” Cowboy said in his gravelly voice. “No way am I sending a pretty female out to do the job I should’ve done. Get a man to feed Leonardo, and you can drive him out there in my car.”

Lukas expected Beverly, with her obviously independent spirit, to spit fire. Instead, she gazed bemusedly at Cowboy and nodded. “I’ll see what I can do.”

Someone approached the trauma room entrance. “Dr. Bower?” It was Lauren’s voice.

“Oh, Doc, please,” Cowboy said. “I’m still practically naked here. Don’t give me an audience.”

Lukas slipped through the partially open door, leaving Cowboy his privacy. “Yes?”

“We have an elderly man in exam room one who has just been brought in unresponsive.”

“I’ll be right there.” He rechecked Cowboy’s wound, then crossed to exam room one, where Lauren was rushing through the vitals of an unconscious, toothless elderly man in his pajamas, who was already hooked to a monitor and a nonrebreather oxygen mask.

A worried-looking woman in her thirties stood at the patient’s side, her eyes puffy and red from crying.

“Hello, I’m Dr. Bower,” he said to the woman. “Are you his daughter? Granddaughter?”

“No, I’m Shelly, Frankie’s neighbor. My children go over to see him every day, and today they found him like this on the floor of his living room. I think he’d been trying to call someone, because the telephone receiver was off the hook and lying beside him.”

“Did you bring him in by yourself?”

“Another neighbor helped me get him into the van. We should have called an ambulance, but I just didn’t think. We only live four blocks from the hospital.”

Lukas adjusted his stethoscope and did a quick auscultation of the man’s chest. He had mild tachycardia and slow respiration. His skin was pale and cool to the touch. A quick check of his head and upper body revealed no signs of injury. Lukas didn’t smell alcohol.

“Lauren, let’s get a bedside glucose on him.”

“Yes, Doctor. We have a new patient in room eight who needs you next.” She lowered her voice. “It’s cancer. She’s a DNR.”

Lukas grimaced. Those were the hardest. “Okay, thank you, Lauren.” He checked Frankie’s eyes. The man had good papillary sparing. Lukas quickly but gently turned the patient’s head, holding his eyes open. The eyes remained fixed on the ceiling. Positive doll’s eyes told him that this was either drug related or that there was bilateral brain swelling.

“Shelly, has he been ill recently? A cold? Flu?”

“No. Yesterday he was fine. He always brags about never getting sick.”

“Does he ever drink?”

“You mean liquor? Never.” She held out two prescription bottles. “I brought these. I found them on the bureau in his bedroom. His bottle is almost full, but the other one is empty. It belonged to his wife. She died last year.”

Lukas took the bottles from her and glanced at the names of the drugs. Both were benzodiazepines for sleep. He glanced at the patient and didn’t like what he was thinking.

“Blood sugar’s 125, Dr. Bower,” Lauren said.

“Thank you.” He glanced again at Shelly, hating to ask his next question. “These are tranquilizers. Is it possible he might have taken an overdose of his wife’s prescription?”

Her eyes widened with alarm. “On purpose? No way! I don’t even want to consider it. He’s so good with the kids, and he never seems depressed. He was doing so well after his wife, Doris, died.”

Lukas was also reluctant to believe this kindly looking older gentleman would do anything so drastic. He’d probably flushed his wife’s pills after her death. But what if he hadn’t?

“He hasn’t talked about going to be with his wife lately?” he asked Shelly.

“No.”

“Has he displayed any changes in his normal habits, like changes in sleep time or amount? Changes in eating habits? Has he given any of his personal items, such as jewelry, to friends or neighbors?”

“Nothing that I know about.”

“How long ago did his wife die?”

“About eight months ago. Long enough for him to show signs of depression if he’s going to, I would think.”

“Not necessarily. A wedding anniversary could have set him off, or her birthday, anything of significance to him.” Lukas was well aware of this because his own father had gone through a similar depression after Mom’s death. So had Lukas, though not as severe as Dad’s.

“But they had just celebrated their wedding anniversary before she died,” Shelly said. “And her birthday was two weeks before their anniversary. We celebrated it with them.”

“Okay, thank you, Shelly. Lauren, set him up for a CBC, a comprehensive chemistry panel, a portable chest, and a drug screen. Then set up a heplock. I want him to have a milligram of Romazicon at 0.2 milligrams per minute. We’ll repeat the dose after twenty minutes.”

“What’s that for, Doctor?” Shelly asked.

“Romazicon is the antidote for benzodiazepine overdose, just in case.” At her blank look, he explained gently, “He may have taken too many of these tranquilizers. I don’t want to dismiss the possibility and take a chance on being wrong.”

He glanced at Frankie’s prescription bottle again. Dr. Robert Simeon had prescribed the drug. “Lauren, also put a call in to Dr. Simeon’s office. He’s the family doc. I’m going to check on Cowboy, then look in on the cancer patient. Would you see if that permission to treat has come in for the track student? We’ll need a CT head scan on Frankie if our workup is negative.”

Dr. Wong entered the E.R. and greeted Lukas with a cheery smile and warm handshake. “Lukas, I hear you have one of my favorite patients visiting with you this morning.”

“Yes, and your patient is already asking for some clothes. Beverly will assist you.”

As soon as Cowboy was settled with his new doctor, Lukas heard Beverly’s cajoling voice through the door.

“Dr. Wong, you’re a kindhearted person,” she said. “What time do you get off?”

“Um, excuse me? Hold it, Beverly, you know I’m married.”

“I know that, silly. How would you like to help out a hungry house pet?”

“Forget it. I know all about Cowboy’s house pets. He just happens to be here because that ‘pet’ mistook his thigh for a drumstick. Isn’t that right, Cowboy?”

Lukas chuckled as he walked back to the central desk. Beverly wanted that Mustang.

His laughter died when he entered exam room eight with a chart for Mrs. Jane Conn. The eighty-six-year-old woman lay moaning in pain in spite of the morphine Lauren had just injected at Lukas’s order. A smooth, shiny sheath of mottled scar tissue obliterated half of Mrs. Conn’s face and showed up plainly beneath the nonrebreather oxygen mask she had received upon arrival. She had been brought here from her daughter’s home about thirty minutes ago, her pain unresponsive to oral medication or morphine suppositories. Lauren had established an IV where dark bruises attested to the failure of the new paramedic to do so.

Since Lauren and Beverly were both busy, Lukas checked the blood pressure himself. It was going down, and the heart rate was dropping, probably due to a decrease in pain—or Mrs. Conn was dying.

Lukas found Lauren and gave instructions for blood tests and X-rays. “You did say Mrs. Conn had filled out a do-not-resuscitate form for her family, didn’t you?”

“Yes, but we haven’t received it yet.” Lauren wrote his instructions down on a sheet. “Her daughter, Ivy Richmond, should have it.”

“I’ll need to get it from her, or we’ll have to take measures to resuscitate if…” He shrugged, hoping they would have no trouble getting the DNR form. He’d been forced to run codes on late-stage cancer patients before, and it had been very painful for everyone, especially for the patient.

As Lauren ran orders for the tests, Lukas listened once again to Mrs. Conn’s chest. He glanced up, and to his surprise, he saw her one unaffected eye watching him.

He took her hand. “Mrs. Conn, we’re trying to reduce your pain. How does—”

“Let me…” her damaged mouth twisted in an effort to form the hoarse words “…go.” Her eye held him a few seconds, then glazed over and closed.

Sadness overwhelmed Lukas as he watched her. He hated to see the pain, had always hated to see suffering of any kind. It was one of the things that had driven him to be a doc in the first place, and ironically, it had been one of his worst hindrances in premed vertebrate physiology. He’d always been physically sick afterward, even though the animals were anesthetized and even though he reminded himself over and over again that human lives would be saved because of the sacrifice.

Mrs. Conn’s moaning had stopped. Lukas placed a hand on her frail arm, then looked over to find the eye watching him again. He couldn’t read the expression, for there was little expression to be displayed on the harsh mask.

She moved her mouth.

Lukas leaned closer to hear her.

“Ready.” The word wasn’t even a whisper, but a breath of sound that barely carried past the barrier of the transparent oxygen mask. “I’m…ready.”

When he looked at her eye it was closed again. For some reason, some infinitesimal sign relayed itself to him—some lightening of expression on that scarred mask? He felt almost…a peace…assurance. Or was he just trying to comfort himself? Cancer was the hardest of all to take since Mom’s days of suffering. Lord, help her.

“Dr. Bower?”

He turned to find the X-ray tech waiting to do the portable chest. Lauren stepped into the room behind her.

“Lauren, where is Mrs. Conn’s daughter?” he asked.

“She’s in the private waiting room. I’m surprised Dr. Mercy isn’t already with her.”

“Dr. Mercy?”

“She’s Mercy Richmond, Ivy Richmond’s daughter and Mrs. Conn’s granddaughter. Dr. Mercy is a nickname a lot of her patients and staff members called her to keep from confusing her with her father, who was also a physician. He was Dr. Cliff, she was Dr. Mercy. If you haven’t met her yet, you will. She hasn’t had an E.R. shift in a couple of weeks. She has a family practice across the street.”

“Good,” replied Lukas. “We can call her when we need to. But I’m going to need to see Ivy Richmond soon. I need that DNR sheet, and she needs to be prepared.”

Lauren stood gazing at Mrs. Conn. “This has been a rough one. Everyone knows and loves Mrs. Conn. She used to do a lot of volunteer work here. Her daughter Ivy has made several large contributions to the hospital in the five years since her husband died.”

The X-ray tech finished her work in the room, and Lauren took Mrs. Conn’s vitals once more. “Down again. BP is 95 over 55 with a 90 pulse.”

“Thanks, Lauren. I’ll go have a talk with her daughter as soon as I check the test results.”

“Okay, I’ll go see Frankie again.” Lauren gave Mrs. Conn another sad look and walked out of the room.

Had there been time, Lukas would have sat with the patient, but he had to return to reassure the mother with the sick baby, talk to the girl with the sprain, and check on Frankie. Where was Mrs. Conn’s daughter, Mrs. Richmond? Why wasn’t she in here? More than likely she was exhausted and had found a sofa or chair on which to sleep.

When Lukas finished his round of the patients, he returned to Mrs. Conn and read the test results. As expected, they looked normal for an elderly woman with late-stage cancer. She continued to rest peacefully, but her blood pressure and respiration were falling.

He found the E.R. secretary at the central desk. “Carol, would you please call Dr. Richmond’s office and advise her of her grandmother’s condition? I’m going—”

Carol raised a hand. “Wait a minute, Dr. Bower. We received permission to treat Cindy Hawkins with the injured wrist. Also, I have Dr. Simeon on the line. You wanted to talk with him about his patient, Mr. Verris?”

After a quick consultation with Dr. Simeon, Lukas made arrangements to have Franklin Verris, the possible suicide attempt, admitted to ICU, then went back to check on the seventy-three-year-old gentleman one more time.

Shelly kept her vigil at her neighbor’s bedside. Lauren stood at the other side of the bed, adjusting an IV line.

“Any change, Lauren?” Lukas asked.

“I’m not sure. There’s no difference in his vitals, but his breathing seemed to change a moment ago. It’s been twenty minutes, and I’m getting ready to give him the next dose. Do you want me to go ahead with it?”

Lukas bent over Mr. Verris and gently raised his right eyelid. He took out a penlight and shone a beam directly at the pupil. There was a faint reaction. The man didn’t look as pale as he had looked before. But according to Dr. Simeon an overdose was highly unlikely. He had disagreed with Lukas’s request for Romazicon. However, Lauren was prepared for another dose, and since Lukas had already given the order, he decided to carry it out.

“Go for it, Lauren. I need to stay and watch him, but I also need to talk to Mrs. Richmond. I’ll be back.”