Sacred Trust (15 page)

Lukas read the note, then motioned to Beverly. “Looks like we have a couple of serious ones. Let's call another nurse down from the floor.”

“Okay.” She still avoided looking at him. “I have room four ready for the first arrival and five for the second.”

“Good.” He turned to see Connie, the paramedic, and a male EMT wheel the first patient in on an ambulance cot with an IV pole. A young woman followed directly behind them.

Lukas recognized the woman and glanced with concern at the patient. He was still unresponsive. The man's features showed clearly, even through the nonrebreather mask. It was Frankie Verris. Disappointment overwhelmed Lukas. Had Frankie taken another overdose?

“Hi, Shelly.” Lukas reached out and took her hand.

Again, as before, she had been crying. In her hand she carried a damp, wadded tissue.

Lukas turned to Beverly. “Are we getting another nurse?”

“No. The floor supervisor said she wouldn't send one down unless it was a real emergency.”

“Did you tell her this was an emergency?”

“Yes.”

“Who is the supervisor?”

“Rachel Simmons tonight.”

Lukas nodded. He was becoming aware of some serious attitude problems among the staff, especially between the E.R. staff and the nurses on the floor, at least while he was on duty. Rachel Simmons was especially bad about refusing to send the float nurse down when they needed one. According to the grapevine, Rachel was having marriage problems and was difficult for everyone to get along with. She was also close to Dr. George. Bingo.

Lukas picked up the phone and dialed Rachel's number. He told her as kindly as possible that they were having an emergency and that he expected to see another nurse in the E.R. by the time the next ambulance arrived. She hung up on him.

The entrance door opened, and ambulance attendants brought in the next patient.

Lukas motioned to Connie, the paramedic with Frankie Verris. “We're ready for you in room four. Have you done a bedside glucose test?” He turned to walk beside them into the exam room.

“Yes, Doctor, it was 122. Nothing there. The patient has also received one amp of Narcan, IV push and 100 milligrams of thiamine.” She pushed the cot up beside the bed and raised the bed up even with the cot.

“Any response?”

“None noted. The patient also received an IV fluid bolus of 250 CCs.”

“I noticed the BP was a little low on report. Do you have a current BP?”

“It's 130 over 85.”

Lukas stepped to the other side of the bed and reached across to help with the transfer.

Connie grasped the edge of the backboard from above Frankie's head. “On three. One. Two. Three.”

They transferred the patient to the bed, and Connie snapped off her monitor leads.

Lukas bent over him. “What about the monitor?” He snapped his own leads onto Frankie's chest and checked the rhythm.

“Occasional PVCs and mild sinus tach,” Connie replied.

He nodded with approval. She seemed to know her stuff. Nevertheless, the PVCs worried Lukas. They could be a signal for cardiac irritability.

While Lukas checked Frankie's pupils, listened to his chest and searched for signs of injury, the neighbor, Shelly, explained that, once again, she had not seen the elderly man fall.

“Did he flush his pills when he got home from his last trip to the hospital?” Lukas asked.

“You'd better believe they got flushed. I cleaned out his medicine chest when I took him home, all except for his aspirin. I nag him to take one every day.”

“Good for you.” Lukas looked up at her with a relieved smile. “I don't think it's an OD this time. Could be his heart.”

Beverly entered the exam room. “Dr. Bower, another nurse just arrived from upstairs, and she says Rachel is having a fit. Too bad, huh? Need some help?”

“Thanks, Beverly. I need you to assist with Mr. Verris while we try to figure out what's going on. Get me an EKG. He's already on a monitor and an IV. I want the new nurse to help with the next one. Does anyone here speak Spanish?”

“Uh, I do, a little,” the EMT who had helped bring Frankie in spoke up. The technician was a big guy with big ears and short hair.

“I know you,” Lukas said. “Buck Oppenheimer. You're supposed to be in a class-two trauma center recovering from a fake tension pneumothorax from the drill. Quick recovery time. I'm impressed.”

The man grinned. “Yeah, I'm feeling better so I opted to work tonight. I'm usually first responder for the fire department, so I don't get in here much. Right now I'm moonlighting.”

“We may need your services with the other patient. He doesn't speak English.”

“Sure, Doc.”

“Hey,” Beverly said, looking with dismay at the spider straps that secured Frankie to the backboard. “Dr. Bower, how can I get an EKG with him strapped down?”

“You may remove the spider straps, but leave the c-spine immobilized,” Lukas said. “We still can't rule out a neck injury.” He turned to Rita and gave instructions for blood tests and X-rays. “That's enough for now.”

He led the way into the next room, where the nurse from upstairs was helping transfer an overweight man, Mr. Mancillas, onto the bed. Through Buck's halting translation, Lukas explained what he was doing as he auscultated the man's chest. Information from the ambulance team revealed that Mr. Mancillas had felt fine until he had been at work for about an hour; then he began
having trouble with confusion and blurred vision, as well as the chest pain.

“Where does he work?” Lukas asked.

“We picked him up at the school bus garage,” the tech told him. “We thought it sounded like his heart.”

Lukas frowned. The patient's skin was very red. “Buck, ask him if he has ever had any problem with his heart before.”

Buck grimaced. “I'll try. Like I told you, I just speak a little Spanish.”

“Understood. Just do the best you can. Nurse, we need to hook up a cardiac monitor.” He ordered an IV, EKG, X-rays and blood work. “Keep him on his O2.”

Beverly came in with the printout of the EKG for Frankie.

Lukas read the lines depicting the intricate rhythm of the elderly man's heart. He was having a heart attack. “Okay, Beverly.” He gave orders for the meds needed.

Still without eye contact, Beverly nodded and left to prepare for another IV. Lukas frowned as he watched her walk away. Was it something he'd said? His breath, maybe? Whatever it was, he had no time to worry about it now.

“Rita, get me a chopper,” he called along the hallway as he stepped over to exam room four. He walked in to find Frankie waking up and blinking. As before, the man looked helpless and vulnerable, and Lukas felt a wave of compassion.

“What's going on?” Frankie asked, his voice weak and shaky. He winced and grabbed at his chest. “Why am I here?” His thin, pale fingers played at the leads of the EKG machine.

Lukas gently moved the man's hands away. “Shelly found you unconscious. Now we know why.”

Mr. Verris groaned. “It hurt so badly.”

“Your chest?” Lukas asked.

Frankie nodded.

Lukas squeezed his arm reassuringly. “On a scale of one to ten, how badly does it hurt now?'

Frankie frowned and thought about it. “Maybe a five or six. Not as much as it did.”

“Okay, we'll take care of your pain. I'm sorry, Frankie, but you're having a heart attack.” He turned to find the nurse coming back into the room. “Beverly, I need morphine. Start at two milligrams, slow IV push; then we'll see how much more we need to relieve his pain. I'll contact Dr. Simeon to see which cardiologist he wants me to call. Frankie, do you remember what you were doing when the pain started? What time was it?”

“About ten o'clock tonight. I was watching the stars, just getting ready to go to bed, when it started. I tried to get over to Shelly's house, but I didn't make it.”

Ten o'clock. If they got him to the cardiac cathlab as soon as possible, they might be able to save a lot of muscle.

Frankie reached out and touched Lukas's arm. “Can you do it again, Doctor? Can you save me?”

Lukas patted the man's hand and leaned forward. “We're going to take good care of you, but it's never up to me.”

Frankie nodded. “You're going to preach again, aren't you?”

Lukas grinned, once again feeling a rush of tenderness for this gentleman. “I'll spare you if you'll just keep in mind what I said last time.”

“Maybe you shouldn't spare me. Maybe—” Frankie winced. “Really hurts.”

“Just hang in there, and we'll try to get rid of that
pain,” Lukas said as Beverly came back into the room with her supplies. He hesitated. “Frankie, do you want me to pray with you?”

The man held his gaze for a moment, then nodded. “Maybe just a short one. I know you've got other patients.” He grimaced as Beverly stuck him for an IV, then relaxed when Lukas laid a hand on his shoulder and bowed his head.

“Lord, we know You're the Great Physician and that You're all-powerful. No healing comes about except through You, and that healing begins when our spirits come into contact with Yours. Please touch Frankie's heart physically, Lord. Ease his pain, both in his body and in his soul, and draw him to You. Show him Your love, and give me Your guidance as I treat him. Help us to work together as a team as we seek Your will. Lord, please help Frankie to understand that he really does matter to You, and that his next home can be with Doris if he will only accept Your gift of love.”

After Lukas closed his short prayer, he raised his eyes to see Frankie watching him. “You can sneak a sermon in as well as Doris used to.”

Lukas returned to his other patient, who seemed better. His face wasn't as red, and the vitals didn't look bad. This probably wasn't even a cardiac.

“Did you notice if there was a motor running in the bus garage when you picked him up?” Lukas asked the ambulance tech.

The man looked surprised. “Yes, there was. He was working on it.”

Lukas nodded. Of course. Carbon monoxide poisoning.

Dr. Simeon called about Frankie, and they arranged for helicopter transport for the elderly man to Cox South.
Since Simeon was the physician on call for the night, he also admitted Mr. Mancillas to his service at Knolls since the carboxy-hemoglobin level could be managed here. As Lukas made the arrangements, he heard voices in the waiting room, both in Spanish and English.

Beverly saw Frankie off on the helicopter, then came back inside.

“Got any more patients?” Lukas asked.

She sighed wearily. “We have three darling little children bouncing off the walls over in three, another elderly gentleman being checked in, and while I was seeing Frankie off, another car drove up and parked in a patient parking slot. We're in for a long night.”

“Just what I always wanted.”

T
heodore Zimmerman awakened in the gray morning darkness with a heaving stomach and a skull that threatened to scatter against the four walls of his room. After three attempts he managed to force open sleep-encrusted eyes to peer toward the digital alarm clock.

No illuminated numbers presented themselves. No night-light glowed from the hallway. Electricity must be out. Had there been a storm?

He forced himself to sit up and swing his legs out of the bed. His left foot hit something hard and sharp, and sudden pain on the inside ankle bone rivaled his headache for a moment.

With a blast of cursing he reached out, disoriented, and felt the hard top of a table. A coffee table. He'd kicked the corner.

He wasn't at home. He was on the lounge sofa at the agency. It was Tuesday morning.

He groaned and laid his head back against a cushion. He'd left Tedi alone last night. He'd failed her. Again. Failed himself, too. He'd tried to sell that albatross for two
years, and it just wouldn't sell. Last night he'd been so sure those men would buy, but after their second walk through the building, they'd found more rotted floorboards, and in spite of all his fast talking, they'd balked, then left. And Tedi…

What if Mercy found out about last night? She could take him back to court, take Tedi away, stop child support. She could even have him evicted….

With difficulty, he slowed his panicked imagination. “She wouldn't.” He allowed himself a tentative smile. She had too much to lose, and she knew it.

Twice he'd requested more money for child support, and both times Mercy had complied without court intervention. Unfortunately, her resentment was becoming more and more obvious, and her sharp tongue had always cut deep. Recently it had been rubbing off on Tedi, who always made such a big deal about the money Mercy sent him. Good grief, didn't the kid even think he had a right to child support? Mercy was the big, important doctor with the big bucks. Sometimes lately, with that long, dark hair and dark brown eyes, Tedi looked too much like her mother. Mercy had always been capable of infuriating him. She always had to prove she was better than him, so much smarter than a lowly real estate agent.

Sometimes the real estate agent called the shots.

Theo pulled himself up from the sofa and felt his way toward his office cubicle. The lighted display on the desk read 6:15 a.m.

In the bathroom he swallowed some Tylenol and splashed his face with cold water. He didn't remember much about last night after the sale fell through, but what he did remember worried him. He'd called Julie to meet
him at the Golden Lion for a drink, and she'd refused, accusing him of being drunk already. She'd hung up on him. All he'd wanted was a little companionship after his disappointment about the building, and she'd hardly ever complained about his drinking before. In fact, she drank with him a lot, so why come across as some perfect Miss Priss when he was already down?

He really needed to sell the Polsner building. Sales were down all over this year. Prices continued to drop, and profits from that handy little land investment he'd made two months ago looked as though they might slip through his fingers. With the cost of improvements, it was a good thing he hadn't gone into it alone. His other investors, however, could become a problem.

Theo looked at himself in the mirror and nearly gagged. Bags puffed out from beneath his eyes, and his face looked as if he'd been drained of blood. He always took pride in his appearance because he knew it helped him sell property, especially to female buyers. But lately the dark circles under his eyes from lack of sleep might even be hindering sales. Who wanted to buy a house from a zombie? He had to figure out how to cut his stress level.

Maybe it was a good thing he hadn't gone home last night, even though Tedi had probably been afraid. It was better to be afraid of the dark than of your own father. That day a couple of weeks ago…That had been too close. Must've gotten ahold of some bad booze. He didn't usually get that mad, especially not at his own daughter.

And since Tedi was on his mind, he'd better take care of a situation he should have dealt with earlier. Mercy was due a telephone call. He punched the speed dial on his speakerphone.

 

Mercy stood in the trickle of lukewarm water that passed as a shower in her rental house, hoping the warmth wouldn't dissipate before she rinsed again. Last time, she'd gotten carried away and stood under the showerhead for a full five minutes. Had to rinse her hair bent over the faucet to keep from freezing in the cold water.

She was washing shampoo out of her eyes when the telephone rang. She finished rinsing, grabbed a towel, and turned off the water as she plunged out to catch the phone. Her answering machine had broken three weeks ago, and she didn't want to miss any possible patient calls.

She dripped water all over the kitchen counter as she grabbed up the receiver. “Hello?”

“Good morning, Dr. Richmond.”

The too-familiar male voice dripped sarcasm, and Mercy almost dropped the telephone. Old anger surfaced in her like hot lava.

She held the line without replying. He hated it when she did that. It scared him, made him wonder what she was thinking. He was intimidated by people who thought for themselves.

“I wanted to catch you before you left for work, Mercy,” Theo said at last.

Mercy smiled darkly to herself. The ploy of silence had worked again, and his tone had gone from hateful to conciliatory. It wouldn't last, but Mercy would milk it. She still didn't say anything.

“Tedi tells me Ivy's having some problems,” he said. “Is she going to be okay?”

Continued silence.

“Mercy?”

“Look, Theo, I've got a job to get to. Cut the garbage and tell me what you want.”

It was his turn for silence, and Mercy could imagine him fighting to control his own temper now. Ever since the day of their wedding, they had brought out the worst in each other, and it had escalated during the divorce. Mercy couldn't remember a single space of time when they'd actually been happy with each other, and for a long time she'd blamed herself. No more.

“I would have thought your daughter would be of more interest to you than your job,” Theo said in a deceptively soft voice.

“Don't start with me this morning, Theodore. I'm not in the mood. Let me talk to Tedi.”

There was a pause. “What, and wake her up?”

“She'll have to get up for school soon, anyway.”

“Well, school was what I wanted to discuss, Mercy. Seems we're going to be out a little more money.”

“
We?
For what?”

“A special tutor. Her grades aren't meeting the expectations of her teacher, Mrs. Watson. The old cow has sent three notes home with Tedi in the past month, and a couple of weeks ago she called me out of an important luncheon to pick Tedi up and take her home.”

“Why didn't you tell me about it when it happened?”

He ignored the question. “Tedi is not paying attention, she disrupts class and she doesn't get along with her peers.”

“Sounds to me as if she needs more counseling, not tutoring.”

“You're not making the decision, I am. I'm the legal guardian, remember?”

“I'm still her mother, and guardianship can change.”

Mercy heard a soft intake of breath.

“We don't need a shrink to tell us what's wrong with Tedi, do we?” His voice grew rougher. “We both know that a mother with a history of mental illness—”

“When did you graduate with a degree in psychology?”

“I don't need a degree to tell me—”

“I think this time we'll let a judge decide,” Mercy snapped, surprising herself. He didn't reply, and she continued. “I'm fed up to here with your threats and your attitude and your insults, and if it's getting to me, it must be getting to my daughter, too.”

“Don't try to blame me for—”

“I've let you bully me for ten years, Theodore Zimmerman, from the day we got married. You're not going to do it anymore, and you're not going to do it to Tedi, either. Furthermore, if you want more money, you're going to have to take me to court.” She paused for breath, then amazed herself. “While we're there, we might as well cover everything at once. I'm going to sue you for damages to my reputation.” Was she actually saying these things? “As you know, a doctor's reputation is her livelihood. You've already damaged that livelihood once. You won't do it so easily again, unless you have a couple of million lying around to donate to the cause.”

She heard Theo gasp, and she shook her head in shock at what she'd just said. What had gotten into her? She'd never spoken so boldly before.

“Hey, hold it, there,” he said in a voice that betrayed his instinct to backpedal fast. “What's going on? What's upsetting you so much, Mercy? We don't want to air our dirty laundry in the public court system. Half the population of Knolls will come for the show.”

“That didn't bother you five years ago. You got a kick out of broadcasting my problems.”

Theo inhaled slowly and deeply. “Look, I know a lot of people found out about things, and I feel bad about that.”

What a liar! He was the one who spread the story.

“I'm willing to shoulder my share of the blame for that,” he continued, his voice shaking more obviously now. “Right now we have a ten-year-old daughter to consider.”

“I'm sick of hearing you use Tedi as a shield. I want her to see a counselor.”

“I'll talk to her about it.”

“Fine, you talk to her. I'm going to do some talking, too. If you can't find help for her, I will—on my terms. I expect to receive word of an appointment by the end of the week.” Mercy slammed the receiver down.

 

The bedside phone shrilled its alert through the call room four times before Lukas could awaken enough to reach out and stop it. He glanced at the lighted dials of the alarm clock beside the phone as he brought the receiver to his mouth. It was ten-thirty Tuesday morning. He'd had three and a half hours of sleep. Must be a wrong number.

“This is Dr. Bower. My twenty-four-hour shift was over at seven. Try the other call room.”

He took the receiver from his ear but heard someone say, “Dr. Bower, please!”

He stayed in position for a moment, trying to recognize the voice of the kamikaze caller. No use. His brain was still numb.

He brought the receiver back to his ear. “I'm sleeping. Leave a message.”

“I'm sorry for bothering you, Dr. Bower.” It was Carol, the courteous, perky E.R. secretary. “Someone you recently treated is begging to talk to you. She says there's an emergency with her brother, and she can't get
him to the emergency room. She says he's too big, and he won't go.”

Lukas groaned. He was too tired to figure this one out. Maybe it was a bad dream. Technically he wasn't here. After twenty-four hours without sleep, he had no business even talking on this phone, much less discussing a patient.

“What's his problem? Who are these people?”

“Her name's Darlene Knight. Her brother is Clarence Knight. She says you treated her for asthma a couple of weeks ago. I told her you were off duty, but she's begging for you to go see Clarence.”

“But I don't treat patients outside the emergency room. My hospital credentials are specifically set up so that—”

“She's on the other line, Doctor. Would you tell her? We're getting piled up out here.”

“Wait, Carol, I don't—”

“Thanks, Dr. Bower. Here she is.”

Lukas groaned again. He needed sleep desperately.

“Hello? Is this the doctor? Hello?”

At the timid sound of the woman's voice, Lukas remembered the asthma patient. She had refused to stay in the hospital because her obese brother had no one to care for him at home. The poor woman was caught in a tragic situation.

Lukas hesitated a moment more. He tried to speak, but it came out in a croak. Even his vocal cords were asleep. He cleared his throat. “Darlene? This is Dr. Bower.”

“Thank goodness.” She sniffed as if she'd been crying, and her voice had a slight wheezing sound. “I don't know what to do, who to turn to. You probably don't remember me, but—”

“I remember you, Darlene. How is your asthma doing? Are you taking your medication?” Stall for time. How
was he going to tell her he couldn't treat her brother at home? When he'd told Darlene she could call and talk to him, he only meant he would listen.

“It's not me, Doctor. It's my brother. He's really sick, worse than ever, and I can't get him out of his room. He won't let me call an ambulance. I told him about how you helped me and seemed to care, and he finally said he would be willing to see you if you would come here.”

“Why don't you tell me some of his symptoms.” Lukas could at least write them down, then try to convince her that Clarence must come to the emergency room.